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Abstract
Shokrollahi K, Sofos S. Twist-over: stainless steel suture technique for skin graft applications. Ann R Coll Surg Engl 2013; 95: 437 doi 10.1308/003588413X13629960048875a
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2
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Bovill ES, Cullen KW, Barrett W, Banwell PE. Clinical and histological findings in re-excision of incompletely excised cutaneous squamous cell carcinoma. J Plast Reconstr Aesthet Surg 2008; 62:457-61. [PMID: 18218349 DOI: 10.1016/j.bjps.2007.11.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 11/26/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Current guidelines mandate treatment of primary cutaneous squamous cell carcinoma (SCC) through to completion, including the demonstration of a margin of normal tissue, with surgical excision as the treatment of choice. Histologically incomplete excisions of all cutaneous SCC are preferably treated by surgical re-excision. The yield of performing further resection of scar tissue in patients with incompletely excised SCCs has not been previously evaluated. METHODS A retrospective audit was conducted of 676 consecutive patients with surgically managed SCCs treated in our unit during 2005-2006. RESULTS One hundred and nineteen (17.6%) tumours were incompletely excised, of which 84 underwent further excision. Routine histological examination revealed residual SCC in 24 (28.6%) of these specimens. Logistic regression analysis revealed tumour diameter and Breslow thickness to contribute independently to residual SCC (P<0.001). A lengthier delay between initial excision and re-excision predicted less residual tumour (P<0.005). Although the positive re-excision group tended towards a higher mean age (79+/-9 vs 74+/-12), with more head and neck lesions (79 vs 66%), logistic regression revealed no independent influence of age, gender, histological grade or anatomical site of the original lesion. CONCLUSION In our series, 28.6% of incompletely excised primary cutaneous SCCs showed residual tumour in re-excision specimens. Factors associated with residual tumour were similar to characteristics of high risk SCCs; larger lesions in particular are more likely to result in residual SCC at re-excision and may benefit from greater excision margins at the time of original resection. It is possible that regression of remaining tumour cells may contribute to our time-dependent findings and this warrants further research.
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Affiliation(s)
- E S Bovill
- Plastic Surgery & Burns Unit, Frenchay Hospital, Frenchay, Bristol BS16 1LE, UK.
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3
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Abstract
Necrotising fasciitis is a condition associated with significant morbidity and mortality. Fournier's gangrene is a variant of the condition affecting the perineum. Although presentation is usually acute, it may also present in an insidious manner. Following radical surgical debridement, meticulous attention to wound management is required.
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Affiliation(s)
- D l Harper
- Department of Plastic Surgery, Radcliffe Infirmary, Oxford, UK
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4
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Abstract
Vacuum force (suction) is commonly used in wound management strategies. Topical negative pressure wound therapy and closed surgical wound drainage both use vacuum force but each have different modus operandi.
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Affiliation(s)
- P E Banwell
- McIndoe Surgical Centre, East Grinstead, UK.
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5
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Abstract
In clinical practice many wounds are slow to heal and difficult to manage. The recently introduced technique of topical negative pressure therapy (TNP) has been developed to try to overcome some of these difficulties. TNP applies a controlled negative pressure to the surface of a wound that has potential advantages for wound treatment and management. Although the concept itself, of using suction in wound management is not new, the technique of applying a negative pressure at the surface of the wound is. This paper explores the origins and proposed mechanisms of action of TNP therapy and discusses the types of wounds that are thought to benefit most from use of this system.
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Affiliation(s)
- S M Jones
- Odstock Burns and Wound Healing Charitable Trust, Laing Laboratory, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ, UK.
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Swan MC, Banwell PE, Hollowood K, Goodacre TEE. Late recurrence of dermatofibrosarcoma protuberans in the female breast: a case report. ACTA ACUST UNITED AC 2005; 58:84-7. [PMID: 15629172 DOI: 10.1016/j.bjps.2004.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2003] [Accepted: 06/14/2004] [Indexed: 11/23/2022]
Abstract
The case presented is of a 39-year-old female who, at the age of 13 years, had had a "dermatofibroma" excised from her left breast. Twenty-six years later she developed an unsightly "stretched scar". Excision biopsy demonstrated a dermatofibrosarcoma protuberans (DFSP). This was managed by wide local excision, preservation of the nipple-areolar complex, and immediate reconstruction with a pedicled latissimus dorsi flap. Review of the original histology confirmed the presence of DFSP, revising the original diagnosis. Most DFSPs recur within 3 years of primary excision. Such prolonged latency prior to recurrence has not been previously described. This reinforces the need to educate patients regarding the importance of long-term scar surveillance following skin tumour excision.
