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Driving while plastered: is it safe, is it legal?
806
Letters to the Editor
AUTHORS’ REPLY Pereira G, Pereira C. Skin edge debridement made easy [Injury 2003;34;954—956]
*Corresponding author. Present address 16 York Street, Harborne, Birmingham B17 0HG, UK Tel.: +44 121 427 2546 E-mail address: [email protected] 25 November 2004
Dear Sir, doi:10.1016/j.injury.2004.12.039
We are grateful to Mr. Cheng and Mr. Holmes for their comments on our paper titled ‘Skin debridement made easy’ which was recently published in your journal. We agree that proper surgical technique, in areas where skin is at a premium such as the face, dictates that skin debridement is kept to the minimum to facilitate relaxed closure. It also goes without saying that the preservation of cosmetic and functional units like the inner canthus of the eye, upper and lower eyelids and the skin overlying joints of the fingers are inarguable. In such cases, obtaining a linear scar is not absolutely necessary and can indeed be detrimental to the final cosmetic/functional outcome. However, devitalised tissue still needs to be excised and our technique can easily be adapted to smaller tissue holding forceps like an Addson’s forceps. Such forceps have smaller tips and hence can hold smaller amounts of tissues for a more minimalistic debridement. We look forward to the results of the proposed randomised controlled trial on skin debridement methods including the ultrasonic debridement. Previous animal studies have shown that simple irrigation is just as effective as ultrasonic debridement of particulate matter in wounds as well as to decrease bacterial contamination.1 Perhaps a combination of surgical debridement of devitalised tissue, irrigation and ultrasonic debridement of ingrained dirt from contaminated but viable tissue would maximise the benefits of the procedure.
Reference 1. McDonald WS, Nicheter LS. Debridement of bacterial and particulate contaminated wounds. Ann Plast Surg 1994;33(2): 142—7.
G. Pereira* University Hospitals Coventry and Warwickshire Stoney Stanton road, Coventry CV1 4FH, UK C. Pereira Department of Surgery University of Texas Medical Branch, Galveston TX 77550, USA DOI of original article: 10.1016/j.injury.2004.12.038
LETTER TO THE EDITOR Driving while plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police I would like to congratulate O.A. Von Arx, A.J. Langdown, R.A. Brooks and D.A. Woods on their excellent paper.1 The issue of patients enquiring about fitness to drive is one that is faced by orthopaedic and trauma surgeons in fracture clinics every day yet as the authors state, there is no clear guideline to follow. Most of the responses have been covered by the authors in their paper. The recalcitrance of the insurance companies is surprising as their contribution to events following any accident as a result of someone driving with a cast on are significant for the individual. I would like to share my usual answer to this question, as this option has not been mentioned in the paper. It puts the responsibility on the patient, but it may be something that not everyone thinks of. I tell the patient to take a lesson from a driving instructor on a dual control car and let the instructor decide if it is safe for the patient to drive! This advice has been well received by the patients, is safe and avoids patients having to take time off work if indeed they are safe to drive. I am sure this practice of mine has been influenced by advice from some of my supervising consultants.
Reference 1. Von Arx OA, Langdown AJ, Brooks RA, Woods DA. Driving while plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police. Injury 2004;35(9):883—7.
DOI of original article: 10.1016/j.injury.2004.12.041
Letters to the Editor
AUTHORS’ REPLY Pereira G, Pereira C. Skin edge debridement made easy [Injury 2003;34;954—956]
*Corresponding author. Present address 16 York Street, Harborne, Birmingham B17 0HG, UK Tel.: +44 121 427 2546 E-mail address: [email protected] 25 November 2004
Dear Sir, doi:10.1016/j.injury.2004.12.039
We are grateful to Mr. Cheng and Mr. Holmes for their comments on our paper titled ‘Skin debridement made easy’ which was recently published in your journal. We agree that proper surgical technique, in areas where skin is at a premium such as the face, dictates that skin debridement is kept to the minimum to facilitate relaxed closure. It also goes without saying that the preservation of cosmetic and functional units like the inner canthus of the eye, upper and lower eyelids and the skin overlying joints of the fingers are inarguable. In such cases, obtaining a linear scar is not absolutely necessary and can indeed be detrimental to the final cosmetic/functional outcome. However, devitalised tissue still needs to be excised and our technique can easily be adapted to smaller tissue holding forceps like an Addson’s forceps. Such forceps have smaller tips and hence can hold smaller amounts of tissues for a more minimalistic debridement. We look forward to the results of the proposed randomised controlled trial on skin debridement methods including the ultrasonic debridement. Previous animal studies have shown that simple irrigation is just as effective as ultrasonic debridement of particulate matter in wounds as well as to decrease bacterial contamination.1 Perhaps a combination of surgical debridement of devitalised tissue, irrigation and ultrasonic debridement of ingrained dirt from contaminated but viable tissue would maximise the benefits of the procedure.
Reference 1. McDonald WS, Nicheter LS. Debridement of bacterial and particulate contaminated wounds. Ann Plast Surg 1994;33(2): 142—7.
G. Pereira* University Hospitals Coventry and Warwickshire Stoney Stanton road, Coventry CV1 4FH, UK C. Pereira Department of Surgery University of Texas Medical Branch, Galveston TX 77550, USA DOI of original article: 10.1016/j.injury.2004.12.038
LETTER TO THE EDITOR Driving while plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police I would like to congratulate O.A. Von Arx, A.J. Langdown, R.A. Brooks and D.A. Woods on their excellent paper.1 The issue of patients enquiring about fitness to drive is one that is faced by orthopaedic and trauma surgeons in fracture clinics every day yet as the authors state, there is no clear guideline to follow. Most of the responses have been covered by the authors in their paper. The recalcitrance of the insurance companies is surprising as their contribution to events following any accident as a result of someone driving with a cast on are significant for the individual. I would like to share my usual answer to this question, as this option has not been mentioned in the paper. It puts the responsibility on the patient, but it may be something that not everyone thinks of. I tell the patient to take a lesson from a driving instructor on a dual control car and let the instructor decide if it is safe for the patient to drive! This advice has been well received by the patients, is safe and avoids patients having to take time off work if indeed they are safe to drive. I am sure this practice of mine has been influenced by advice from some of my supervising consultants.
Reference 1. Von Arx OA, Langdown AJ, Brooks RA, Woods DA. Driving while plastered: is it safe, is it legal? A survey of advice to patients given by orthopaedic surgeons, insurance companies and the police. Injury 2004;35(9):883—7.
DOI of original article: 10.1016/j.injury.2004.12.041