Edmund Fitzgerald O'Connor

Guy's and St Thomas' NHS Foundation Trust · Department of Plastic Surgery

This chapter discusses the principles of lower limb microsurgical reconstruction with a focus on peri-operative assessment and decision-making to optimise recipient vessel selection and free tissue transfer outcomes. We will revise the relevant vascular anatomy, imaging investigation modalities and illustrate details of the surgical approach to the...

The anterolateral thigh flap is a workhorse flap for reconstructive microsurgery. Typically based on the descending branch of the lateral circumflex femoral artery, it can be designed to include a combination of skin, fascia and muscle, offering a skin paddle approximately 22 cm × 8 cm. It can be used as a pedicled flap or free flap and has been wi...

Background: The Covid-19 pandemic has compounded existing training issues for plastic surgeons. The issues which 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...

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 plast...

Major trauma may result in severe open elbow fractures with significant soft tissue injury and skin loss. Reconstruction of those defects can be complicated and inadequate cover can result in severely limited functional outcome. The free anterolateral thigh flap (ALT) is one of the ways to reconstruct those defects. Its utilisation in severe comple...

Introduction There are several reasons microsurgeons may not use coupler device in arterial anastomosis: may be thick-walled, non-pliable due to atherosclerotic calcification or present vessel geometrical discrepancies. This review summarises the current applications, efficacy, and troubleshooting of microvascular coupler devices in arterial end-to...

End-to-side arterial anastomoses require a high level of technical competency. The main challenge to a successfully patent anastomosis is intimal interposition during the standardized microvascular suturing. Technical errors during arteriotomy pose a significant challenge for the microsurgical technique, making the end-to-side anastomosis prone to...

Background Microvascular free tissue transfer has become the gold standard for breast reconstruction. While safe and reliable, there are operative complications, with hematomas developing under the free flap among the more common. These can compromise flap viability, lead to hemodynamic instability and infection. This study aims to identify predict...

Background: Peri-ankle defects are difficult to reconstruct due to sharp contours, thin skin, aesthetic value, function and footwear impact. The medial sural artery perforator flap (MSAP) is increasing in popularity as a thin and pliable flap. This study aims to demonstrate its versatility in reconstructing defects around the ankle area and our ap...

The surgical management of proximal interphalangeal joint fracture subluxations is challenging. The hemi-hamate autograft is a useful but technically challenging technique for these injuries. We describe a simple technical note, using a bone wax template to help guide the harvest of a geometrically accurate hemi-hamate graft to facilitate accurate...

Hand burns are unique in their functional, aesthetic and emotional impact on patients. Measuring the progress of a patient's ability to carry out essential and desired tasks, their emotional state, interaction with society as well as scar, pain and itch as their burn heals, has until now relied on the use of a combination of several different tools...

Introduction: Trauma is a leading cause of death and disability worldwide. Patients presenting with severe trauma and burns benefit from specifically trained multidisciplinary teams. Regional trauma systems have shown improved outcomes for trauma patients. The aim of this study is to determine whether the development of major trauma systems have i...

Hand burns represent a unique challenge to the burns team due to the intricate structure and unrivalled functional importance of the hand. The initial assessment and prognosis relies on consideration of the specific site involved as well as depth of the burn. We created a simple severity score that could be used by referring non-specialists and res...

We present the case of a 69-year-old man who was found collapsed close to a heat source and admitted to hospital for severe sepsis. He was also found to have widespread blistering and ulceration of his right leg; however, a history was unobtainable due to reduced consciousness levels. The leg lesions had the initial appearance of mixed depth burns...

Background: Stacked and bipedicled abdominal flaps are useful in women who require a large breast reconstruction but have relative paucity of abdominal tissue. A new classification system is described to assist the surgeon in achieving the best possible aesthetic outcome. Methods: A retrospective review of 25 consecutive stacked and/or bipedicle...

