Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · May 2021
Multicenter StudyThe role of plastic surgery in major trauma in the United Kingdom and workforce recommendations.
The 22 major trauma centres (MTCs) in England were appointed in 2012 to provide care to severely injured patients despite variation in existing infrastructure, resources, culture and skillset. Six MTCs remain unsupported by a co-located plastic surgery department. We describe the plastic surgical major trauma workload in England, the plastic surgical workforce and skillset available in each centre, and suggest what plastic surgical skills are required in an MTC. ⋯ Plastic surgery contributes substantially to major trauma care and the majority of this workload relates to extremity trauma. However, there is significant variability in the size, accessibility and skillset of the workforce available. On the basis of these data, we suggest a plastic surgical skillset which should be represented in plastic surgical departments supporting an MTC.
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J Plast Reconstr Aesthet Surg · Jun 2019
Multicenter StudyTenosynovial giant cell tumours of the hand: A multicentre case-control study.
Many factors have been proposed to contribute to the risk of recurrent tenosynovial giant cell tumours (TSGCT); however, we remain unable to predict those at risk, which formed the rationale for this multicentre retrospective case-control study of 28 patients with recurrence. We included cases of recurrence in a 1:1 ratio matched for age and sex with controls over 10 years. Using Cox regression, we present hazard ratios (HRs) for recurrence with 95% confidence intervals (CIs). ⋯ Recurrent TSGCT had a higher mitotic count/mm2 in the primary tumour (median increase of 3 [IQR 1, 7]). Mitotic count in the primary tumour was associated with the risk of recurrence (adjusted HR 1.1 [95% CI 1.1, 1.2]) meaning that for every additional mitosis, the risk of recurrence increased by 10% per annum. We recommend a prospective cohort study to validate our findings.
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J Plast Reconstr Aesthet Surg · Nov 2017
Multicenter StudyIncidence and risk factors for venous thromboembolism in bilateral breast reduction surgery: An analysis of the National Surgical Quality Improvement Program.
The risk of venous thromboembolism (VTE) in patients undergoing bilateral breast reduction surgery remains unknown. This study aimed to determine VTE incidence and risk factors in this patient cohort. ⋯ In bilateral breast reduction surgery, older patients, patients requiring blood transfusion, and patients who have unplanned return to the operating room are at an increased risk of developing postoperative VTE. These factors can be considered for patient risk-stratification and perioperative decision-making regarding VTE prevention.
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J Plast Reconstr Aesthet Surg · Jun 2017
Multicenter StudyOrthoplastic surgical collaboration is required to optimise the treatment of severe limb injuries: A multi-centre, prospective cohort study.
Open fractures are severe, complex, limb-threatening and high-energy injuries, often involving lesions of both bone and soft tissues. Traditionally, treatment has been piecemeal by orthopaedic and plastic surgeons. This study aimed to prospectively investigate whether combining orthopaedic and plastic surgery in treating these injuries is more effective than the conventional orthopaedic care. ⋯ Of these, 70% were treated with an orthoplastic approach, whereas 30% were treated by an orthopaedic team. All outcome measures were statistically improved by the orthoplastic approach. A coordinated, combined pathway to both the bony and the soft tissue components of open tibial fractures through orthoplastic surgery can be successfully delivered with attention to important timelines to achieve better patient outcomes in different socio-economic settings.
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J Plast Reconstr Aesthet Surg · Jan 2015
Multicenter StudyPrognostic factors for outcome after median, ulnar, and combined median-ulnar nerve injuries: a prospective study.
A major problem in the surgical treatment of peripheral nerve injuries of the upper extremities is the unpredictable final outcome. More insight and understanding of the prognostic factors is necessary to improve functional outcome after repair of the peripheral nerves. The objective of this study was to identify prognostic factors for the functional recovery of peripheral nerve injury of the forearm and their independent contribution in the outcome in the first year after reconstruction. ⋯ Our prospective analysis of prognostic factors shows several factors to be predictive for the functional recovery after peripheral nerve injuries of the median and/or ulnar nerve of the forearm. Sensibility of the hand, power grip, and DASH score (DASH, Disabilities of Arm, Shoulder and Hand) have proven to be the three best prognostic factors in this study. Of these prognostic factors, only posttraumatic stress can be influenced to optimize functional outcome.