A Mixed Methods Feasibility Study of Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers

Hitchman, L; Totty, J; Lathan, R; Sidapra, M; Smith, G; Carradice, D; Chetter, I

doi:10.1093/bjs/znab259.1127

Hand and Wrist Trauma: AntimicrobIals and Infection – Audit of Clinical Practice (HAWAII - ACP) (2024)
Journal Article
Shafi, S., Yoshimura, R., Harrison, C., Wade, R., Shaw, A., Totty, J., …Wormald, J. (2024). Hand and Wrist Trauma: AntimicrobIals and Infection – Audit of Clinical Practice (HAWAII - ACP). Bone & Joint Open, 5(4), 361-366. https://doi.org/10.1302/2633-1462.54.BJO-2023-0144.R1

Aims
Hand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore resu... Read More about Hand and Wrist Trauma: AntimicrobIals and Infection – Audit of Clinical Practice (HAWAII - ACP).

The role of sentinel lymph node biopsy in the management of Merkel Cell Carcinoma – a systematic review and meta-analysis (2024)
Journal Article
Kanakopoulos, D., Lacey, H., Payne, A., Houlihan, M., Riyat, H., Wheelan, R., Cubitt, J., & Totty, J. (2024). The role of sentinel lymph node biopsy in the management of Merkel Cell Carcinoma – a systematic review and meta-analysis. Plastic and Reconstructive Surgery Global Open, 12(4), Article e5760. https://doi.org/10.1097/GOX.0000000000005760

Background:
Merkel cell carcinoma (MCC) is a rare cutaneous malignancy with high metastatic potential. Sentinel lymph node biopsy (SLNB) is used to assess locoregional spread, facilitate staging, and inform prognosis. Positive nodal status is assoc... Read More about The role of sentinel lymph node biopsy in the management of Merkel Cell Carcinoma – a systematic review and meta-analysis.

The cost of keeping warm: the relationship between a rise in the cost of domestic energy and burn injuries caused by personal heating equipment (2024)
Journal Article
Totty, J. P., Austin, O., Umair Anwar, M., Muthayya, P., & Phipps, A. R. (2024). The cost of keeping warm: the relationship between a rise in the cost of domestic energy and burn injuries caused by personal heating equipment. Burns, 50(6), 1475-1479. https://doi.org/10.1016/j.burns.2024.03.025

INTRODUCTION
During 2022-2023, the UK found itself in the midst of a domestic energy crisis, with the average domestic gas and electricity bill rising by 75% between 2019 and 2022. As a result, the use of hot water bottles, radiant heaters, and elec... Read More about The cost of keeping warm: the relationship between a rise in the cost of domestic energy and burn injuries caused by personal heating equipment.

The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy (2023)
Journal Article
McMillan, A., Ho, N., Izard, C., Matteucci, P., & Totty, J. (online). The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, https://doi.org/10.1016/j.bjps.2023.10.086

Background
Lymph node surgery, is commonly performed in staging of, and treatment of metastatic skin cancer. Previous studies have demonstrated sentinel lymph node biopsy (SLNB) and particularly lymph node dissection (LND) to be plagued by high rate... Read More about The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy.

Electrochemotherapy vs radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies: A systematic review and narrative synthesis (2023)
Journal Article
McMillan, A., McElroy, L., O’Toole, L., Matteucci, P., & Totty, J. (2023). Electrochemotherapy vs radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies: A systematic review and narrative synthesis. PLoS ONE, 18(7), Article e0288251. https://doi.org/10.1371/journal.pone.0288251

Background
Electrochemotherapy has gained international traction and commendation in national guidelines as an effective tool in the management of cutaneous malignancies not amenable to surgical resection. Despite this, no level 5 evidence exists co... Read More about Electrochemotherapy vs radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies: A systematic review and narrative synthesis.

Considerations for a Post-Surgical Wound Dressing Aligned with Anti-Microbial Stewardship Objectives: A Scoping Review (2023)
Journal Article
Ousey, K., Rippon, M., Rogers, A., & Totty, J. (2023). Considerations for a Post-Surgical Wound Dressing Aligned with Anti-Microbial Stewardship Objectives: A Scoping Review. Journal of Wound Care, 32(6), 334-347. https://doi.org/10.12968/jowc.2023.32.6.334

Background: Most surgical wounds heal by primary intention or secondary intention. Surgical wounds can present specific and unique challenges including wound dehiscence and surgical site infection, either of which can increase risk of morbidity and m... Read More about Considerations for a Post-Surgical Wound Dressing Aligned with Anti-Microbial Stewardship Objectives: A Scoping Review.

