A pilot study of performance enhancement coaching for newly appointed urology registrars.

Objectives: To assess the feasibility of performance enhancement coaching (PEC) for newly appointed Urology registrars (ST3s), specifically: whether the concept appealed, and which areas beyond technical skills acquisition were felt to be most relevant or useful.

Subjects And Methods: All delegates on the Urology Bootcamp 2023 were invited to take part in an online survey before and after a 2-hour PEC workshop, collecting: basic demographic data, performance challenges, and the important aspects to include in, and consider with, a coaching programme. The workshop was delivered by a surgeon with a professional coaching qualification, to groups of four delegates at a time over 4 days.

Buried Autologous Breast Reconstruction: Outcomes and Technical Considerations.

The purpose of this study is to compare outcomes in patients undergoing buried and non-buried free flaps for breast reconstruction, in addition to evaluating the safety and reliability of venous flow couplers. A retrospective review was performed of all patients undergoing free flap breast reconstruction between 2013 and 2023. The primary outcomes were free flap failure, complications and the number of procedures required to complete the reconstructive journey.

Implementing mindfulness meditation in hand surgery training: a feasibility study.

Background: Surgery can be stressful, requiring decision-making and performance under pressure. The COVID-19 pandemic has further challenged surgeons' well-being and training. Excess stress adversely affects well-being, technical and non-technical performance, and, by extension, patient care.

Single-stage buried autologous breast reconstruction (BABR).

Background: Breast reconstructive standards are increasingly high oncologically, aesthetically, and practically. Autologous breast reconstruction remains the gold standard which, buried, after nipple-sparing mastectomy (where oncologically safe) or wise pattern reduction for large or ptotic patients, with contralateral symmetrisation where required, enables single-stage reconstruction. However, previous series report prohibitively high revision rates.

Trainee and trainer experiences and recommendations for plastic surgery training: A qualitative pilot study.

Background: The COVID-19 pandemic has compounded existing training issues for plastic surgeons. The issues that exist result from a complex interplay of system, generational and individual factors, and can be hard to tease out by quantitative means. This pilot study aimed to investigate the perceptions of trainees and trainers of plastic surgical training in the UK.

Utilisation of a 3D printed ex vivo flexor tendon model to improve surgical training.

Background: Surgery for hand trauma accounts for a significant proportion of the plastic surgery trainee activity. The aim of this article is to create a standardised simulation training module for flexor tendon repair techniques for residents prior to their first encounter in the clinical setting.

Methods: A step-ladder approach flexor tendon repair training with four levels of difficulty was conducted using a three-dimensional (3D) printed anatomical simulation model and a silicone tendon rod on a cohort of 28 plastic surgery Senior House Officers (SHOs) of various stages in their training (n=28).

Augmented Reality and Plastic Surgery Training: A Qualitative Study.

Background and objective The coronavirus disease 2019 (COVID-19) pandemic has led to many challenges in face-to-face teaching and training in plastic surgery. However, it has also proved to be an incubator for many technological solutions. Augmented reality (AR) platforms may offer a safe, equitable, and efficient means to provide training in plastic surgery.

A three-dimensional scar assessment tool for keloid scars: Volume, erythema and melanin quantified.

Background: There is no non-invasive objective assessment tool to measure keloid scar characteristics over time. This study aimed to ascertain the ability of the Antera 3D camera to detect differences in keloid features pre- and post-steroid injection. In order to identify whether those variation could be considered as treatment response predicting factors.

Recurrent calcifying aponeurotic fibroma of the hand: managing a rare hand tumour in an evolving healthcare landscape.

Calcifying aponeurotic fibroma (CAF) is a rare benign tumour originating from the aponeuroses of tendons and their bony insertions. A 15-year-old student presented to his general practitioner with a 1-year history of a progressively enlarging painless finger swelling. The lesion was excised by the local paediatric orthopaedic service and recurred over the course of the following 4 months.

