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Oral presentation / British Journal of Oral and Maxillofacial Surgery 49S (2011) S1–S25 S23
effects of infections to healing time or final outcomes, pro-
phylactic antibiotics are not indicated for any elective skin
cancer surgery.
doi:10.1016/j.bjoms.2011.04.058
58
Facial lacerations—what makes for less painful local
anaesthetic infiltration?
N. Vig∗, A. Ujam, J. Haq, S. Holmes
Barts and The London, United Kingdom
Introduction: This paper asks whether administration of
local anaesthetic infiltration within a wound is more comfort-
able than administration dermally (through intact skin) in the
treatment of facial lacerations.
The vast majority of lacerations presenting in the emer-
gency setting are sutured under local anaesthetic and
infiltrationcan be very uncomfortable. Currently, no evidenceexists to support this as in-wound infiltration as less painful
than through-skin for facial wounds, and so practice varies.
Methods: A prospective, single-blind, randomised study
was conducted at a busy London teaching hospital. Exclu-
sions included patients aged below 16, and patients with
heavily contaminated wounds. Subjects received local anaes-
thetic within the wound on one side, and dermally on the
other, and visual analogue pain scale was used to measure
pain after each injection. They were also asked to report
which was more painful.
Results: Preliminary results of the study are based on 36
patients to date (total dataset to include 70 patients). Median
pain scoreswerehigher in those infiltrated dermally versus in-
wound (40 mmvs 16mm; p < 0.001). Order of infiltration has
no bearing on the result. There was also significant difference
in patients reporting the dermal injection as more painful than
the subcutaneous ( p < 0.001).
Conclusion: Early results of this study demonstrate in-
wound infiltration as a more comfortable option in achieving
anaesthesia for facial lacerations and should be used where
clinically indicated.
doi:10.1016/j.bjoms.2011.04.059
59
Mortality and morbidity from combat neck injury
J. Breeze∗, L.S. Allanson-Bailey, N.C. Hunt, R.J. Delaney,
A.E. Hepper, J. Clasper
Academic Department of Military Surgery and Trauma,
Royal Centre for Defence Medicine, United Kingdom
Introduction: Neck injury represents 11% of battle
injuries in UK forces in comparison to 2–5% in US forces.
The aim of this study was to determine the causes of
death and long-term morbidity from combat neck injury in
an attempt to recommend new methods of protecting the
neck.
Method: Hospital and post mortemrecords for all UK ser-
vicemen sustaining battle injuries to the face or eye between
01 January 2006 and 31 October 2010 were analysed.
Results: Neck wounds were found in 152/1528 (10%) of
battle injured service personnel. 79% of neck wounds weredue to explosions and were associated with a mortality rate
of 41% compared to 78% from gunshot wounds. Current UK
neck collars can potentially protect zone I from explosive
fragments but all service personnel in this series chose not to
wear them. The most common cause of death from explosive
fragments was vascular injury (85%). 14% of survivors sus-
tained permanentcomplications from theirneck wound. Zone
II was the most commonly affected area overall by explosive
fragments (57%) but Zone I was associated with the highest
morbidity in survivors.
Conclusions: Nape protectors, that cover zone III of the
neck posteriorly, would only have potentially prevented 3%
of injuries and therefore this study does not support their
use. Had current neck collars been worn, potentially 22% of
wounds could have been prevented. Modifications to neck
collar design have been implemented that maintain exist-
ing surface area coverage but will reduce load and thermal
burden.
doi:10.1016/j.bjoms.2011.04.060
60
OMFS referral: an audit of standard practice and pilot
of a novel web-based referral system
N. Cronin∗, S. Dev, J. Coombes, K. Fan
Kings College Hospital, London, United Kingdom
Introduction: Oral and Maxillofacial surgery (OMFS)
telephone referrals can be a protracted process. As King’s
moves to electronic records, a web referral system may
improve delivery of maxillofacial services.
Aim: To review the traditional inter-hospital telephone
referral pathway, implement a web-based referral pathway,
and compare their effectiveness.
Methods: Both pathways were audited using a proforma
by the referring and receiving teams. The ease and speed of
referral, availability of information, accessibility of OMFSon-call and educational value were assessed.
Results: The appraisal of the telephone pathway demon-
strated a good service by the OMFS on-call team: speed
and accessibility of referrals were very satisfactory, as evi-
dence by respective average scores of 7.5/10 and 9/10 on
Likert scales of user satisfaction. However, the traditional
telephone referral pathway was of limited educational value
(3.1/10). The OMFS team scored the traditional telephone
referral 4.6/10 for adequacy of information provided by the
referrer, improving to 9/10 with web-referrals.
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