PRESS survey: PREvention of surgical site infection—a global pan-specialty survey of practice protocol (2023)
Journal Article
Heinz, J., Walshaw, J., Kwan, J. Y., Long, J., Carradice, D., Totty, J., …Yiasemidou, M. (2023). PRESS survey: PREvention of surgical site infection—a global pan-specialty survey of practice protocol. Frontiers in Surgery, 10, Article 1251444. https://doi.org/10.3389/fsurg.2023.1251444

Background: Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across differen... Read More about PRESS survey: PREvention of surgical site infection—a global pan-specialty survey of practice protocol.

Long term outcomes of ‘Christmas Tree’ banding for haemodialysis access induced distal ischemia: A 13-year experience (2022)
Journal Article
Ravindhran, B., Totty, J. P., Sidapra, M., Lathan, R., Carradice, D., Chetter, I. C., & Smith, G. E. (in press). Long term outcomes of ‘Christmas Tree’ banding for haemodialysis access induced distal ischemia: A 13-year experience. The journal of vascular access, https://doi.org/10.1177/11297298221141497

Background: The reduction in distal arterial flow following arteriovenous fistula (AVF) creation can cause a perfusion deficit known as haemodialysis access induced distal ischemia (HAIDI). Various techniques have been advocated to treat this difficu... Read More about Long term outcomes of ‘Christmas Tree’ banding for haemodialysis access induced distal ischemia: A 13-year experience.

Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review (2022)
Journal Article
Hitchman, L., Totty, J., Smith, G. E., Carradice, D., Twiddy, M., Iglesias, C., Russell, D., & Chetter, I. C. (2022). Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review. International wound journal, https://doi.org/10.1111/iwj.14035

Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of ESWT in DFU healing and impact of different ESWT doses. Databases were searched fo... Read More about Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review.

Do we need routine antibiotics for hand surgery? (2022)
Presentation / Conference Contribution
Wormald, J., & Totty, J. (2022, October). Do we need routine antibiotics for hand surgery?. Paper presented at British Society for Surgery of the Hand (BSSH) Autumn Scientific Meeting 2022, Winchester, UK

Both the incidence of hand trauma, and the demand for elective hand surgery, continue to rise in the UK. The incidence of surgical site infection (SSI) following hand surgery is around 5%. Traditionally, antibiotic prophylaxis at the time of surgery... Read More about Do we need routine antibiotics for hand surgery?.

Frailty Assessment in UK and Irish Vascular Centres (FAVE): A survey to investigate data collection methods and impact on clinical practice (2022)
Journal Article
Hitchman, L. H., Palmer, J., Lathan, R., Totty, J., Smith, G. E., Carradice, D., & Chetter, I. C. (in press). Frailty Assessment in UK and Irish Vascular Centres (FAVE): A survey to investigate data collection methods and impact on clinical practice. Journal of Vascular Societies Great Britain and Ireland,

Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis (2022)
Journal Article
Lathan, R., Sidapra, M., Yiasemidou, M., Long, J., Totty, J., Smith, G., & Chetter, I. (2022). Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis. npj Digital Medicine, 5(1), Article 108. https://doi.org/10.1038/s41746-022-00655-0

The Sars-CoV-2 pandemic catalysed integration of telemedicine worldwide. This systematic review assesses it’s accuracy for diagnosis of Surgical Site Infection (SSI). Databases were searched for telemedicine and wound infection studies. All types of... Read More about Diagnostic accuracy of telemedicine for detection of surgical site infection: a systematic review and meta-analysis.

Wound complications following surgery to the lymph nodes: A protocol for a systematic review and meta-analysis (2022)
Journal Article
Nzenwa, I. C., Iqbal, H. A., Hardie, C., Smith, G. E., Matteucci, P. L., & Totty, J. P. (2022). Wound complications following surgery to the lymph nodes: A protocol for a systematic review and meta-analysis. PLoS ONE, 17(8), Article e0272490. https://doi.org/10.1371/journal.pone.0272490

Background Malignancies that spread to the lymph nodes may be identified through surgical biopsy, and treatment of metastatic disease may be through lymph node dissection. These surgeries, however, may be associated with significant adverse outcomes,... Read More about Wound complications following surgery to the lymph nodes: A protocol for a systematic review and meta-analysis.

The impact of COVID19 on the presentation, diagnosis and management of cutaneous melanoma and squamous cell carcinoma in a single tertiary referral centre (2022)
Journal Article
McClean, A., Matteucci, P., & Totty, J. (in press). The impact of COVID19 on the presentation, diagnosis and management of cutaneous melanoma and squamous cell carcinoma in a single tertiary referral centre. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, https://doi.org/10.1016/j.bjps.2022.06.062

The SARS-CoV-2 pandemic has had a substantial impact on the provision of surgical services worldwide1. In the United Kingdom, staff redeployment and reduced staffing due to infection and self-isolation has reduced the availability of clinic slots and... Read More about The impact of COVID19 on the presentation, diagnosis and management of cutaneous melanoma and squamous cell carcinoma in a single tertiary referral centre.

