{"title":"Hyperhidrosis","authors":"Daryll Baker","doi":"10.1016/j.mpsur.2024.10.002","DOIUrl":"10.1016/j.mpsur.2024.10.002","url":null,"abstract":"<div><div>Hyperhidrosis is the excess production of abnormal quantities of normal sweat. It affects up to 5% of the population. A careful history confirms the diagnosis and determines the sites affected and the physical and psychological severity of the problem. Armed with this, appropriate treatment can be initiated. It is usual to progress along the “hyperhidrosis treatment ladder” gradually increasing the degree of intervention. Long term follow up and adapting management is needed.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 850-856"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ioana Cosgarea, Thomas Oliphant, Sahan Rannan-Eliya, Neil Rajan
{"title":"Melanoma","authors":"Ioana Cosgarea, Thomas Oliphant, Sahan Rannan-Eliya, Neil Rajan","doi":"10.1016/j.mpsur.2024.09.007","DOIUrl":"10.1016/j.mpsur.2024.09.007","url":null,"abstract":"<div><div>The treatment of melanoma has witnessed groundbreaking changes over the last decade, transforming the standard of care for patients with high-risk, advanced or metastatic disease. Whilst the treatment approach depends on the stage of disease, the management of primary melanoma remains complete wide excision of the primary. Sentinel node biopsy is offered in selected higher risk melanoma and complete nodal dissection is performed in patients who present with palpable nodal disease. Tumour genetic analysis for <em>BRAF</em> mutation should be performed in all patients with stage IIB to IV disease as this will determine if patients are suitable for targeted treatment with BRAF and MEK inhibitors. Systemic treatment with targeted treatment with BRAF and MEK inhibitors and immunotherapy are recommended as adjuvant treatment options and in metastatic settings. Patients with a personal or family history of three or more melanomas require genetic assessment.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 827-833"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of burn injury","authors":"Eunsol Kim, Peter J. Drew","doi":"10.1016/j.mpsur.2024.08.005","DOIUrl":"10.1016/j.mpsur.2024.08.005","url":null,"abstract":"<div><div>Burns are a major cause of morbidity and mortality worldwide. Vulnerable people such as children, the frail and elderly, and the socially deprived are at particular risk. Most burns are caused by thermal injury to the skin, but electrical and chemical burns can be very severe. Fortunately, most burns are minor and superficial and can be managed by primary healthcare professionals. However, major and severe burns require in-hospital management from a team of surgeons and other specialists. Life-threatening conditions such as smoke inhalation airway damage and severe fluid loss should be addressed during the initial resuscitation. Prevention of further thermal damage by cooling is important along with prevention of secondary infection of burn injuries. A wide variety of dressings is available for the management of burns and expert nursing care is vital. Surgical intervention may be urgently required for fasciotomy or escharotomy in cases of compartment syndrome or circumferential burns, respectively. Debridement, skin grafting and reconstructive procedures will be required over the medium or long term for patients with severe or complex burns and should be planned with appropriate multidisciplinary expertise. The functional and psychological impact of major burn injury should not be underestimated.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 842-849"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diabetic foot disease","authors":"Pasha Normahani, Joseph Shalhoub","doi":"10.1016/j.mpsur.2024.08.004","DOIUrl":"10.1016/j.mpsur.2024.08.004","url":null,"abstract":"<div><div>Diabetic foot disease, or ulceration, is prevalent and is associated with high rates of lower limb amputation and mortality. Its underlying aetiology is complex and multifactorial. However, neuropathy and peripheral arterial disease represent two important precipitating risk factors. Regular, comprehensive foot examinations are important in the prevention of ulceration and cardiovascular complications as they provide an opportunity to assess risk, modify risk factors and deliver patient education. Charcot neuropathic osteoarthropathy is commonly misdiagnosed and should always be suspected in an individual with diabetes presenting with a hot and swollen foot. Diabetic foot ulcers are challenging to manage. The key to optimizing outcomes includes early diagnosis with referral for coordinated multidisciplinary care where prompt treatment of infection and peripheral arterial disease, as well as appropriate wound care and offloading, can be initiated and monitored.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 834-841"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prevention of surgical site infections","authors":"Nicola Reeves, Jared Torkington","doi":"10.1016/j.mpsur.2024.08.003","DOIUrl":"10.1016/j.mpsur.2024.08.003","url":null,"abstract":"<div><div>Surgical site infections (SSIs) may affect up to 40% of patients post-operatively depending on the type of operation. They are a burden both for the patient and the healthcare system due to the valuable resources they consume, with each colorectal SSI costing the National Health Service (NHS) on average £10,523 per patient. SSIs can be classified as superficial, deep and/or organ/space, and there are many modifiable and non-modifiable risk factors. There has been recent published guidance on SSI prevention by a number of international organizations including the World Health Organization (WHO) in 2016, the Centers for Disease Control and Prevention (CDC) in 2017 and the National Institute for Health and Care Excellence (NICE) in 2020.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 800-804"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The pathology of healing and repair","authors":"Norman J. Carr","doi":"10.1016/j.mpsur.2024.08.006","DOIUrl":"10.1016/j.mpsur.2024.08.006","url":null,"abstract":"<div><div>Tissues that have been damaged respond by complex interactions between haemostatic, inflammatory and immunological mechanisms. Understanding these processes is central to promoting good outcomes in clinical practice, whether the injury is due to a disease or to the surgeon’s scalpel. Although there are common themes that apply throughout the body, the details vary according to the type of injury and the tissues involved. This article describes general principles of healing by regeneration and repair, then wound healing in the skin by primary and secondary intention is used to illustrate the stages of haemostasis, inflammation, proliferation and remodelling. Healing mechanisms in the central nervous system and bone are also discussed, as are complications that can result from repair processes. Factors affecting healing and repair are covered with emphasis on principles relevant to surgery.