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Book: Plastic surgery

Hettiaratchy, Shehan

a problem based approach

2012

Author's details	Shehan Hettiaratchy ... (ed.)
Language	English
Size	XIX, 244 S. : Ill.
Publisher	Springer
Publishing place	New York u.a.
Publishing country	United States
Document type	Book
HBZ-ID	HT017090779
ISBN	978-1-84882-115-6 ; 1-84882-115-8 ; 9781848821163 ; 1848821166
Database	Catalogue ZB MED Medicine, Health

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2012 A 180	order for loan	Magazin

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Article ; Online: Editorial - A year of war in Ukraine: hope for reconstructive surgery.

Hettiaratchy, Shehan / Reid, A J

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2023 Volume 78, Page(s) A1–A2

MeSH term(s)	Humans ; Ukraine ; Surgery, Plastic ; Military Medicine ; Plastic Surgery Procedures
Language	English
Publishing date	2023-03-24
Publishing country	Netherlands
Document type	Editorial
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2023.02.035
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Article ; Online: Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study.

Kennedy, Donna L / Hettiaratchy, Shehan / Alexander, Caroline M

Scars, burns & healing

2024 Volume 10, Page(s) 20595131241230742

Abstract: Introduction: The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective ... ...

Abstract	Introduction: The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. Methods: With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Results: Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. Conclusion: People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Lay summary: Background:
Language	English
Publishing date	2024-02-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2837910-X
ISSN	2059-5131 ; 2059-5131
ISSN (online)	2059-5131
ISSN	2059-5131
DOI	10.1177/20595131241230742
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Article ; Online: An evaluation of the management of severe open tibial fractures in the United Kingdom's major trauma centres.

Wilson, Elizabeth / Young, Katie / Kwasnicki, Richard / Hettiaratchy, Shehan

Injury

2024 Volume 55, Issue 6, Page(s) 111475

Abstract: Aim: To evaluate the management of patients with severe open tibial fractures at major trauma centres (MTCs) in the UK with respect to BOAST 4 guidelines.: Methods: Data collected by the Trauma and Audit Research Network (TARN) for all severe open ... ...

Abstract	Aim: To evaluate the management of patients with severe open tibial fractures at major trauma centres (MTCs) in the UK with respect to BOAST 4 guidelines. Methods: Data collected by the Trauma and Audit Research Network (TARN) for all severe open tibial fractures treated at the 23 adult MTCs were evaluated. Key performance indicators (KPIs) included MTC admission under orthoplastics, administration of antibiotics within three hours of injury, initial debridement within 24 h and definitive fixation and soft tissue coverage within 72 h. Outcomes included 30-day infection rate, amputation rate and mortality rate. A score was calculated according to overall attainment of KPIs, and correlated to outcomes. Results: From 2014 to 2020, 3359 adults with Gustilo-Anderson (GA) IIIB and/or IIIC fractures were admitted to MTCs. Male to female ratio was 2:1 with a mean age of 43 and 65 years respectively. There was a negative correlation between KPI score and mortality rate (r=-0.4929, p = 0.0169). Direct admission to an MTC was positively correlated with receipt of antibiotics within three hours (r = 0.5452, p = 0.0070). Joint orthoplastic plans were documented in 89 % of patients (MTC range 30-95 %). Soft tissue cover was achieved within 72 h for 48 % (MTC range 5.23-89.39 %). Patients over 65 were significantly more likely to have a delay to MTC admission and prophylactic antibiotic administration. Mortality rate in this group was 6% vs 2 % in those under 65. The older cohort were twice as likely to require an amputation. Conclusion: This is the largest cohort of open tibial injuries managed in the UK with wide variation in practice between centres demonstrated and better adherence to BOAST guidelines linked to reduced mortality in those aged 65 and over. The older cohort of patients also had higher rates of infection and amputation. It is unclear whether these poor outcomes are due to the pre-morbid physiological status of the patient or non-compliance to Standards. We present these data to highlight the need for improved adherence to Standards - the adoption of a scoring system provides a simple way to evidence this.
Language	English
Publishing date	2024-03-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2024.111475
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Selective non-operative management for penetrating extremity trauma (SNOM-PET).

Khajuria, Ankur / Hettiaratchy, Shehan

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2019 Volume 72, Issue 4, Page(s) 685–710

MeSH term(s)	Abdominal Injuries ; Humans ; Positron-Emission Tomography ; Wounds, Penetrating
Language	English
Publishing date	2019-01-14
Publishing country	Netherlands
Document type	Letter ; Comment
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2019.01.015
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Article ; Online: Pulse oximetry for the diagnosis of vascular injury following limb trauma.