Background: The approach and operative techniques associated with breast reconstruction have steadily been refined since its inception, with abdominal perforator-based flaps becoming the gold standard reconstructive option for women undergoing breast cancer surgery. The current study comprises a cohort of 632 patients, in whom specific operative t...

Background: Venous couplers are ubiquitous around the world and are a useful tool for the reconstructive microsurgeon. A systematic review of coupler performance studies demonstrated a thrombosis rate range of 0% to 3%, whilst the average time of using the device is 5 minutes. There is sparse published data on cost analysis and the impact of opera...

Unlabelled: The survival of 75 consecutive digital replantations carried out between 2006 and 2010 at a regional hand centre in the United Kingdom was determined. The patient demographics, mechanism of injury, co-morbid factors, operative and post-operative details were extracted and reviewed from the medical and hand therapy notes. Predictive fac...

Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumour excision, burns, etc. There are many techniques described in the literature including residual scrotal skin mobilization, skin grafts, pedicled and free flaps. The management is complex and challenging shown by the multiplicity of flaps and techniques described in the li...

Introduction Periorbital burns are an infrequent but potentially devastating injury. This study aimed to elucidate the spectrum of such injuries presenting to a UK burns centre and the outcome achieved in the cases requiring periorbital reconstruction for the restoration of function and form. Methods Patients admitted to a UK regional burns centre...

Aims. The introduction of laser Doppler (LD) techniques to assess burn depth has revolutionized the treatment of burns of indeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At the same time we hope to highlight current controversies and areas where further research is necess...

Introduction: We report the first published description of transoral use of the transnasal flexible laryngoesophagoscope during surgical correction of choanal atresia. Case report: A four-month-old boy was referred to the ear, nose and throat department by his general practitioner with a two-week history of left-sided, watery, green, nasal disch...

The use of systemic heparin in patients with ruptured abdominal aortic aneurysms (rAAAs) remains a contentious issue with no clear guidelines. This review reports the current understanding, at a molecular and clinical level, of the possible benefits and risks of heparin in emergency aneurysm repair (both open and endovascular). MEDLINE, EMBASE, AME...

Abbreviations: GAPDH, glyceraldehyde-3-phosphate dehydrogenase; HAT, histone acetyltransferase; HDAC, histone deacetylase; IHC, immunohistochemistry; TGFβ, transforming growth factor-β

Wounds of the lower limb in patients with diabetes are frequently difficult to heal. Some wounds fail to heal despite optimal medical and surgical care. This review examines the evidence for whether free tissue transfer techniques may reduce the requirement of amputation in these patients. A systematic review. Pubmed, Embase, AMED, SCOPUS and CINAH...

Although the indications and surgical technique for cochlear implantation are well formalized, the introduction of hearing preservation surgery and electric acoustic stimulation have posed new questions for the cochlear implant clinician. This study was designed to crystallize the contemporary views of the implant community on how best to implement...

Monobloc distraction has been demonstrated to be an efficacious, safe, and stable method of providing functional and aesthetic improvement in children with syndromic craniosynostosis. Although the movement of bony structures following monobloc distraction has been quantitatively assessed before, objective analysis of the movement of soft tissues, s...

The frontofacial monobloc advancement is a safe, effective, and cosmetically acceptable treatment of frontal and midface retrusions present in craniofacial syndromes. Although a number of modifications have been put forward to supplement this procedure, the basic steps of cleaving the facial skeleton from the skull base remain the same. We present...

The UK undergraduate medical curriculum has undergone significant changes following the recommendation of Tomorrow's Doctors, a report by the UK's General Medical Council (GMC). One consequence of these reforms is believed to be an overall reduction in basic science teaching. Many anatomists, surgeons and medical students have objected to the reduc...

This survey investigated potential disparity between foundation year 1 doctors' formal undergraduate venepuncture training and their actual clinical practice. Is there still a high prevalence of needle and syringe use?