Ian M. Smith

Free Vascularized Fibular Bone Graft

Autologous bone grafting for large segmental bone defects >6–8 cm, ±soft tissue cover, such as seen in posttraumatic (Fig. 21.1a–d) or postinfectious bone loss and tumor resection (Fig. 21.2a).

Cutaneous squamous cell carcinoma arising within generalised morphea

Morphea is a group of cutaneous conditions, also termed localised scleroderma, that is characterised by benign inflammation of the skin. We present a case of cutaneous squamous cell carcinoma arising within a morphoeic plaque. We discuss our rationale for aggressive treatment.

Intraosseous cavernous haemangioma of the inferior turbinate.

Intraosseous cavernous haemangiomas usually occur in the vertebral and calvarial bones, and account for <1% of primary bone tumours. Nasal cavity intraosseous cavernous haemangiomas are extremely rare. We present a case of a 47-year-old woman with an incidental left inferior turbinate mass noted on CT scan for an unrelated pathology. She had no rhinological symptoms other than a 2-year history of left-sided nasal obstruction. Preoperative imaging failed to determine the aetiology of the mass. The lesion, contiguous with the left inferior turbinate, was successfully resected via an endoscopic approach. Histopathological examination of the resected specimen demonstrated a left inferior turbinate intraosseous cavernous haemangioma.

Inner table corticectomy of the fronto-orbital bar in correction of metopic and coronal craniosynostoses.

Abstract Fronto-orbital advancement is an established method for correction of metopic and coronal craniosynostoses. Many techniques involve creation of a single fronto-orbital bar that is then shaped with osteotomies with or without bone grafting. We present a technique that minimizes osteotomy of the frontal bar and gives superior lateral brow aesthetics. Standard fronto-orbital bar bone cuts are made without a midline osteotomy. Selective inner table corticectomy of the fronto-orbital bar allows the bone to become malleable without greensticking. The need for osteotomy of the fronto-orbital bar is obviated. An additional bandeau is created from the temporoparietal calvaria. The malleable fronto-orbital bar is then fixed to this bandeau. The frontal bar and bandeau complex is then advanced in a conventional manner. The remaining frontal calvaria is then rotated creating a more vertical forehead. This technique has been used in Leeds for more than 10 years with good cosmetic results. It has become our standard method for management of the fronto-orbital bar in correction of nonsyndromic metopic and coronal craniosynostoses.

An Unusual Neck Mass: A Case of a Parathyroid Cyst and Review of the Literature.

Parathyroid cysts (PC) are an unusual cause of neck swellings. The majority are nonfunctioning and prove to be a diagnostic challenge given their nonspecific physical and radiological characteristics. This is compounded by their rare occurrence, leading them to be overlooked in the differential diagnosis of neck lumps. Imaging techniques fail to determine the origin of these lesions, but a preoperative diagnosis can be achieved by fine-needle aspiration and measurement of cystic fluid C-terminal parathyroid hormone levels. Treatment of nonfunctioning cysts remains controversial and includes needle aspiration, injection of sclerosant, or surgical excision. We present a case of a 44-year-old female presenting with an asymptomatic anterior neck swelling, diagnosed postoperatively as a parathyroid cyst.

Improving patient care in plastic surgery: With structured documentation

Clear, accurate clinical documentation is essential in ensuring safe, high quality continuity of care. Numerous studies, including the Dr Foster report have demonstrated that patients are at greater risk of receiving substandard care and that mortality rates are also increased out of hours. This is often due to poor hand over and inadequate clinical documentation, which is often too vague or abbreviated. This not only affects patient care but also impacts on any future legal action or inquiry. A recent audit carried out in our department highlighted that we are meeting the GMC guidance for documentation; however, the content often did not fully reflect the daily management of the patients. An audit was, therefore, carried out to identify this apparent deficit and as a result of the findings we implemented remedial action. This was retrospective study of patient notes over a two month period in the department. The notes were assessed to identify areas of inadequate documentation, using our local trust guideline. After identifying the weaknesses, we developed an acronym for documentation. Acronym implemented is as follows: