RESUMEN
Deliberate self-harm is common. It is usually by drug overdose or ingestion of other noxious substances, but self-harm by cutting or burning often comes to the attention of plastic surgeons. We report three variant cases involving insertion of paperclips, a ballpoint pen cartridge and sewing needles into the forearm. We discuss the management considerations of each case and emphasise the importance of actively addressing the underlying psychiatric problems for all instances of deliberate self-harm.
Asunto(s)
Antebrazo , Cuerpos Extraños/terapia , Conducta Autodestructiva/terapia , Adulto , Femenino , Cuerpos Extraños/etiología , Humanos , Trastornos Mentales/complicaciones , Conducta Autodestructiva/psicologíaRESUMEN
INTRODUCTION: There is good evidence for the benefits of bilateral breast reduction (BBR). However, such surgery is often considered cosmetic and is rationed. The NHS Modernisation Agency and the British Association of Plastic Surgeons (as was) have produced national guidelines, but Primary Care Trusts adapt these for local implementation. METHODS: We surveyed the funding criteria for BBR of all 303 Trusts in England. 245 (81%) responded. RESULTS: The NHS guidelines were followed accurately by only 11 Trusts. 198 trusts specified a maximum BMI (range 25 to 32; guideline 30). 187 accepted musculoskeletal symptoms as an indication and 117 accepted intertrigo. 31 required a professionally fitted bra. Many Trusts included other restricting criteria that are not in the NHS guidelines. Some Trusts mentioned the American Society of Plastic Surgeons' guidelines, but did not follow them wholly. CONCLUSIONS: Even with explicit guidelines, considerable variation in local funding criteria exists with resultant inequalities in provision. The so-called 'postcode lottery' of healthcare in the UK is rife within Plastic Surgery. The recent reconfiguration of English Primary Care Trusts provides an excellent opportunity for the rationalisation of BBR provision and to this end we will distribute our findings and the NHS guidelines to the new Trusts and to the National Institute for Health and Clinical Excellence.
Asunto(s)
Asignación de Recursos para la Atención de Salud/normas , Mamoplastia/normas , Selección de Paciente , Antropometría , Índice de Masa Corporal , Mama/patología , Inglaterra , Femenino , Adhesión a Directriz/normas , Investigación sobre Servicios de Salud , Humanos , Mamoplastia/economía , Mamoplastia/psicología , Guías de Práctica Clínica como Asunto , Medicina Estatal/normasRESUMEN
INTRODUCTION: Two systems exist for describing fingers and phalanges: Naming and Numbering. This can cause confusion for clinicians. We compared the two systems to see if one was better understood. METHODS: Thirty-eight clinicians were asked a questionnaire to identify 11 terms on hand outline drawings. RESULTS: Naming was better understood than Numbering both overall (McNemar's test, p=0.000026) and with just abbreviations (p=0.0017) or full terms (p=0.000074). Radial/ulnar was superior to medial/lateral for laterality (p=0.046). Within the Naming system, the full terms were less ambiguous than abbreviations (p=0.000012). Our study suggests that Naming is better understood than Numbering and that full terms are preferable to abbreviations. To describe laterality, radial and ulnar are less ambiguous that medial and lateral.
Asunto(s)
Dedos , Terminología como Asunto , Falanges de los Dedos de la Mano , Humanos , PulgarAsunto(s)
Mamoplastia/métodos , Pezones/trasplante , Estética , Femenino , Humanos , Trasplante de Piel/métodosRESUMEN
Chest drains are normally inserted in the fifth intercostal space in the mid-axillary line. The classical technique for chest drain insertion involves locating the drain in an interspace just superior to the inferior rib, so as to avoid the neurovascular bundle. While teaching thoracic wall anatomy on cadavers, considerable variation was noted in the position of the neurovascular bundles, frequently lying well away from the generally accepted subcostal groove. We endeavoured to perform a comprehensive cadaveric study of the neurovascular relationships in the mid-axillary line in the fifth and adjacent spaces to try to describe a 'Safe Zone' for drain insertion to minimise damage to associated structures. The idea that the neurovascular bundle is safely protected in the subcostal groove should be dispelled, as should the concept that there is nothing to damage in the zone immediately superior to the inferior rib. Clinicians should be aware that the Safe Zone is narrower than hitherto appreciated and should be between 50-70% of the way down an interspace to avoid the variably positioned superior intercostal neurovascular bundle and the inferior collateral artery.