Beryl De Souza

Suturing v conservative management of hand lacerations : All lacerations need to be examined thoroughly

Editor—Quinn et al show that conservative treatment is faster and less painful for small uncomplicated lacerations of the hand.1 However, we think that lacerations to the hand, no matter how small, must be examined thoroughly to exclude injuries to tendons, nerves, or joints. The authors make no comment on the mechanism of injury, which is extremely important. A knife stab laceration or glass injury to the hand would make exploration of the wound mandatory. An unimpressive skin wound may hide a remarkable amount of damage to deep structures.2 Similarly, injuries caused by thin slivers of glass produce unimpressive skin wounds but commonly divide flexor tendons and nerves in the forearm.3 In emergency settings we think that it is crucial to take a good history from the patient about the mechanism of injury and to examine the patient thoroughly before deciding on further management of hand lacerations, albeit suturing or conservative management. In our plastic surgery unit the nurse practitioners who refer cases of hand trauma to us have all been on a hand trauma study day organised by our department. If the mechanism of injury raises any suspicion of a tendon or nerve injury, patients are referred to us and their wounds formally explored in an operating theatre.

Family friendly workplaces for doctors in training

Creating family friendly workplaces for doctors in training brings benefits for both employers and employees. Beryl De Souza and Paul Deemer consider what trainees should look out for from employers in terms of supporting those with caring responsibilities

The art of negotiating as a doctor

Beryl De Souza and Andrew Barton look at the importance to doctors’ work and careers of negotiation skills

The ABC of the LNC

Beryl De Souza looks at how your local negotiating committee can help you

A research and development framework

Beryl De Souza gives tips on setting up a departmental research and development framework

Choosing your specialty foundation training

Beryl De Souza stakes out the options