Christopher Dunkin

Prospective survey of factors affecting risk discussion during consent in a surgical specialty

The Department of Health in the UK has developed new consent guidance but without clear recommendations on how the incidence and severity of a given risk should influence its discussion during the process of obtaining informed consent. Plastic surgery is a litigation‐prone specialty that offers a paradigm for assessing attitudes to consent.

PR14 LATISSIMUS DORSI MYOCUTANEOUS FLAP WITH ANATOMICAL EXPANDER‐IMPLANTS FOR SINGLE STAGE BREAST RECONSTRUCTION – AN ACHIEVABLE GOAL?

Introduction  Implant‐based breast reconstruction has evolved from two‐stage methods using round smooth expanders to single‐stage using definitive textured biodimensional anatomical expander‐prostheses. The aim of this study was to assess if single‐stage reconstruction is achievable using McGhan 150 expander‐implants with latissimus dorsi (LD) myocutaneous flaps and if so, at what cost.

Burns in patients with impaired sensibility of the hands—a case of osteomyelitis in a neglected thumb burn

Inadvertent thermal injury is a constant potential hazard for individuals with impaired sensibility. As a result of the absence of normal physiological protective reflexes contact with a noxious stimulus may be prolonged, resulting in an injury of greater depth than might otherwise be expected. Subsequent complications, such as infection, may develop in the absence of classical signs and symptoms. Clinically significant osteomyelitis is a rare complication of burns [1]. In this article the case of a woman with syringomyelia is presented. As a result of marked thermo-anaesthesia of both hands she sustained a burn to the left thumb and subsequently developed septic arthritis of the interphalangeal joint that progressed to osteomyelitis of the proximal phalanx. The pathophysiology of osteomyelitis after burns is discussed and the hazard of inadvertent thermal injury in patients with impaired sensation is highlighted to raise awareness of potential complications in this group of patients.

Re: Perineural fibromatosis - a rare cause of ulnar nerve Palsy

We have used costal osteochondral grafts for partial cartilage injuries on one side of a finger joint in 17 cases with satisfactory results (Sato et al., 2008). Beneficial characteristics of this graft include biological and anatomical similarity to the original joint. No other joint is sacrificed. Recently, Kitaoka et al. (2001) indicated that costal cartilage showed phenotypic similarities to the articular cartilage and that the costal cartilage might be useful as the donor transplantation site for the treatment of articular cartilage defects. This is the first report of total joint reconstruction of the finger joint using costal osteochondral graft. It may represent a significant new treatment if this excellent result can be maintained and reproduced.

Plastic surgery beyond the human genome.

We read with interest the article by Cole and Isik on the Human Genome Project, microarrays, and the implications for plastic and reconstructive surgery (Plast. Reconstr. Surg. 110: 849, 2002). The authors present a lucid account of a powerful screening technique, but we believe that their emphasis is misplaced. Genes provide the instruction template for cellular structure and function. RNA molecules act as intermediaries. However, the true intracellular and extracellular workhorses are proteins.