Professor Charles Malata | Anglia Ruskin Uiversity (original) (raw)

Papers by Professor Charles Malata

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2010

Since the recent introduction of ''Payment by Results'' as part o... more Since the recent introduction of ''Payment by Results'' as part of NHS financial reforms, it has been noted that there is an imbalance between allocated Healthcare Resource Group tariffs and actual resource use for certain procedures. This study was undertaken to assess the impression that bilateral breast reconstruction using autologous flaps is under-funded. Patients who underwent bilateral flap breast reconstruction following mastectomy between 2000 and 2006 at Addenbrooke's University Hospital were identified. Resource cost analysis for each patient was based on the following parameters: number of operating consultants, theatre running costs, and length of hospital stay. The estimated hospital costs were then compared to the national tariff for the Healthcare Resource Group ''Complex Breast Reconstruction using Flaps''. Over the 7-year period 24 patients underwent bilateral flap breast reconstruction (7 paired latissimus dorsi and 17 paired abdominal flaps). The mean operative time was 9.4h (£4.5/min), the mean hospital stay was 10 days (£150/day) and ten patients required 2 consultants (£34/h) operating. The average total cost equated to £5 492. The allocated tariff of £4 053 is insufficient, even before the inclusion of hidden costs. Bilateral free flap breast reconstructions are grossly under-funded at present. With increasing financial pressures on NHS Trusts there may be a drive towards simpler operations, which receive proportionally greater remuneration.

International Journal of Surgery Case Reports, 2013

Chondrosarcomas are the most common primary chest wall malignancy. The mainstay of treatment is r... more Chondrosarcomas are the most common primary chest wall malignancy. The mainstay of treatment is radical resection, which often requires chest wall reconstruction. This presents numerous challenges and more extensive defects mandate the use of microvascular free flaps. Selecting the most appropriate flap is important to the outcome of the surgery. A 71-year-old male presented with a large chondrocarcoma of the chest wall. The planned resection excluded use of the ipsilateral and contralateral pectoralis major flap because of size and reach limitations. The latissimus dorsi flap was deemed inappropriate on logistical grounds as well as potential vascular compromise. The patient was too thin for reconstruction using an abdominal flap. Therefore, following radical tumour resection, the defect was reconstructed with a methyl methacrylate polypropylene mesh plate for chest wall stability and an anterolateral thigh free flap in a single-stage joint cardiothoracic and plastic surgical procedure. The flap was anastomosed to the contralateral internal mammary vessels as the ipsilateral mammary vessels had been resected. The outcome was complete resection of the tumour, no significant impact on ventilation and acceptable cosmesis. This case demonstrates the complex decision making process required in chest wall reconstruction and the versatility of the ALT free flap. The ALT free flap ensured adequate skin cover, subsequent bulk, provided an excellent operative position, produced little loss of donor site function, and provided an acceptable cosmetic result.

AESTHETIC PLASTIC SURGERY, 2011

This report describes a case of aesthetic and functional abdominal wall reconstruction performed ... more This report describes a case of aesthetic and functional abdominal wall reconstruction performed to salvage a deformed, scarred, and herniated anterior abdomen after severe peritonitis and partial rectus muscle necrosis secondary to multiple bowel perforations sustained during liposuction performed in a cosmetic clinic. The diagnosis of intestinal perforation was missed intraoperatively and in the immediate postoperative period. The patient was admitted 4 days after the surgery to the intensive therapy unit in septicemic shock. After resuscitation and stabilization, she was treated by debridement of the abdominal wall, bowel resection, and temporary jejunostomy and colostomy (reversed 10 months later). She was referred 18 months after liposuction to the Plastic Surgery Service with a large central midline abdominal incisional hernia presenting with thinned out skin (14 9 11 cm) overlying adherent bowel. A components separation technique was successfully used to reconstruct the abdominal wall, with no recurrent herniation 2 years later. Survivors of bowel perforations sustained during abdominal liposuction may later present with challenging aesthetic and functional problems, as described in this report. These long-term sequelae have not been addressed hitherto in the literature.