Acellular dermal matrix reconstruction of a nail bed avulsion in a 13-year-old child.

Nail bed avulsion injuries often require reconstruction, particularly in cases where the avulsed fragment is lost. We describe a simple way to reconstruct a large nail bed defect, with no donor site. A 13-year-old boy with a hypoplastic left heart and autism accidentally sustained a left little distal phalanx injury with an avulsion of 60% of the nail bed, exposing the distal phalanx.

The optimal management of Seymour fractures in children and adolescents: a systematic review protocol.

Background: Seymour fractures are open, displaced juxta-epiphyseal fractures of the distal phalanx, with an overlying nail bed laceration that occur in children and adolescents with an open physis. This fracture occurs rarely, but its potential consequences are clinically significant. Due to anatomical particulars and proximity to the growth plate, this open fracture may result in soft tissue infection and osteomyelitis, leading to growth arrest and persistent mallet deformity.

Microvascular anastomotic coupler application learning curve: A curriculum supporting further deliberate practice in ex-vivo simulation models.

Introduction: Microvascular anastomosis with coupler devices has revolutionized microsurgery practice. Couplers are considered easier to apply and offer improved operating time while maintaining success rates. This study aims to map the learning curve, skill acquisition, and decay of novice microsurgeons in performing coupler anastomosis.

Developing a Three-Layered Synthetic Microsurgical Simulation Vessel.

Background:  Microsurgery is increasingly relevant, and is difficult to learn. Simulation is relied upon ever more in microvascular training. While living models provide the ultimate physiological feedback, we are ethically obliged to optimize non-living models to replace, refine, and reduce the use of animals in training.

Paradoxical Frontalis Activation: An Underrecognized Consequence of Facial Palsy.

Background: Aberrant reinnervation and synkinesis are common and debilitating after facial palsy. Paradoxical frontalis activation can antagonize eye closure and increase the risk of corneal damage. If recognized, judicious botulinum toxin injection to the affected side may reduce this risk.

Defining Normal Parameters for the Male Nipple-Areola Complex: A Prospective Observational Study and Recommendations for Placement on the Chest Wall.

Background: The nipple-areola complex (NAC) is important aesthetically and functionally for both sexes. Methods for positioning the NAC in males are less well established in the literature compared to females but are just as important.

Objectives: This study aims to determine the normal parameters for the male NAC, to review literature, and to present a reliable method for preoperative placement.

Bleeding on the cutting edge: A systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery.

Background: Anticoagulant and antiplatelet (AC/AP) use is common and practice surrounding AC/AP continuation or cessation peri-operatively for minor cutaneous surgery lacks evidence-based consensus.

Objective: To determine the risks of haemorrhagic and thromboembolic complications associated with the continuation or cessation of AC/AP therapy in minor cutaneous surgery.

Methods: A systematic literature search was conducted using PubMed, MEDLINE, Embase and CENTRAL, to identify all articles involving the use of AC/AP in patients undergoing minor cutaneous surgery, including skin grafts and local flaps.

Lyme disease and Bell's palsy: an epidemiological study of diagnosis and risk in England.

Background: Lyme disease is caused by a tick-borne spirochaete of the species. It is associated with facial palsy, is increasingly common in England, and may be misdiagnosed as Bell's palsy.

Aim: To produce an accurate map of Lyme disease diagnosis in England and to identify patients at risk of developing associated facial nerve palsy, to enable prevention, early diagnosis, and effective treatment.

Botulinum toxin treatment for facial palsy: A systematic review.

Background: Facial palsy may be complicated by ipsilateral synkinesis or contralateral hyperkinesis. Botulinum toxin is increasingly used in the management of facial palsy; however, the optimum dose, treatment interval, adjunct therapy and performance as compared with alternative treatments have not been well established. This study aimed to systematically review the evidence for the use of botulinum toxin in facial palsy.

Course Review: Cadaveric Hand Trauma Course.

The St Thomas' Cadaveric Hand Trauma course is described and evaluated.