Prep with P'Fella thePlasticsFella

On today's episode, we challenge the long-held belief about avoiding the use of adrenaline (or epinephrine) in fingers, toes, ears, and noses, a fear largely rooted in the risk of gangrene or tissue necrosis.

Key points from today's conversation include:


The Origins: We explore the origins of this belief, tracing it back to the pioneering work of Braun in the early 20th century. He used a combination of cocaine and adrenaline for anesthesia, yet cautioned against excessive use, especially in the fingers.


Shaky Evidence: Despite the caution, we highlight that there have been only 48 reported cases of digital necrosis attributed to local anesthetics in the past 120 years. Interestingly, none involved the use of Xylocaine (lidocaine), and only 21 involved the use of epinephrine.


Persistent Dogma: Despite contradicting evidence, this cautionary stance has been ingrained in medical practice, thanks in part to influential textbooks such as Bunnell's 'Surgery of the Hand' and Frederick Christopher's 'Textbook of Surgery.'


Current Evidence: We delve into current studies, like the 2005 "Dalhousie Project," and a 2008 randomized-controlled study, both of which show no significant evidence of ischemia or tissue damage when using adrenaline. Furthermore, a peer-reviewed survey shows that the fear of using adrenaline in digits is still prevalent among junior doctors and medical students, highlighting the endurance of this myth.


The Cochrane Review: Although the Cochrane Review didn't add much to the discussion, it agreed with the other evidence that there's no conclusive proof that adrenaline causes finger Ischaemia.


Clinical Efficiency: The use of adrenaline in hand and finger surgeries could potentially increase clinical efficiency by eliminating the need for tourniquets and associated risks with sedation or general anesthesia.

In this episode, we embark on a comprehensive voyage through the world of Basal Cell Carcinoma (BCC), the most common skin cancer. Guided by the case of Captain Jack Sparrow, we navigate the risk factors, subtypes, and treatment options for BCC. We delve into the genetic and environmental causes, the role of the Hedgehog signaling pathway, and the importance of differentiating between high-risk and low-risk cases. We also explore the surgical treatment of BCC, the use of topical therapies and radiotherapy, and the importance of patient follow-up.

This episode is packed with practical, real-world applications, and we even have a mnemonic to help you remember the main histological subtypes of BCC. We wrap up with a quick quiz to test your knowledge and provide recommendations for further reading.

For more in-depth information, check out the following articles:


NICE guidelines for BCC management
Hedgehog Pathway Inhibition for Locally Advanced Periocular Basal Cell Carcinoma and Basal Cell Nevus Syndrome
British Association of Dermatologists guidelines for the management of basal cell carcinoma 2018

For a detailed overview of BCC, visit thePlasticsFella.com article on Basal Cell Carcinoma.

Welcome to another episode of "Prep with P Fella." In this episode, we delve deep into the world of melanoma. Join us as we embark on a thrilling investigation, from the first signs of clinical suspicion to the final stages of treatment. We'll break down complex concepts like risk factors, staging, and various treatment options, and take you through the patient journey as if you're solving an intricate puzzle. Whether you're already knowledgeable about melanoma or just starting to learn, this episode promises to enrich your understanding of this significant medical condition.



Topics Covered


Intro: Brief overview and introduction to the episode topic
Clinical Suspicion: Understanding the ABCDE criteria for melanoma detection
Risk Factors: Unraveling the complex web of melanoma risk factors
Histological Analysis: The importance of biopsy and how to read a melanoma histology report
Melanoma Subtypes: Exploring different melanoma subtypes and their unique features
Treatment Options: Detailed discussion on surgical intervention, immunotherapy, and targeted therapy
Patient Journey: Mapping the patient journey from diagnosis to treatment completion
Recap: Three key learning points and references for further reading
Outro: Wrapping up and a sneak peek into the next episode



References and further reading:


Morton DL, et al. Technical Details of Intraoperative Lymphatic Mapping for Early Stage Melanoma. Arch Surg. 1992;127(4):392–399.
Gershenwald JE, et al. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017 Nov;67(6):472-492.
Faries MB, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017 Jun 8;376(23):2211-2222.

In this informative and engaging episode of Prep with P Fella, we delve into the fascinating world of infantile haemangiomas, exploring the three distinct phases of their development: proliferative, involuting, and involuted. We discuss the various treatment options available, including the first-line treatment propranolol, as well as alternatives like corticosteroids, laser therapy, sclerotherapy, and surgery. Join us as we uncover key insights, share an interesting fun fact, and recommend essential articles for further reading. Whether you're a medical professional or simply curious about the topic, this episode will leave you equipped with valuable knowledge on infantile haemangiomas and their management. Don't forget to subscribe and leave a review!