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Affiliation(s)
- M C Swan
- Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, University of Oxford, Woodstock Road, Oxford OX2 6HE, UK
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7
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Banwell PE, Bovill E, Carter P, Ahmed S. Diagnosing necrotising fasciitis. J Wound Care 2005; 14:110-1. [PMID: 15782437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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8
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Banwell PE, Fischer P, Bovill E. Treatment of dehisced and infected wounds. J Wound Care 2005; 14:110. [PMID: 15779639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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9
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Abstract
A new classification system has been devised for open abdominal wounds. This will help identify an appropriate management strategy, and indicate the associated morbidity and outcome. In all cases, early intervention is vital.
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Affiliation(s)
- M C Swan
- Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, Oxford, UK
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11
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Abstract
Topical negative pressure is a novel non-pharmacological therapy that is now being adopted as a standard of care in wound care management programmes. This review assesses where and how it can be best used.
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Affiliation(s)
- P E Banwell
- Department of Plastic Surgery, Radcliffe Infirmary, Oxford, UK.
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Banwell PE, Evison D. Burn wound blisters. J Wound Care 2001; 10:298-9. [PMID: 12964331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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15
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Abstract
The Internet and the World Wide Web have revolutionised communication and provide a unique forum for the exchange of information. It has been proposed that the Internet has given the public more access to medical information resources and improved patient education. This study assessed the impact of the Internet on the availability of information on wound care management. The search phrases 'wound care', 'wound healing' and 'wounds' were analysed using a powerful Metacrawler search engine (www.go2net.com). Web site access was classified according to the target audience (wound-care specialists, other health professionals, patients) and the author (societies, institutions or commercial companies). The largest proportion of web sites were commercially based (32%). Of the total number, 23% specifically targeted patients, mostly by advertising. Only 20% were aimed at wound specialists. Extensive surfing was required to obtain wound-care information, and objective information sites were under-represented. Regulated, easily accessible, objective information sites on wound-healing topics are needed for improved patient education and to balance the existing commercial bias.
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Affiliation(s)
- E S Bovill
- Burns and Reconstructive Surgery Research Trust, Stoke Mandeville Hospital, Aylesbury, UK
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Gillespie PH, Banwell PE, Hormbrey EL, Inglefield CJ, Roberts AH. A new model for assessment in plastic surgery: knowledge of relaxed skin tension lines. Br J Plast Surg 2000; 53:243-4. [PMID: 10738333 DOI: 10.1054/bjps.1999.3265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- P H Gillespie
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK
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Banwell PE, Gillespie PH, Hormbrey E, Tyler MP, Roberts AH. Immunohistochemistry and burn depth. J Burn Care Rehabil 2000; 21:187-8. [PMID: 10752753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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18
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Abstract
Frostbite, once almost exclusively a military problem, is becoming more prevalent among the general population and should now be considered to be within the scope of the civilian physician's practice. Studies into the epidemiology of civilian frostbite have identified several risk factors that may aid the clinician in the diagnosis and management of cold injuries. Research into the pathophysiology has revealed marked similarities in inflammatory processes to those seen in thermal burns and ischemia/reperfusion injury. Evidence of the role of thromboxanes and prostaglandins has resulted in more active approaches to the medical treatment of frostbite wounds. Although the surgical management of frostbite involves delayed debridement 1 to 3 months after demarcation, recent improvements in radiologic assessment of tissue viability have led to the possibility of earlier surgical intervention. In addition, several adjunctive therapies, including vasodilators, thrombolysis, hyperbaric oxygen, and sympathectomy, are discussed.
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Affiliation(s)
- J V Murphy
- Burns and Reconstructive Surgery Research Trust, Stoke Mandeville Hospital, United Kingdom
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Affiliation(s)
- M G Berry
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
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20
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Abstract
A review of the development and use of sub-atmospheric pressures in the management of patients with different types of wound
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Affiliation(s)
- P E Banwell
- Burns and Reconstructive Surgery Research Trust, Stoke Mandeville Hospital, Aylesbury, UK
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24
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Abstract
Paronychial infection is a common condition seen in the accident and emergency department. Treatment is by antibiotics or incision and drainage under local anaesthetic. Complications are rare but may occur if treatment is delayed or inadequate. A case is described of symmetrical necrotising chest wall infection, of unusual anatomical distribution, that occurred following a paronychia and required surgical debridement and skin grafting.