Background: Complex central chest wall resection defects present a challenging management problem... more Background: Complex central chest wall resection defects present a challenging management problem for both thoracic and reconstructive surgeons. Although most chest wall defects can be repaired using local and regional flaps, more complicated cases require increasingly sophisticated techniques such as microsurgical free tissue transfer. This study reviews a single plastic surgeon's experience over a 4-year period with complex chest wall reconstruction using the anterolateral thigh free flap. Methods: Five female patients who underwent the above procedure between 2004 and 2007 were reviewed retrospectively. The clinicopathologic details recorded included histologic diagnosis, extent of resection, type of skeletal defect, flap size, receipt vessels, ischemia time, and flap/donor-site complications. Skeletal reconstruction used methylmethacrylate/polypropylene mesh sandwich prostheses. Results: The indications for surgery were metastatic breast cancer (n ϭ 3), advanced primary fibrosarcoma (n ϭ 1), and extensive radionecrosis (n ϭ 1). The average surface area of the chest wall resection was 197 cm 2 (range, 156 to 270 cm 2 ). The four patients who underwent partial sternectomy and rib resection required skeletal reconstruction and subsequent ventilatory support postoperatively in the intensive care unit. The mean anterolateral thigh flap size was 188 cm 2 (range, 143 to 252 cm 2 ); none of the donor sites was skin grafted. There was 100 percent flap survival, and the prostheses remained fully covered in all cases after a mean follow-up of 16 months (range, 5 to 28 months). No major complications were observed. Conclusions: The anterolateral thigh free flap is a safe and reliable option for reconstructing complicated composite chest wall defects. It therefore provides a practical alternative when regional pedicled flap options are unavailable or inadequate. (Plast. Reconstr. Surg. 126: 1

Annals of Plastic Surgery, 2013

This paper aims to simplify the approach to reconstruction of the perineum after resection of mal... more This paper aims to simplify the approach to reconstruction of the perineum after resection of malignancies of the anal canal, lower rectum, vulva, and vagina. The data were collected from 2 centers, namely, Addenbrooke's Hospital, University of Cambridge, United Kingdom and Christchurch Hospital, University of Otago, New Zealand. All patients who underwent perineal reconstruction from 1997 to 2009 at Christchurch Hospital (13 years) and 2001 to 2009 at Addenbrooke's Hospital (9 years) were included. The diagnosis (indication), primary surgery, reconstructive surgery, complications, tumor outcomes (recurrence and survival), and follow-up were entered into a database (Microsoft Excel; Redmond, Wash). The incidence of previous radiotherapy, requirement for adjuvant radiotherapy, and length of inpatient stay were also recorded. Forty-six patients were identified for this study--13 in New Zealand and 33 in Cambridge. Indications for perineal reconstruction included resection of anal and rectal malignancies (24), vulval and vaginal malignancy (19), perineal sarcoma (1), and perineal squamous cell carcinoma arising in an enterocutaneous fistula (Table 1). The reconstructive strategies adopted included rectus abdominis myocutaneous flaps (26), gluteal fold flaps (9), gracilis V-Y or advancement flaps (7) and others (4), gluteal rotation flaps (1), local flap (2), and free latissimus dorsi flaps (1). Although various surgeons performed the reconstructive surgeries at 2 different centers, the essential approach remained the same. Smaller defects were best treated by local flaps, whereas the rectus abdominis flap remained the standard option for larger defects that additionally required closure of dead space. On the basis of our 2 center experience, we propose a simple algorithm to facilitate the planning of reconstructive surgery for the perineum.

Scandinavian journal of infectious diseases. Supplementum, 1990

The preliminary results of a trial to examine and compare the safety, tolerability and efficacy o... more The preliminary results of a trial to examine and compare the safety, tolerability and efficacy of a single dose of teicoplanin with three doses of cephradine combined with metronidazole are presented in a series of 113 patients undergoing elective vascular surgery. There were no obvious differences in the infection rates and sepsis indicators in either group. Neither drug regimen produced any evidence of renal or hepatic damage, though the levels of three hepatocellular enzymes, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl-transferase (GGT), were seen to be transiently elevated, peaking 7 days post-operatively. The trial continues.

cambridgeshirecosmeticsurgery.co. …

... Consultant Plastic Surgeon Catherine Lau MB ChB MRCS ... The classification by Rohrich where ... more ... Consultant Plastic Surgeon Catherine Lau MB ChB MRCS ... The classification by Rohrich where the fatty and glandular tissue is determined by pinch test medially, laterally and beneath the nippleJareola complex and grades III and IV have either mild or severe ptosis, has similar ...

