The Reconstructive Trauma Surgery Interface Fellowship and its applicability to military and civilian trainees

The Reconstructive Trauma Surgery Fellowship is a based at the Queen Elizabeth Hospital, Birmingham, and focuses on the multidisciplinary management of major trauma from presentation to discharge. It is unique to the UK in that it provides both management and leadership experience as well as operative surgical skills particularly in terms of reconstruction on complex trauma patients including those from the military. This paper describes the relevance of fellowships in modern surgical training, composition of the reconstructive trauma fellowship and the relevance for both civilian and military trainees. [Abstract copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Ocean enemy’s lasting sting: chronic cutaneous reaction after Cnidarian attack

AbstractCnidaria stings cause a wide range of cutaneous and systemic symptoms, normally occurring shortly after the venomous insult (1). We report a case of worsening cutaneous reaction over an eight-year period following a Cnidaria attack sustained whilst maritime swimming. The lesion was characterised by severe, ulcerating chronic inflammation that required wide local excision and skin grafting. Prevention and early identification of Cnidaria envenomation is important for those treating maritime swimmers.</jats:p

New Technique for Bloodless Surgery to the Scalp

Skin cancers such as malignant melanoma, squamous cell carcinoma, and basal cell carcinoma are common on the scalp, and the usual treatment is wide local excision with disease- free margins. Margins vary depending on the type of cancer, the size and depth of invasion, and the cytological findings, as described in the British Association of Dermatology guidelines. Because the blood supply of the scalp is rich, excision is usually accompanied by brisk bleeding, which can be troublesome and even affect the success of the graft. The layer of connective tissue between the skin and the epicranial aponeurosis consists of lobules of fat bound in tough fibrous septa, through which the main blood vessels that supply the scalp travel. Because these vessels are attached to this fibrous layer, they do not easily go into vasospasm when cut, which results in profuse bleeding. When lacerated they may also retract between the septa, which causes more pronounced bleeding and it may take a considerable time to achieve haemostasis. Diathermy may injure hair follicles in the remaining skin and induce additional alopecia. Here we present a new technique that considerably reduces bleeding and consequently saves time and reduces the need to use diathermy