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Affiliation(s)
- P E Banwell
- Department of Plastic and Reconstructive Surgery, St George's Hospital, London, UK
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25
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Abstract
Isolated limb perfusion (ILP) is a well-tolerated method of regional chemotherapy for melanoma, with response rates ranging from 40-80%, used to treat recurrences or metastases confined to the limb from which the original tumour was excised. We present the case of a 75-year-old woman with a third recurrence of melanoma of the left leg, referred for ILP, in whom staging investigations revealed two probable malignant polypoid lesions of the gallbladder (PLG). These were thought likely to represent metastatic melanoma. In view of the diagnostic difficulty, she underwent laparoscopic cholecystectomy together with left superficial femoral ILP. Multiple papillary adenomatosis, with dysplasia ranging from mild to severe, and with areas of invasive adenocarcinoma, were found on gallbladder histology. No previous case of this combination of tumours has been reported. This case provides evidence of an adenoma-carcinoma sequence, and to our knowledge no previous case has been reported with both carcinoma and the full range of dysplasia from mild to severe within the same gallbladder. The use of minimally invasive surgery allowed the ILP to be performed at the same operation. The pathology, natural history and place of laparoscopic surgery in the management of PLG is discussed.
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Affiliation(s)
- S W Gould
- General Surgical Unit, St. Mary's Hospital, London, UK
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Gould SW, Banwell PE, Rosin RD. A method to facilitate transcystic exploration of the common bile duct at laparoscopic cholecystectomy. Ann R Coll Surg Engl 1996; 78:228-9. [PMID: 8779512 PMCID: PMC2502717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- S W Gould
- General Surgical Unit, St Mary's Hospital, London
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28
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Abstract
Laparoscopic surgery may reduce the inflammatory response to surgery by the avoidance of a skin incision which is frequently the site of maximum tissue trauma. We hypothesized that the inflammatory response is less with minimally invasive procedures. The aim of this study was to evaluate the response of inflammatory mediators following laparoscopic and open hernia repair. Thirty-four patients undergoing unilateral primary inguinal hernia repair were prospectively assigned to either laparoscopic mesh hernia repair (n = 14), open mesh hernia repair (n = 11), or a Bassini repair (n = 9). Serum samples withdrawn prior to surgery, 6 h after surgery, and then again at 24 h after surgery were assayed for interleukin-6 and C-reactive protein content. Interleukin-6 levels at 24 h in the laparoscopic (13.1 +/- 3.1 pg/ml), open mesh (15.5 +/- 2.5 pg/ml), or Bassini group) (15.4 +/- 2.0 pg/ml) did not differ significantly. Neither did C-reactive protein levels at 24 h in the laparoscopic (12.4 +/- 2.7 pg/ml), open mesh (23.0 +/- 7.8 pg/ml), or Bassini group 18.6 +/- 6.6 pg/ml) differ significantly. The response of inflammatory mediators to hernia repair is not modified by undertaking the procedure laparoscopically.
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Affiliation(s)
- A D Hill
- Department of Surgery, Central Middlesex Hospital, Park Royal, London, United Kingdom
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Affiliation(s)
- P E Banwell
- Department of Minimally Invasive Surgery, Central Middlesex Hospital, London, UK
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30
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Banwell PE, Hill AD, Menzies-Gow N, Darzi A. Laparoscopic cholecystectomy: safe and feasible in emphysematous cholecystitis. Surg Laparosc Endosc Percutan Tech 1994; 4:189-91. [PMID: 8044360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report three cases of emphysematous cholecystitis managed by laparoscopic cholecystectomy. The diagnosis was made by ultrasound in all cases. Two patients developed postoperative infections. There were no fatalities. The mean postoperative stay was 6 days. In experienced hands, laparoscopic removal of the gallbladder in emphysematous cholecystitis is feasible with good results.
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Affiliation(s)
- P E Banwell
- Department of Minimally Invasive Surgery, Central Middlesex Hospital, Park Royal, London, England
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