Basal cell carcinomas: do they need to be followed up?

Basal cell carcinoma (BCC) is the commonest of the malignant skin tumours. The follow-up of patients following excision of these lesions varies immensely. The aim of this study was to assess the need for outpatient follow-up of patients who had a primary BCC excised.

An audit of case-load and work-load in a regional plastic surgery unit using intermediate equivalents: a one-year study.

Until March 1992, when it was transferred to St John's Hospital, Livingston, the Regional Plastic Surgery Service for Adults in the Lothians was based at Bangour, West Lothian. Plastic surgery for children continues to be provided by the same staff but at the Sick Children's Hospital in Edinburgh. With increasing interest in improving efficiency of care and audits several ways in which assessments can be done have been suggested.

Skin tumours of the hand. A 10-year review.

A 10-year retrospective study was performed in order to determine the incidence, distribution, histological type and behaviour of skin tumours of the hand that were referred to a regional Plastic Surgery unit. 85 patients were studied and 98 malignant or pre-malignant lesions identified. The majority were squamous cell carcinomas in male manual workers.

Retrospective analysis of the Bangour Burn Unit.

The Bangour Burn Unit was opened in 1968 having been built using existing buildings modified in a relatively inexpensive way. The buildings were unsophisticated because the Unit was designed to be temporary before an eventual move into a new regional plastic surgery unit elsewhere. An analysis of some salient observations over the 22-year period of its lifetime is discussed.

Tissue expansion in the treatment of tubular breast deformity.

Four cases of tubular breast deformity were treated using tissue expansion. The expanders were inserted through either an axillary or an infra-mammary approach in as low a position as possible. The expanders were then over-inflated and allowed to settle for a period of time before removal and insertion of a permanent implant.

Pressure sores: a personal comment.

Pressure sores have always been with us and remain so. The care and prevention of sores in spinal injuries have shown a dramatic improvement over the past decade while for other categories this cannot be said.

Audit of pressure sores treated in a regional plastic surgery unit (1971-1990).

The results of a previous study of pressure sores over the 10-year period 1971-1980 in this unit were compared with those of the subsequent 10 years, 1981-1990. Factors reviewed included the source of referral, underlying aetiological problems, management and outcome. By combining the two studies a continuous 20-year audit has been obtained.

Efficiency of blood use and prospects for autologous transfusion in general surgery.

A 6-month retrospective audit of crossmatch and transfusion practice in a general surgical unit has been performed. Inefficiencies in blood ordering practices have been demonstrated and the value of performing a local audit to allow estimation of blood needs has been proven. Using criteria based on the suggested tariff for operations derived from this audit, only a small number of general surgical patients would be considered as potential autologous blood donors.

A cheek island flap for the lower eyelid.

An island transposition flap for use in lower eyelid reconstruction and the treatment of ectropion is described. The flap is based on a subcutaneous pedicle 1 to 2 cm lateral to the outer canthus. Its long axis extends inferolaterally from this point, and the donor site can be closed directly.

Practical surgical audit: a morbidity profile.

A prospective study of 248 patients admitted consecutively under the care of a single surgeon was performed and data on a variety of patient details were collected daily during the period of their hospitalization. Analysis of the data identified four quantifiable indices of morbidity, namely duration of hospitalization, duration of intravenous infusion, analgesic requirement and antibiotic administration, which can be combined arithmetically and used to produce a morbidity profile. The use of such a profile may allow comparisons to be made between different units if applied to specific conditions and permit a more accurate assessment of overall patient morbidity than can be presently done using mortality rates.

Malignancy in nonagenarians.

In a series of 143 necropsies on aged subjects, age range 90 to 100, 20 patients were found to have died of malignant disease and a further 16 patients had a total of 20 non-fatal malignant tumours. The rate of clinical recognition was lower than would be expected in other age groups. Adenocarcinomas of the digestive system predominated in the fatal group.

Pulse oximetry in postoperative monitoring of free muscle flaps.

The use of a pulse oximeter for monitoring free muscle transfers is described. Three cases are presented, two of which were uncomplicated and one in which the need for revision of anastomosis was identified by the oximeter. Observations on a pedicled muscle flap are also reported.

Bacterial colonization of the skin after chemical depilation.

A study of the effects of preoperative skin depilation on skin microflora has been performed. Areas of skin were prepared with a chemical depilatory agent and compared with areas of unprepared skin. Preparation of skin with a chemical depilatory agent causes no increase in skin microflora, in contrast to the effects of shaving as demonstrated by earlier studies.

Successful transfer of two reverse forearm flaps despite disruption of both palmar arches.

The advantages of the ipsilateral forearm flap in emergency post-traumatic hand reconstruction are now well-established. A prerequisite for such a transfer has always been the presence of at least one intact palmar arch. We report the successful transfer of two reverse forearm flaps despite disruption of both palmar arches.

Backslabs and plaster casts: which will best accommodate increasing intracompartmental pressures?

Plaster-of-Paris backslabs are presently used after closed or operative reduction of fractures as they are thought to accommodate any swelling which may occur. This study was designed to examine the ability of different types of cast to expand with increasing internal pressure. The results of the study show clearly that a split and spread cast is the only safe cast to use after fracture as it allows for swelling.

Reconstruction of the oral commissure by vascularised toe web transfer.

Reconstruction of a large post-excisional defect of the oral commissure by free transfer of the great/second toe web is reported. A comparison with other methods of repair is briefly made.

Disc battery swallowers--two contrasting cases.

Increased use and availability of disc batteries has been reflected in the number of children presenting following ingestion of such batteries. An expectant, non operative policy is advocated. Battery manufacturers, however, recommend immediate removal of the battery.

Transurethral resection of the prostate without routine antibiotic prophylaxis: screening for complications.

In a prospective study of 61 patients undergoing transurethral resection of the prostate without antibiotic prophylaxis there were no major postoperative complications in 55 cases (90%). A bacteriological screen involving culture of a preoperative sample of urine, an immediate preoperative urethral swab, prostatic chippings, immediate postoperative blood cultures and catheter-removal sample of urine was carried out to investigate the ability to detect infective complications. The blood cultures had a predictive value of 80% (sensitivity 80%, specificity 93%).

The distally-based dorsal hand flap.

The planning and clinical applications of a series of reverse dorsal hand flaps are described. This new flap is based on a direct cutaneous branch of the dorsal metacarpal artery. It is particularly useful in resurfacing web spaces as well as dorsal metacarpal and phalangeal skin defects.

Extreme distal migration of premolar in association with an unusual fracture of the mandible.

A case of an unerupted mandibular premolar, discovered as an incidental finding during investigation of a fracture of the mandible, is described. The possible mechanisms and outcome of migrations of such teeth are reviewed.