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Publications (103)
Aim: There is an urgent need to mitigate the environmental impact of surgery, with surgery representing a major contributor to carbon emissions. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used to facilitate the attainment of net zero targets. Methodology: Follow...
Introduction
Breast cancer is the leading cause of cancer amongst women in the United Kingdom, with implant-based reconstruction (IBR) using Acellular Dermal Matrices (ADM) gaining popularity for post-mastectomy procedures. This study compares outcomes of different ADMs that are commonly used in women undergoing IBR, this was short and long-term co...
Background:
The deep inferior epigastric perforator (DIEP) flap provides an effective and popular means for autologous breast reconstruction. However, with the complexity of the pathway, the environmental impact of the pathway has yet to be evaluated.
Methods:
A retrospective analysis of 42 unilateral DIEPs at a single reconstructive center was...
Background
Breast cancer is the most common malignancy among women in the UK. Reconstruction – of which implant-based breast reconstruction (IBBR) is the most common – forms a core part of surgical management of breast cancer. More recently, pre-pectoral IBBR has become common as technology and operative techniques have evolved. Many surgeons use a...
How new technology and surgical techniques can lead to an improved patient experience.
How process mapping can be used to create and improve sustainable surgical practices.
Leveraging international collaboration and innovation to improve patient safety.
Aim
Rapid advancements in technology have paved the way for the use of artificially intelligent (AI) conversational agents. Conversational AI has the potential to transform patient pathways, with increasing use in triage, virtual consultations and post-operative care. The aim of this systematic review is to evaluate the scale and scope of conversat...
Aim
There is an urgent need to tackle climate change, with surgery being a carbon hotspot for emissions in healthcare. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used facilitating the pursuit of achieving net zero targets.
Method
Following the PRISMA guidelines...
Aim
Unregulated proliferation of the aesthetic Botulinum Toxin injection industry represents a potential public health risk to patients. Robust educational standards are key to ensuring practitioner competence. This study assesses the current standard of educational courses in the UK, auditing compliance with Cosmetic Standards Practice Standards A...
Aim
The rise of social media has resulted in heightened patient expectations of cosmetic outcomes. The increasing trend of selfies and image collection may promote higher-powered predictive analytics to inform research and pre-operative consultations supporting informed consent. However, given the scattered and siloed nature of such databases, litt...
Aim
Breast cancer is the most common malignancy among females in the UK. Surgical management commonly comprises mastectomy and reconstruction, of which implant-based breast reconstruction (IBBR) are most prevalent. Acellular dermal matrices (ADM) are widely used in pre-pectoral implant-based breast reconstruction, however there is limited high-qual...
Aim
The increasing demand for aesthetic facial botulinum toxin injections have resulted in a significant public health challenge internationally. There is variation in international practice pertaining to accreditation and licensing of practitioners to perform such procedures. The Keogh Review of 2013 identified education as a key area for improvem...
Aim
The global aesthetic Botulinum Toxin market has been growing yearly, with concomitant concerns over lack of regulation and oversight. Whilst robust laws are in place in UAE regarding who is licensed to practice, practitioners remain largely unknown. This study aims to quantitatively evaluate practitioners and their professional background in th...
Aim
Generative Adversarial Networks (GANs), based on zero-sum game theory, involve two neural networks—the generator and discriminator—to create realistic synthetic data. They're becoming increasingly significant in medicine and plastic surgery. This review assesses GANs' impact in Plastic Surgery, offering a framework for their application and eva...
Aim
The rapid growth of the aesthetic injectables sector presents a public health challenge given limited regulations to date. This study aimed to establish agreed proposals from industry experts and practitioners to uphold and safeguard patient safety.
Method
A Delphi consensus design was adopted comprising three survey rounds. Industry practitio...
Background
Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications, but with developments in...
Background
Breast cancer is the most common malignancy among women in the UK. Reconstruction – of which implant-based breast reconstruction (IBBR) is the most common – forms a core part of surgical management of breast cancer. More recently, pre-pectoral IBBR has become common as technology and operative techniques have evolved.
Many surgeons use a...
Introduction
Generative Adversarial Networks (GANs) are a form of deep learning architecture based on zero-sum game theory, which uses real data to generate realistic fake data. GANs use two opposing neural networks working, a generator and discriminator. They represent a powerful tool for generation of realistic synthetic patient data sets and hav...
