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Perineal reconstruction in the UK: An internet survey
Correspondence and communications
Reference 1. Thomas MP. The role of simulation in the development of technical competence during surgical training: a literature review. Int J Med Educ 2013;4:48e58.
A. Elfaki S. Murphy N. Abreo M. Wilmot P. Gillespie Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK E-mail address: [email protected] ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.04.011
Perineal reconstruction in the UK: An internet survey Dear Sir, We write to report the results of an internet survey of BAPRAS members circulated by the Perineal Reconstruction Special Interest Group (PRSIG) in January 2014. As you are aware, the PRSIG was first convened in 2012 as a forum for members practicing in this area, and following an apparently widespread increase in demand for reconstruction by colorectal and gynaecological surgeons undertaking radical cancer surgery. The survey focused on the 6 month period between January and July 2013 and provides a ‘snapshot’ view of the current level of demand and the clinical setting in which this work was being undertaken. It also attempted to establish whether any consensus exists among reconstructive surgeons in their approach to some common clinical scenarios. A link to the survey was circulated in the BAPRAS newsletter on 7th January 2014. Of the 34 members who responded (a disappointing 7.8% of full members), 23 indicated that they had carried out some form of perineal reconstruction during the survey period. Fourteen (61%) performed less than 1 case per month, 5 (22%) performed 1e2 cases per month and 4 (17%) performed more than 2 cases per month. The most common subspecialties in which the operating plastic surgeon also practiced were skin cancer (70%) and breast reconstruction (48%). Most respondents (82%) reported undertaking an immediate reconstruction in a majority of cases, usually on operating lists allocated to the referring specialty. Approximately one third of respondents reported operating at a hospital other than their base hospital. Interestingly, only 7 (32%) respondents took part in a pelvic oncology MDT meeting or combined clinic. We asked respondents to indicate the type of session in which they normally operated on cases requiring perineal
1165 reconstruction. The majority (96%) undertook this work on an occasional basis (i.e. not as a planned part of their job plan) with most (50%) doing so in sessions normally allocated to non-operating activity. Nine percent reported taking on this work in normally un-contracted sessions. Lastly, we found a degree of consensus in respondent’s approach to some, but not all of the three common clinical scenarios described in the survey. When considering flap reconstruction for a 51 year-old female patient following abdomino-perineal excision of a locally advanced rectal adenocarcinoma en bloc with the posterior vaginal wall, opinion was divided. Most (59%) of respondents opted for a myocutaneous flap (VRAM or gracilis), while 29% opted for a fasciocutaneous flap from the gluteal crease or buttock (SGAP or IGAP). However, when considering reconstruction following total pelvic exenteration, all respondents included myocutaneous flaps (VRAM or gracilis) among their preferred options, and all bar one included fasciocutaneous gluteal crease flaps among their preferred options for reconstructing a radical vulvectomy defect. In summary, although the response to our survey was disappointingly small, it demonstrates that of those who did respond, two thirds were engaged in perineal reconstruction surgery at some level, with a small number undertaking relatively high volumes of this work. Unsurprisingly, these procedures are frequently undertaken on other specialty’s lists, commonly at a remote hospital and in work time normally allocated to non-surgical activity. A minority of plastic surgeons were involved in MDTs dedicated to treating pelvic disease. We believe that perineal reconstruction is now a growing subspecialty of plastic surgery and should be recognized as such by other specialty associations.
Conflict of interest statement The authors do not hold any conflict of interest. This letter has not been published elsewhere.
Funding None.
Ethical approval Not required. J. Cubitt Welsh Centre for Burns and Plastic Surgery, UK E-mail address: [email protected] L. Cogswell Oxford University Hospitals, UK P. Drew Welsh Centre for Burns and Plastic Surgery, UK ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.03.030
Reference 1. Thomas MP. The role of simulation in the development of technical competence during surgical training: a literature review. Int J Med Educ 2013;4:48e58.
A. Elfaki S. Murphy N. Abreo M. Wilmot P. Gillespie Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK E-mail address: [email protected] ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.04.011
Perineal reconstruction in the UK: An internet survey Dear Sir, We write to report the results of an internet survey of BAPRAS members circulated by the Perineal Reconstruction Special Interest Group (PRSIG) in January 2014. As you are aware, the PRSIG was first convened in 2012 as a forum for members practicing in this area, and following an apparently widespread increase in demand for reconstruction by colorectal and gynaecological surgeons undertaking radical cancer surgery. The survey focused on the 6 month period between January and July 2013 and provides a ‘snapshot’ view of the current level of demand and the clinical setting in which this work was being undertaken. It also attempted to establish whether any consensus exists among reconstructive surgeons in their approach to some common clinical scenarios. A link to the survey was circulated in the BAPRAS newsletter on 7th January 2014. Of the 34 members who responded (a disappointing 7.8% of full members), 23 indicated that they had carried out some form of perineal reconstruction during the survey period. Fourteen (61%) performed less than 1 case per month, 5 (22%) performed 1e2 cases per month and 4 (17%) performed more than 2 cases per month. The most common subspecialties in which the operating plastic surgeon also practiced were skin cancer (70%) and breast reconstruction (48%). Most respondents (82%) reported undertaking an immediate reconstruction in a majority of cases, usually on operating lists allocated to the referring specialty. Approximately one third of respondents reported operating at a hospital other than their base hospital. Interestingly, only 7 (32%) respondents took part in a pelvic oncology MDT meeting or combined clinic. We asked respondents to indicate the type of session in which they normally operated on cases requiring perineal
1165 reconstruction. The majority (96%) undertook this work on an occasional basis (i.e. not as a planned part of their job plan) with most (50%) doing so in sessions normally allocated to non-operating activity. Nine percent reported taking on this work in normally un-contracted sessions. Lastly, we found a degree of consensus in respondent’s approach to some, but not all of the three common clinical scenarios described in the survey. When considering flap reconstruction for a 51 year-old female patient following abdomino-perineal excision of a locally advanced rectal adenocarcinoma en bloc with the posterior vaginal wall, opinion was divided. Most (59%) of respondents opted for a myocutaneous flap (VRAM or gracilis), while 29% opted for a fasciocutaneous flap from the gluteal crease or buttock (SGAP or IGAP). However, when considering reconstruction following total pelvic exenteration, all respondents included myocutaneous flaps (VRAM or gracilis) among their preferred options, and all bar one included fasciocutaneous gluteal crease flaps among their preferred options for reconstructing a radical vulvectomy defect. In summary, although the response to our survey was disappointingly small, it demonstrates that of those who did respond, two thirds were engaged in perineal reconstruction surgery at some level, with a small number undertaking relatively high volumes of this work. Unsurprisingly, these procedures are frequently undertaken on other specialty’s lists, commonly at a remote hospital and in work time normally allocated to non-surgical activity. A minority of plastic surgeons were involved in MDTs dedicated to treating pelvic disease. We believe that perineal reconstruction is now a growing subspecialty of plastic surgery and should be recognized as such by other specialty associations.
Conflict of interest statement The authors do not hold any conflict of interest. This letter has not been published elsewhere.
Funding None.
Ethical approval Not required. J. Cubitt Welsh Centre for Burns and Plastic Surgery, UK E-mail address: [email protected] L. Cogswell Oxford University Hospitals, UK P. Drew Welsh Centre for Burns and Plastic Surgery, UK ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.03.030