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Biomedical subjects

R W Griffiths

Publications and source records attributed to R W Griffiths.

At least 19 recordsLinked to original sources
PubMed1999

Audit of histologically incompletely excised basal cell carcinomas: recommendations for management by re-excision.

In an audit of 1392 basal cell carcinomas arising in 1165 patients, excised under the care of one consultant in the 10 years from 1988 to 1997, 99 (7%) were reported histologically as incompletely excised. Lateral margins alone were involved in 54 (55%), deep margins in 36 (36%) and both in 9 (9%). Although the policy throughout this period was to re-excise all such lesions, 74/99 (75%) were re-excised (compared with an average re-excision rate of 30% through other published series). For those patients undergoing re-excision, residual tumour was reported histologically in 40/74 (54%). Peri-orbital lesions showed an overall incomplete excision rate of 13% (range 11-17%); however, only 4/16 of re-excisions in this area revealed residual tumour. Many clinicians have traditionally observed patients with incompletely excised basal cell carcinomas. The present study reports the largest series of re-excisions after incomplete excision of basal cell carcinoma, and has revealed that on the balance of probability such re-excisions will reveal residual tumour. Re-excision appears the appropriate course in almost all the anatomical areas studied although, with the exception of the inner canthus, periorbital lesions will have a low probability of residual tumour being identified.

Adolescent↗
PubMed1995

A retrospective analysis of the results of 218 consecutive rhinoplasties.

In a 7-year period, 218 consecutive rhinoplasties were performed within a joint rhinoplasty service comprising a plastic surgeon and an otorhinolaryngologist. Retrospective analysis of these procedures revealed a minor surgical complication rate of 5%, no major complications and requests for revisional surgery in 10% of patients after primary rhinoplasty by the service. However when patients had not had their first operation by our joint service, the revisional operation rate after our first operation was 19%. These results are discussed in relation to other published series. The data generated should enable more precise preoperative patient counselling and act as a useful baseline for subsequent audit of performance. Specifically, patients should know that after rhinoplasty 1 in 10 patients may request revisional surgery. All trainers and trainees should be aware of such data on their own patients in order that standards be set and enhanced with time.

Adolescent↗
PubMed1992

Pharmacokinetics of lignocaine in children after infiltration for cleft palate surgery.

We have studied the pharmacokinetics of lignocaine in children after local infiltration for cleft palate surgery. After induction of anaesthesia, lignocaine 2.5 mg kg-1 with adrenaline 1:200,000 was injected into the palate. Blood samples were collected before and at 2, 5, 10, 15, 20, 30, 60 and 120 min after infiltration. Plasma concentrations of lignocaine were measured by a gas-liquid chromatographic technique. There were no signs of systemic toxicity on routine monitoring of the patients and the peak plasma concentrations were less than the accepted toxic values. Mean half-life was 72.9 (SEM 9.9) min, similar to that found previously in adults and children. However differences in mean clearance (24.6 (2.04) ml kg-1 min-1) and volume of distribution (0.80 (0.07) litre kg-1) were found between this and previous studies.

Anesthesia, General↗
PubMed1990

Plastic surgery outpatient audit: principles and practice of "consultant only" clinics.

The effect of instituting "consultant only" clinics on plastic surgery outpatient activity was to produce a 19% reduction in both clinic sessions and new patient bookings, but a 50% reduction in booked follow-up patients; non-attender rates reduced from 20% to 11% (Northern General Hospital, April 1986-March 1989). Mean clinic attendances reduced from 35 to 26 (Northern General Hospital) and from 33 to 27 (Barnsley District Hospital)--26% and 18%, respectively. Analysis of new referrals to such clinics in the 6 months January-June 1989 showed 41% of patients came from general practitioners, although 80% of "aesthetic" conditions came from this source. 31% of referrals were for malignancy, 51/72 (70%) being basal cell carcinomas. Malignancies waited on average 4 weeks, benign conditions 15 weeks, and "aesthetic" conditions 28 weeks from referral to consultation. Such clinic management has dramatically reduced follow-up episodes, but regulation of new patient attendances is associated with appreciable waiting times for non-malignant conditions. To reduce such waiting times and pursue a "consultant only" clinic policy nationally requires many more consultants.

Adolescent↗
PubMed1989

Skin malignancy and the reconstructive plastic surgeon.

Skin malignancy represents at least 25% of the plastic surgeon's workload. The commonest tumour, the basal cell carcinoma, usually arises in the skin of elderly patients who are frequently managed by surgery under local anaesthetic, often as outpatients. The recurrent basal cell carcinoma poses a difficult problem regardless of the primary therapy. Skin repair with direct closure or skin grafts is usually simple, but skin flaps will be needed when bone, cartilage or major neurovascular structures are exposed, or where tissue vascularity has been reduced by irradiation fibrosis. Squamous cell carcinomas of lip, ear and hand may recur as lymph node metastases despite clinical and histological clearance. Malignant melanoma continues to present as advanced disease (thick tumours) in this country, and this largely dictates prognosis, since tumour thickness is recognised as the single most important dominant prognostic variable. Incisional biopsy compromises histological microstaging and should be avoided. Indirect evidence from narrow margin excision of invasive head and neck cutaneous melanomas suggests no detriment, and narrow margin excision of melanomas is increasingly being practised.

