- Email: [email protected]
Useful material for skin flap training for inexperienced residents
Short reports and correspondence were surgically reduced over a 12-month period (2005). The women were under the care of two consultant plastic surgeons. They were aged between 18 and 73 years (mean 39 years), and the weights of excised breast tissue were 152e 1274 g (mean 595 g). In most operations, the consultant was the main operator. The inferior pedicle technique was used in all cases. No prophylactic antibiotics were given. One consultant infiltrated the incision lines and the periphery of the breast with lidocaine and epinephrine, and the other consultant did not. No postoperative drains were used. The postoperative inpatient records were reviewed. No clinically apparent haematomas were treated conservatively. One patient had swelling of one breast in the recovery room after surgery. Immediate exploration of the breast under general anaesthetic revealed only a small haematoma, not enough to cause the swelling. For 29 of the 42 patients, outpatient dressing clinic records could also be reviewed. Fat necrosis was documented in three breasts in three patients, and minor wound problems, including at the T-junction, were documented in six breasts in six patients (in half of these six cases, the patient admitted to smoking cigarettes). A recent survey of 140 consultant plastic surgeons in the UK and Ireland found that 67% used the inferior pedicle technique, 79% always used drains, 11% often did and 10% either never or occasionally used drains.3 Our audit confirms for us the relevance of the published prospective randomised trials, and gives further support to Abood and Mallucci’s4 encouragement to other surgeons to consider stopping the routine use of drains after breast reduction surgery.
1169 Useful material for skin flap training for inexperienced residents Local flap technique is an essential topic in reconstructive surgery, and should be learnt at the beginning of plastic surgery training. Conventional training includes an observation period followed by surgical application. This method involves considerable time and additional stress to residents. To overcome these limitations, modern training equipment, including industrial and animal models, have been developed.1e3 However, these materials are not always reasonably priced or readily available. We used abdominoplasty specimens for training inexperienced plastic surgery residents in local flap reconstruction (Figs. 1e3). Specimens that did not require pathologic examination were selected for use. Written consent was obtained from all patients to use the specimens. The advantage of using abdominoplasty specimens is that it is easily available and costs nothing. Additionally, it seems to be the most suitable tissue for flap training because of its human origin. In addition, we think that new flap designs can be practiced on this specimen.
References 1. Wrye SW, Banducci DR, Mackay D, et al. Routine drainage is not required in reduction mammaplasty. Plast Reconstr Surg 2003; 111:113e7. 2. Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trial. Br J Plast Surg 2005;58:286e9. 3. Iwuagwu OC, Platt AJ, Drew PJ. Breast reduction surgery in the UK and Ireland e current trends. Ann R Coll Surg Engl 2006;88: 585e8. 4. Abood A, Mallucci P. In response to: Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trial. Br J Plast Surg 2005;58: 286e9. J Plast Reconstr Aesthet Surg 2006;59:433.
Figure 1 Abdominoplasty specimen. Written consent of the patient obtained.
J. Tan M.J. Timmons D.A.L. Watt Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK E-mail address: michael.timmons@ bradfordhospitals.nhs.uk ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.06.005
Figure 2
The design of flaps.
1170
Short reports and correspondence
BOOK REVIEW Essentials of Plastic Surgery, Jeffrey Janis (Ed.), QMP, 2007, Paperback, 1,000 pages with approx. 560 illustrations, £68.
Figure 3
The final state of the flap practice.
References 1. Bjellerup M. Novel method for training skin flap surgery: polyurethane foam dressing used as a skin equivalent. Dermatol Surg 2005;31:1107e11. 2. Grunwald T, Krummel T, Sherman R. Advanced technologies in plastic surgery: how new innovations can improve our training and practice. Plast Reconstr Surg 2004;114:1556e67. 3. Ellabban MG, Oudit D, Juma A. A simple model for practicing local flap design. Plast Reconstr Surg 2005;115:656e7.
