Dorsal metatarsal artery perforator flaps (DMTAPF) applied for paediatric foot reconstruction: A review of the aetiology of primary injury, surgical technique applied, and long-term outcome for the child.

Aim: Dorsal metatarsal artery perforator flap (DMTAPF) reconstructions were reviewed to assess indications for application, variation of surgical technique and the long-term impact of growth.

Method: A cohort of 15 children presented with 17 DMTAPFs on 16 feet. Patient demographics, the aetiology and timing of primary injury and details of flap reconstruction were recorded.

Some reflections on war for countries at peace: Would we know what to do?

In the west we have enjoyed peace for decades, but war is globally always present. Recent events have brought this into clear evidence. Once mass casualties occur, war enters civilian hospitals.

A review of the first wave of lower limb amputees from the Great March of Return in Gaza: Taking stock and preparing for the task ahead.

Aim: Ballistic injuries during the Great March of Return (GMR) protests in Gaza have resulted in young, civilian amputees. This article defines this unique population, their injuries and clinical variables that impacted on amputation.

Method: A multidisciplinary team (MDT) assessed 103 lower limb amputees (104 stumps).

Stump-plasty: An Operation Born of Necessity in Gaza.

Aim And Objective: The most recent wave of lower limb amputees in Gaza arises from ballistic injuries sustained during protests. This study evaluates the requirement for surgical revision of these mature stumps to allow prosthetic fit and mobility.

Materials And Methods: A multidisciplinary team (MDT) comprising a prosthetist, orthopaedic and plastic surgeons and a physiotherapist screened 104 amputee stumps (103 cases).

Correction of Tuberous Nipple Areolar Complex Deformity in Gynecomastia: The Deformity That Can Get Forgotten.

The desired end point of surgical reduction of gynecomastia is a masculine breast appearance and symmetry. This article concentrates on the tuberous deformity of the nipple areolar complex (NAC) that can present in gynecomastia and is sometimes overlooked at surgical correction.This deformity can be corrected at primary surgery if it is recognized preoperatively.

Isolated Dorsoradial Capsular Tear of the Thumb Metacarpophalangeal Joint: Missed Diagnosis and the Management of Delayed Presentation.

Isolated dorsoradial capsule injuries of the thumb metacarpophalangeal joint are different from those associated with collateral ligament disruption. Early suspicion of this rare injury is important because, if overlooked, ulnarward subluxation of extensor pollicis longus tendon can develop. Functionally, active thumb extension becomes impaired, and over the long term, a thumb Boutonniere's deformity becomes established.

The Impact of Cervical Musculoskeletal Disorders on UK Consultant Plastic Surgeons: Can We Reduce Morbidity With Applied Ergonomics?

Background: Based on anecdotal and observational evidence, we hypothesized that the prevalence of cervical musculoskeletal disorder (C-MSD) would be high among plastic surgeons. A questionnaire review was undertaken to test this hypothesis. Ergonomic assessment was undertaken to assess causal factors of C-MSD.

The Gaza Hand Board.

This article describes an economical, versatile hand board that was conceived in Gaza during a surgical mission in the absence of commercially available hand holding devices. It was initially created to allow access and immobilization of the hand when addressing volar digital burn contractures. It has been applied subsequently during 5 further missions and now forms a standard part of our surgical kit.

The application of Integra in a challenging context.

Integra dermal regeneration template is commonly used in the developed world. This case history documents the application of Integra for the first time in Gaza, Palestine. This single case history illustrates how a tried and tested technique can be imported to a more challenging environment.

Soft, Brown Rupture: Clinical Signs and Symptoms Associated with Ruptured PIP Breast Implants.

Background: Preoperative signs and symptoms of patients with Poly Implant Prothese (PIP) implants could be predictive of device failure. Based on clinical observation and intraoperative findings 4 hypotheses were raised: (1) Preoperative clinical signs including acquired asymmetry, breast enlargement, fullness of the lower pole, decreased mound projection, and change in breast consistency could be indicative of implant rupture. (2) Device failure correlates with a low preoperative Baker grade of capsule.

A comparison of the patient and surgeon opinion on the long-term aesthetic outcome of reduction mammaplasty: have we improved over 15 years?

In 1996 we published a study evaluating the difference between patient and surgeon opinion on the aesthetic outcome of reduction mammaplasty (see Ref. 1). The patients rated the aesthetic outcome of their surgery as significantly higher than the consultant panel.

Assessment of the presence of independent flexor digitorum superficialis function in the small fingers of professional string players: is this an example of natural selection?

This study estimated the prevalence of independent flexor digitorum superficialis function in the small fingers of 90 violin and viola players. The hypothesis tested was that the independent digital movements required in this population would select out those with absent flexor digitorum superficialis function. Professional string players were tested clinically, using standard and modified tests, for flexor digitorum superficialis function.

Convective burn from use of hairdryer for heel warming prior to the heel prick test - a case report.

Background: Blood sampling through heel lancing is the most common invasive painful procedure performed on newborn infants.

Case Presentation: We report the case of a five day old infant who sustained burns to the left foot and leg after the mother's hairdryer was used by the midwife to warm the baby's heel prior to capillary blood sampling (CBS) with an automated device.

Conclusion: Heel warming is not recommended for routine CBS although it is often practiced.

Paediatric trigger finger: Literature review and management algorithm.

Trigger finger in the paediatric population is a distinct condition from trigger thumb in the child or trigger finger in the adult. This paper reviews the current practices applied in the treatment of paediatric trigger finger. Intra-operative photographs are used to illustrate the anatomic anomalies that may be present.

The use of local anesthetic motor block to demonstrate the potential outcome of depressor labii inferioris resection in patients with facial paralysis.

Background: If a patient with unilateral facial paralysis has marked depressor activity on the normal side, the appearance of the lower lip when smiling is asymmetrical. Defunctioning the muscle on the contralateral side to the palsy can restore balance. This can be achieved by resecting a portion of the depressor labii inferioris muscle on the nonparalyzed side.

Investigation into the possible cause of subjective decreased sensory perception in the nipple-areola complex of women with macromastia.

Patients with macromastia often comment on a lack of sensation in their nipple-areola complex. A study was designed to investigate the cause of this decreased sensation. Two hypotheses were proposed.

Extra-abdominal desmoid tumour of the breast: review of the primary management and the implications for breast reconstruction.

This case report illustrates the presentation and management of an extra-abdominal desmoid tumour of the breast. A review of the literature describing the aetiology, pathology and risk of recurrence was undertaken to determine how current understanding of this rare tumour may affect the management of patients, should they require breast reconstruction after radical excision of the primary tumour. The natural progression of the disease is variable and there are no markers predictive of recurrence or regression.

Do they listen? A review of information retained by patients following consent for reduction mammoplasty.

For valid informed consent the nature, purpose and material risks of the proposed procedure must be discussed. This study aims to clarify how much of this information is retained by the competent patient who gives written consent for reduction mammoplasty. A total of 38 patients were taken through specific and general factors relating to reduction mammoplasty by their surgeon at the time of obtaining consent.