International Journal of Surgery, 2015

Journal of wound care, 1995

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2015

The Breast, 1992

SUMMA R Y. Recent media attention and controversy coupled with the FDA's product review have prom... more SUMMA R Y. Recent media attention and controversy coupled with the FDA's product review have prompted a reappraisal of the potential health risks of silicone breast implants. The pertinent literature on this subject is reviewed and it is concluded that:

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2007

Background: Skin-sparing mastectomy (SSM) is a well-established technique for immediate breast re... more Background: Skin-sparing mastectomy (SSM) is a well-established technique for immediate breast reconstruction (IBR). When used for large and/or ptotic breasts, traditional SSM patterns produce long skin flaps prone to necrosis or 'T' junction breakdown. The authors have previously demonstrated the applicability of the LeJour-type vertical mammaplasty skin pattern to this group of patients. With further experience, indications for this procedure have been widened and the technique refined. Results: Over five years, 26 immediate breast reconstructions were carried out in 19 patients using this technique: three expandable implants, seven LDs, three pedicled TRAMs, five free TRAMs, seven DIEPs and one SIEA flap. Fourteen patients (74%) had simultaneous contralateral balancing LeJour breast reductions or mastopexies. The remaining five patients had bilateral mastectomies and reconstructions using the vertical mammaplasty skin pattern for both breasts. All flaps were successful, but there were three cases of minor skin flap necrosis, three of delayed wound healing and two instances of significant post-operative bleeding. Cosmesis was suboptimal in the prosthetic reconstruction group, necessitating revisional surgery. Discussion and conclusions: The vertical mammaplasty skin pattern was successfully used with a wide range of reconstructions. However, to avoid suboptimal

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013

British Journal of Plastic Surgery, 1998

British Journal of Plastic Surgery, 1996

In reconstructive breast surgery, the permanent tissue expander has become popular because it avo... more In reconstructive breast surgery, the permanent tissue expander has become popular because it avoids expander-implant exchange and gives the patient some control over the final breast size. It may, however, be associated with a number of complications. We therefore analysed the clinical notes of 111 consecutive recipients of Becker breast expanders with respect to complications and their possible predisposing factors. 120 prostheses were inserted in 111 consecutive patients with a mean age of 42.6 years. Median follow-up was 12 months (range 8 to 22). The commonest indication was postmastectomy breast reconstruction (81%) followed by congenital hypoplasia (14%) and acquired breast asymmetry following repeated biopsies (3%). Overexpansion before size adjustment was achieved after an average of 8 expander inflations. Complications included capsular contracture (9%), local tumour recurrence (8%), wound dehiscence (8%), filling port failure (6%), infected prostheses (4.5%) and ruptured implants (1.6%). The significant predisposing factors to wound dehiscence/infection were heavy smoking and radiotherapy (P < or = 0.05, chi 2 test). Expansion rate was not a factor. 89% of patients expressed satisfaction with the final aesthetic result. Despite the excellent results obtained with this technique, caution must be exercised in heavy smokers and the previously irradiated.

British Journal of Plastic Surgery, 2003

Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is f... more Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is faced with a wide range of excisional and liposuction procedures. There is a paucity of literature describing an integrated approach to the management of this condition and the roles of the different treatment modalities. A review of all gynaecomastia patients operated on by one surgeon over a 2-year period was undertaken. Patient satisfaction was assessed using a linear analogue scale with a maximum score of 10. In total, 48 breasts in 29 patients were treated-31 breasts by liposuction alone (19 by conventional liposuction, 12 by ultrasound-assisted liposuction), eight breasts by liposuction and open excision, and nine breasts by liposuction, open excision and skin reduction (concentric or Lejour mastopexy). There were no early postoperative complications, such as haematoma, seroma or infection, and 91% of patients were very satisfied (score: 8 -10) with their cosmetic outcome. The most frequently encountered complication was a residual subareolar lump (five breasts), all in patients treated by conventional liposuction alone. In order to avoid the common complication of an uncomfortable residual subareolar nodule, the threshold for open excision in patients undergoing conventional liposuction should be low. Ultrasound-assisted liposuction extends the role of liposuction in gynaecomastia patients. Although skin excess remains a challenge, it can be satisfactorily managed without excessive scarring. A practical approach to the surgical management of gynaecomastia, which takes into account breast size, consistency, skin excess and skin quality, is proposed. q