Introduction
Surgery represents a major source of carbon emissions, with numerous initiatives promoting more sustainable practices. Healthcare innovation and the development of a digitally capable workforce are fundamental in leveraging technologies to tackle challenges, including sustainability in surgery.
Methods
A surgical hackathon was organis...
Introduction
Plastic, reconstructive and aesthetic surgery (PRAS) is a significant yet often overlooked specialty in medical school curricula. The impact of social media and unregulated information sources can distort the perceptions of medical specialties, including PRAS, leading to a decline in student interest, inappropriate referrals and strain...
Introduction
Ten years on from the Keogh Review of cosmetic surgery in the UK, improvements in training and education are yet to be achieved. Gamified learning and metaverse technology have been posited as transformational media for learning. This study evaluates the usability of a metaverse gamified platform for aesthetic education.
Methods
An ae...
Human papillomavirus (HPV) is a common sexually transmitted infection with wide-ranging clinical manifestations. High-risk anogenital HPV genotypes have also been reported to cause extragenital disease. We describe the case of a 69-year-old male patient living with HIV who was diagnosed with HPV-16 associated Bowen’s Disease (BD) of the right middl...
Introduction
Targeted muscle reinnervation (TMR) surgery is now increasingly performed when individuals with amputation develop problems with chronic, nerve-related limb pain. This study evaluates the effectiveness of TMR for individuals with upper-limb amputations in terms of quality-adjusted life years (QALYs) and subjective neuroma pain (NP) and...
How can we increase education around non-surgical cosmetic procedures and the complications that arise from these treatments?
TikTok (San Jose, CA) is a popular and rapidly growing social media platform. With beauty and skincare among the top 5 most popular categories, TikTok represents an important platform for plastic surgery education and communication. However, given the vast array of content shared daily, regulating content for veracity is challenging. It may also be...
Aim
This systematic literature review evaluates medical students’ knowledge and perceptions of plastic surgery as a primary outcome, whilst identifying barriers and facilitators to choosing a career in plastic surgery as a secondary outcome.
Method
A systematic literature search was conducted on EMBASE, PubMed, PsychInfo and Web of Science accordi...
Burns are wounds of the tissue architecture caused predominantly by thermal, electrical, or chemical injury. Their severity depends on the total body surface area involved and on the depth of the damage to the skin and underlying deep structures. Superficial injuries harbour the potential for self-regeneration due to the integrity of epidermal appe...
Introduction
In the United Kingdom (UK), complications that arise following the administration of Botulinum Toxin are reported to the Medicines and Health Regulatory Agency (MHRA) via the Yellow Card Reporting Scheme. Over the past decade, there has been a significant increase in the number of non‐surgical aesthetic procedures. Concerns have been r...
Background:
Currently, safe practice in the UK esthetics industry is largely reliant on self-regulatory bodies. If these bodies do not maintain high standards of safety guidelines and properly accredit practitioners, patient safety may be at risk. To our knowledge, no studies have addressed cosmetic self-regulatory bodies and their websites on Goo...
The groin flap is one of the first described successful free flaps. It was initially introduced as an axial pattern flap. However, its ease of harvest and predictable anatomy made it a workhorse flap for upper limb soft tissue coverage both as a pedicled flap as well as a free flap. The groin flap’s thinness, pliability and robust blood supply conf...
Introduction:
The proliferation of providers and practitioners of cosmetic botulinum toxin and dermal filler has profound public health implications. The Advertising Standards Authority (ASA) regulates the use of advertising materials in the United Kingdom and prohibits the promotion of prescription-only medicines.
Aims:
We aim to perform a cros...
Aim: Targeted muscle reinnervation (TMR) surgery has fundamentally changed the management of patients who have suffered or are about to undergo amputation. Providing nerve stumps with a muscle target has been shown to have profound effects on levels of post-amputation pain in relation to phantom limb pain (PLP) and neuroma pain (NP). The primary ob...
Adrenaline auto-injectors are the first line treatment for anaphylaxis in the community setting. Both anaphylaxis and auto-injector carriage are increasing in prevalence. Adrenaline auto-injector injuries are common and most often involve the hand or digits. Such injuries carry a risk of ischemic necrosis due to profound vasoconstriction, especiall...
Introduction:
Medical simulation has provided favorable outcomes in the improvement of clinical competence at both the undergraduate and postgraduate levels. The recall of information demonstrably increases when it has been taught in environments similar to the workplace. This study aimed to evaluate the role of a one-day burn simulation session i...