Kwasnicki, Richard Mark / Burgin, Joseph / Paton, Christopher / Hettiaratchy, Shehan

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2022 Volume 75, Issue 9, Page(s) 3182–3189

Abstract: Prompt diagnosis and intervention are essential for acute limb ischaemia after trauma. Guidelines for diagnosis are changing with new evidence. Pulse oximetry may be a useful adjunct. We aim to assess the value of pulse oximetry and other common tests ... ...

Abstract	Prompt diagnosis and intervention are essential for acute limb ischaemia after trauma. Guidelines for diagnosis are changing with new evidence. Pulse oximetry may be a useful adjunct. We aim to assess the value of pulse oximetry and other common tests for diagnosing vascular injury. Electronic medical records of patients with limb injuries were identified. Patient demographics, the mechanism of injury, comorbidities, the results of diagnostic tests or examinations, and the end outcome were extracted. Receiver Operator Characteristics (ROC) curves were used to calculate cut-offs with optimum sensitivity and specificity for pulse oximetry. Performance characteristics to predict vascular injury for all documented tests were calculated and compared. SpO2 values were significantly different in the group with and without vascular disruption (p = 0.034). Using a cut-off of 96% calculated from ROC curve analysis, SpO
MeSH term(s)	Humans ; Ischemia/diagnosis ; Ischemia/etiology ; Oximetry/methods ; Oxygen ; Peripheral Vascular Diseases ; Sensitivity and Specificity ; Vascular System Injuries/diagnosis
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2022-05-01
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2022.04.080
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Article: Quantifying the Limitations of Clinical and Technology-based Flap Monitoring Strategies using a Systematic Thematic Analysis.

Kwasnicki, Richard M / Noakes, Alex J / Banhidy, Norbert / Hettiaratchy, Shehan

Plastic and reconstructive surgery. Global open

2021 Volume 9, Issue 7, Page(s) e3663

Abstract: Background: Multiple techniques exist to monitor free flap viability postoperatively, varying with practical and personal preference, yet the limitations of each technique remain unquantified. This systematic review aims to identify the most commonly ... ...

Abstract	Background: Multiple techniques exist to monitor free flap viability postoperatively, varying with practical and personal preference, yet the limitations of each technique remain unquantified. This systematic review aims to identify the most commonly reported limitations of these techniques in clinical practice. Methods: A systematic review was conducted according to PRISMA guidelines using MEDLINE, EMBASE, and Web of Science with search criteria for postoperative free flap monitoring techniques. Search results were independently screened using defined criteria by two authors and a senior clinician. Limitations of the techniques found in the discussion section of eligible articles were recorded and categorized using thematic analysis. Results: A total of 4699 records were identified. In total, 2210 articles met the eligibility criteria and were subsequently reviewed, with 195 papers included in the final analysis. The most frequently reported limitations of clinical monitoring were interpretation requiring expertise (25% of related papers), unsuitability for buried flaps (21%), and lack of quantitative/objective values (19%). For noninvasive technologies, the limitations were lack of quantitative/objective values (21%), cost (16%), and interpretation requiring expertise (13%). For invasive technologies, the limitations were application requiring expertise (25%), equipment design and malfunction (13%), and cost (13%). Conclusions: This is the first systematic review to quantify the limitations of different flap monitoring techniques, as reported in the literature. This information may enhance the choice in monitoring strategy for a reconstructive service, and inform the development and refinement of new flap monitoring technologies.
Language	English
Publishing date	2021-07-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000003663
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Article ; Online: Analysis of 983 civilian blast and ballistic casualties and the generation of a template of injury burden: An observational study.

Maitland, Laura / Middleton, Lawrence / Veen, Harald / Harrison, David J / Baden, James / Hettiaratchy, Shehan

EClinicalMedicine

2022 Volume 54, Page(s) 101676

Abstract: Background: Terrorism and armed conflict cause blast and ballistic casualties that are unusual in civilian practice. The immediate surgical response to mass casualty events, with civilians injured by these mechanisms, has not been systematically ... ...

