Plastic surgery and burns

Buckinghamshire Healthcare NHS Trust’s department of Plastic Surgery and Burns Care is the regional specialist burns unit for adults and children, part of the London and South East Burns Network.
The department offers planned and emergency care, including:

Skin cancer treatment
Breast reconstruction service
Elective hand and congenital hand surgery
Complex upper limb reconstruction for spinal injuries patients
Hypospadias repair
Burns emergency care
Burns elective reconstruction including laser treatment
Complex wound treatment
Plastic surgery emergencies

Our emergency work is based at Stoke Mandeville Hospital, while our elective operating is done at Stoke Mandeville and Wycombe hospitals.
Our outpatient clinics run at Stoke Mandeville, Wycombe, Amersham, Buckingham, Thame, Marlow, Newport Pagnell and Leighton Buzzard.

Skin cancer treatment

• all types of benign skin lesions requiring plastic surgical intervention, with funding approval
• all types of skin cancers with or without lymph node involvement. We also provide a sentinel lymph node service for specific types of melanoma. This service forms part of the regional skin cancer multi-disciplinary team (MDT) and is supported by our specialist skin cancer nurse.
• intraoral tumours are managed via the head and neck MDT at Churchill Hospital, Oxford, while soft tissue sarcomas via the MDT at John Radcliffe Hospital, Oxford
• our expansion to 9 consultants allows us to meet the needs of the local community, with shorter waiting times for referral to clinic and >92% compliance on the Referral to Treatment pathway
• we are planning to create a ‘See and Treat’ service
• the service lead is Mr Budny, while the operations are performed by Mr Budny, Mr Ghosh, Miss Murray and Mr Tanos

Breast reconstruction service

• according to current guidelines, the option of breast reconstruction should be offered to all women considering or undergoing mastectomy, unless not advised for specific contraindications
• we cater for all types of breast conditions requiring plastic surgical input, ranging from congenital to those secondary to breast cancer. Our department offers a full range of reconstructive options from immediate to delayed techniques in conjunction with our breast cancer surgeons, including implant-based to autologous tissue based reconstructions e.g. DIEP flap reconstruction. We are planning to offer areola tattooing in the near future
• high volume free flap breast reconstruction service, with success rate of 98%
• the service lead is Mr M Tyler, while the operations are performed mainly by Mr M Tyler, Miss A Murray, Mr G Tanos and Mr P Govilkar

Elective hand and congenital hand surgery

• all types of general adult and paediatric upper limb problems including nerve compression syndromes, Dupuytren’s disease and arthritis
• specialist care and plastic surgical input for patients with rheumatoid disease and other arthritis - care is managed jointly with our trust rheumatologists.
• complex upper limb reconstructive services for patients with spinal injuries, including tendon and nerves transfers, are provided by our team working closely with the National Spinal Injuries Centre
• all types of congenital hand deformities for paediatric patients, from removal of extra digits to complex cases, such as syndactyly (joint fingers) and underdeveloped or duplicate thumb deformities
• Hand surgery is provided by Mr T Heywood, Mr P Govilkar, Miss R Shirley and Mr C Powell

Hypospadias surgery

• this condition affects 1 in 300 boys and is related to a deformity of the urogenital system, where the urethra meatus (opening of the urethra) is not centred over the glans of the penis, but misplaced more proximally on the shaft
• it can also be related to a cord that prevents straight erectile function, causing a curvature that interferes with function.
• treatment includes one or two stage reconstruction and our team offers treatment according to national guidelines
• the service is run by Mr S Ghosh

Burn emergency care

• all types of acute burn injuries in adults and children with varying mechanisms. As a designated burns unit, we can treat patients with injuries below the accepted unit level of 40% total body surface area TBSA in adults and 20% TBSA in children
• we are part of the London and South East Burns Network, with a highly skilled multi-disciplinary team, made up of specialist consultant surgeons, specialist nurses, occupational therapists, physiotherapists, psychologists, a dietician and a social worker
• we have six beds for adult patients on our Burns Unit and two beds for paediatric burns, on the paediatric ward 3, at Stoke Mandeville Hospital
• as part of our diagnostic process, our unit is utilising laser Doppler imaging that facilitates the assessment of burn depth on day 2-5 post injury
• the service lead is Miss Murray, while the operations are performed by Miss Murray, Mr Tyler, Mr Ghosh and Mr Tanos

Burns elective reconstruction

• we offer elective treatment to patients that had burn injuries in the past and have recovered with problematic scars that lead to functional, psychological and cosmetic problems.
• we offer all aspects of scar therapy and psychological help which is dedicated to the burns patients
• surgical techniques include release or resurfacing of burn scars and reconstruction with skin grafting or replacement of layers with artificial skin products. We also offer reconstruction of scars with local or free flaps, and the use of tissue expanded skin, that is ways of introducing non-burned tissue from the patient’s own body into the burn scars, to break contractures and restore mobility and function.
• we run complex scar clinics every month, where patients are seen and combined treatment options are offered on individualised basis. We are one of the two units in the country that now offer fractional carbon dioxide laser treatment for complex scars (thanks to ScanAppeal and charitable burns funds)
• the service lead is Miss Murray, while the operations are performed by Miss Murray, Mr Tyler, Mr Ghosh and Mr Tanos

Complex wound treatment

• as part of our joint work with other specialities, we often deal with the management and reconstruction of complex wounds
• Stoke Mandeville Hospital hosts the National Spinal Injuries Centre and we offer joint care to patients with pressure ulcers and complex wounds that present wound healing challenges. We employ techniques that include debridement, negative pressure therapy and reconstruction with a wide variety of flaps that imports well vascularised tissue from the patient’s body to help in the healing of a complex wound.
• we also offer reconstruction to patients with complex perineal wounds, such as patients treated for colorectal or urogenital cancer, that need reconstruction with muscle or skin flaps to restore function and healing
• the operations are performed by Miss Murray, Mr Ghosh, Mr Tyler, Miss Shirley and Mr Powell

Plastic surgery emergencies

• all types of plastic surgical trauma including all hand (bony and soft tissue) and the full range of soft tissue trauma in adults and children, with the exception of major trauma and open lower limb fractures which are managed at John Radcliffe Hospital, Oxford
• microsurgical facilities for the replantation of amputated digits or devascularised hand injuries
• acute soft tissue problems and infections requiring specialist plastic surgical input and acute surgical intervention, including the care of patients with complex skin loss including necrotising fasciitis
• we run regular combined hand follow up clinics, where patients are seen after their operation, for wound check and replacement of their cast or splints, while they can start an early rehabilitation regime under the care of our specialist physiotherapists and occupational therapists
• emergency care is provided by our junior doctors on a 24/7 basis, under the direct supervision of our Consultants on a weekly rolling rota basis. This is soon to include the provision of daily consultant-led emergency clinics for rapid review and decision making for all trauma patients.