RSTN launches TRIGGER Trial

The Reconstructive Surgery Trials Network (RSTN) is leading the design of a trial of the treatment of trigger fingers in adults along with Dutch colleagues. We are looking for collaborators around the UK to coordinate a survey of practice as part of this.

We are also hosting a webinar to discuss the trial on 21st February, in conjunction with ICOPLAST.

To learn more, and to sign up for both, please visit: http://reconstructivesurgerytrials.net/trigger/

Expanded version pedicled free-style perforator flaps in clinical practice: a need for a more comprehensive classification system

J. Eur J Plast Surg (2017). https://doi.org/10.1007/s00238-017-1365-0 

The evolution of the angiosome concept into the perforasome theory as we increasingly move towards the distal end of the microvascular tree for reconstructive options has allowed us to design ad hoc perforator flaps.

It is feasible to perform the many variations of perforator flaps provided; the microsurgical anatomy of the area is well defined, aided by imaging studies as necessary. Risk stratification also needs to be taken into account when planning these flaps. Based on our results and observations, an alternative pedicled perforator flap classification is put forward.

UHCW Research: J. Hardwicke

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Breast. 2017 Jul 30;35:182-190. doi: 10.1016/j.breast.2017.07.016. [Epub ahead of print]

The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK.

The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored.

UHCW Research: Skillman JM

Oncoplastic techniques: Attitudes and changing practice amongst breast and plastic surgeons in Great Britain

Breast. 2017 May 12;34:58-64. doi: 10.1016/j.breast.2017.04.010. [Epub ahead of print]

The availability, acceptability and practice of oncoplastic surgery has increased over the last 5 years. This study aims to describe how the breast and plastic surgical workforce has adapted to provide oncoplastic breast surgery.

UHCW Research: Challoner T., Skillman J., Vourvachis M. and Hardwicke J.

Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction

Psycho-Oncology. 6 March 2017 DOI: 10.1002/pon.4397

Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post-mastectomy breast reconstruction.

UHCW Research: Alan Park, Jo Skillman, Kate McCarthy and Elizabeth A. Grunfeld

Predictors of satisfaction and quality of life following post‐mastectomy breast reconstruction

Psycho-Oncology, March 6, 2017. http://dx.doi.org/10.1002/pon.4397

Objective Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post‐mastectomy breast reconstruction.

UHCW Research:  Park, Alan ^, Skillman, Jo and McCarthy, Kate 

Re: Should we consider devolution of "head and neck" surgery from the specialties of oral and maxillofacial surgery; ear, nose and throat surgery; and plastic surgery?

Br J Oral Maxillofac Surg. 2017 Feb 14. pii: S0266-4356(17)30042-6. doi: 10.1016/j.bjoms.2016.12.019. [Epub ahead of print]

We were interested in Islam’s editorial regarding the devolution of head and neck surgery from the parent specialties that feed into it.1 We have had a devolved arrangement of practice at University Hospitals Coventry and Warwickshire Hospitals NHS Trust since 2003. To the best of our knowledge this is the only service in the country in which this is the case, and it is recognised as such within the clinical and management structure of the hospital. The service has a separate clinical lead, QIPS (Quality, Improvement, and Patient Safety), business, and departmental meetings

UHCW Research: Elledge R, Walton G, Sandhu R, Prasad S and Howe D.

The evolution of a microsurgical reconstruction service at a central England Major Trauma Centre

Journal of plastic, reconstructive & aesthetic surgery : JPRAS (December 7, 2016)

With the recent development of Major Trauma Networks in England and the push for a combined orthoplastic approach to the treatment of open fractures, there has been a pressure on Plastic Surgery to provide this service in a timely manner.1,2 The hub Major Trauma Centre (MTC) has grown, in some cases, from a hospital that was home to an existing Plastic Surgery service that was providing soft tissue cover for open fractures on an unplanned and ad hoc basis. As a service becomes established within the network, and the potential demand for free tissue transfer for lower and upper limb reconstruction increase due to improved referral patterns, what impact will this have on the provision of emergency free flaps, and how is the existing elective reconstructive microsurgical service affected? In this report we aim to review our practice and the development that have been made.

UHCW Research: J. T. Hardwicke, P. Vermaak, A. J. Park, J.M. Skillman, M. R. Venus and

D.L. Wallace

The iBRA-2 (immediate breast reconstruction and adjuvant therapy audit) study: protocol for a prospective national multicentre cohort study to evaluate the impact of immediate breast reconstruction on the delivery of adjuvant therapy

BMJ Open 2016;6:e012678 doi:10.1136/bmjopen-2016-012678

Immediate breast reconstruction (IBR) is routinely offered to improve quality of life for women with breast cancer requiring a mastectomy, but there are concerns that more complex surgery may delay the delivery of adjuvant oncological treatments and compromise long-term oncological outcomes. High-quality evidence, however, is lacking. iBRA-2 is a national prospective multicentre cohort study that aims to investigate the effect of IBR on the delivery of adjuvant therapy.

UHCW Research: Joanna Skillman

The iBRA (implant breast reconstruction evaluation) study: protocol for a prospective multi-centre cohort study to inform the feasibility, design and conduct of a pragmatic randomised clinical trial comparing new techniques of implant-based breast reconstruction

Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure in the UK. The introduction of techniques to augment the subpectoral pocket has revolutionised the procedure, but there is a lack of high-quality outcome data to describe the safety or effectiveness of these techniques. Randomised controlled trials (RCTs) are the best way of comparing treatments, but surgical RCTs are challenging. The iBRA (implant breast reconstruction evaluation) study aims to determine the feasibility, design and conduct of a pragmatic RCT to examine the effectiveness of approaches to IBBR.

Pilot and Feasibility Studies20162:41 DOI: 10.1186/s40814-016-0085-8

UHCW Research - Joanna M Skillman