RESUMEN
BACKGROUND: Cosmetic surgery tourism is rapidly becoming more prevalent in the United Kingdom. We aim to identify the motivational factors underlying patients' decisions to go abroad for their treatment and gather information about the ensuing complications. METHODS: A retrospective review (January 2013-August 2017) was conducted of patients seen at a single major trauma center for complications from cosmetic surgery performed overseas. Cost analysis was performed based on national tariffs. Complications were grouped based on Clavien-Dindo classification and the Clinical Commissioning Group cost. A telephone survey was conducted to evaluate reasons for travel, details of complications, and impression of healthcare at home and abroad. RESULTS: A total of 20 patients (one male, 19 females) with a mean age 36 years (23-59 years) were included. Lower cost was the most popular reason for travel, followed by lack of expertise and friend's recommendation. Abdominoplasty (n = 9) had the highest number of complications followed by gluteal augmentation (n = 7). All major complications were due to gluteal augmentation (n = 4). The cost was for minor (n = 8, £3,448), intermediate (n = 8, £18,271), and major (n = 4, £42,083.59) complications. CONCLUSIONS: We raise serious concerns about the lack of regulation in cosmetic tourism and the absence of patient follow-up abroad. A particular concern was all gluteal augmentation cases had major complications. An international consensus to regulate surgical practice abroad is crucial to protect patients' interests and promote safe cosmetic surgery.
RESUMEN
Chronic wounds on the dorsum of the hand are often challenging to treat. Vacuum-assisted closure has enjoyed widespread use in recent years for many difficult chronic wounds as an alternative to surgery. Unfortunately, owing to the unique anatomy of the hand, it is usually very difficult to get a seal without significantly immobilising the hand. We report a case of a chronic wound on the dorsum of the hand as a result of osteomyelitis in a 37-year-old man, which was treated with Single Use Negative Pressure Wound Therapy, 'PICO' (Smith and Nephew Co, UK). We combined the PICO dressing with a rubber glove to get a good seal enabling appropriate suction without immobilising the hand. Once the wound bed was ready, the defect was covered with a reverse forearm flap.
Asunto(s)
Guantes Protectores , Traumatismos de la Mano/etiología , Terapia de Presión Negativa para Heridas/métodos , Osteomielitis/complicaciones , Adulto , Traumatismos de la Mano/diagnóstico , Traumatismos de la Mano/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Huesos del Metacarpo/diagnóstico por imagen , RadiografíaRESUMEN
OBJECTIVES: Traumatic wounds and surgery inherently have their complications. Localized infections, wound dehiscence, and excessive wound leakage can be devastating to the patient with a prolonged recovery, but it is also costly to the hospital with an increased length of stay, extra workload, and dressing changes. The single use PICO (Smith and Nephew Healthcare, Hull, United Kingdom) negative pressure wound therapy (NPWT) dressing has revolutionized our management of various acute, chronic, and high output wounds. It requires fewer dressing changes than conventional practice, is used in the outpatient setting, and is a necessary adjuvant therapy to hasten wound healing. AIMS: To observe the efficacy of the PICO vacuum-assisted healing within a cost improvement programme. SETTINGS: Plastic surgery department, Royal London Hospital. MATERIALS AND METHODS: Twenty-one patients with a diversity of postoperative or posttraumatic wounds were considered suitable for PICO application and treated totally on an outpatient basis once the PICO dressing was applied. All wounds were then subjected to continued PICO dressings until healed. RESULTS: All patients tolerated the PICO well with no dressing failure or failure to comply. The number of dressings per patient ranged from 1 to 7. The cost per patient of treatment ranged from £120 to £1578. Estimated cost of all PICO dressing for 21 patients including plastic surgery dressing clinic appointments = £13,345. Median length of treatment to healing (days) = 16; standard deviation = 9.5. Eight patients would have had an inpatient bed stay with conventional therapy, total 24 bed days saved at Bartshealth @£325 per day. CONCLUSIONS: The outpatient application of a disposable NPWT can benefit a wide range of clinical wounds that optimizes patient care, promotes rapid wound healing, and importantly helps manage costs.