HighlightsThere is a lack of evidence for composite grafting for distal finger tip amputation.We present a systematic review protocol on the use of composite grafts.This review will aim to provide clinicians with more guidance.

HighlightsThere is no consensus on the use of antibiotic prophylaxis.Antibiotics have benefits and risks when used.Do prophylactic antibiotics alter skin graft outcomes?We seek to guide surgeons by comparing outcomes with or without antibiotics.

There is debate in the literature surrounding the management of fingertip amputations. The role of composite grafts lacks clarity in terms of outcomes and complications. Hence, there is a need for an evidence synthesis to guide practice. A search of the databases OVID MEDLINE, PubMed, EMBASE, SCOPUS, The Cochrane Library, and clinical trial registries was conducted, from 1946 to January 2020, using the key terms “fingertip,” “digital tip,” “digit,” “finger,” “thumb,” “amputation,” “replantation,” “reattachment,” “reimplantation,” and “composite graft.” Studies reporting primary data on the outcomes of composite grafts of 5 or more digits were included. The studies included in this systematic review ranged in year of publication from 1959 to 2019. Data extraction included demographic details, functional, esthetic and adverse outcomes. Twenty-three articles were included. Outcome data on composite grafts are heterogeneous and little standardization of measurements exists, making interpretation challenging. Identified factors associated with improved outcomes include lower age, distal amputation levels by cut mechanism and decreased time to operation. Smoking is associated with poorer composite graft outcomes. Although survival rates vary greatly, composite grafting may be useful in certain cases and provide good functional and sensation outcomes with good patient satisfaction.

BACKGROUND: Patients in psychiatric inpatient settings are at increased risk of developing physical health complications due to the structure of inpatient wards, the metabolic side-effects of antipsychotic medications and socioeconomic factors. Robust physical health monitoring and interventions are paramount in reducing this health inequality. OBJECTIVE: To improve the quality of physical health interventions in the ward environment and empower patients to follow healthy lifestyle guidance to reduce their risk of metabolic syndrome. METHODS: Patient weight and waist circumference data were collected at baseline and weekly throughout the 8-week intervention period. A questionnaire was recorded from baseline to week-5 to assess patient understanding. Two PDSA cycles were completed: (1) Series of weekly psychoeducation sessions and group exercise and (2) Implementation of healthy living diaries. RESULTS: Our data did not demonstrate any definitive impact upon the waist circumference and weight of participants. However, analysis of the questionnaires showed a consistent trend in knowledge improvement. CONCLUSION: Whilst our aim of reducing patient weight and waist circumference was not realised, there was a significant impact on participant’s knowledge, demonstrating a subjective benefit of our interventions. Our project also highlighted inconsistencies in physical health measurements and data collection, providing vital information for further quality improvement measures.

Introduction: Plastic surgeons may opt to administer prophylactic perioperative antibiotics in elective skin graft surgeries to curtail the risk of surgical site infections (SSI). However, the use of antibiotics brings the risk of adverse events or antibiotic resistance and evidence comparing the risk versus benefit is still lacking. Thus, there are no specific guidelines regarding the use of antibiotics prophylaxis in skin graft surgery and the potential for misuse of antibiotics is high. Methodology: A systematic literature search was conducted to retrieve all articles comparing the use versus nonuse of “prophylactic antibiotics” in “skin graft surgery” on March 29, 2020. All comparative study designs were considered for inclusion. The primary outcome was occurrence of SSI. A meta-analysis using the Mantel-Haenszel method with random effect model was used to pool the effect estimates from included studies. Result: A total of 1403 articles were identified, of which, 6 were included in the meta-analysis. The 6 articles included were all comparative studies (5 RCTs and 1 cohort study) and reported the outcomes of 391 patients and 404 grafts. A total of 202 patients received prophylactic antibiotics and 202 patients did not receive antibiotics. All 6 studies were included in the meta-analysis. The overall pooled effect estimates comparing treatment groups showed no significant difference for outcomes in terms of SSI (odds ratio: 0.43; 95% confidence interval: 0.18, 1.02; I 2 0%; P=0.06). Conclusion: Incidence of SSI in elective skin graft surgery is relatively low. Our data shows there is limited utility in the use of prophylactic antibiotics to prevent clinically significant SSI in patients undergoing elective skin graft surgery. However, there are still only a small number of studies conducted on the topic to date, and more work is required before definitive conclusions can be used.