The superficial branch of the radial nerve (SBRN) is highly vulnerable to trauma and iatrogenic injury. This study aimed to map the course of the SBRN in the context of surgical approaches and identify a safe area of incision for de Quervain's tenosynovitis. Twenty-five forearms were dissected. The SBRN emerged from under brachioradialis by a mean of 8.31 cm proximal to the radial styloid (RS), and remained radial to the dorsal tubercle of the radius by a mean of 1.49 cm. The nerve divided into a median of four branches. The first branch arose a mean of 4.92 cm proximal to the RS, traveling 0.49 cm radial to the first compartment of the extensor retinaculum, while the main nerve remained ulnar to it by 0.64 cm. All specimens had branches underlying the traditional transverse incision for de Quervain's release. A 2.5-cm longitudinal incision proximal from the RS avoided the SBRN in 17/25 cases (68%). In 20/25 specimens (80%), the SBRN underlay the cephalic vein. In 18/25 (72%), the radial artery was closely associated with a sensory nerve branch near the level of the RS (SBRN 12/25, lateral cutaneous nerve of the forearm (LCNF) 6/25.) A longitudinal incision in de Quervain's surgery may be preferable. Cannulation of the cephalic vein in the distal third of the forearm is best avoided. The close association between the radial artery and first branch of the SBRN or the LCNF may explain the pain often experienced during arterial puncture. Particular care should be taken during radial artery harvest to avoid nerve injury.

F rail older adults have complex health and social care needs, and their functional abilities often decompensate in the face of acute illness. 1 Adverse events occur in the short term (e.g., increased length of stay or hospital complications) 2 and long term (e.g., readmission or death). 3,4 One approach to quantifying frailty-associated risk has been to consider the accumulation of health deficits, as operationalized in the Frailty Index. 5 This too is well-established in community samples; however, the extent to which these risk prediction tools can be translated in the acute setting where chronic and acute issues co-exist is unclear. Understanding how to measure accumulated deficits in frail patients presenting with acute illness would be an important step toward identifying patients who require targeted interventions such as those that maximize physical and cognitive function, 6 or patients with many active health conditions. Recent studies have used laboratory investigations combined as a frailty index (the FI-Laboratory) to identify incipient frailty states that might increase risk of adverse outcomes from clinically detectable frailty. 7-14 Adapted from animal studies, 15 the human FI-Laboratory was developed and used in communitydwelling populations 9,13,14,16-18 and in older adults in institutional RESEARCH Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results

Mesh use in surgical breast reconstruction is becoming increasingly common; however, there is still no consensus on whether synthetic matrices or biological matrices produce the best outcomes. This review analyses these outcomes, namely the differences in aesthetic outcomes, cost, and the rates of the most commonly reported complications.The results indicate that breast reconstruction with a synthetic matrix produces comparable aesthetic outcomes to a biological matrix, with lower costs and complication rates. The individual results for complication rates show that biological matrixes are associated with lower infection rates and slightly lower capsular contracture, but higher haematoma rates, and slightly higher rates of skin necrosis and explantation—although many had post-op radiotherapy.The majority of the studies evaluated used biological matrices, and there are no randomised controlled trials directly comparing the two types of meshes; definite conclusions cannot be drawn from the available evidence. The authors suggest that a randomised controlled trial comparing these outcomes in synthetic and biological matrix use is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-016-0874-9) contains supplementary material, which is available to authorized users.

BackgroundWhile medicine in general is becoming more female-dominated, women are still under-represented in surgery. Opinion is divided as to whether this is due to lifestyle considerations, disinterest or perceived discrimination. It is not clear at what stage these careers decisions are made.Methods300 first year medical students at Guy's King's and St Thomas' School of Medicine (GKT) were asked their view on possible career choices at this stage.ResultsWhile men represented only 38% of the student population, they represented over two-thirds of the students wishing to pursue a career in surgery.Women still opt for general practice and paediatrics.ConclusionSurgery is a disproportionately unpopular career choice of the female first-year medical students of GKT compared to the male students. It appears that the choice is freely made and, at this stage at least, does not represent concerns about compatibility with lifestyle.

SummaryLarge discrepancies in the available data on skin microbiology stimulated investigations of the number, interactions, and location of commensals and the true efficiency of disinfection by using skin biopsy, culture of frozen sections, and other methods.Most current procedures were less than 0 5% as sensitive as the biopsy method described. This gave mean bacterial counts ranging from 4,400/cm2 on the breast to 400,000/cm2 in the axillae. An iodine preparation removed 95% of accessible organisms, but about 20% of bacteria were protected by follicles, crevices, and lipids. Commensals in over 20% of people produced antibiotics against a wide range of pathogens. Conversely, "satellitism" was demonstrable in 12% of people.

Burst abdomen, incisional hernia and sinus formation continue to bedevil the surgeon. Significant associated factors include postoperative wound infection and the suture material used. A series of experiments was therefore designed to test suture materials for their use in infected abdominal wound closure. The nearest to the ideal, is a monofilament non-absorbable suture (monofilament nylon). It has a low infectivity, resulted in satisfactory wound tissue strength when used in infected wounds, and retained its strength. Infected, braided sutures of silk, nylon and polyglycolic acid even after 70 days were seen to contain bacteria and polymorphonuclear cells when examined electron microscopically. Absorption of silk and polyglycolic acid and encapsulation of non-absorbable braided nylon was delayed by the presence of infection. Monofilament nylon, in contrast, was unaffected, a fibrous capsule having formed by 10 days even in the infected state.

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