Saturday, 21 January 2012

Reconstructive hand surgery in Nepal

Nola Lloyd reports on hand surgery in Nepal.

On the dusty planes of Nepal under the shadow of Mount Everest small communities of farmers struggle to survive off the land. They live precarious lives with basic living conditions, little education, and minimal healthcare. In addition to these hardships, an illness of biblical shame stalks the weak and vulnerable. This is leprosy, a disease that remains a huge global health issue.

Many in the developed world believe leprosy no longer exists. They equate the disease with historical film footage of shuffling, voiceless corpses shrouded in muslin, loosing digits as they move. It comes as a surprise that over 12 million people are affected, many of them children.

The bacillus, Mycobacterium leprae, causes leprosy. It multiplies slowly in the human host, often resulting in a prolonged incubation period of five years or more. The chronic granulating infection affects the skin, peripheral nerves and eyes.

Unlike polio, it causes both muscle paralysis and sensory loss. The combination of paralysis and insensate limbs means that recurrent trauma and infection lead to ulceration and erosion of hands and feet. Loss of sensation and paralysis of eyelids causes blindness. De-pigmented skin patches, deformed limbs and a collapsed nose and coarsened features leave onlookers in no doubt about the diagnosis.

Along with their functional consequences, these stigmata of disease cause considerable distress and prejudice. Families can go to great lengths to hide afflicted relatives from public view.

Leprosy is easily treatable
The treatment for leprosy has been freely available from the WHO for many years. Multidrug therapy renders a patient no longer infective within a month and continues for 6 to 12 months for full treatment. However, established sensory loss and paralysis cannot be reversed.

It is for these problems that physical therapy and surgery can help to restore form and function. For example, this might enable a farmer with a paralyzed hand to return to work or correct a child’s claw hand so that she can feed herself and marry in the future.

Tuesday, 17 January 2012

How to use Quick Response codes for plastic surgery

Quick Response (QR) codes are simple barcodes, which can be scanned by Smartphones. The QR code can encode a link to a document, contact details etc. They are a great way of disseminating information.

1. Create a document (e.g. department guidelines or patient information leaflet)

2. Save it as a PDF and store it in a shared folder online e.g. Dropbox

3. Copy the 'public link' for the file. This is the web address of the file (URL)

4. Paste the link into a website that creates QR codes e.g. SPARQCode

5. Print the QR code and stick it up so people can scan it with their Smartphone

6. Download a QR code scanner from the app store. Search for "QR code" and a number of them will appear. Examples include i-nigma and NeoReader.

Job done.

Tuesday, 10 January 2012

RSM programme for plastic surgery section 2012

All at the RSM apart from the Northwest Aesthetics Day, which is in Liverpool. At the RSM registration is at 6.30 pm and the proceedings start at 7pm.


21 February The legal, psychological and surgical aspects of gender reassignment

13 March Bone and soft tissue sarcomas and their reconstruction

30 March Northwest annual aesthetics day

17 April Brachial plexus injuries in Paris and Gaza

8 May How to optimize your CV for a consultant post

12 June Presidential address: Plastic surgery, art and history

Top of The TOCs January 2012

Happy New Year! Selected articles from JPRAS, PRS, Annals, European Journal, J Hand Surgery and others that caught my eye. . . .

Pomahac B et al. Three patients with full facial transplantation. N Eng J Med 2011. Online first. DOI: 10.1056/NEJMoa1111432. Data from these pioneering operations are now coming form the various teams. This paper outlines the details of the three performed at the Brigham and Women’s Hospital. There is a table with the week-by-week issues encountered. . . 

Kaoutzanis C at al. When should pelvic sentinel lymph nodes be harvested in patients with malignant melanoma? J Plast Reconstr Aesth Surg 2012; 65(1):85-90. doi:10.1016/j.bjps.2011.08.027.  One from St George's Hospital . . . .

Singhal D et al. The Brigham and Women's Hospital face transplant program: a look back. Plast Reconstr Surg 2012; 129(1):81e-88e. doi: 10.1097/PRS.0b013e31823621db Complements the article highlighted in last months TOTTPS.

Saint-Cyr, M et al. Simple approach to harvest of the anterolateral thigh flap. Plast Reconstr Surg 2012; 129(1):207-211. doi: 10.1097/PRS.0b013e318233ef4a

Eaves FF et al. ASAPS/ASPS position statement on stem cells and fat grafting. Plast Reconstr Surg 2012; 129(1):285-287. doi: 10.1097/PRS.0b013e3182362caf

Yagi S et al. A New Technique for Abdominal Closure in Obese Patients. Plast Reconstr Surg 2012; 129(1):213e-214e. doi: 10.1097/PRS.0b013e3182365e03

Nguyen A et al. Cosmetic medicine: facial resurfacing and injectables. Plast Reconstr Surg 2012; 129(1):142e-153e. doi: 10.1097/PRS.0b013e3182362c63. Related video content available online.

Monday, 9 January 2012

British Burns Association session at SARS

I have just returned from a couple of days at the Society of Academic and Research Surgeons (SARS) in Nottingham.

I had not been before. SARS is the main UK forum for surgical research and has been going just over 50 years. It is run out of the RCSEng. It is dominated by the general surgical sub-specialities; plastics, neurosurgery, ENT etc are poorly represented.

The BBA has recently become involved with two sessions of presentations and is allowed to put one abstract forward for the prestigious Patey Prize. The session was stimulating with a mixture of clinical and basic science presentations covering both burns and plastic surgery.

Apparently all of the submitted abstracts were accepted. The BBA is trying to grow this section - well worth submitting an abstract for the 2013. As an incentive there is a best presentation prize for each session!

Friday, 6 January 2012

The curious incident of the disappearing breast implant

This month the NEJM reports the bizarre case of a woman who reported that her “body swallowed one of the implants” during a Pilates stretching session. She had previously had a bilateral mastectomy and implant reconstruction.

It turns out that she had undergone a minimally invasive mitral-valve repair resulting in an unstable intercostal space in the region of the surgical access.

The implant was extricated from the chest and repositioned. . . .

Image Copyright NEJM 2012