Abstract	Background: Terrorism and armed conflict cause blast and ballistic casualties that are unusual in civilian practice. The immediate surgical response to mass casualty events, with civilians injured by these mechanisms, has not been systematically characterised. Standardising an approach to reacting to these events is challenging but is essential to optimise preparation for them. We aimed to quantify and assesses the surgical response to blast and ballistic injuries managed in a world-class trauma unit paradigm. Methods: This was an observational study conducted at the UK-led military Medical Treatment Facility, Camp Bastion, Afghanistan from original theatre log-book entries between Nov 5, 2009, and Sept 21, 2014; a total of 10,891 consecutive surgical cases prospectively gathered by surgical teams were catalogued. Patients with combatant status/wearing body-armour to various degrees including interpreters were excluded from the study. Civilian casualties that underwent primary trauma surgery for blast and ballistic injuries were included ( Findings: The three most common surgical procedures for civilian blast injuries were debridement, amputation, and laparotomy. For civilian ballistic injuries, these were debridement, laparotomy and vascular procedures. Blast injuries generated more amputations in both adults and children compared to ballistic injuries. Blast injuries generated more removal of fragmentation material compared to ballistics injuries amongst adult casualties. Ballistic injuries lead to more chest drain insertions in adults. As a rate per 100 casualties, adults injured by blast underwent significantly more debridement (63·5); temporary skeletal stabilisation (13·2) and vascular procedures (12·8) compared to children (43·4, Interpretation: This is the first evidence-based, template of the immediate response required to manage civilians injured by blast and ballistic mechanisms. The template presented can be applied to similar conflict zones and to prepare for terror attacks on urban populations. Funding: The work was supported in part by a grant to LM from School of Medicine, University of St Andrews.
Language	English
Publishing date	2022-09-29
Publishing country	England
Document type	Journal Article
ISSN	2589-5370
ISSN (online)	2589-5370
DOI	10.1016/j.eclinm.2022.101676
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Book: Plastic surgery

Hettiaratchy, Shehan

a problem based approach

2012

Author's details	Shehan Hettiaratchy ... [et al.], (editors)
MeSH term(s)	Reconstructive Surgical Procedures
Language	English
Size	xix, 244 p. :, ill.
Publisher	Springer
Publishing place	London
Document type	Book
Note	Includes index.
ISBN	9781848821156 ; 1848821158 ; 9781848821163 ; 1848821166
Database	Catalogue of the US National Library of Medicine (NLM)

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Article ; Online: Triaging of respiratory protective equipment on the assumed risk of SARS-CoV-2 aerosol exposure in patient-facing healthcare workers delivering secondary care

Prashanth Ramaraj / Ruben Doyle / Christopher Aylwin / Shehan Hettiaratchy

BMJ Open, Vol 10, Iss

a rapid review

2020 Volume 10

Abstract: Objectives In patient-facing healthcare workers delivering secondary care, what is the evidence behind UK Government personal protective equipment (PPE) guidance on surgical masks versus respirators for SARS-CoV-2 protection?Design Two independent ... ...

Abstract	Objectives In patient-facing healthcare workers delivering secondary care, what is the evidence behind UK Government personal protective equipment (PPE) guidance on surgical masks versus respirators for SARS-CoV-2 protection?Design Two independent reviewers performed a rapid review. Appraisal was performed using Critical Appraisal Skills Programme checklists and Grading of Recommendations, Assessment, Development and Evaluations methodology. Results were synthesised by comparison of findings and appraisals.Data sources MEDLINE, Google Scholar, UK Government COVID-19 website and grey literature.Eligibility criteria Studies published on any date containing primary data comparing surgical facemasks and respirators specific to SARS-CoV-2, and studies underpinning UK Government PPE guidance, were included.Results Of 30 identified, only 3 laboratory studies of 14 different respirators and 12 surgical facemasks were found. In all three, respirators were significantly more effective than facemasks when comparing protection factors, reduction factors, filter penetrations, total inspiratory leakages at differing particle sizes, mean inspiratory flows and breathing rates. Tests included live viruses and inert particles on dummies and humans. In the six clinical studies (6502 participants) included the only statistically significant result found continuous use of respirators more effective in clinical respiratory illness compared with targeted use or surgical facemasks. There was no consistent definition of ‘exposure’ to determine the efficacy of respiratory protective equipment (RPE). It is difficult to define ‘safe’.Conclusions There is a paucity of evidence on the comparison of facemasks and respirators specific to SARS-CoV-2, and poor-quality evidence in other contexts. The use of surrogates results in extrapolation of non-SARS-CoV-2 specific data to guide UK Government PPE guidance. The appropriateness of this is unknown given the uncertainty over the transmission of SARS-CoV-2.This means that the evidence base for UK ...
Keywords	Medicine ; R ; covid19
Subject code	306
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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