The Plastic Surgery Project story so far . . .

As 2011 draws to a close I thought I would reflect on the progress of the blog.

I started it in January 2010 as a 'clinical' distraction from my PhD in matrix biology.

I thought it would encourage me to read some clinical articles and stay in touch with the world of plastic surgery, which can appear along way off when deep in the matrix!

As you can see the number of page views has steadily increased over the last couple of years. Accumulative page views is over 13,000; this is still small but growing! Hits have come from over 70 countries with the UK and USA out in front.

I am pleased to see that the number of hits from mobile devices is slowly increasing and now represents around 10% of the total.

In 2012 I hope to have a larger number of contributors and improve the delivery of journal article information and courses/conference information. Watch this space.

Any comments or contributions very welcome. Please email me at plastsurgproj@gmail.com.

Holiday reading: A History of Plastic Surgery

I have been eyeing up this book for a while. The exorbitant price had rather put me off until I snapped up a bargin basement copy on Amazon market place.

A review will follow. . . .

Reconstructive plastic surgery reported by media: shock!

On my daily tube commute I often have a flick through the Evening Standard. Over the last year they have run a number of plastic surgery related stories from the Royal Free.

These have included "Boy born without ear gets one built from rib cartilage", "Cancer woman has new breast made from her tummy tissue", and lastly the ". . boy born with a frozen face".

None of the stories report new advances. However, it is good to see the reconstructive side of plastic surgery getting coverage for once.

The ear reconstruction and bilateral facial reanimation surgery was also covered by The One Show on BBC1..

Image: Joe Henson smiling with plastic surgeon Adriaan Grobbelaar.
Copyright London Evening Standard

Review of UPRAS 2011

By Dominic Yue

The 4th annual Undergraduate Plastic Reconstructive and Aesthetic Surgery Conference (UPRAS) took place at the Royal Society of Medicine in London this year, drawing in medical students and junior doctors from all over the UK, with a handful of delegates from overseas. The programme spanned a weekend, consisting of lectures and, for those who registered early, practical sessions.

Experience in plastic surgery for undergraduates is generally woefully lacking and if any medical student entered the building with thoughts that the specialty is predominantly a route to an opulent lifestyle funded by copious private aesthetic work, the opening talk from the RSM’s Plastic Surgery Section President, certainly realigned such misconceptions with reality.

The immediate focus was on reconstructive work and highlighted principles of restoring form and function. Subsequent speakers echoed this along with vivid descriptions of experiences working in developing countries and charities. There was a variety of presentation styles, and one of the talks included a BAPRAS award-winning video that demonstrated the management of lower limb open fractures.

I was once told that plastic surgery is one of the most portable surgical specialties, with its surgeons able to perform a plethora of operations with relatively simple instruments – a blade, skin hooks, suture-holders and other such tools – all of which could fit into a briefcase.

It is also a true general surgical specialty in that its practitioners have to be able to operate anywhere from head-to-toe, not least because burns and skin lesions can affect all areas of the body. The sometimes complex but always wide-ranging skill of plastic surgery was clearly displayed in the lectures, describing the simplest of procedures to newly developed techniques.

Top of TOCs December 2011

Selected articles from JPRAS, PRS, J Hand Surgery and others that caught my eye. . . .

Zhong, T et al. Intravenous fluid infusion rate in microsurgical breast reconstruction: important lessons learned from 354 free flaps. Plast Reconstr Surg 2011; 128(6):1153–1160. DOI: 10.1097/PRS.0b013e318221da56 A topic I have become interested in. Increasing evidence across surgical specialties and ICU for judicious use of IV fluid.

Findlay, M et al. Tissue-engineered breast reconstruction: bridging the gap toward large-volume tissue engineering in humans. Plast Reconstr Surg2011; 128(6):1206–1215. DOI: 10.1097/PRS.0b013e318230c5b2

Siemionow, M and Ozturk, C. An update on facial transplantation cases performed between 2005 and 2010. Plast Reconstr Surg 2011; 128(6):707e–720e. DOI: 10.1097/PRS.0b013e318230c77b. Detailed account of the face transplants to date. It includes illustrations of the various anastomoses performed and postoperative outcomes.

Warren, R. Face lift. Plast and Reconstr Surg 2011; 128(6): 747e–764e. DOI: 10.1097/PRS.0b013e318230c939. This months PRS CME article. . . .

Jalali, M et al. The UK plastic surgery trainee. J Plast Reconstr Aesthet Surg 2011; 64(12):1716-1717. doi:10.1016/j.bjps.2011.06.006. Like the authors, I was surprised that only 50% of trainees had undertaken an intercalated degree and 39% a higher research degree. This may reflect the run-through years and a sampling error - seven units were missed out. For more on academic plastic surgery check out the BAPRAS website.  

