THE BLOND McINDOE AWARD FOR OVERCOMING ADVERSITY

On Thursday, the 27th of September, I was part of a strong team of surgeon scientists from the University of Manchester attending the Blond McIndoe award for overcoming adversity. Led by Prof. McGrouther and Terenghi, we were received by the Royal College of Surgeons of England, and hosted by Peter Blond, Chairman of the Blond McIndoe Research Foundation.
The award was presented by the President of the Royal College of Surgeons, in honour of Dame Simone Prendergast, Member of the Court of Patrons - Royal College of Surgeons, to one of the few surviving members of the Guinea Pig Club.
The Guinea Pig Club represents all those pilots who benefitted from the care and treatment of Archibald McIndoe at the Queen Victoria Hospital, East Grinstead, during the Second World War. These patients were pioneers for many of the reconstructive surgery techniques in use today.

The Guinea Pig Club Anthem (sung to the tune of 'The Church's one Foundation)

 We are McIndoe's army
 We are his Guinea Pigs
With dermatomes and pedicles
Glass eyes, false teetch and wigs
And when we get our discharge
We'll shout with all our might:
'Per ardua ad astra'
We'd rather drink than fight

John Hunter runs the gas works
Ross Tilley wields the knife
And if they are not careful
They'll have your flaming life
So, Guinea Pigs, stand ready

For all your surgeon's calls:
And if their hands aren't steady
They'll whip off both your balls

We've had some Australians
Some French, some Czechs, some Poles
We've even had some Yankees
God bless their precious souls
While as for the Canadians
Ah, that's a different thing
They couldn't stand our accent
And built a separate wing

Tougher sentences for dangerous dogs do not go far enough

There has been much interest in the media regarding the rising number of dog bite victims admitted to hospital. This follows extensive coverage in the national press after the death of John Paul Massey in 2009, as well as the year-on-year rise highlighted by a recent article in The Telegraph. Data from Hospital Episode statistics (HES) and the Health and Social Care Information Centre (HSCIC) demonstrate that hospital admissions as a direct result of being bitten or struck by a dog has risen by almost a third in four years. The severity of these dog bite injuries also warrants consideration in light of the distinct mechanisms of injury.

Dog bites can be classified into ‘snap and release’, or ‘grip and retain’. It is this latter mechanism that is associated with increasing severity of injuries with dogs locking unto their victims and shaking them. According to Richard Milner, President of The British Association of Plastic, Reconstructive, and Aesthetic Surgeons (BAPRAS), ‘the really bad wounds that you occasionally see are caused by the dog being very aggressive and shaking and biting again’.

 Stricter laws for ‘dangerous dogs’ require urgent and immediate attention. The Dangerous Dogs Act 1991 currently prohibits any dog of the type ‘pit bull terrier’ or ‘Japanese tosa’ from being in a public place without being muzzled or kept on a leash. Under new Sentencing Council guidelines, which come into force in August 2012, the new advice for judges and magistrates aims to encourage the courts to use harsher sentences when dealing with dangerous dog offences. The offence will now have a starting point of six months in jail – and, where appropriate, judges are encouraged to consider up to 18 months imprisonment. Other breeds are subject to dog control orders enforced by the Department for Environment Food and Rural Affairs, which make it an offence for a dog to be on public land without a lead.

As the vast majority of dog bites occur in the home, the ability of leash laws to minimise dog bites is questionable. It is not only pit bulls causing harm. Hence, it is necessary for laws to be brought into force, which protects the victim from dog bites in domestic settings. The Sentencing Council has broadened the definition of vulnerable victims to include children, the elderly, disabled, and blind or visually impaired people. It may be necessary for laws to protect such vulnerable groups from direct contact with dangerous dogs, even at home. 

Sparks!

Having attended the 3rd meeting of the fifth series of the Instructional Courses in Hand Surgery at the Manchester Conference Centre, I came across fantastic international speakers. Some of their work includes leprosy, tetraplegia and cerebral palsy. This disability prevents children from leading what you and I would consider a 'normal' lifestyle.

http://www.youtube.com/watch?feature=player_embedded&v=Iz0V9Nm0zAo

Sparks is one of the only charities funding research across a whole spectrum of conditions that includes Cerebral Palsy. Around 70 babies in the UK are born every day with conditions that can affect them for life. I have decided to do my bit to support this worthwhile charity by registering to run the Brighton Marathon. In doing so, I hope to raise £500 so that Sparks doesn't run out of money.

To help realise this goal, please log into  http://www.justgiving.com/Obi-Wan  

The PIP Silicone Gel Breast Implant Scandal

PIP Silicone Gel Breast Implants

Having assisted in the first national case of Poly Implant Prothese (PIP) breast implant removal following the international scandal, I have just written a case report for publication in the BJS Snapshots in Surgery. Watch this space...

The PIP breast implant scandal has affected an estimated 40,000 British women. The entrepreneur at the centre of the global storm, Jean-Claude Mas was apprehended with Claude Couty, the former Chief Executive of PIP, and the pair are in police custody following admissions that unapproved Silicone was used in the breast implants.

The Department of Health recommends removal or exchange of ruptured implants. For patients without symptoms or signs of rupture or leak, removal should be offered in cases where the Surgeon considers that the benefits outweigh the risks. The NHS will replace the implants if the original operation was done by the NHS.

Patients from the private sector who have been unable to secure help from their original provider will be eligible for help from the NHS. The government has offered implant removal but implants will not be replaced in these patients.

There is no link to cancer and there is no clear evidence of an increased risk of harm compared to other brands of breast implants. Nevertheless, the Medicines and Healthcare products Regulatory Agency (MHRA) is collecting data based on explants in order to further inform the debate.

Watch this space...

What's new in Plastic Surgery training?

The specialty of plastic and reconstructive surgery is that branch of surgery concerned with the restoration of normal form and function. I prefer the term, 'Reconstructive' surgery, as it leans away from the mainstream trend of nip tucks, face lifts, and boob jobs, though these are justified.

It is a varied specialty involving adults and children, and encompassing a wide range of conditions affecting different parts of the body. Implicit in the wide ranging nature of the specialty is the requirement that a Consultant in Plastic Surgery demonstrates a high level of skill, experience, and judgement in carrying out all the roles that his/her job entails.

The curriculum and training programmes are designed to produce surgeons competent to take up such Consultant appointments in the UK. The curriculum is designed to provide trainees in the specialty of Plastic Surgery with a structured training programme that will enable them to progress from the introductory stages of training through to the level required of a surgeon working independently as a Consultant in the NHS.

FUTURE TRENDS
There are approximately 300 Consultants in the UK, which translates into 1:205,000 population. To achieve the recommendation made by the Senate of Surgery of 1 Consultant per 100,000 population for the UK and to allow a Consultant delivered service, a doubling of Consultant numbers to 600 will be required.

Over the coming months, the focus of work at the Joint Committee on Surgical Training (JCST) will be updating the Plastic Surgery curricula (last version updated in 2010 by Vivian Lees, SAC chair). I wait in anticipation for what the new curriculum will propose for trainees in Plastic Surgery.