High Commissioner for the Republic of Cyprus to the UK: “A Brexit would not be in the interests of the Commonwealth”

If Britain chose to leave the European Union, it would not only have an effect inside the UK, but also on the rest of Europe. In the final month of the referendum campaign, we will be featuring comments from some of Europe’s Ambassadors to the UK on how they view a potential Brexit. Euripides L. Evriviades, High Commissioner for the Republic of Cyprus to the United Kingdom, writes why Brexit would not be in the interests of the Commonwealth

Comparing the surgical timelines of military and civilians traumatic lower limb amputations

The care and challenges of injured service have been well documented in the literature from a variety of specialities. The aim of this study was to analyse the surgical timelines of military and civilian traumatic amputees and compare the surgical and resuscitative interventions. A retrospective review of patient notes was undertaken. Military patients were identified from the Joint Theatre Trauma Registry (JTTR) in 2009. Civilian patients were identified using the hospital informatics database. Patient demographics, treatment timelines as well as surgical and critical care interventions were reviewed. In total 71 military patients sustained traumatic amputations within this time period. This represented 11% of the total injury demographic in 2009. Excluding upper limb amputees 46 patients sustained lower extremity amputations. These were investigated further. In total 21 civilian patients were identified in a 7-year period. Analysis revealed there was a statistically significant difference between patient age, ITU length of stay, blood products used and number of surgical procedures between military and civilian traumatic amputees. This study identified that military patients were treated for longer in critical care and required more surgical interventions for their amputations. Despite this, their time to stump closure and length of stay were not statistically different compared to civilian patients. Such observations reflect the importance of an Orthoplastic approach, as well as daily surgical theatre co-ordination and weekly multi-disciplinary meetings in providing optimal care for these complex patients. This study reports the epidemiological observed differences between two lower limb trauma groups

Clinical outcomes and response to treatment of patients receiving topical treatments for pyoderma gangrenosum: a prospective cohort study

Background: pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment. Objective: to estimate the effectiveness of topical therapies in the treatment of PG. Methods: prospective cohort study of UK secondary care patients with a clinical diagnosis of PG suitable for topical treatment (recruited July 2009 to June 2012). Participants received topical therapy following normal clinical practice (mainly Class I-III topical corticosteroids, tacrolimus 0.03% or 0.1%). Primary outcome: speed of healing at 6 weeks. Secondary outcomes: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality-of-life; treatment failure and recurrence. Results: Sixty-six patients (22 to 85 years) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28/66 (43.8%) of ulcers healed by 6 months. Median time-to-healing was 145 days (95% CI: 96 days, ∞). Initial ulcer size was a significant predictor of time-to-healing (hazard ratio 0.94 (0.88;80 1.00); p = 0.043). Four patients (15%) had a recurrence. Limitations: No randomised comparator Conclusion: Topical therapy is potentially an effective first-line treatment for PG that avoids possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone

The Reconstructive Trauma Surgery Interface Fellowship and its applicability to military and civilian trainees

The Reconstructive Trauma Surgery Fellowship is a based at the Queen Elizabeth Hospital, Birmingham, and focuses on the multidisciplinary management of major trauma from presentation to discharge. It is unique to the UK in that it provides both management and leadership experience as well as operative surgical skills particularly in terms of reconstruction on complex trauma patients including those from the military. This paper describes the relevance of fellowships in modern surgical training, composition of the reconstructive trauma fellowship and the relevance for both civilian and military trainees. [Abstract copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

New Technique for Bloodless Surgery to the Scalp

Skin cancers such as malignant melanoma, squamous cell carcinoma, and basal cell carcinoma are common on the scalp, and the usual treatment is wide local excision with disease- free margins. Margins vary depending on the type of cancer, the size and depth of invasion, and the cytological findings, as described in the British Association of Dermatology guidelines. Because the blood supply of the scalp is rich, excision is usually accompanied by brisk bleeding, which can be troublesome and even affect the success of the graft. The layer of connective tissue between the skin and the epicranial aponeurosis consists of lobules of fat bound in tough fibrous septa, through which the main blood vessels that supply the scalp travel. Because these vessels are attached to this fibrous layer, they do not easily go into vasospasm when cut, which results in profuse bleeding. When lacerated they may also retract between the septa, which causes more pronounced bleeding and it may take a considerable time to achieve haemostasis. Diathermy may injure hair follicles in the remaining skin and induce additional alopecia. Here we present a new technique that considerably reduces bleeding and consequently saves time and reduces the need to use diathermy

Pedicled anterolateral thigh flap for contralateral groin composite defect

Pedicled anterolateral thigh flap has been well described for ipsilateral groin defects. Its versatility depends on the intact femoral vessels. When the external iliac and the femoral vessels are absent, especially secondary to wide surgical tumour ablations in the groin region, ipsilateral ALT flap is not an option. Free flaps also are difficult because of lack of recipient vessels. We report a case of composite groin defect following wide resection of recurrent liposarcoma along with encased vessels which was covered with a pedicled anterolateral thigh flap from the opposite thigh. The technique of lengthening the vascular pedicle and medializing the pedicle, to effectively increase its reach to the contralateral anterior superior iliac spine without vascular compromise, is described