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Raised serum lactate as a marker in the diagnosis of necrotising fasciitis
A 10-year prospective study of cases of suspected necrotising fasciitis was made, involving 53 patients. Of these, 28 had histologically proven necrotising fasciitis, 25 did not. Serum lactate measured at presentation of those who had the condition was 4.1+or-1.62 mmol/l...
Pose in imaging the breast
Inconsistency in breast imaging is remarkably frequent. Even a simple photograph can mislead, depending upon whether or not the arms are held by the sides, are raised above the head or are akimbo. However, the real gold standard in three...
Modifying the DIEP flap in autologous breast reconstruction, introducing a fifth ‘Fleur-de-lis’ zone
With current consumer disquiet about silicone implants, more patients may request autologous reconstruction. This can cause difficulties in patients who have undergone massive weight loss. The authors describe an ingenious solution, modifying the deep inferior epigastric perforators (DIEP) flap to...
Classification of contour deformities after massive weight loss, using the Pittsburgh Rating Scale
While the treatment of patients by skin reduction following massive weight loss is increasing, the conclusions of this study from the Netherlands finds that the Pittsburgh Rating Scale is not entirely suitable for this classification purpose and another system must...
A review of treatment options for acute flexor tendon injuries in zone one
This review reports the techniques that have been and are still used to repair acute injuries in this difficult area. The review does not end with a ‘best buy’ in the tradition of a consumer magazine, concluding that there is...
Platysma muscle use for oral sphincter substitution or countering excessive pull of a free muscle, following facial palsy
The use of the platysma muscle as a pedicled ‘apron’ flap in order to minimise the overactivity of a free muscle transfer, used in the treatment of facial palsy, is described in admirable detail. The successful results are carefully assessed...
The Accordion Severity Grading System in the assessment of negative outcomes following carpal tunnel release
Classification systems come and go, some more memorable than others. Without such systems it is not possible to compare like with like and so it must be conceded that they are necessary, although I personally find them difficult to commit...
First signs of late nodal metastases
This is a retrospective review of 65 patients who had late metastases during follow-up after initial curative treatment. They analyse the detection methods of palpation, ultrasound, CT and subjective symptoms. Palpation detected the nodes in 31 patients, ultrasound in 17,...
Drinks in Newcastle, Australia
This paper assesses patients presenting with oral and maxillofacial trauma over a 13-year period spanning January 2003 to December 2015. During this period of time, in March 2008, trading hours and conditions of service were restricted within the Newcastle central...
Tissue engineered flaps
This article provides a thorough summary of the current techniques available in head and neck reconstruction. It details the challenge of restoration of form and function posed by the shape of the craniofacial skeleton and soft tissue. The introduction on...
