No abstract

Substantial loss of chondrocytes occurs in rat articular cartilage which may result from increased vulnerability to elevated intracellular ROS levels, consequent upon a decline in antioxidant defence.

Monitoring free-tissue transfers in the postoperative period is valuable for detection of failing flaps. As well as conventional methods, a myriad of sophisticated techniques have been reported in the literature. Using a postal questionnaire, a survey was conducted to delineate current protocols employed in UK plastic surgery units. Data were received from 148 plastic surgeons in 51 units. All surgeons used clinical assessment, although there was significant disparity in the duration and frequency of postoperative monitoring. Adjuvant techniques such as laser Doppler flowmetry were routinely used by less than 20% of surgeons. We conclude that there is considerable variation in postoperative monitoring of free flaps, with significant clinical and resource implications. A protocol based on robust evidence is thus recommended.

No abstract

The aim of this study was to establish whether or not to cement the hemiarthroplasty for displaced intracapsular femoral neck fractures in the elderly. Consecutive patients treated by hemiarthroplasty in adjacent hospitals were reviewed. The same monoblock prosthesis was used; in hospital A they were uncemented (121 patients), and in hospital B they were cemented (123 patients). Notes were reviewed retrospectively. Surviving patients (50 and 56 respectively) were assessed prospectively for pain and functional ability using validated scoring systems. Follow-up was 32-36 months. Patient demographics were similar. Fewer of the cemented group had been revised or were awaiting revision ( P=0.036). There was no difference in general complication or mortality rates. There was a highly statistically significant greater deterioration in pain ( P=0.003), walking ability ( P=0.002), use of walking aids ( P=0.003) and activities of daily living ( P=0.009) in the uncemented group. Our findings support the use of cemented hemiarthroplasty in the elderly.

tion options with patients, irrespective of whether they are available locally. 6 Fifty three per cent of women having surgery for breast cancer will undergo mastectomy (box 1). 7 8 In the UK and United States, bilateral mastectomy is increasingly being used for risk reduction in BRCA carriers, for those with a high risk of developing breast cancer (lifetime risk of 30%), or as a planned management strategy for unilateral cancer (fig 1, bmj.com). 9-15 In general, bilateral mastectomy is associated with a higher rate of breast reconstruction. A recent Cochrane review showed that bilateral prophylactic (risk reduction) mastectomy reduced the incidence of, and death from, breast cancer, but it highlighted that more rigorous prospective studies are needed to assess absolute risk reduction. 16 The review also found that although contralateral prophylactic (risk reduction) mastectomy decreases the incidence of cancer in the contralateral breast, it is unclear whether, and for whom, this practice improves survival. 16 How is a mastectomy performed?When performing a mastectomy, the anatomical (oncological) plane between breast tissue and subcutaneous fat needs to be identified. It is, however, impossible to remove all breast tissue because the oncological plane is not uniform throughout the breast. A standard (simple) mastectomy removes the breast skin envelope, but a skin sparing mastectomy preserves the breast skin envelope Breast cancer is the most common cancer in women, with almost 1.38 million new cases a year worldwide; it accounts for 23% of all cancers and 14% of deaths from cancer. 1 However, mortality from breast cancer is d eclining-increasing numbers of women are long term survivors (>5 years) (currently 549 000 in the United K ingdom). 2 3 Surgery remains a mainstay of treatment, either breast conservation or mastectomy, but any breast surgery can greatly alter breast aesthetics and body image.Breast reconstruction restores breast symmetry after a mastectomy by creating a breast mound, similar in size, shape, contour, and "out of bra position" to the contralateral breast. In England and Wales in 2002, about 10% of women had immediate breast reconstruction; by 2009 this had risen to 21%. 4 Post-mastectomy breast reconstruction is associated with improved body image, quality of life, self confidence, and wellbeing. 5 In this review, we outline the indications for breast reconstruction along with the timing and techniques available to patients after mastectomy. What is post-mastectomy breast reconstruction?Breast reconstruction is a surgical procedure that restores shape to the breast after mastectomy. Although it will not re-create the exact look and feel of a natural breast, it aims to create a breast mound contour similar to that before mastectomy. When, and to whom, should breast reconstruction be offered?In 2009 the National Institute for Health and Clinical Excellence (NICE) revised guidance on improving breast cancer outcomes. It recommended discussing immediate reconstruction with all patients ha...

The coronavirus disease-2019 pandemic has had a significant impact on the delivery of surgical services, particularly reconstructive surgery. This article examines the current evidence to assess the feasibility of recommencing immediate breast reconstruction services during the pandemic and highlights considerations required to ensure patient safety.

Mortality following head and neck cancer surgery shows significant national variation and is associated with fixed risk factors like age and co-morbidities, but also with modifiable risk factors like performing major surgery during an emergency admission, tracheostomy, reconstructive surgery and medical complications. We propose that the quality of tracheostomy care, reconstructive surgery, emergency major surgery rate, and occurrence and treatment of major medical complications should be closely examined and formally benchmarked as part of loco-regional and national quality improvement audits.