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 1993

90 consecutive free tissue transfers to the upper limb have been performed in 75 patients (33 chi... more 90 consecutive free tissue transfers to the upper limb have been performed in 75 patients (33 children and 42 adults) by one surgeon over a 3-year period. The average age for children was 5 years, and 25 years in adults. 17 transfers were performed as emergency or urgent procedures. The main indications were congenital and traumatic defects. Included in this series were 44 toe transfers, 28 lateral arm flaps and six functional muscle transfers. The overall succes 99%. The re-exploration rate was 5.6% with only one failure. There were no failures i

Eplasty, 2012

The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis wh... more The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis which was previously resistant to multiple surgical procedures and nonoperative treatment of chronic nipple sepsis. We employed a multidisciplinary approach to the treatment of end-stage periductal mastitis using a combination of central breast excision and immediate autologous latissimus dorsi flap reconstruction. Clearance of periductal mastitis and infection has been achieved with no recurrence at 3 years. Good symmetry of breast shape and volume has been achieved using this technique. This method of partial breast reconstruction, commonly used for reconstruction of breast cancer ablative defects, may also provide good outcomes in nonmalignant disease.

Journal of wound care, 2014

Peripheral vascular disease (PVD) is a condition requiring aggressive management to minimise the ... more Peripheral vascular disease (PVD) is a condition requiring aggressive management to minimise the associated increased morbidity and mortality. Femoro-distal bypass grafting is used in patients with extensive occlusion affecting the crural arteries and poor limb function, but is associated with infection, wound dehiscence and graft exposure. We report a case of a 73-year-old male with history of PVD and occluded ipsilateral femoro-distal bypass graft who underwent limb salvage surgery with a left 6 mm heparin-bonded polytetrafluoroethylene femoro-distal bypass graft in September 2011. He later presented with exposure of the graft over the lateral aspect of the knee following wound dehiscence. During surgery, the exposed portion of the graft was covered by a lateral gastrocnemius muscle flap with an overlying split thickness skin graft. Minor donor site healing problems were noted, but he otherwise made an excellent recovery. While gastrocnemius muscle flaps have been used to cover so...

Journal of wound care, 2005

Full-thickness periumbilical wounds after extensive abdominal surgery present a major challenge. ... more Full-thickness periumbilical wounds after extensive abdominal surgery present a major challenge. In this case report the traditional tensor fasciae latae flap was modified, improving flap mobility while also facilitating donor defect repair.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2010

Since the recent introduction of ''Payment by Results'' as part o... more Since the recent introduction of ''Payment by Results'' as part of NHS financial reforms, it has been noted that there is an imbalance between allocated Healthcare Resource Group tariffs and actual resource use for certain procedures. This study was undertaken to assess the impression that bilateral breast reconstruction using autologous flaps is under-funded. Patients who underwent bilateral flap breast reconstruction following mastectomy between 2000 and 2006 at Addenbrooke's University Hospital were identified. Resource cost analysis for each patient was based on the following parameters: number of operating consultants, theatre running costs, and length of hospital stay. The estimated hospital costs were then compared to the national tariff for the Healthcare Resource Group ''Complex Breast Reconstruction using Flaps''. Over the 7-year period 24 patients underwent bilateral flap breast reconstruction (7 paired latissimus dorsi and 17 paired abdominal flaps). The mean operative time was 9.4h (£4.5/min), the mean hospital stay was 10 days (£150/day) and ten patients required 2 consultants (£34/h) operating. The average total cost equated to £5 492. The allocated tariff of £4 053 is insufficient, even before the inclusion of hidden costs. Bilateral free flap breast reconstructions are grossly under-funded at present. With increasing financial pressures on NHS Trusts there may be a drive towards simpler operations, which receive proportionally greater remuneration.

International Journal of Surgery Case Reports, 2013

Chondrosarcomas are the most common primary chest wall malignancy. The mainstay of treatment is r... more Chondrosarcomas are the most common primary chest wall malignancy. The mainstay of treatment is radical resection, which often requires chest wall reconstruction. This presents numerous challenges and more extensive defects mandate the use of microvascular free flaps. Selecting the most appropriate flap is important to the outcome of the surgery. A 71-year-old male presented with a large chondrocarcoma of the chest wall. The planned resection excluded use of the ipsilateral and contralateral pectoralis major flap because of size and reach limitations. The latissimus dorsi flap was deemed inappropriate on logistical grounds as well as potential vascular compromise. The patient was too thin for reconstruction using an abdominal flap. Therefore, following radical tumour resection, the defect was reconstructed with a methyl methacrylate polypropylene mesh plate for chest wall stability and an anterolateral thigh free flap in a single-stage joint cardiothoracic and plastic surgical procedure. The flap was anastomosed to the contralateral internal mammary vessels as the ipsilateral mammary vessels had been resected. The outcome was complete resection of the tumour, no significant impact on ventilation and acceptable cosmesis. This case demonstrates the complex decision making process required in chest wall reconstruction and the versatility of the ALT free flap. The ALT free flap ensured adequate skin cover, subsequent bulk, provided an excellent operative position, produced little loss of donor site function, and provided an acceptable cosmetic result.