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 793-799"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Physiology of the skin","authors":"Jasmine Shah, Gerard McKnight, Rachel Hargest","doi":"10.1016/j.mpsur.2024.09.008","DOIUrl":"10.1016/j.mpsur.2024.09.008","url":null,"abstract":"<div><div>The skin is the main interface between the individual and the environment. It has essential physiological functions which allow the individual to live safely, even under changing external conditions which might pose potential threats. The most important physiological function of the skin is protection against various forms of noxious stimuli including physical and chemical trauma, micro-organisms and radiation. The skin and its appendages are also vital for thermoregulation. Several modalities of sensation are mediated via the skin allowing the individual to recognize the context of their relationship to the environment. The skin is a significant water-storage organ. Although it mainly acts as a barrier, the skin does have some ability to absorb various substances, particularly lipophilic compounds. Synthesis of vitamin D occurs in sun-exposed skin and is the major site of production in normal health. It is important for surgeons to understand the functions of the skin and the process of wound healing in order to recognize when clinical problems occur and to appreciate how patients with disordered skin physiology are likely to respond to traumatic or surgical injury.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 788-792"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgical anatomy of the skin","authors":"Matthew McKenna, Megan Allman, Rachel Hargest","doi":"10.1016/j.mpsur.2024.08.008","DOIUrl":"10.1016/j.mpsur.2024.08.008","url":null,"abstract":"<div><div>The skin is the largest organ in the body and forms the interface between the body and the environment. Its structure is highly adapted to protect the body from many forms of noxious agents, to maintain homeostasis in several physiologic domains and to allow the individual to appreciate various modalities of sensation. The skin is divided into three layers – the epidermis, dermis and hypodermis (or subcutaneous tissue). The epidermis is a continually regenerating structure formed mainly from keratinocytes which account for the majority of cells in the epidermis. The pigment melanin, produced in the melanocyte cells of the epidermis is a major factor in determining skin colour. The dermis supports and gives strength and flexibility to the epidermis. It contains multiple blood vessels, lymphatics and nerves within its connective tissue architecture. The hypodermis is composed of various amounts of subcutaneous fat which plays a role in thermoregulation and water storage. It is essential that surgeons have a good knowledge of the structure of skin in order to choose the optimum site for surgical incisions, to understand the best methods of wound closure and to anticipate potential problems with wound healing. Furthermore, recognizing the role of specialist advice from plastic, reconstructive, or trauma surgeons is crucial for managing wounds that are complex, large, involve underlying structures, or are located on exposed skin such as the face and neck.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 781-787"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Wound dressings","authors":"Samantha Holloway, Sarah Bradbury","doi":"10.1016/j.mpsur.2024.08.009","DOIUrl":"10.1016/j.mpsur.2024.08.009","url":null,"abstract":"<div><div>The purpose of wound dressings is to support the local wound environment to facilitate wound healing. Dressings range from simple or passive dressings that essentially provide a contact layer to protect the wound bed from further damage and maintain a moist environment, to more advanced or interactive dressings that can modify the physiology of the wound milieu to optimize healing by, for example, promoting debridement, enhancing granulation tissue formation and re-epithelialization, managing exudate levels and bacterial load. There are also bioactive dressings which can change the cellular or biological aspects of the wound, an example of this would be a topical antimicrobial product. Hence a fundamental prerequisite to choosing the most appropriate dressing is having a clear objective in mind. Essential to this is an accurate assessment of the wound. This article will describe the features of the clinical assessment process as a basis for understanding the principles of wound management and provide details of various dressings and devices together with the indications and limitations of their use.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 805-813"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical features and management of pressure ulcers for the general surgeon","authors":"Annie Price, Ian Williams","doi":"10.1016/j.mpsur.2024.08.002","DOIUrl":"10.1016/j.mpsur.2024.08.002","url":null,"abstract":"<div><div>Although widely considered to be preventable, pressure ulcers (PU) are common and cause a significant burden to the individual, their carers and healthcare services. International collaborative panels publish consensus documents and guidelines aiming to standardize PU classification, assessment and management. There is a huge emphasis on prevention, which requires awareness and education for clinicians, patients and carers. Surgeons may be referred patients with PU for advice on surgical options or management of infected wounds. Surgical patients may develop PU after prolonged surgical procedures, during periods of critical illness or in association with their surgical condition. Additionally, as some PU become chronic and non-healing, individuals with PU may be referred for assessment of other medical issues. An awareness and understanding of PU aetiology, management strategies and complications are therefore important for the surgical trainee.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 11","pages":"Pages 814-819"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142656100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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