Simon Withey

Attitudes to face transplantation: results of a public engagement exercise at the Royal Society Summer Science Exhibition.

Hettiaratchy and Butler (Lancet 2002;360:5–6) framed face transplantation as the next logical step on the reconstructive ladder for severe facial injury, in particular, pan-facial burns. The procedure formed the basis for a Royal College of Surgeons of England working party report. Ethical, surgical, and psychological issues were identified as research priorities before face transplantation is attempted in the United Kingdom. Public engagement is a vital mechanism if people are to be informed about the risks and benefits of the technique and ultimately to be able to consent to either receiving or donating facial tissue. To sample public opinion about the procedure, 304 people attending the Royal Society Summer Science Exhibition were sampled by online questionnaire to determine their attitude toward face transplantation. Although people were more cautious about face transplantation when comparing this with solid-organ transplantation, most of the sample were in favor of the procedure, whether receiving a donor face or donating their own face after their death. Only 10% were against the idea in principle. Concerns about altered identity were not a barrier to face transplantation for 69% of the sample, with most people appropriately identifying the long-term problems of immunosuppression as the issue that most concerned them. There is a substantial population of people who, given the right circumstances, would contemplate face transplantation for themselves and would be willing to donate their own face for transplantation after their death.

Objective evidence for the use of polylactic acid implants in HIV-associated facial lipoatrophy using three-dimensional surface laser scanning and psychological assessment

The advent of highly active antiretroviral therapy (HAART) has dramatically improved the life expectancy of people infected with human immunodeficiency virus (HIV). Although patients often have excellent disease control with these combinations of antiretrovirals, they are at risk for the multiple toxicities associated with these drugs. Facial lipoatrophy is a particularly distressing complication of some HAART regimes. This disfigurement can lead to significant psychosocial stress, resulting in decreased treatment compliance. Polylactic acid (PLA) facial implants provide a potential method of restoring a normal appearance. One hundred consecutive patients had a course of PLA facial implants. All patients were assessed clinically and had photographs, facial surface laser scans and completed psychological questionnaires throughout the course of treatment. After a mean of 4.85 treatments per patient, there were improvements in all measures. The mean clinical scores improved from a moderate-severe grade to none-mild grade after treatment. Three-dimensional (3D) laser surface scans showed a volume increase of 2.81 cc over the treated area of the cheek. There were significant improvements in all of the psychological measures. This study shows clear objective evidence of the psychological and physical benefit of PLA implants in HIV-associated facial lipodystrophy.

Facial atrophy in HIV-related fat redistribution syndrome: a plastic surgical perspective on treatment options and a look to the future

Approximately 50% of patients on highly active antiretroviral therapy (HAART) develop lipodystrophy with central and visceral fat accumulation and/or facial and limb atrophy. Although the exact mechanisms of this are not fully understood, the facial atrophy encountered is secondary to atrophy of the subcutaneous fat, and not the deeper fat pads, as has been suggested. More recently, the above features in combination with hyperlipidaemia and insulin resistance have been described and are referred to as HIV-related fat redistribution syndrome. This review looks at treatment options available for this stigmatizing condition.

Diagnostic fine-needle aspiration in postoperative wound infections is more accurate at predicting causative organisms than wound swabs.

INTRODUCTION Postoperative wound infections are common. Antibiotics are often prescribed empirically, usually in the absence of any microbiological sensitivity data. This study demonstrates the role of fine-needle aspiration microbiology (FNAM) in determining the causative organisms in these wounds compared to wound swabs taken from the same patients. PATIENTS AND METHODS A total of 20 patients with clinical signs of soft tissue infection were tested using wound swabs and fine-needle aspiration. RESULTS Six of the wound swabs yielded a single organism but 16 out 20 of the FNAM group yielded a single organism (P = 0.002). CONCLUSIONS The FNAM approach allows antibiotic sensitivities to be obtained enabling specific antimicrobial therapy to be implemented early. FNAM also has a higher yield of cultures than wound swabs. Cellulitic areas can be sampled even when use of wound swabs is not possible.

Forehead Flap Method for Total Nasal Reconstruction

One of the very first recorded methods developed over the ages to correct the mutilating deformity of rhinectomy was the forehead flap. While many other techniques have also been devised, this surgical method has stood the test of time better than any other. Further refined during the 20th century, it has now become the gold standard for obtaining the best results in nasal reconstruction. We present an illustrative case of a young man who was assaulted outside a night club and who suffered a clean separation of the nasal pyramid from the facial plane. We highlight the novel use of osseous, as opposed to cartilaginous, reconstruction of the upper lateral cartilages, which has not previously been reported in the literature.

Variations in Clinical Audit Collection: A Survey of Plastic Surgery Units Across the British Isles

INTRODUCTION Clinical audit is a requirement of good medical and surgical practice and is central to the UK Governments plans to modernise the NHS. MATERIALS AND METHODS A survey was conducted to assess clinical audit data collection and collation within plastic surgery departments across the UK. The survey identified a variety of different data collection and collation methods, with extensive differences between plastic surgery departments. Those responsible for data collection and its funding were also identified by the survey. RESULTS Results were obtained from 45 plastic surgery departments. Of the 45 departments surveyed, 12 collect data prospectively, whereas 26 units collect data retrospectively. The remaining departments collect data using a combination of methods. Of the units surveyed, 28 collect data on paper-based systems, with only 13 units using electronic applications. The personnel responsible for data collection were identified as being junior doctors. Departments collecting data prospectively do so from a greater number of sources than those collecting data retrospectively. CONCLUSIONS This survey has focused on plastic surgery. The authors believe that similar results would be obtained from a survey of other surgical specialties. A huge variation in all parameters relating to the collection and collation of clinical audit data is seen. There are few standards within this specialty for data collection. Much work must be done in order to reach targets set by the UK Government.

A portal to validated websites on cosmetic surgery: the design of an archetype.

There has recently been an increase in the usage of the Internet as a source of patient information. It is very difficult for laypersons to establish the accuracy and validity of these medical websites. Although many website assessment tools exist, most of these are not practical. A combination of consumer- and clinician-based website assessment tools was applied to 200 websites on cosmetic surgery. The top-scoring websites were used as links from a portal website that was designed using Microsoft Macromedia Suite. Seventy-one (35.5%) websites were excluded. One hundred fifteen websites (89%) failed to reach an acceptable standard. The provision of new websites has proceeded without quality controls. Patients need to be better educated on the limitations of the Internet. This paper suggests an archetypal model, which makes efficient use of existing resources, validates them, and is easily transferable to different health settings.