UPRAS 2011: Burns tutorial

Enjoyed the first day of UPRAS 2011 at the Royal Society of Medicine. Lots of enthusiastic students and junior docs immersing themselves in the world of plastic surgery. The burns tutorial is below.

The fun continues tomorrow. . .

Burns tutorial on Prezi

Changes to Intercollegiate Specialty Examinations (FRCS)

The Joint Committee on Intercollegiate Examinations has released some new guidance on the Specialty Examinations (FRCS). This comes into effect from January 2012.

The PDF can be downloaded here.

Bottom line:

Section 1 will now have a 2 year limit from the first attempt and a maximum of 4 attempts.

Section 2 will have a maximum of 3 attempts with no re-entry.

Sculpting aspirations: reviews of the 7th BAPRAS Undergraduate Day

By Tom Henderson, 5th year medical student at the University of Oxford. He is their representative to the BMA Student Committee and has an interest in education and training issues.

So it was that the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) held its 7th Undergraduate day, in the salubrious surroundings of RCS’s London base. After a welcome coffee the day’s programme of talks kicked off with an introduction from Prof McArthur, from Liverpool.

His opening slide akin to the odd-one-out round from Have I Got New For You, it asked students to spot the image least in keeping with modern plastic surgery. It wasn’t much of a challenge – a buxom blonde on a beach clearly set out to demonstrate to the audience that this was a day when any stereotypes of plastic surgeons based on Nip/Tuck would be dispelled.

Following on from the introduction, a well-presented tour of the extent of plastic surgery and its relations to other surgical and medical specialities, came a few sessions on the training pathway and applications. In a room of perhaps a hundred eager medical students this was always going to be the challenging one. 

It is to the speaker’s credit that no illusions were allowed about the competition involved and the perhaps brutal nature of the ST3-crunch (where there are currently 5 jobs going). The tips on how to succeed were the same as one can find elsewhere, and probably apply to all specialities: look up the job specification, work with focus and determination towards your goal.

When this sobering session was over, there came the pick-me-up: more explanation of the many wonders that a career plastic surgery has in store for those who succeed. The talks covered plastic surgery in the developing world, burns, skin cancer, hand surgery, breast reconstruction and aesthetic surgery. Most combined a healthy dose of teaching around the basics of plastic surgery scope and technique with the obligatory and remarkable before-and-after pictures. Also woven in through the day were registrar led sessions on basic suturing technique and a poster competition for which a prize (the important aspect being the associated CV points!) was later awarded.

Whilst all of the surgeons talks contained these remarkable tales, it was Mr Sammut’s talk about his experiences of (principally) hand surgery in India and Nepal that I found most inspiring. It is all too easy in the developed world to think of as trivial relatively modest improvements in hand function or to focus on the cosmetic aspects of hand repair.

But in societies without the levels of welfare and support that we are fortunate to have, one can more easily appreciate how a simple functional improvement (even where cosmesis is less than ideal) can transform the life not only of a patient but also their family. The modest becomes the difference between a livelihood and nothing, and the talk neatly demonstrated the true importance of plastic surgery.

Medical school teaching and experiences of different specialities focus (and rightly so) on the workload of junior members of the team, which evolve significantly on the road the Consultancy. I’m not sure there can ever be a better way of finding out about a speciality than getting as much first hand experience – and for surgery that means time in clinic and theatre – as possible, be it through a placement whilst at medical school or a Foundation/Core rotation. 

As valuable as days like these can be, whatever your ensuing impression of the profession, they are surely not enough to make a definitive career choice. However the challenge with limited time for medical students might be which specialities to focus their attentions on, and it is perhaps in that respect that days such as these are the most useful.

_______________________________

By Irving Ling, final year medical student, Newcastle University. www.irvingling.com

The BAPRAS 7th undergraduate day, held at the Royal College of Surgeons of England, London, provided a platform for eminent consultants to celebrate the genius works of plastic, reconstructive and aesthetic surgery.

In their eloquently, slyly humorous presentations, each speaker sought to untangle the misconception that has cast Plastic surgery as a glorified Hollywood money churning business and painted a picture of what the speciality really is - a creative, innovative, diverse and satisfying job that aims to sacrifice the cheap to reconstruct the expensive and restore functionality that is aesthetically pleasing.

The sessions was an inventive blend of career advice and clinical cases, dissecting every element into fine introductions to this diverse speciality for an audience that ranged from A-level students to junior doctors.

The day was punctuated with surgical suturing sessions, offering many, a glimpse into the dexterous task of wound closure, and provided a display of 10 exceptional poster presentations. The day ended hopefully inspiring many to strive for this competitive but rewarding speciality.

