Waseem Bhat

Breast Augmentation with Implants Following Previous Enhancement with MacrolaneTM Filler Injections

Macrolane TM is a product marketed for breast enhancement. It is composed of hyaluronic acid (HA) in an injectable form that allows breast enhancement via a nonsurgical outpatient procedure. We present the preoperative and intraoperative findings for breast augmentation in a patient who had previous Macrolane injections for breast enhancement. There are few previous reports of surgical augmentation following a series of Macrolane injections for breast enhancement. A 62-year-old woman presented to the plastic surgical outpatient department complaining of unhappiness with the size and shape of her breasts. She had undergone bilateral breast enhancement with Macrolane injections on three previous occasions over the course of 2 years, the last injection being performed 4 months prior to her consultation. Her breast size had begun to diminish to her previous size and she was also unhappy with the subsequent contour irregularities and palpable lumpiness that had developed in the breasts.

A retrospective survey of brachial plexus blockade in pediatric hand trauma patients.

our expectations, GV provides similar intubation performance characteristics compared with DL. However, a skilled experience is needed in using GV to acquire comparable time to intubation with DL. We excluded patients with upper airway abnormalities because the purpose of this study is to evaluate the usefulness of GV for nasotracheal intubation compared with DL in pediatric patients. The usefulness of GV for nasotracheal intubation in normal population should be defined before the evaluation in children with difficult airway. Afterward, further studies are required to clarify the usefulness of GV in children with difficult airway. Hyun-Jung Kim Jin-Tae Kim Hee-Soo Kim Chong-Sung Kim Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea Email: kimjintae73@dreamwiz.com

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:

The Significance of Bone Abrasions in Fight Bite Injuries: Beware of the Osteochondral Defect

Sir, Fight bites are commonly seen in emergency departments worldwide and are referred to hand surgeons. Seemingly innocuous puncture wounds over the metacarpophalangeal (MCP) joint, left untreated, can rapidly progress to septic arthritis with a hot, erythematous, painful and swollen joint. Mismanagement results in disastrous outcomes and inevitable destruction of the joint. 1) As implied, fight bites are usually sustained through violent altercations. Patients are often unreliable historians due to poor recollection, reluctance to seemingly incriminate themselves, and an under appreciation that dental contact is relevant to their management. We recommend careful, tactful questioning using neutral terms by the first line clinician: “Could the wound have been caused by contact with another person’s teeth? We ask as such injuries can cause serious infections.”

Clinical and histological resolution of a basal cell carcinoma in a patient undergoing concurrent treatment of B-cell lymphoma with systemic R-CHOP *

Surgical resection is the definitive treatment modality for basal cell carcinoma (BCC). However, not all patients may be suitable for surgery. We describe a patient with a BCC, which resolved clinically and histologically when he underwent systemic R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) for treatment of a high grade B-cell lymphoma. Although topical and intra-lesional 5-fluorouracil (5-FU) has been used as an adjunct to treatment, more recent reports have illustrated the treatment of BCC with systemic 5-FU in combination with bleomycin and cisplatin. We postulate that the combination of cyclophosphamide and doxorubicin with rituximab and prednisolone, which has not been previously reported in the literature, contributed to remission in this case.

Upper limb salvage following near skeletalisation.

Upper extremity limb salvage following near total skeletalisation remains difficult. Early robust soft tissue cover is crucial to enable restoration of future function.Wedescribe the early management of a case that was repatriated to a UK trauma centre. A 46-year-old right hand dominant woman suffered near total arm amputation while working in Ghana. As a passenger on a minibus with her arm resting on the window, a larger vehicle scraped down the side of the minibus causing extensive injuries to her left arm. During the accident, skin, fat and muscle were stripped from her shoulder to her wrist over the whole extensor and part of the flexor surface of her left upper limb (Figure 1). This exposed multi-level fractures of the humerus, radius and ulna as well as an open comminuted elbow fracture. Her ulnar nerve was avulsed. The Mangled Extremity Severity Score (MESS) was calculated at 8 for this patient predicting the need for an amputation. However other authors have described upper extremity salvage with MESS scores greater than 7.