AESTHETIC PLASTIC SURGERY, 2011

This report describes a case of aesthetic and functional abdominal wall reconstruction performed ... more This report describes a case of aesthetic and functional abdominal wall reconstruction performed to salvage a deformed, scarred, and herniated anterior abdomen after severe peritonitis and partial rectus muscle necrosis secondary to multiple bowel perforations sustained during liposuction performed in a cosmetic clinic. The diagnosis of intestinal perforation was missed intraoperatively and in the immediate postoperative period. The patient was admitted 4 days after the surgery to the intensive therapy unit in septicemic shock. After resuscitation and stabilization, she was treated by debridement of the abdominal wall, bowel resection, and temporary jejunostomy and colostomy (reversed 10 months later). She was referred 18 months after liposuction to the Plastic Surgery Service with a large central midline abdominal incisional hernia presenting with thinned out skin (14 9 11 cm) overlying adherent bowel. A components separation technique was successfully used to reconstruct the abdominal wall, with no recurrent herniation 2 years later. Survivors of bowel perforations sustained during abdominal liposuction may later present with challenging aesthetic and functional problems, as described in this report. These long-term sequelae have not been addressed hitherto in the literature.

Background: Complex central chest wall resection defects present a challenging management problem... more Background: Complex central chest wall resection defects present a challenging management problem for both thoracic and reconstructive surgeons. Although most chest wall defects can be repaired using local and regional flaps, more complicated cases require increasingly sophisticated techniques such as microsurgical free tissue transfer. This study reviews a single plastic surgeon's experience over a 4-year period with complex chest wall reconstruction using the anterolateral thigh free flap. Methods: Five female patients who underwent the above procedure between 2004 and 2007 were reviewed retrospectively. The clinicopathologic details recorded included histologic diagnosis, extent of resection, type of skeletal defect, flap size, receipt vessels, ischemia time, and flap/donor-site complications. Skeletal reconstruction used methylmethacrylate/polypropylene mesh sandwich prostheses. Results: The indications for surgery were metastatic breast cancer (n ϭ 3), advanced primary fibrosarcoma (n ϭ 1), and extensive radionecrosis (n ϭ 1). The average surface area of the chest wall resection was 197 cm 2 (range, 156 to 270 cm 2 ). The four patients who underwent partial sternectomy and rib resection required skeletal reconstruction and subsequent ventilatory support postoperatively in the intensive care unit. The mean anterolateral thigh flap size was 188 cm 2 (range, 143 to 252 cm 2 ); none of the donor sites was skin grafted. There was 100 percent flap survival, and the prostheses remained fully covered in all cases after a mean follow-up of 16 months (range, 5 to 28 months). No major complications were observed. Conclusions: The anterolateral thigh free flap is a safe and reliable option for reconstructing complicated composite chest wall defects. It therefore provides a practical alternative when regional pedicled flap options are unavailable or inadequate. (Plast. Reconstr. Surg. 126: 1

