Richard D. Price

The role of hyaluronic acid in wound healing: assessment of clinical evidence.

Hyaluronic acid (hyaluronan), a naturally occurring polymer within the skin, has been extensively studied since its discovery in 1934. It has been used in a wide range of medical fields as diverse as orthopedics and cosmetic surgery, but it is in tissue engineering that it has been primarily advanced for treatment. The breakdown products of this large macromolecule have a range of properties that lend it specifically to this setting and also to the field of wound healing. It is non-antigenic and may be manufactured in a number of forms, ranging from gels to sheets of solid material through to lightly woven meshes. Epidermal engraftment is superior to most of the available biotechnologies and, as such, the material shows great promise in both animal and clinical studies of tissue engineering. Ongoing work centers around the ability of the molecule to enhance angiogenesis and the conversion of chronic wounds into acute wounds.

Squamous Cell Carcinoma of the Temporal Bone: Clinical Outcomes From Radical Surgery and Postoperative Radiotherapy

Objective To review the treatment of squamous carcinoma of the temporal bone at a regional skull base unit for the period 1982–2012. Study Design Retrospective case review. Setting Tertiary referral center. Patients Sixty patients with primary squamous carcinoma of the temporal bone. Interventions Multidisciplinary team approach including surgical resection, reconstruction, and postoperative radiotherapy. Main Outcome Measures Disease-specific survival, overall survival. Results The 5-year disease-specific survival for the whole cohort was 44% (CI, 37%–51%). Multivariable analysis revealed nodal status, poorly differentiated squamous cell histology, and carotid involvement to be poor prognostic indicators. Conclusion Although the survival figures in this series are comparable with the best outcomes from other units, our experience would suggest improvements can still be achieved by reconsidering the selection of patients for neck dissection and temperomandibular joint excision in early stage disease. We also conclude that postoperative radiotherapy should be delivered to all patients, including surgical salvage cases who may have received previous irradiation. Finally, the minority of patients with poor prognostic features should be offered a more palliative therapeutic approach.

Tissue engineering for skin transplantation

Publisher Summary This chapter outlines the structure and function of skin and also the different delivery systems for keratinocyte application. There are a number of pathologies in which skin loss or damage is a salient feature. Most notable amongst these are burns, in particular large-area injuries, and chronic ulcers. Problems common to both pathologies include the loss of superficial epidermis and dermis, abnormal wound healing, and the failure of wound healing. Both pathologies present enormous economical and medical challenges, and have received a large amount of interest with the advent of tissue engineering. The chapter describes that the structure of skin is very complex consisting of an epithelial and mesenchymal component. True tissue-engineered skin will need both these components and all the cell types.

The Use of Tissue Glue in Prominent Ear Correction Surgery

Cyanoacrylate tissue glues have been used for many years in otoplasty and specific indications for its use are as described. As well as being an effective means of dressing the postauricular suture line, its use in gluing the pinna back to the postauricular skin may negate the use of the head bandage in the postoperative period.

Manoeuvring a-head in plastic surgery

Surgical training has undergone a rapid transformation over the last decade. One outcome of these changes is the interest that has been generated in the possibility of training surgical skills outside the operating theatre. We describe a cost-effective tool that may be used to improve surgical handling and improve surgical concepts in facial plastic surgery.

Are non-melanoma skin cancer incomplete excision rates different between grades of plastic surgeons?

Non-melanoma skin cancers (NMSCs) are increasing in incidence and worldwide there are currently 2e3 million new cases each year. In the majority of departments, local anaesthetic (LA) day case NMSC surgery is undertaken by all grades of surgeon and is considered a valuable training opportunity. When NMSC excision margins are involved, the recommendation is usually for re-excision, radiotherapy or close outpatient follow-up. All of these have a negative effect on patient experience and incur additional financial costs. In an era where demand is increasing on limited resources and risk-adjusted clinical performance data is used to allocate funding to departments and trusts, significant differences in incomplete excision rates between grades of surgeons may have a significant bearing on future skin cancer service provision. We retrospectively compared NMSC incomplete excision rates of consultants versus trainees for procedures performed in the outpatient clinic setting under LA.