Top of the TOCs November 2011

Selected articles from JPRAS, PRS, J Hand Surgery and others that caught my eye. . . . 

 
Ball, C et al. Validation of a one-stop carpal tunnel clinic including nerve conduction studies and hand therapy. Ann R Coll Surg Engl 2011; 93(8):634-638. One example of efficiency in the NHS . . .

Shores JT et al. The current state of hand transplantation. J Hand Surg 2011; 36(11): 1862-1867.

Suissa, D et al. Negative-pressure therapy versus standard wound care: a meta-analysis of randomized trials. Plast Recontr Surg 2011; 128(5):498e–503e. doi: 10.1097/PRS.0b013e31822b675c.

Berry, MG et al. Breast augmentation: Part III–preoperative considerations and planning. J Plast Reconstr Aesthet Surg 2011; 64(11):1401-1409. See also: Berry MG, Davies DM. Breast augmentation: part I - a review of the silicone prosthesis. J Plast Reconstr Aesth Surg 2010;63:1761-1768. and Berry MG, Cucchiara V. Davies DM.Breast augmentation: part II - adverse capsular contracture. J Plast Reconstr Aesthet Surg;2010 Jun 23 [Epub ahead of print].

History of plastic surgery II

I was grilled on the history of plastic surgery in theatre last week. There was certainly room for improvement!

Online resources for the history of plastic surgery are a bit patchy. I have placed the ones I have found in the links section.

The Carl Ferdinand van Graefe Institute for the History of Plastic Surgery is slowly adding more information to the pages for various key figures in the history of plastic surgery.

"A History of Plastic Surgery" by Paolo Santoni-Rugiu and Philip J. Sykes published in 2007 by Springer had good reviews. It is a substantial text.

Image: The 'big four' - Mowlem, Kilner, Gillies and McIndoe.

From inspiration to ink

Warning blatant plug coming up. . . .

The RSM Trainees' Committee is holding an evening meeting next Wednesday called 'From inspiration to ink'. 

The aim is to link up budding writers with medical publishers and provide some tips on how to succeed. 

The fun part should be a 'Dragon's Den' style competition when potential authors will pitch their ideas to a panel of publishers and editors. There is a prize for the best proposal.

I will be giving a short talk on 'Finding time to write as a junior doctor' based on my experience producing the Oxford Specialty Training Series. . . .

Click here to register.

Update: Khalil Secker, a medical student from Manchester, won the competition. He gave a passionate pitch on 'Beyond the Hippocratic Oath: A History of Medical Revolutionaries'. Everyone loved it. Watch out for the book deal and TV series . . .

Padgett dermatome

I have just moved south of the river Thames to St George's Hospital in Tooting. A few of us decided to tidy up the registrars office and came across these old dermatomes gathering dust on the top shelf.

The 'new and improved' Padgett dermatome is a museum piece. It was one of the first drum dermatomes and dates from the 1930s-40s. The beautifully illustrated manual was dated 1948.

G.W. Pierce wrote an article in 1942 commending the great advances this dermatome provided.

Must find out more about them . . .

e-LPRAS and the Plastic Surgery Education Network

The BAPRAS Council has just agreed to fund the e-LPRAS project through to completion.

This will total around £1,000,000 over the duration of the project, which is due to be completed at the end of 2017. There is a move to speed this up so that it is completed by 2015. This will require more cash.

The sessions I have seen look good. One concern though is whether the topics will be regularly updated to take account of the most recent evidence.

In the US they are embracing online delivery of course material with the development of the Plastic Surgery Education Network (PSEN).

This project is a collaboration of the main American plastic surgery societies and provides resources both for trainees and life long learning/CME opportunities for fully qualified surgeons.

Should BAPRAS be considering the future CME requirements of consultant plastic surgeons as well?

Top of the TOCs October 2011

Selected articles from JPRAS, PRS, J Hand Surgery and others that caught my eye. . . .

Rughani MG et al. Sentinel lymph node biopsy in melanoma: The Oxford ten year clinical experience. JPRAS 2011; 64(10): 1284-1290.

Terzis J. Developmental facial paralysis: A review. JPRAS 2011; 64(10):1318-1333.

Miyagi K and Shah AK. Tetanus prophylaxis in the management of patients with acute wounds. JPRAS 2011; 64(10):e267-e269. A reminder of how to do it properly . . .

CME - A practical guide to wound healing – Video 1 – Basic suturing for medical students. PRS 2010. This is from the PRS archive and has been released for FREE.