Annals of Plastic Surgery, 2013

This paper aims to simplify the approach to reconstruction of the perineum after resection of mal... more This paper aims to simplify the approach to reconstruction of the perineum after resection of malignancies of the anal canal, lower rectum, vulva, and vagina. The data were collected from 2 centers, namely, Addenbrooke's Hospital, University of Cambridge, United Kingdom and Christchurch Hospital, University of Otago, New Zealand. All patients who underwent perineal reconstruction from 1997 to 2009 at Christchurch Hospital (13 years) and 2001 to 2009 at Addenbrooke's Hospital (9 years) were included. The diagnosis (indication), primary surgery, reconstructive surgery, complications, tumor outcomes (recurrence and survival), and follow-up were entered into a database (Microsoft Excel; Redmond, Wash). The incidence of previous radiotherapy, requirement for adjuvant radiotherapy, and length of inpatient stay were also recorded. Forty-six patients were identified for this study--13 in New Zealand and 33 in Cambridge. Indications for perineal reconstruction included resection of anal and rectal malignancies (24), vulval and vaginal malignancy (19), perineal sarcoma (1), and perineal squamous cell carcinoma arising in an enterocutaneous fistula (Table 1). The reconstructive strategies adopted included rectus abdominis myocutaneous flaps (26), gluteal fold flaps (9), gracilis V-Y or advancement flaps (7) and others (4), gluteal rotation flaps (1), local flap (2), and free latissimus dorsi flaps (1). Although various surgeons performed the reconstructive surgeries at 2 different centers, the essential approach remained the same. Smaller defects were best treated by local flaps, whereas the rectus abdominis flap remained the standard option for larger defects that additionally required closure of dead space. On the basis of our 2 center experience, we propose a simple algorithm to facilitate the planning of reconstructive surgery for the perineum.

Scandinavian journal of infectious diseases. Supplementum, 1990

The preliminary results of a trial to examine and compare the safety, tolerability and efficacy o... more The preliminary results of a trial to examine and compare the safety, tolerability and efficacy of a single dose of teicoplanin with three doses of cephradine combined with metronidazole are presented in a series of 113 patients undergoing elective vascular surgery. There were no obvious differences in the infection rates and sepsis indicators in either group. Neither drug regimen produced any evidence of renal or hepatic damage, though the levels of three hepatocellular enzymes, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl-transferase (GGT), were seen to be transiently elevated, peaking 7 days post-operatively. The trial continues.

cambridgeshirecosmeticsurgery.co. …

... Consultant Plastic Surgeon Catherine Lau MB ChB MRCS ... The classification by Rohrich where ... more ... Consultant Plastic Surgeon Catherine Lau MB ChB MRCS ... The classification by Rohrich where the fatty and glandular tissue is determined by pinch test medially, laterally and beneath the nippleJareola complex and grades III and IV have either mild or severe ptosis, has similar ...

International Journal of Surgery, 2015

Journal of wound care, 1995

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2015

The Breast, 1992

SUMMA R Y. Recent media attention and controversy coupled with the FDA's product review have prom... more SUMMA R Y. Recent media attention and controversy coupled with the FDA's product review have prompted a reappraisal of the potential health risks of silicone breast implants. The pertinent literature on this subject is reviewed and it is concluded that:

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2007

Background: Skin-sparing mastectomy (SSM) is a well-established technique for immediate breast re... more Background: Skin-sparing mastectomy (SSM) is a well-established technique for immediate breast reconstruction (IBR). When used for large and/or ptotic breasts, traditional SSM patterns produce long skin flaps prone to necrosis or 'T' junction breakdown. The authors have previously demonstrated the applicability of the LeJour-type vertical mammaplasty skin pattern to this group of patients. With further experience, indications for this procedure have been widened and the technique refined. Results: Over five years, 26 immediate breast reconstructions were carried out in 19 patients using this technique: three expandable implants, seven LDs, three pedicled TRAMs, five free TRAMs, seven DIEPs and one SIEA flap. Fourteen patients (74%) had simultaneous contralateral balancing LeJour breast reductions or mastopexies. The remaining five patients had bilateral mastectomies and reconstructions using the vertical mammaplasty skin pattern for both breasts. All flaps were successful, but there were three cases of minor skin flap necrosis, three of delayed wound healing and two instances of significant post-operative bleeding. Cosmesis was suboptimal in the prosthetic reconstruction group, necessitating revisional surgery. Discussion and conclusions: The vertical mammaplasty skin pattern was successfully used with a wide range of reconstructions. However, to avoid suboptimal

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013

British Journal of Plastic Surgery, 1998

British Journal of Plastic Surgery, 1996

In reconstructive breast surgery, the permanent tissue expander has become popular because it avo... more In reconstructive breast surgery, the permanent tissue expander has become popular because it avoids expander-implant exchange and gives the patient some control over the final breast size. It may, however, be associated with a number of complications. We therefore analysed the clinical notes of 111 consecutive recipients of Becker breast expanders with respect to complications and their possible predisposing factors. 120 prostheses were inserted in 111 consecutive patients with a mean age of 42.6 years. Median follow-up was 12 months (range 8 to 22). The commonest indication was postmastectomy breast reconstruction (81%) followed by congenital hypoplasia (14%) and acquired breast asymmetry following repeated biopsies (3%). Overexpansion before size adjustment was achieved after an average of 8 expander inflations. Complications included capsular contracture (9%), local tumour recurrence (8%), wound dehiscence (8%), filling port failure (6%), infected prostheses (4.5%) and ruptured implants (1.6%). The significant predisposing factors to wound dehiscence/infection were heavy smoking and radiotherapy (P < or = 0.05, chi 2 test). Expansion rate was not a factor. 89% of patients expressed satisfaction with the final aesthetic result. Despite the excellent results obtained with this technique, caution must be exercised in heavy smokers and the previously irradiated.