Measurement of the local physiological effects of a single use topical negative pressure device in healthy volunteers– The PICO-1 Study (2022)
Journal Article
Prabakaran, P., Totty, J., Carradice, D., Chetter, I., & Smith, G. (in press). Measurement of the local physiological effects of a single use topical negative pressure device in healthy volunteers– The PICO-1 Study. Journal of Wound Care,

Aims
This study aimed to investigate the effects of a Single use Negative Pressure Wound Therapy (sNPWT) device upon tissue perfusion, oxygenation and pressure, in the intact skin of healthy volunteers.

Methods
12 healthy volunteers wore a PIC... Read More about Measurement of the local physiological effects of a single use topical negative pressure device in healthy volunteers– The PICO-1 Study.

Dermoscopy as an adjunct to surgical excision of non-melanoma skin lesions: a systematic review and meta-analysis (2022)
Journal Article
Hurley, A., Totty, J., & Pinder, R. (in press). Dermoscopy as an adjunct to surgical excision of non-melanoma skin lesions: a systematic review and meta-analysis. The Journal of Clinical and Aesthetic Dermatology,

Context: Non-melanoma skin cancers (NMSC) have an incidence of 152,000 cases per year in the UK which continues to rise. Incomplete excision rates for NMSC are estimated to be around 10% and result in patients having a higher risk of recurrence or ha... Read More about Dermoscopy as an adjunct to surgical excision of non-melanoma skin lesions: a systematic review and meta-analysis.

Electrochemotherapy vs radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies: A protocol for a systematic review and meta-analysis (2022)
Journal Article
McMillan, A., McElroy, L., O'Toole, L., Matteucci, P., & Totty, J. (2022). Electrochemotherapy vs radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies: A protocol for a systematic review and meta-analysis. Journal of Surgical Protocols and Research Methodologies, 2022(1), Article snac005. https://doi.org/10.1093/jsprm/snac005

Electrochemotherapy has emerged as a valuable tool in the treatment of cutaneous malignancies that are unamenable to surgical resection. Despite growing recognition and recommendation in national guidelines, to date, no Level 1 evidence exists compar... Read More about Electrochemotherapy vs radiotherapy in the treatment of primary cutaneous malignancies or cutaneous metastases from primary solid organ malignancies: A protocol for a systematic review and meta-analysis.

The use of perioperative prophylactic antibiotics following excision of ulcerated skin lesions in the UK – A national, multi-speciality survey of clinicians (2021)
Journal Article
Totty, J., Matin, R., Wernham, A., Ray, R., Thomas-Jones, E., & Abbott, R. (in press). The use of perioperative prophylactic antibiotics following excision of ulcerated skin lesions in the UK – A national, multi-speciality survey of clinicians. Clinical and experimental dermatology, https://doi.org/10.1111/ced.15075

Skin cancer is the most common malignancy in the UK, and up to a third of lesions are ulcerated at the time of excision. Ulceration has been shown to increase the risk of developing surgical site infection post-excision, with some studies finding inf... Read More about The use of perioperative prophylactic antibiotics following excision of ulcerated skin lesions in the UK – A national, multi-speciality survey of clinicians.

Chlorhexidine versus Povidone-Iodine Skin Antisepsis Prior to Upper Limb Surgery (CIPHUR): An International Multicentre Prospective Cohort Study (2021)
Journal Article
Wade, R., Bourke, G., Wormald, J., Totty, J., Stanley, G., Lewandowski, A., …The CIPHUR Collaborative. (2021). Chlorhexidine versus Povidone-Iodine Skin Antisepsis Prior to Upper Limb Surgery (CIPHUR): An International Multicentre Prospective Cohort Study. BJS Open, 5(6), Article zrab117. https://doi.org/10.1093/bjsopen/zrab117

Introduction: Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) prior to surgery but upper limb surgeons continue to use other antiseptics, ci... Read More about Chlorhexidine versus Povidone-Iodine Skin Antisepsis Prior to Upper Limb Surgery (CIPHUR): An International Multicentre Prospective Cohort Study.

A Mixed Methods Feasibility Study of Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers (2021)
Presentation / Conference Contribution
Hitchman, L., Totty, J., Lathan, R., Sidapra, M., Smith, G., Carradice, D., & Chetter, I. (2021). A Mixed Methods Feasibility Study of Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers. British journal of surgery, 108(supp.6), Article 1031. https://doi.org/10.1093/bjs/znab259.1127

Aim
The purpose of this mixed methods feasibility study was to assess the feasibility of delivering ESWT to patients with DFUs. It also aimed to explore any potential clinical effect of ESWT on wound healing and investigate whether ESWT may offer an... Read More about A Mixed Methods Feasibility Study of Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers.

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