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Correspondence and Communications| Volume 72, ISSUE 4, P685-710, April 2019

Letter to the editor regarding: Selective non-operative management for penetrating extremity trauma: A paradigm shift in management

Published:January 14, 2019DOI:https://doi.org/10.1016/j.bjps.2018.12.054
      We read with great interest the recently published cohort study by Khajuria et al.
      • Khajuria A.
      • Geoghegan L.
      • Solberg Y.
      • et al.
      Selective non-operative management for penetrating extremity trauma: a paradigm shift in management?.
      comparing penetrating extremity injury examination results to operative findings. The increasing rate of crime involving a knife or sharp object

      Office for National Statistics. Crime in England and Wales: year ending June 2018 [Internet]. 2018 [cited 2018 Dec 6]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/crimeinenglandandwales/yearendingjune2018.

      is of concern to all trauma surgeons, and a great pressure to develop safe and effective clinical pathways for penetrating trauma. We agree with the authors that more pragmatic methods may be appropriate to treat these injuries, but question the author's assertion that their data has shown selective non-operative management to be a safe alternative to surgical exploration.
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      References

        • Khajuria A.
        • Geoghegan L.
        • Solberg Y.
        • et al.
        Selective non-operative management for penetrating extremity trauma: a paradigm shift in management?.
        J Plast Reconstr Aesthet Surg. 2018; 71: 1239-1244
      1. Office for National Statistics. Crime in England and Wales: year ending June 2018 [Internet]. 2018 [cited 2018 Dec 6]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/crimeinenglandandwales/yearendingjune2018.

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      2. British Association of Plastic, Reconstructive and Aesthetic Surgeons. Open Fractures of the Lower Limb [Internet]. 2009 [cited 2018 Dec 6]. Available from: http://www.bapras.org.uk/professionals/clinical-guidance/open-fractures-of-the-lower-limb.

      Linked Article

      • Selective non-operative management for penetrating extremity trauma: A paradigm shift in management?
        Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 71Issue 9
        • Preview
          Selective non-operative management (SNOM) has been proposed as a safe and adequate strategy for penetrating extremity trauma (PET) management. This may reduce unwarranted surgical exploration and enhance cost-effectiveness. Our experience at a UK major trauma centre advocates SNOM-PET as a viable and safe strategy for selected patients. A PET management algorithm is proposed.
        • Full-Text
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      • Selective non-operative management for penetrating extremity trauma (SNOM-PET)
        Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 72Issue 4
        • Preview
          We appreciate the comments by Dickson and colleagues in their letter to the editor on our published article.1 We agree with them that non-operative management is a pragmatic approach for penetrating trauma and our paper is the first documented attempt to apply this approach to a UK trauma population. It is inevitable and appropriate that conservative management of trauma is scrutinized as it is counter to most current plastic surgical doctrine, though conservative management of other types of trauma is commonplace.
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