British Journal of Plastic Surgery, 2003

Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is f... more Numerous techniques have been described for the correction of gynaecomastia, and the surgeon is faced with a wide range of excisional and liposuction procedures. There is a paucity of literature describing an integrated approach to the management of this condition and the roles of the different treatment modalities. A review of all gynaecomastia patients operated on by one surgeon over a 2-year period was undertaken. Patient satisfaction was assessed using a linear analogue scale with a maximum score of 10. In total, 48 breasts in 29 patients were treated-31 breasts by liposuction alone (19 by conventional liposuction, 12 by ultrasound-assisted liposuction), eight breasts by liposuction and open excision, and nine breasts by liposuction, open excision and skin reduction (concentric or Lejour mastopexy). There were no early postoperative complications, such as haematoma, seroma or infection, and 91% of patients were very satisfied (score: 8 -10) with their cosmetic outcome. The most frequently encountered complication was a residual subareolar lump (five breasts), all in patients treated by conventional liposuction alone. In order to avoid the common complication of an uncomfortable residual subareolar nodule, the threshold for open excision in patients undergoing conventional liposuction should be low. Ultrasound-assisted liposuction extends the role of liposuction in gynaecomastia patients. Although skin excess remains a challenge, it can be satisfactorily managed without excessive scarring. A practical approach to the surgical management of gynaecomastia, which takes into account breast size, consistency, skin excess and skin quality, is proposed. q

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 1993

90 consecutive free tissue transfers to the upper limb have been performed in 75 patients (33 chi... more 90 consecutive free tissue transfers to the upper limb have been performed in 75 patients (33 children and 42 adults) by one surgeon over a 3-year period. The average age for children was 5 years, and 25 years in adults. 17 transfers were performed as emergency or urgent procedures. The main indications were congenital and traumatic defects. Included in this series were 44 toe transfers, 28 lateral arm flaps and six functional muscle transfers. The overall succes 99%. The re-exploration rate was 5.6% with only one failure. There were no failures i

Eplasty, 2012

The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis wh... more The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis which was previously resistant to multiple surgical procedures and nonoperative treatment of chronic nipple sepsis. We employed a multidisciplinary approach to the treatment of end-stage periductal mastitis using a combination of central breast excision and immediate autologous latissimus dorsi flap reconstruction. Clearance of periductal mastitis and infection has been achieved with no recurrence at 3 years. Good symmetry of breast shape and volume has been achieved using this technique. This method of partial breast reconstruction, commonly used for reconstruction of breast cancer ablative defects, may also provide good outcomes in nonmalignant disease.

Journal of wound care, 2014

Peripheral vascular disease (PVD) is a condition requiring aggressive management to minimise the ... more Peripheral vascular disease (PVD) is a condition requiring aggressive management to minimise the associated increased morbidity and mortality. Femoro-distal bypass grafting is used in patients with extensive occlusion affecting the crural arteries and poor limb function, but is associated with infection, wound dehiscence and graft exposure. We report a case of a 73-year-old male with history of PVD and occluded ipsilateral femoro-distal bypass graft who underwent limb salvage surgery with a left 6 mm heparin-bonded polytetrafluoroethylene femoro-distal bypass graft in September 2011. He later presented with exposure of the graft over the lateral aspect of the knee following wound dehiscence. During surgery, the exposed portion of the graft was covered by a lateral gastrocnemius muscle flap with an overlying split thickness skin graft. Minor donor site healing problems were noted, but he otherwise made an excellent recovery. While gastrocnemius muscle flaps have been used to cover so...

Journal of wound care, 2005

Full-thickness periumbilical wounds after extensive abdominal surgery present a major challenge. ... more Full-thickness periumbilical wounds after extensive abdominal surgery present a major challenge. In this case report the traditional tensor fasciae latae flap was modified, improving flap mobility while also facilitating donor defect repair.