Smoking when operating, 9 events, Scaphoids & Landmark Papers

Get insights in the the impact of surgical smoke, deep dive on scaphoids, 9 upcoming events & P'Fella answers your questions.
Smoking when operating, 9 events, Scaphoids & Landmark Papers

In this week's edition

  1. ✍️ Letter from P'Fella
    Smoking in the Operating Room 🚬
  2. 🤓 The Sunday Quiz
    The scaphoid & its blood supply
  3. 🎭 New & Upcoming
    9 upcoming events to check out.
  4. 📸 Image of the Week
    AI-generated scar revision.
  5. 🐣 Tweets of the Week
    P'Fella's 3 favourite tweets
  6. 🤔 Ask P'Fella
    Tips to improve your surgical markings.
  7. 📝 Articles of the Week
    3 hot reads on sensation, antibiotics and carpal tunnel.
    Deep dive: should we treat scaphoid fractures?
  8. 💕 Feedback
    Always looking to improve :)

BTW: You can ask P'Fella a question here.

A Letter from P'Fella

Smoking in the Operating Room 🚬 

👋
Happy Sunday,

There's a smoky issue lurking in our operating rooms and it's becoming a surgeon's unintended cigarrete. Surgical smoke may be as bad, if not worse, than cigarettes. Let's dive in!

Read more 👇

Today, I'm diving deep into an issue that's been 'floating' around our operating rooms: surgical smoke. Thought your only encounter with smoke was when passing by that local cigar lounge? Think again.

A slew of evidence published has shed light on a surprising revelation: the smoke generated during surgical procedures could be as harmful, if not worse, than puffing on those notorious cigarettes.

What's in the Smoke?

Surgical smoke arises from operated tissues, releasing more than just visible fumes:

  • Cellular Material: Contains both dead and live cells, risking disease transmission.
  • Water Vapor: While abundant, the real concern lies in what's mixed with it.
  • Chemicals: Houses over 80 harmful substances, including benzene and formaldehyde.
  • Viruses & Bacteria: Certain procedures release viruses and possibly aerosolized bacteria.
  • Odorous Compounds: The distinctive smell hints at various, sometimes carcinogenic, compounds.

Effectiveness of the evacuation systems

What's the Impact?

Surgical smoke presents silent threats in the operating room. From the review "A systematic review of the harmful effects of surgical smoke inhalation on operating room personnel":

  • Particle Size: Easily inhalable.
  • Viral Presence: Contains viral DNA.
  • Chemicals: Packed with carcinogens, often beyond safe levels.

Further, the study "Impact of Surgical Smoke on the Surgical Team and Operating Room Nurses" indicates:

Category Description
Carcinogenicity Elevates cancer risks.
Mutagenicity Potential for genetic changes.
Respiratory Diseases Linked to various lung issues.
Pathogenic Spread Can transmit HPV DNA and HBV.
Tumor Transmission Risks moving tumor cells.


Considering this, exhaust ventilation and protective measures are crucial. And ventilation works! Just check out the data above. Your thoughts on this subject? Hit reply and let's chat.

Lots of love,

P'Fella ❤️

The Sunday Quiz

The Scaphoid's Blood Supply 🩸

The scaphoid's vascular supply is predominantly retrograde, intricately moving from distal to proximal. It primarily receives its blood supply from the radial artery, which further bifurcates into the dorsal carpal branch and the superficial palmar/volar branch.

These vessels enter the scaphoid through distal half of the bone.

Multiple Choice Question

What percentage of the scaphoid bone's intraosseous blood supply is provided by the radial artery, and how is the remaining supply distributed?

  • A) 60-70% by the radial artery, 30-40% by the volar branch
  • B) 70-80% by the radial artery, 20-30% by the superficial palmar/volar branch
  • C) 50-60% by the radial artery, 40-50% by the dorsal carpal branch
  • D) 80-90% by the radial artery, 10-20% by the ulnar artery



New and Upcoming

Educational Tools, Events & Courses

P'Fella spotlights impactful events, crucial webinars, and hand-picked courses we know you'll love. Also, if there's a new feature, you'll be the first to know right here.