Fosnot, J at al. Closer to an understanding of fate: the role of vascular complications in free flap breast reconstruction. PRS 2011; 128(4):835-843. DOI: 10.1097/PRS.0b013e318218fc95. Not sure this paper adds a huge amount to the literature. Suggests intraoperative vascular complications might predict postoperative flap complications - not surprising. None the less worth looking at for the cited literature and discussion of flap failure.

Burdette, T et al. Harmonic Scalpel versus Electrocautery in Breast Reduction Surgery: A Randomized Controlled Trial. PRS 2011; 128(4):243e-249e. DOI: 10.1097/PRS.0b013e318221da3e. Harmonic scalpel is expensive and shows no benefit over electrocautery.

Fisher D and Sommerlad, B. Cleft lip, cleft palate, and velopharyngeal insufficiency. PRS 2011; 128(4):342e-360e. DOI: 10.1097/PRS.0b013e3182268e1b. Excellent CME article. I had the privilege of working for Mr Sommerlad a few years ago. His energy and passion for cleft lip and palate surgery is infectious. He has a website and will send you a selection of educational DVDs if you ask nicely. . . 

Sub-specialty training posts: reconstructive cosmetic surgery and therapeutic use of lasers

There are up to 18 posts available. As always the recruitment is run by the Severn Deanery. Application forms here and contact them on 01454 252610. Further details of the posts are below.

Closing date: 13 October 2011
Invitations to interview expected: 18 October 2011
Interview dates: 31 October 2011.

There are 3 Interspecialty Fellowships in therapeutic use of lasers available at the University Hospitals of Swansea.

There are 15 Fellowships in reconstructive cosmetic surgery available in the following centres:

· Edinburgh
· Leicester
· London - Guys and Guildford
· London - Royal Marsden Hospital
· Newcastle
· Nottingham
· Salisbury and Portsmouth
· Sheffield
· Liverpool
· Birmingham - awaiting final confirmation
· Leeds - awaiting final confirmation

Each fellowship will be 4 months in duration starting:
· 1st February 2012
· 1st June 2012
· 1st October 2012

Pulvertaft Hand Centre web based mini c-arm image intensifier course

It is usually a requirement to pass this or a similar course before using a mini c-arm. The course is delivered online by The Pulvertaft Hand Centre. It was reviewed in the BMJ Careers when it was run in Derby over a single afternoon.

It costs £130. They estimate ten hours of work is required before taking the online assessment. A pass mark of 70% is required to get the certificate.

The course is delivered in five units. The course material is downloaded as PDFs and there is also some web based information.

The course satisfies the theoretical knowledge required by the legislation under the Ionising Radiations Regulations 1999 and Ionising radiation (Medical Exposure) Regulations 2000. You may need some local practical training before actually using the mini c-arm.

The Pulvertaft Hand Centre runs a number of other courses.

Top of the eTOCs September 2011

Selected articles from JPRAS, PRS, Annals as well as others that caught my eye. . . .








Birke-Sorensen H et al. Evidence-based recommendations for negative pressure wound therapy: Treatment variables (pressure levels, wound filler and contact layer) – steps towards an international consensus. JPRAS 2011; 64(9): S1-S16. Good review on current state of negative pressure therapy.

Lee J et al. Treatment options for cutaneous pyogenic granulomas: A review. JPRAS 2011; 64(9): 1216-1220. Take home message: excise and close.

Yu P et al. Perforator patterns of the anteromedial thigh flap. PRS 2011; 128(3): 151e-157e.

Sebastin S et al. A systematic review of the outcomes of replantation of distal digital amputation. PRS 2011; 128(3): 723-737.

Rubayi, S et al. Trunk, abdomen, and pressure sore reconstruction PRS 2011; 128(3): 201e-215e. Another good CME article.

Patterson, RW et al. Complex regional pain syndrome of the upper extremity. JHS 2011; 36(9):1553-1562.

iPad 2 - how to be an appy plastic surgeon

I am sitting here in a San Diego coffee shop waiting for the first session of the World Congress of Osteorthritis 2011 to get underway. This post is a first for me as it is coming from my new toy - an iPad 2.

Suffering from jet lag I woke at 0430 and couldn't get back to sleep. So what else it there to do than find some great apps for use as a plastic surgery trainee?

Here is a quick run down of the ones I've found so far. Some are medical and others just generally useful. I will go into more detail once back on the laptop.

Medscape has produced a free app that contains over 4000 disease and conditions. Within plastic surgery there are most major conditions covered as well as a number of operative techniques. On the whole they are well written and referenced.

Visible Body ($29.99) provides 3D anatomy using a similar format to the Google Body Browser. The detail is lacking in places but overall it is a fantastic piece of software that can also be used for both brushing up on anatomy and patient education.

Papers ($79) creates a 'personal library of research'. During my PhD is was the sole reason I switched to using a Mac. It allows you to create and manage a library of PDFs. There is also a function to cite as you write.

Dropbox is one of a number of free services that provide server space enabling syncing of files across multiple devices. You can store your Papers library in Dropbox, making it available across multiple devices.

Evernote is one of the best free note taking apps around. It allows you to take voice, picture and text notes and sync them across multiple devices.

Osirix ($29.99) is a DICOM viewer for radiographic imaging.

Post other suggestions in the comments section . . . .

Update: M. Felix Freshwater has an article in the October JPRAS on apps for the iPhone/iPad 2. He makes a good point about finding the right tools for the job even if they are not specifically designed for use by a plastic surgeon. I think the selection above demonstrates this. . . 

Virtual anatomy - smartphone applications for the plastic surgery trainee

I've finally come up with enough excuses to justify an iPad 2. During this process, I came across a few websites that review medical Apps, such as iMedicalApps and iPhoneMedicalApps.

One App that caught my eye was from Visible Body. For $99 you get a virtual human body sitting right on your iPad. The trial head and neck region was incredible - things have come along way since I was demonstrating anatomy back in 2003/4.

I carried on searching and stumbled upon Google Body Browser from Google Labs. How did this pass me by? It looks as impressive and is completely free. It uses WebGL for the 3D graphics, which is built into the latest Chrome and Firefox browsers. This avoids the need for Flash player or other plugins. Enjoy!

Update: 
Kavit Amin has an article "Smartphone applications for the plastic surgery trainee" in this month's JPRAS. There aren't really any specific apps designed for a plastic surgery trainees BUT there are many good apps to improve productivity and manage articles. Also, what about Medscape?

Face transplant books

A couple of years ago I bought Joseph E. Murray's memoirs "Surgery of the Soul", which is well worth a read. Today, I received an email from Amazon promoting transplant related books. Many of them were on the topic of face transplants. Here is a run down:

The Match: Complete Strangers, a Miracle Face Transplant, Two Lives Transformed Susan Helfgot and William Novak Simon and Schuster 2010

Someone Else's Face in the Mirror: Identity and the New Science of Face Transplants, Carla Bluhm and Nathan Clendenin Praeger 2009

Face to Face: My Quest to Perform the First Full Face Transplant Maria Siemionow Kaplan Publishing 2009

Transplanting a Face: Notes on a Life in Medicine Maria Siemionow Cleveland Clinic Press 2007

RSM Plastic Surgery Section 2011/12

The programme for the Plastic Surgery Section of the Royal Society of Medicine has been released. Miss Barbara Jemec is the Section President this academic year. She was recently interviewed on Radio 4's Women's Hour about immediate breast reconstruction after mastectomy.

Friday 14 October
Aesthetic day: A comprehensive overview of surgical methods for rejuvenation in the face and neck

Tuesday 8 November
Taking hand surgery and hand therapy to Nepal and India

Tuesday 13 December
Hidradenitis: Treatment options and new insights

International Journal of Burns and Trauma

The International Journal of Burns and Trauma is in the process of being launched. There is a list of forthcoming articles but no content yet. It will be open access but will cost $800 per article to publish. The editorial board are from North America and Australia.

I will add it to the journal page once there is some content.

Evidence-based plastic surgery

The July issue of PRS was the first to present a level of evidence question (diagnostic, therapeutic, or risk) for each article.

The editorial by Sullivan et al. outlines the new system. This is part of a wider initiative started last year to encourage evidence based plastic surgery.

As an example the levels of evidence for a therapeutic article are outlined below:

I    High-quality, multicenter or single-center, randomized controlled trial with adequate power; or systematic review of these studies.

II   Lesser-quality, randomized controlled trial; prospective cohort or comparative study; or systematic review of these studies.

III  Retrospective cohort or comparative study; case-control study; or systematic review of these studies.

IV Case series with pre/post test or only post test.

V Expert opinion developed via consensus process; case report or clinical example; or evidence based on physiology, bench research, or "first principles".

Double leg transplant

Allotransplantation continues a pace. The New Scientist reports the first double lower limb transplant has taken place at La Fe Hospital in Valencia. Spain is emerging as a leading force in allotransplantation. . . .

BAPRAS Summer Scientific Meeting fast approaching

The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) Summer Scientific Meeting is in Oxford this year. The programme looks good and of course the setting could not be better (unless it was in Cambridge).

This year there is going to be an expert session for trainees on the Thursday afternoon. It includes a session on plastic surgery research. Talking of which, the BAPRAS research section has been up dated.

Does anyone fancy providing some blog posts from the meeting?

e-LPRAS: last batch of topics for 2011

The last batch of topics for 2011 has just been released. Picking a topic is on a first come first served basis. Contact elpras.project@googlemail.com for the list and to volunteer. There should be more next year if funding is available.

