During the past decade, NPWT has become a common treatment of acute and chronic wounds. It has revolu-

Objective  To measure the proportion of tubal pregnancies managed laparoscopically and those suitable for laparoscopic surgery based on departmental guidelines in a district general hospital in the northwest of England. Design  A retrospective audit of the surgical management of tubal pregnancies over a 12‐month period. Setting   A district general hospital. Participants   All women operated on for tubal pregnancy in Sharoe Green Hospital between 1 January 2001 and 31 December 2001. Methods   Cases of tubal pregnancy requiring surgery during 2001 were identified from the computerized theatre log. The case notes of these women were reviewed and assessed as to whether they were managed appropriately by laparotomy and laparoscopic surgery. Audit standard   All cases (100%) to be managed appropriately with laparoscopic surgery in accordance with Royal College of Obstetricians and Gynaecologists (RCOG) guidelines. Results   Fifty‐two possible cases were identified. Five were not tubal pregnancies upon review of the notes and therefore excluded. Nine case notes could not be traced by the audit department. The remaining 38 cases of tubal pregnancy were reviewed. A total of 18% of cases underwent appropriate laparotomy and 82% were deemed suitable for operative laparoscopy. Only 39% of tubal pregnancies deemed suitable were managed by appropriately by laparoscopic surgery. Conclusion   The majority of cases of tubal pregnancy were not managed appropriately with laparoscopic surgery in Sharoe Green Hospital. The proportion of tubal pregnancies suitable for laparoscopic surgery in a district general hospital is approximately 82%.

Objective: To determine the frequency of success of acellular dermal matrix and split thickness skin graft in release of post burn contractures in hand using Vancouver scar scale. Study Design: Descriptive Case Series. Setting: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: 1st March, 2019 to 30th October, 2019. Material & Method: A descriptive case series conducted at Plastic Surgery Department, Jinnah Burn and Reconstructive Surgery Center, Lahore. A sample size of 75 patients, who full filled the inclusion criteria, was selected through non probability consecutive sampling Informed consent was obtained from all the patients. Pre-operative photography was done to compare the post-operative results. After the release of contractures, coverage with acellular dermis and split thickness skin graft was performed. All the patients were followed up to 2 months and the outcome was assessed by Vancouver Scar Scale. The collected data was entered and analyzed by using SPSS version 20. Descriptive statistics were calculated. Quantitative variables like age, size of scar were presented as mean, ± standard deviation. Qualitative variables were presented as frequencies and percentages. Results: Mean age of patient was 30 ± 9 years. Among them 40 were males and 35 females. Vancouver scale showed successful outcome (score ≤4) in 70.66 % of the patients. Partial release of contracture was the major complication seen in 5.33% of cases. Conclusion: Acelluar dermal matrix followed by split thickness skin graft is a very reliable option for coverage after release of post-burn contractures in hand as it provides very pliable, thin and lax skin with good color match and better contour to surrounding tissue.

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Introduction:We reviewed the number of nailbed injuries referred to a busy plastic surgery department to identify areas of improvement.Methods: A retrospective study of 142 patients referred over a 12 month period. All notes were reviewed to analyse patient demographics, details of injury, ensuing operation and follow-up.Results: The mean age of patient was 24 years (1 month to 87 years), commonest injured finger was the middle (36%) with commonest cause trapping the finger in a door (33%). 75% of both internal and external referrals were seen within 24 h. All patients underwent operative management and 71% were operated on within 48 h of injury. The majority of operations performed by specialist registrars, under local anaesthetic (LA) and the native nail replaced. 75% of patients were offered follow-up appointments with 15% not attending. The complication rate was 6.4% with abnormal nail growth accounting for more than half. There is no difference in the complication rate in paediatric patients compared to adults. Clinical fellows performing the nailbed repair had an 18% complication rate compared to specialist registrars 1%; consultants and senior house officers had no complications. Having the procedure performed under LA had a 10% complication rate in comparison of 3% under G.A.Conclusions: Nailbed injuries are seen and managed promptly in the department. Complication rates were low and are affected by choice of operator and anaesthetic. More training or supervision may need to be given to non-training post middle-grade surgeons. With the low complication rate, follow-up should be in nurse-led dressing clinics.

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