N. Turhan-Haktanir N. Sancaktar Kocatepe University, Faculty of Medicine, Plastic, Reconstructive and Aesthetic Surgery, Afyonkarahisar, Turkey E-mail address: [email protected] ª 2007 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
I was rather taken by this concise handbook which is based on the Plastic Surgery training programme at the University of Texas. It sets out to ‘convey the essentials and provide a valuable plastic surgery foundation’ in the form of a ‘quick and dirty’ reference. It succeeds in this aim. 28 authors cover 88 chapters set out in 7 sections, ranging from Basic Principles of Wounds to Body Contouring in Massive Weight Loss Patients. It is just under 1000 pages in length and includes 560 illustrations. There are interesting chapters on medical photography, and biomaterials not commonly found in other tomes. It is compact in presentation and conveys a great deal of information. The style is very much that of the detailed revision card approach with bullet-point layout. There are useful practical hints for those beginning their career and also a useful reminder to the more experienced surgeon. Each chapter finishes with a summary of key points and a comprehensive list of the salient references to previous literature. Some of the diagrams are unfortunately somewhat small and the labelling indistinct which derives from the size of the book which is said to fit into the lab-coat pocket (if only they were worn, but is a handy size for brief cases or ‘manbags’). This book has been written by residents and trainers and will I feel quickly be accepted by undergraduates and trainees, in particular those preparing for the FRCS (Plast) exam, and would also be useful were revalidation to take exam form!! Priced at approximately £50 (100$) it is good value and I will certainly recommend it to our trainees. A. Roger Green Whiston Hospital, Liverpool, UK E-mail address: [email protected]
doi:10.1016/j.bjps.2007.06.033 doi:10.1016/j.bjps.2007.03.032
1169 Useful material for skin flap training for inexperienced residents Local flap technique is an essential topic in reconstructive surgery, and should be learnt at the beginning of plastic surgery training. Conventional training includes an observation period followed by surgical application. This method involves considerable time and additional stress to residents. To overcome these limitations, modern training equipment, including industrial and animal models, have been developed.1e3 However, these materials are not always reasonably priced or readily available. We used abdominoplasty specimens for training inexperienced plastic surgery residents in local flap reconstruction (Figs. 1e3). Specimens that did not require pathologic examination were selected for use. Written consent was obtained from all patients to use the specimens. The advantage of using abdominoplasty specimens is that it is easily available and costs nothing. Additionally, it seems to be the most suitable tissue for flap training because of its human origin. In addition, we think that new flap designs can be practiced on this specimen.
References 1. Wrye SW, Banducci DR, Mackay D, et al. Routine drainage is not required in reduction mammaplasty. Plast Reconstr Surg 2003; 111:113e7. 2. Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trial. Br J Plast Surg 2005;58:286e9. 3. Iwuagwu OC, Platt AJ, Drew PJ. Breast reduction surgery in the UK and Ireland e current trends. Ann R Coll Surg Engl 2006;88: 585e8. 4. Abood A, Mallucci P. In response to: Collis N, McGuiness CM, Batchelor AG. Drainage in breast reduction surgery: a prospective randomised intra-patient trial. Br J Plast Surg 2005;58: 286e9. J Plast Reconstr Aesthet Surg 2006;59:433.
Figure 1 Abdominoplasty specimen. Written consent of the patient obtained.
J. Tan M.J. Timmons D.A.L. Watt Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK E-mail address: michael.timmons@ bradfordhospitals.nhs.uk ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.06.005
Figure 2
The design of flaps.
1170
Short reports and correspondence
BOOK REVIEW Essentials of Plastic Surgery, Jeffrey Janis (Ed.), QMP, 2007, Paperback, 1,000 pages with approx. 560 illustrations, £68.
Figure 3
The final state of the flap practice.
References 1. Bjellerup M. Novel method for training skin flap surgery: polyurethane foam dressing used as a skin equivalent. Dermatol Surg 2005;31:1107e11. 2. Grunwald T, Krummel T, Sherman R. Advanced technologies in plastic surgery: how new innovations can improve our training and practice. Plast Reconstr Surg 2004;114:1556e67. 3. Ellabban MG, Oudit D, Juma A. A simple model for practicing local flap design. Plast Reconstr Surg 2005;115:656e7.
N. Turhan-Haktanir N. Sancaktar Kocatepe University, Faculty of Medicine, Plastic, Reconstructive and Aesthetic Surgery, Afyonkarahisar, Turkey E-mail address: [email protected] ª 2007 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.
I was rather taken by this concise handbook which is based on the Plastic Surgery training programme at the University of Texas. It sets out to ‘convey the essentials and provide a valuable plastic surgery foundation’ in the form of a ‘quick and dirty’ reference. It succeeds in this aim. 28 authors cover 88 chapters set out in 7 sections, ranging from Basic Principles of Wounds to Body Contouring in Massive Weight Loss Patients. It is just under 1000 pages in length and includes 560 illustrations. There are interesting chapters on medical photography, and biomaterials not commonly found in other tomes. It is compact in presentation and conveys a great deal of information. The style is very much that of the detailed revision card approach with bullet-point layout. There are useful practical hints for those beginning their career and also a useful reminder to the more experienced surgeon. Each chapter finishes with a summary of key points and a comprehensive list of the salient references to previous literature. Some of the diagrams are unfortunately somewhat small and the labelling indistinct which derives from the size of the book which is said to fit into the lab-coat pocket (if only they were worn, but is a handy size for brief cases or ‘manbags’). This book has been written by residents and trainers and will I feel quickly be accepted by undergraduates and trainees, in particular those preparing for the FRCS (Plast) exam, and would also be useful were revalidation to take exam form!! Priced at approximately £50 (100$) it is good value and I will certainly recommend it to our trainees. A. Roger Green Whiston Hospital, Liverpool, UK E-mail address: [email protected]
doi:10.1016/j.bjps.2007.06.033 doi:10.1016/j.bjps.2007.03.032