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Lead extraction using an ablative sheath is safe and effective. In our small study, there were no significant differences between EDS and laser sheaths in terms of success, time, or safety.

Therapeutic, V.

Timely and effective assessment, resuscitation and transfer of patients with severe burns has been demonstrated to improve outcome. A dedicated one-day course exists to equip all frontline emergency healthcare workers with the necessary knowledge and skills to manage severe burn injuries. More recently, a board game has been developed which aims to act as a learning and practice development tool for those managing burn injuries. We present the findings of our preliminary evaluation of this game. We played this game with a multidisciplinary group of staff including doctors, nurses and therapists. A proportion of these participants had previously completed the Emergency Management of Severe Burns (EMSB) course. We obtained subjective results from a questionnaire, using both Likert-type ratings and open-ended questions. The styling of the game and ease of instructions was rated from ‘average’ to ‘excellent’. The relevance of questions was rated from ‘good’ to ‘excellent’. The usefulness of the game to increase knowledge and stimulate discussion was rated between ‘good’ and ‘excellent’. All participants stated that they would recommend the game to other healthcare professionals. This is the only burns and plastic surgery-related educational game in the literature. Educational games adhere to principles of adult learning but there is insufficient evidence in the literature to either confirm or refute their utility. Our preliminary evaluation of this game has shown that it achieves its main aims, namely to increase knowledge in burn care and to stimulate discussion. Further work is required to assess the board game.

Malignant eccrine spiradenoma (MES) is an extremely rare but aggressive tumour, resulting in high mortality. We report the first case in the UK of metastatic MES on the scalp of a 37-year-old man who initially presented with a raised nodular mass which had grown rapidly over a few months. Excision biopsy of the lesion was performed and histology confirmed MES with evidence of cytological atypia and necrosis. A further wide local excision of the lesion with a 1 cm surgical margin was performed and full clearance was achieved. At 10-month follow-up another similar lesion had developed close to the previously excised area. A CT scan demonstrated metastatic lesions in the lungs, liver and pelvis, and subsequently chemotherapy was initiated. Although MES is uncommon, it has a high propensity to metastasise, therefore prompt identification, treatment and close follow-up of these tumours is essential.

Background:Recent papers and guidelines agree that patients with locally advanced breast cancer (LABC) should be offered breast reconstruction. Yet, the type of reconstruction in this group of patients is still a point of controversy.Methods:One hundred fourteen patients, treated for LABC from 2007 to 2013, were divided into 3 groups based on the reconstructive option: no reconstruction (NR), implant-based/expander-based reconstruction (IBR), and autologous tissue reconstruction (ATR). We analyzed demographics and compared delay in adjuvant therapy, length of hospitalization, surgical complications, failure of reconstruction, local recurrence, and disease-free survival.Results:Twenty-six patients had NR, 38 had IBR, and 50 had ATR. No significant difference was found in the percentage of patients who had their adjuvant treatment delayed [16% (NR) vs 22% (IBR) vs 14% (ATR)]. Mean length of hospitalization for the NR, IBR, and ATR groups was 2.7, 6, and 7.5 days, respectively. Complication rates requiring readmission were 36% (NR), 42% (IBR), and 32% (ATR). In the IBR group, 37% of implants were removed because of complications. Failure of reconstruction was 37% and 0% for the IBR and ATR groups, respectively. Local recurrence rates in the NR and Reconstruction (groups IBR and ATR combined) groups were 7% and 2%, respectively. Mean survival times in patients were 18 (NR), 10.3 (IBR), and 12.2 (ATR) months.Conclusions:No significant difference was found in the hospital stay length, adjuvant treatment delay, and complication rates between IBR and ATR. High rates of failed reconstruction suggest that the use of implants should be considered very carefully in patients with LABC.

Wide resection and microvascular free tissue transfer provide versatile solutions for the reconstruction of extensive chest wall defects. With good reported perioperative outcomes even in advanced cases, surgical resection of LABC may offer a useful approach in difficult and/or palliative cases.