Basal Cell Carcinoma↗
PubMed1988

Outpatient clinics.

Explore the source record for details and available documents.

Appointments and Schedules↗
PubMed1988

The bolus tie-over "pressure" dressing in the management of full thickness skin grafts. Is it necessary?

It has been taught that the bolus tie-over "pressure" dressing is essential for the successful "take" of full thickness skin grafts. This was tested in a prospective randomised trial in which 40 full thickness grafts were either managed with the conventional bolus dressing, or alternatively with quilting sutures and no dressing. Whether under local or general anaesthesia there was only one total graft failure from haematoma (tie-over bolus group) and one partial graft failure from haematoma (quilted group). Sixty-five per cent. of all grafts were performed by junior surgical trainees. The bolus tie-over "pressure" dressing does not appear essential for full thickness skin graft survival in the areas of the head and neck studied.

Aged↗
PubMed1988

Relative risk: mortality probability and plastic surgery.

Recent publications indicate an increasing interest in the description and assessment of risks related to medical and surgical treatment. The law may come to require fuller disclosure of therapeutic risks than was formerly the case. Against this background the mortality risks of plastic surgery procedures are considered in relation to other well documented mortality probabilities. The possible implications for clinical practice and "informed consent" are discussed.

Adolescent↗
PubMed1987

Necrotising fasciitis caused by dental infection.

A case of necrotising fasciitis caused by dental infection is presented, which resulted in severe mutilation but the patient survived. The diagnosis and management of this condition is discussed.

Adult↗
PubMed1987

Plastic surgery manpower, training, and prospects in Great Britain.

Compared with all other developed Western countries, Great Britain has a gross underprovision of trained and trainee plastic surgeons. As a result, it has become essential to define specific priority conditions admitted for treatment without unreasonable delay. This has resulted in large waiting lists for nonurgent surgery. In 1985 the average number of patients on each plastic surgeon's waiting list exceeded 400, of which over 60% had waited over 12 months for operative treatment. The implications of this situation for patient care and trainee experience are discussed.

Humans↗
PubMed1986

Incidence of locally metastatic ('recurrent') cutaneous malignant melanoma following conventional wide margin excisional surgery for invasive clinical stage I tumours: importance of maximal primary tumour thickness.

In a minimum 5-year follow-up study of 638 primary clinical Stage I invasive cutaneous malignant melanomas (excluding lentigo maligna melanomas) excised with conventional wide normal tissue margins, the incidence of local tumour metastasis was 48/638 (8 per cent). The incidence of locally metastatic tumours rose from 2 per cent for tumours less than 0.99 mm thick, to 14 per cent for tumours between 5 and 6 mm in thickness. The rate of local metastasis was significantly greater for tumours greater than 2.0 mm compared with tumours less than 2.0 mm thick (P less than 0.01). Despite the anatomical restrictions to wide resection margins in the head and neck, these areas had the lowest regional incidence for local tumour metastasis (2 per cent). Over the prolonged postoperative follow-up period (median 11 years) 67 per cent (32/48) of patients with locally metastatic disease died of disseminated malignant melanoma, compared with a 31 per cent mortality (180/590) for those without local disease metastasis. The term 'local recurrence' is unhelpful in our attempts to understand the pathology of malignant melanoma, and the term 'local metastasis' could replace it with benefit.

Biometry↗
PubMed1986

Observations on dermal blood flow as reflected by technetium-99m pertechnetate clearance.

Skin blood flow as reflected by the clearance rate of intradermal injections of Technetium-99m (99mTc) was studied in the skin of human volunteers and in a variety of clinical situations. In volunteers comparisons between the effect on clearance following intradermal injections of either lignocaine or lignocaine/adrenaline showed that the latter resulted in a dramatic reduction in the clearance rate of the technetium isotope and that such clearance curves exhibited no fast component. Clinical studies in grossly ischaemic skin revealed a similar absence of the fast component of isotope clearance and this was also the case for healed split thickness skin grafts. The dermal isotope clearance was also used in pedicle skin flaps both before and after clamping the axial pedicle in order to derive clearance ratios which would reflect the degree of neovascularisation to the flap. These preliminary observations suggest that the technique is safe, and easy to use in many clinical circumstances. We consider that it offers a valuable method by which changes in dermal blood flow may be quantified, when simultaneous control areas of isotope clearance are also studied. Suggestions are made for further avenues of study.

Adult↗