New GMC guidance on "Making and using visual and audio recordings of patients"

Plastic surgeons are frequently taking photos for one reason or another. The GMC issued some new guidance that came into force in May 2011. Download it here.

TOTTPS June 2011

So here goes - the first month of Top of the TOCs for plastic surgery. Below are articles that caught my eye, selected from PRS, JPRAS, Annals, the American and European Journals of Hand Surgery amongst others.

JUNE 2011

Anaplastic Large Cell Lymphoma and Breast Implants: A Systematic Review

Kim, B et al. Plast Reconstr Surg. 2011; 127(6):2141-2150. 

doi: 10.1097/PRS.0b013e3182172418

This article is accompanied by a good discussion outlining when ALCL should be suspected and investigated. Further information is available on the FDA breast implant website. 

Current concept: Microsurgery of the Upper Extremity

Lerman, OZ et al. J Hand Surg 2011; 36(6):1092-1103. 

doi: 10.1016/j.jhsa.2011.03.038

Surgical Treatment of Chronic Mallet Finger

Makhlouf, VM and Deek, AN. Ann Plast Surg 2011; 66(6):670-672. 

doi: 10.1097/SAP.0b013e3181e6d017

Course Review: BTEC Professional Certificate in Medical Lasers and Light-Based Therapies

Davis, M. Ann Plast Surg 2011; 66(6):584. 

doi: 10.1097/SAP.0b013e3181de83aa

Sentinel-Lymph-Node Biopsy for Cutaneous Melanoma

Gershenwald, JE and Ross, MI. N Engl J Med 2011; 364:1738-1745.

The efficacy and safety of fasciectomy and fasciotomy for Dupuytren's contracture in European patients: a structured review of published studies. S. M. Crean et al. J Hand Surg (European Volume) 2011;36 396-407.

Dressed for success: which dressings to use?

The are a multitude of wound dressings out there. Designed for different types of wound and anatomical location. The website dressings.org is quite a good starting point. It has data sheets for the different types of dressings including their indications and contraindications.

Bionic reconstruction of the upper limb

Newsnight on BBC2 had a feature on the work of Dr Oskar C. Aszmann this evening. The early successes of bionic arms were presented. A medical ethicist from Oxford was interviewed about the ethical challenges of this work.

Currently only non-functioning hands have been amputated. As the technology improves patients with functioning hands may request bionic arms for improved function. Paxman then interviewed a recipient. The hands are made by Touch Bionics in Scotland.

iPhone App: Leg.Fracture

Just noticed that the BAPRAS/BOA "Standards for the management of severe lower limb trauma" published in 2009 is available as an iPhone App.

It has been produced by Alex Varey, is called 'Leg.Fracture' and is available for download from iTunes.

The info presented is very limited - less than the executive summary but the images are useful.

Alternatively get the Papers2 App for the iPhone/iPad and download the short guide PDF of the guidelines. The full guide can be viewed on line here.

Sentinel lymph node biopsy for cutaneous melanoma

This months New England Journal of Medicine (NEJM) has a clinical therapeutics article and video on sentinel-lymph-node biopsy for cutaneous melanoma. It starts with a clinical scenario before discussing SLNB in detail.

The Melanoma Study Group has a 'FOCUS on Melanoma' day on 19th October 2011. It will be held at the Royal College of Physicians, London. Check the website for further details.

Top of the TOCs for plastic surgery

There are a large number of plastic surgery related journals, most of which are listed on the Journals page. Signing up to the eTOCs is a good way to keep up-to-date with new articles.

The Twitter feeds from PRS and other journals are also worth signing up to.

Coming soon: each month I am going to select articles from the key journals that have caught my eye as a trainee. . . .

Reconstructive Surgery at the Science Museum

The lay public and media usually equate plastic and reconstructive surgery with cosmetic surgery. Most related TV shows focus on boobs and bums with a few notable exceptions.

Debate continues amongst plastic surgeons as to how the public understanding of reconstructive surgery can be improved.

Challenging the publics perception of disfigurement does seem to be making some progress. This is mainly through high profile individuals, such as Katie Piper, and related media. Recent successes in face transplantation have also generated interest.

I was pleased to come across the Science Museum 'Brought to Life' website, which explores the history of medicine. It is funded by the Wellcome Trust and uses some of their material.

Reconstructive surgery features prominently. The section gives an introduction to the history and contribution of plastic surgery. Gillies and McIndoe, as always, are given pride of place.

Talking of the Wellcome, they are currently displaying the winners of their Wellcome Image Awards 2011. I am sure an image from within the sphere of plastic and reconstructive surgery could be a winner!