9 Upcoming Events

  1. World Reconstructive Microsurgery - 18th August
  2. New Zealand Plastics Annual - Queenstown, 18 August
  3. PLASTA Facial Rehabilitation - 30th August 
  4. BAPRAS Celtic Meeting - Dunblane, 14th Sept. 
  5. ASSH Annual Meeting - Toronto, 5th October
  6. BAPRAS Cleft Lip, Palate & EAR - Sheffield, 10th Oct
  7. European Hand Trauma Congress - Bulgaria, Oct 19. 
  8. Plastic Surgery - The Meeting: Texas, 26th Oct
  9. BAPRAS Congress - 29th Nov

Image of the Week

AI-generated clinical images

Patient requiring oral commissure reconstruction post dog-bite.

Tweets of the Week

Don't forget to follow P'Fella!

Ask P'Fella

You ask, I'll answer

Every Sunday, you can ask P'Fella anything related to plastic surgery. You'll be answered the following week. Let's check out what questions came in. 

Pedro's Question, from Mexico.

Hola, desde Mexico , soy residente de primer año y tengo mucho problema con lo de los marcajes preoperatorios , siento que necesito mejorar mi relación con el espacio y la orientación , hay videos de marcajes o algo que ayude..?

Translation: Hello, from Mexico, I am a first-year resident and I have a lot of problems with the preoperative markings, I feel that I need to improve my relationship with space and orientation, are there videos of markings or something that helps...?



First off, kudos for reaching out! We've all been there, and trust me, preoperative markings can be tricky at first. But with time and practice, it'll become second nature.

Here are some tips to help you out:

  1. Videos: Check out YouTube. There are tons of surgeons sharing their marking techniques for different procedures. It's a goldmine!
  2. Workshops: Keep an eye out for any local workshops or conferences. They often have hands-on sessions where you can learn from the pros.
  3. Find a Mentor: If there's someone at your place who's a whiz at markings, maybe shadow them for a bit? It's always great to learn from someone with experience.
  4. Simulators: There are some cool surgical simulators out there. They might help you get the hang of things.
  5. Back to Basics: A quick anatomy refresher never hurts. There are some cool apps out there that can help with this.
  6. Feedback: After you're done, ask someone to check your markings. It's the best way to learn.

Hang in there, and keep practicing. And remember, every surgeon started where you are now.



3 questions submitted in the last 24 hours...

Articles of the Week

3 must-read articles, 1 deep-dive! 📚

3 Must-reads

  1. Sensation in lower limb flap reconstruction
    Kim et al. The Fate of Sensation in Noninnervated Perforator Free Flaps in the Lower Extremity. Plastic and Reconstructive Surgery 152(2):p 440-449, August 2023.
  2. Decrease your use of antibiotics in hand surgery
    McKay et al. Evidence-Based Antibiotic Prophylaxis in Clean Hand Surgeries: An Educational Intervention to Decrease Use. J Hand Surg Am. 2023 Aug;48(8):770-779.
  3. Endoscopic carpal tunnel release, not a good idea?
    Carroll et al. Endoscopic Versus Open Carpal Tunnel Surgery: Risk Factors and Rates of Revision Surgery. J Hand Surg Am. 2023 Aug;48(8):757-763.

How should we treat Scaphoid Fractures?


This study investigates surgical versus non-surgical treatments for scaphoid fractures, focusing on those with displacements of 2mm or less. The multicenter, randomized trial shows no significant difference in pain and function beyond 12 weeks, but surgical fixation can increase complications.

Read the deep-dive!

Feedback

P'Fella is always looking to make this weekly newsletter as good as can be!

Let me know your thoughts below :) 

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