Background
Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications but with developments in...
Background
Hyaluronidase is used as an adjunct or main treatment to manage complications associated with cosmetic hyaluronic acid (HA) filler injections such as necrosis, blindness, hypersensitivity, delayed nodules, and poor aesthetic outcomes.
Objective
To systematically map the available evidence and identify the gaps in knowledge on the effect...
Introduction
Core Surgical Training has become increasingly competitive over the last 5 years with the competition ratio reaching 4.16 in 2021 compared to 2.31 in 2015. This is thought to be due to two key factors: a large yearly increase in the number of applicants and an unchanging number of jobs. Steps are taken by HEE to ensure the process is a...
Background: Intra-abdominal adhesion formation is still unavoidable and a cause of significant morbidity in abdominal surgery. Platelet-rich plasma gel and hyaluronic acid have been studied for their protective of therapeutic effects on adhesions. The aim of the present study is to compare Platelet-rich plasma and hyaluronic acid in adhesion preven...
Aim
The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDex™ laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems.
Method
In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a uni...
Aim
This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation.
Method
In this prospective randomised trial, novices (n=40) without laparoscopic experience were recru...
Aim
The training of cosmetic and aesthetic practitioners has received national attention since the 2013 Keogh review of the regulations of cosmetic interventions. The 2015 HEE cosmetic guidelines recommended level 7 accreditation in Injectables for Aesthetic Medicine. The Royal College of Surgeons has now established the Cosmetic Surgery Certificat...
Aim
Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation with increasingly pervasive use in cosmetic clinical practice. This study analyzes the safety profile of cosmetic glabellar and forehead BoNT-A injections and assesses the influence of the practitioner factor and BoNT-A type on the complication ra...
Objective: Reduction in patient-facing teaching encounters has limited practical exposure to Emergency Medicine for medical students. Simulation has traditionally provided an alternative to patient-facing learning, with increasing integration in courses. Rapid advancements in technology facilitate simulation of realistic complex simulations encount...
Introduction:
The face is a cosmetically sensitive region where the process of ageing is most clearly manifested. With increased focus on anti-ageing and longevity, more anti-senescent treatments are being proposed despite limited evidence. This study outlines the pathways and mechanisms underpinning the biological process of ageing in the face....
Background
Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation with increasingly pervasive use. The increase in popularity and use is met with limited regulations potentially posing a significant risk to patient safety and public health.
Objectives
This study aims to assess the safety profile of cosme...
Aim
This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation.
Methods
In this prospective randomised trial, novices (n = 40) without laparoscopic experience were re...
Wide awake local anesthetic no tourniquet (WALANT) is gaining popularity amongst hand surgeons. Digital adrenaline use has been shown to be safe in multiple studies and the misconception forbidding it is receding. Phentolamine has been shown to safely reverse the effects of adrenaline should the feared complication of digital ischemia occur. A surv...
Aim
The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDexTM laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems.
Methods
In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a u...
Introduction
Natural Rubber Latex (NRL) gloves have been ubiquitously used in surgical practice. Over the past few decades, there have been many reports of NRL allergies associated with their use presenting a safety hazard to both patients and healthcare workers. Powder-free and latex-free gloves have been shown to offer reductions in incidence of...
Aim
Pressure ulcers (PUs) affect over 700,000 patients per annum and are associated with an up to fourfold increase in mortality rate in older populations with complex pathologies. NICE guidelines for PU management involve a combination of low-grade technological interventions, including dressings and foam mattresses, while technology-centric thera...
This peculiar case highlights the detrimental effects of Anorexia Nervosa (AN) on myocardial tissue, and the significant impact this can have on surgical outcome.
A 49-year-old female with history of AN presented acutely unwell with confusion, dizziness, deranged electrolytes and metabolic acidosis. She had lost significant weight in the past month...
Aim
Seymour fractures are distal phalanx fractures of the finger in children with a juxta-epiphyseal or Salter-Harris Type I/II pattern associated with a nail-bed injury. There remains a paucity in literature regarding the development of complications between Seymour fracture management options, with early studies encouraging non-operative manageme...
Introduction
Non-surgical / minimally invasive aesthetic procedures are a growing trend in the UK. A range of devices are available for soft tissue augmentation, including injectable Poly-L-Lactic acid (PLLA). PLLA is used for soft tissue augmentation and is thought effective for the correction of contour deficiencies, facial wrinkles and in restor...