Image: Indian method of nose reconstruction, illustrated in the Gentleman's Magazine, 1794. Wellcome Library, London, UK

Plastic Surgery in Uganda

There is an interesting article by Jonathan Cubitt in this months RCS Bulletin on plastic surgery in Uganda. He spent time with Andrew Hodges working for a charity called Comprehensive Rehabilitation Services in Uganda (CoRSU).

The website is very comprehensive with case stories outlining the work they perform. Andrew Hodges published a review article on the experiences of working in Uganda a couple of years ago.

CoRSU has been added to the charities list. . . .

Cubitt J. An out-of-programme experience: plastic surgery in Uganda. Ann R Coll Surg Engl (Suppl) 2011;93:180-181.

Hodges S, Wilson J, Hodges A. Plastic and reconstructive surgery in Uganda - 10 years experience. 2009; 19(1):12-18

BSSH Instructional Courses in Hand Surgery

The British Society for Surgery of the Hand (BSSH) has released the dates for Series 5 of the instructional courses in hand surgery over the next couple of years. They are held at the Manchester Conference Centre. Full details are available on their website.

10th - 11th June 2011: Nerve injury and compression, pain, anaesthesia

3rd - 4th February 2012: Tendon injury, paralysis, rehabilitation

8th - 9th June 2012: Fractures, joint injuries, arthritis

1st - 2nd February 2013: Congenital, neoplasia, ganglia

14th - 15th June 2013: Wrist, occupational and medicolegal aspects

Advanced Training Posts In Head and Neck Surgical Oncology

JCST and the Training Interface Group in Head and Neck Surgical Oncology is recruiting up to 7 fellows for 12 months training. As always the Severn Deanery is managing the recruitment via their website.

Closing date for applications is 16th May 2011. The interview date will be 6th June 2011. 

Candidate support line on 01454 252610.

Is Surgery Scientific?

Programme on BBC Radio 4 this evening exploring whether surgeons are scientific enough in their approach to surgery and new procedures.

The age old comparison to Sir Lancelot Sprat was made.

I don't have time for a longer post as just finishing writing my PhD thesis!
Listen again here.

Anatomy of the Upper Hand and Limb (Windsor Anatomy at King's)

This course has been postponed until 15th/16th October 2011.

Check out www.hand-clinic.co.uk for further information or contact Lindsey Waite (Assistant Course Organiser) on 01753 838431.



Image by Mr Donald Sammut.

The Face Trust

An article in the Evening Standard yesterday reported on the current state of assessing patients for a face transplant. Patients are ready and waiting but a suitable donor is yet to be found. The team is led by Prof. Butler who set up the The Face Trust to raise money for the research and surgical treatment in this field.

Life as a junior surgeon: Direct Red

The Friday Play on BBC Radio 4 was an abridged version of 'Direct Red: A Surgeon's Story'. A book written by London ENT surgeon Gabriel Weston and published in 2009.

I had not come across the book but I might just go and buy a copy after hearing the play. It was funny, poignant and brought back many memories of being a House Surgeon. Much of it was very familiar.

It is worth catching on Listen Again. Details of the book are below; it was published to critical acclaim. Gabriel Weston read English at Edinburgh before deciding on a career in medicine.


Weston G. Direct Red: A Surgeon's Story. Jonathan Cape; 2009.
ISBN-13: 978-0224084390

RCS Surgical Workforce Report 2010

The Royal College of Surgeons of England has published their first comprehensive survey of the surgical workforce in England, Wales and Northern Ireland.

The survey was sent to all consultant surgeons on the RCS(Eng) database. They had a 60% response, which is not bad for a survey, but is far from definitive.

According to their records there are 334 consultant plastic surgeons in the UK. Plastic surgery does well on the number of female surgeons (44, 13.1%) compared to other specialties. It comes second highest after paediatric surgery but still disappointingly low.

The 334 consultants hold NHS appointments but there are many more plastics surgeons out there. My Freedom of Information request to the GMC showed that there are currently over 700 surgeons on the GMC specialty register with plastic surgery as their primary qualification.

Skin: A Natural History

I picked-up this book when I went to the Skin exhibition at the Wellcome Collection last year. It promised a different perspective on skin, well beyond its anatomical and physiological properties so familiar to plastic surgeons.

The Nature review said "Tells us everything we might want to know about skin". It is certainly covers a wide range of topics yet remains a slim volume (179 pages before the extensive references). Core anatomy and physiology is covered for a lay audience and offers little for a surgeon.

However, the book is catalogued under 'anthropology / evolution'. Placing skin in this context is the book's purpose and it is done very successfully.

There is an extensive reference and note section at the back. It is available in hardback, softcover and eBook.


PSP Rating 4/5

N.G. Jablonski. Skin: A Natural History. University of California Press; 2006
ISBN-13: 978-0520242814

Enhanced coverage of cosmetic surgery

Cosmetic surgery appears to have gone high brow. The London Underground has plenty of posters advertising 'Anne Nicole' the latest offering from the Royal Opera House. Anne Nicole Smith of course was an avid fan of surgical enhancement. It has opened to good reviews.

The topic has even made it on to Radio 4 with Laurie Taylor discussing cosmetic surgery in Brazil on his programme "Thinking Allowed".

Channel Four managed to lower the tone though with the "50 Greatest Plastic Surgery Shockers".

As usual cosmetic surgery is always referred to as plastic surgery. How about some programmes on reconstructive surgery?

New e-LPRAS blog

The e-Learning Project for Plastic Reconstructive and Aesthetic Surgery has a blog to keep you up to date on the latest developments. The first batch of topics have been allocated and a new batch are now available.

Masters Course in Oncoplastic Breast Surgery

This course has gained quite a bit of media coverage. It is a new three-year e-learning Masters course based at the University of East Anglia.

It is a joint venture between UEA, Association of Breast Surgery and BAPRAS.

You can work towards three levels: certificate, PGDip or full Masters. The full course will take up to three years.

There are various entry requirements. For instance you need to be  at least an ST5 trainee or associate specialist in breast surgery.

eLPRAS update

The first batch of topics has been released:

Structure and function of normal skin; blood supply of the skin; healing of wounds; principles of management of skin wounds; gunshot wounds and blast injuries; stab wounds; human and animal bites; extravasation injury; normal scars (natural history); hypertrophic and keloid scars; atrophic and stretched scars; scar contractures; acute wound infections; chronic wound infections; MRSA in plastic surgery patients; topical therapy for wound infections; systemic antibiotics in wound infection; necrotising fasciitis; skin lesions in meningococcal septicaemia; hydradenitis suppurativa.

If you are not already on the mailing list contact Mrs Sarah A. Pape (Clinical Lead) at elpras@gmail.com. She will send you a content author job description, sample session and the topics above with their descriptions.

eLPRAS: back from the dead

Good news! e-Learning for Plastic, Reconstructive and Aesthetic Surgery (eLPRAS) is back in the pipeline, albeit in a 'credit crunch' version.

The curriculum has eight topic areas:
1. General principles
2. Surgical principles
3. Head and neck
4. Congenital head, neck and skin
5. Upper limb
6. Breast and chest
7. Lower limb
8. Burns

The first batch of ten topics will be released soon. The turn around times are short and so you will need to be able to commit to producing the content over a 6 week period.

If you are a consultant or trainee interested in contributing contact Mrs Sarah A. Pape, Clinical Lead, with details of your current position, grade/CCT date, and Deanery.

eLPRAS email: elpras.project@googlemail.com

"Hands" exhibition on at the Wellcome Collection

I grabbed a quick bite to eat in the Wellcome Collection cafe and noticed the Lightbox gallery currently has a "Hands" exhibition on. It is small but worth a quick wander around.

There are a number of images related to hands and their place in history of medicine. Pictures ranged from a healer delivering 'animal magnetism' with their hands, to Dupuytren's contracture.

Place: Wellcome Collection, 183 Euston Road, London, NW1 2BE

Closes: Mid-February 2011

Image: Valentine Greatrakes, an Irish faith-healer who claimed to cure scrofula or 'the kings evil' just by laying his hands on the patient.

Bionic reconstruction of the upper extremity

The Royal Society of Medicine is following up the interesting talk on the first full face transplant with 'Bionic reconstruction of the upper extremity'.

The speaker is Dr Oskar C. Aszmann, Director of the Center for Extremity Reconstruction and Rehabilitation, Division of Plastic and Reconstructive Surgery Medical University of Vienna, Austria.


Date: Tuesday 8th February 2011 at 7 pm.
Venue: RSM, 1 Wimpole Street, London, W1G 0AE

Register here.

Advice for meeting indicative logbook requirements*

* A PSP take on the classic woodblock poster by Antony Burrill. 

CME: Skin grafts and local flaps

There is a great CME article in the latest PRS on skin grafts and local flaps. It includes links to various videos showing how to harvest and use the flaps.

Face Transplants: The Inside Story

'Face transplants' is the topic of the first meeting of 2011 for the Plastic Surgery Section of the Royal Society of Medicine (RSM).

The Section is fortunate to have Dr Joan P. Barret speaking on his experience of leading the team that performed the first full face transplant.

Date: Tuesday 11 January 2011 at 7 pm.
Venue: RSM, 1 Wimpole Street, London, W1G 0AE

Register here.