Topical 2 per cent diltiazem ointment used as an agent for chemical sphincterotomy for chronic anal fissure offers significant healing rates but does not have a significant side-effect profile, which may aid compliance to treatment. Early recurrences are common but usually amenable to further chemical sphincterotomy.
Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre-operatively.
We retrospectively reviewed a consecutive single surgeon series of 57 Ascension pyrocarbon proximal interphalangeal joint arthroplasties, with a mean follow-up of 7.1 years (range 2 years to 11 years 6 months). We assessed the ranges of motion, deformity, stability and pain of the operated joints, grip strength of the hand and patient satisfaction. Of the cases, 44 were for osteoarthritis, five for rheumatoid arthritis and eight for post-traumatic arthritis. The median post-operative active arc of motion was from 0° to 60°. The median post-operative visual analogue pain score was 0.3 out of ten. Thirty six of the joints had no complications; 14 had minor complications (squeak, slight swan neck); three required early reoperation (joint release, flexor tenodesis); and five required implant removal. A total of 69% of our patients would have the same operation if they had to make the decision again. The Kaplan-Meier survival method estimates the mean implant survival to be 10.7 years (95% confidence intervals 9.96-11.37 years). All five failures occurred during the first 2 years.Level of evidence 4 (Case-series).
Clinical care is often directed at improving patient's quality of life, the effectiveness of which can be measured by objective or subjective outcomes. Surgical intervention, especially in plastic and reconstructive surgery, can often provide hard objective measures, for example, breast size reduction after bilateral reduction mammaplasty, or improved joint position/movement after Dupuytren's surgery. These measurements do not describe how a particular intervention affects the patient's life, from their point of view.
Patient-reported outcome measures (PROMs) are validated questionnaires completed by patients about their health, functioning, health behaviors and quality of care. Patient-reported outcome measures reflect the patient's perspective and their use increases the meaningfulness of outcomes measured, for whatever purpose. There is therefore a growing interest in PROMs as part of routine clinical practice in the United Kingdom and worldwide.
This article aims to provide an introduction of PROMs to plastic surgeons, a description of how PROMs are developed and scored, along with the most commonly used tools currently most applicable to plastic surgery. The benefits of PROMs on a local, regional, and national level are discussed, and we aim to set out how these tools can be used in auditing individual and departmental performance against national standards. We will also provide suggestions for sustainable use of PROMs in the clinical environment, advice on choosing the right outcome measure, and our views on electronic data collection, analysis, and interpretation of the results.
Patient-reported outcome measures are highly relevant clinical practice and will undoubtedly with time become routine. We encourage plastic surgeons to explore the possibilities these tools can provide in helping improve the quality of care we deliver to our patients.
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