Aims
Orthopaedic infection is a potentially serious complication of elective and emergency trauma and orthopaedic procedures, with a high associated burden of morbidity and cost. Optimization of vitamin D levels has been postulated to be beneficial in the prevention of orthopaedic infection. This study explores the role of vitamin D in orthopaedic...
The use of Wide Awake Local Anaesthetic No Tourniquet (WALANT) amongst Plastic and Orthopaedic Hand Surgeons has been accelerated by the impact of the COVID-19 pandemic and associated risks of general anaesthesia. Benefits of WALANT include a bloodless field, improved recovery, on-table testing, as well as cost and time savings. Whilst more clinica...
Background: Botulinum toxin A (BoNT-A) injection is one of the most frequently undertaken procedure in aesthetic medicine. The Medicines & Healthcare products Regulatory Agency (MHRA) is the government body in the United Kingdom mandated to ensure the provision and administration of medicines is safe. We sought to analyse adverse events of facial c...
This paper aims to establish a ranking of the 50 most cited research articles pertaining to ankle surgery in the field of orthopaedics. In addition, the demographic features such as the date of publications, location of primary author and country of the publisher were all analysed. Studies similar to these have been completed in other subspecialtie...
Ectopic extramammary Paget's disease describes an exceedingly rare intraepithelial adenocarcinoma arising within non-apocrine tissues. We present a case report of E-EPMD arising on the lower abdomen without underlying secondary malignancy in a 56-year-old female patient. We performed a wide local excision of the lesion with subsequent mini abdomino...
Disruption of services has resulted in a profound knock-on effect for plastic surgery trainees, with limited training opportunities available. The emergence and increased engagement with novel surgical technologies including Augmented and Virtual reality simulation represents an essential adjunct to mitigate limited training opportunities, though i...
Background: Ischeamia reperfusion injury is a frequent challenge during tissue reconstruction. Atorvastatin and Sildenafil, have been studied for their protective and/or therapeutic effects on various organ systems subjected to IRI. The aim of the present study was to compare a single dose of Atorvastatin and Sildenafil pretreatment on acute oxidat...
Technology represents an invaluable tool with the potential to transform the delivery and dissemination of scientific and educational content. During the COVID-19 worldwide pandemic there has been profound disruption to delivery of care, education, and training. Leveraging technology to host and deliver conferences may provide value in terms of cos...
Background
An estimated one in two healthy adults in the United Kingdom suffer from low levels of 25[OH]D. Vitamin D is involved in modulating immune response, but there is less clarity over its role in orthopaedic infection. This study assesses the relationship between serum 25[OH]D concentration and orthopaedic infection.
Methods
A total of 205...
Background
Orthopaedic surgery is underrepresented in the United Kingdom medical school curriculum, with an average of less than 3 weeks of exposure over the five-year degree. This study evaluates the effectiveness of high-fidelity virtual reality (VR) and physical model simulation in teaching undergraduate orthopaedic concepts.
Methods
A modified...
Background
Retro-hepatic inferior vena cava (RHIVC) injuries resulting from blunt or penetrating abdominal trauma are rare but devastating events that remain a considerable challenge to even the most experienced doctors, which continue to carry a considerable mortality.
Aim
To establish a better understanding of the management of RHIVC injuries an...
Oral and maxillofacial surgery (OMFS) is under-represented in the medical curriculum with 90% of medical students reporting no exposure to the specialty in medical school. This can result in clinicians having problems recognising emergency presentations, and referrals being made inappropriately. OMFS trainees delivered an educational simulation cou...
Background
This study assesses the scope for using technology to supplement the undergraduate anatomy curriculum at medical school.
Methods
A narrative literature review explored the current landscape of anatomy learning. Medical student usage and preferences of technological interventions for anatomy learning were then explored through a cross-se...
Successful reproduction is a fundamental physiological process that relies on the integration of sensory cues of attraction with appropriate emotions and behaviors and the reproductive axis. However, the factors responsible for this integration remain largely unexplored. Using functional neuroimaging, hormonal, and psychometric analyses, we demonst...
Knee Surgery is one of the most commonly performed orthopedic procedures, and a rapidly evolving area of research. A bibliographic analysis was conducted to explore the characteristics of the top 50 most cited articles in knee surgery. The Web of Science Core Collection Database was used to search for Knee AND Surgery, further refined for orthopedi...