434
Correspondence and communications
topical gentamicin, and that the complex nature of the wound namely an extensive cavity along with the duration of treatment, may have played a role in increasing gentamicin systemic absorption. The data available on the systemic toxicity of topical gentamicin are scarse.1,3 It is also unclear in which patients gentamicin serum concentrations should be measured, but it is advisable to monitor renal function and gentamicin levels during the treatment.1 Besides its rarity, this clinical case highlights the possibility of renal toxicity with topical usage in the treatment of complex wounds. In these situations, even topic antibiotics can see their toxicity increased due to higher absorption rates by the wound. A more liberal control of gentamicin plasmatic levels and renal function should be encouraged and recommended, specially in complex wounds with large surface areas.
Conflict of interest The authors have no conflict of interest; nothing to disclose.
References 1. Swieringa AJ, Goosen JH, Jansman FG, Tulp NJ. In vivo pharmacokinetics of a gentamicin-loaded collagen sponge in acute periprosthetic infection: serum values in 19 patients. Acta Orthop 2008 Oct;79(5):637e42. 2. Lapid O. Use of gentamicin collagen sponges for the treatment of periprosthetic breast implant infection. J Plast Reconstr Aesthet Surg 2011 Dec;64(12):e313e6. 3. Klaver PA, Hendriks JG, van Onzenoort HA, Schreurs BW, Touw DJ, Derijks LJ. Gentamicin serum concentrations in patients with gentamicin-PMMA beads for infected hip joints: a prospective observational cohort study. Ther Drug Monit 2012 Feb;34(1):67e71. 4. Guzma ´n VGG, Guerrero TS, Lluck MC, et al. Effectiveness of collagen-gentamicin implant for treatment of “dirty” abdominal wounds. World J Surg 1999 Feb;23(2):123e6. 5. Stemberger A, Grimm H, Bader F, Rahn HD, Ascherl R. Local treatment of bone and soft tissue infections with the collagengentamicin sponge. Eur J Surg Suppl 1997;578:17e26.
Rita Valenc ¸a-Filipe Joana Costa Jorge Carvalho Ricardo Horta Teresa Burnay ´ lvaro Silva A Anto ´nio Costa-Ferreira Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery and Burn Unit, Centro Hospitalar de Sa˜o Joa˜o Porto Medical School, Porto, Portugal E-mail address: [email protected] ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.10.005
International masters degree in reconstructive microsurgery: Studying at the European School of Reconstructive Microsurgery Dear Sir, During 2011e2013 I was enrolled in the Masters programme of the European School of Reconstructive Microsurgery, together with 24 other fellow students from Europe, South America and Asia. The Masters programme, starting every year in October, is arranged in monthly clinical modules from October to March the following year. The primary teaching venue is Hospital Sant Pau in Barcelona, apart a few modules in other locations in Europe. The teaching covers basic principles of reconstructive surgery, as well as more clinically oriented reconstructive surgery in different anatomical areas of the body. There is also a course in supermicrosurgery focusing on lymphatic reconstructive procedures and one module teaching microsurgical-suturing technique. Each clinical module includes theoretical lectures, in combination with live surgery, during three to four days. At the end of most modules there is a theoretical exam to sum up the topic of the week. Having finished the theoretical modules, there is a period of clinical immersion, during which time the students are supposed to visit at least two different plastic surgery units for at least two weeks per location, but many of my fellows chose to spend much longer time in each unit. At the end of the Masters program all students meet in Barcelona for a final oral exam, including a presentation of clinical cases. In general my impression of the Masters program is very good. The faculty of well-experienced “masters” in microsurgery share a “state-of-the-art” knowledge in each topic and the atmosphere is very friendly and supportive. The programme is perfectly led by dr. Jaume Masia at the Hospital Sant Pau, together with an efficient team of local co-workers. There is also a web site available to each class, with information on the forthcoming modules, reference articles, correspondence with the faculty and some “home-work”. The main problem was the difference in clinical experience among the students, as some of us would have years of microsurgical experience whereas others were in the beginning of their training. With a more homogenous group, the complexity of the curriculum would have been easier to adjust to the audience, as some of the lectures now seemed to be somewhat too basic and possibly not what one would have expected from a teaching programme at this level. However, the faculty is constantly improving the content of the Masters programme and a growing number of applicants have made the selection of students easier, in order to achieve a less diverse group. Other aspects of the Masters programme are the cost and the time spent. The whole teaching programme costs 10 000 Euro, with the possibility to complete only parts of the program at a lower price. The students completing the full programme are awarded a Master’s degree,
Correspondence and communications equivalent of Master of 78 ECTS (European Credits Transfer System) points. This degree is recognized by the Universitat Autonoma de Barcelona, but to my understanding not yet recognized an official MSc degree in the European community in general. The students completing a shorter programme or single modules will be awarded a Postgraduate diploma or a Certificate respectively. All in all, the teaching modules take close to seven weeks, after which at least four weeks will be spent during clinical immersion. Despite of the differences in clinical experience and background my impression was that the vast majority of the students were very pleased with the Masters programme and would happily recommend it to others. From a personal point of view, the clinical immersion was maybe the most rewarding part of the training. In addition there is a great value in the “net-working” between students and faculty, for help and support with future microsurgical challenges long after the Masters programme is finished. This is an educational program well worth considering, and at its best at the end of one’s training in reconstructive microsurgery. Further information of the Masters programme and registration is found at www.rmes.es.
435
Conflict of interest None.
Funding None. T.K. Sjo ¨berg Department of Plastic and Hand Surgery, University hospital of North Norway, Sykehusvn 1, 9038 Tromsø, Norway E-mail addresses: [email protected], [email protected] ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.10.038
Correspondence and communications
topical gentamicin, and that the complex nature of the wound namely an extensive cavity along with the duration of treatment, may have played a role in increasing gentamicin systemic absorption. The data available on the systemic toxicity of topical gentamicin are scarse.1,3 It is also unclear in which patients gentamicin serum concentrations should be measured, but it is advisable to monitor renal function and gentamicin levels during the treatment.1 Besides its rarity, this clinical case highlights the possibility of renal toxicity with topical usage in the treatment of complex wounds. In these situations, even topic antibiotics can see their toxicity increased due to higher absorption rates by the wound. A more liberal control of gentamicin plasmatic levels and renal function should be encouraged and recommended, specially in complex wounds with large surface areas.
Conflict of interest The authors have no conflict of interest; nothing to disclose.
References 1. Swieringa AJ, Goosen JH, Jansman FG, Tulp NJ. In vivo pharmacokinetics of a gentamicin-loaded collagen sponge in acute periprosthetic infection: serum values in 19 patients. Acta Orthop 2008 Oct;79(5):637e42. 2. Lapid O. Use of gentamicin collagen sponges for the treatment of periprosthetic breast implant infection. J Plast Reconstr Aesthet Surg 2011 Dec;64(12):e313e6. 3. Klaver PA, Hendriks JG, van Onzenoort HA, Schreurs BW, Touw DJ, Derijks LJ. Gentamicin serum concentrations in patients with gentamicin-PMMA beads for infected hip joints: a prospective observational cohort study. Ther Drug Monit 2012 Feb;34(1):67e71. 4. Guzma ´n VGG, Guerrero TS, Lluck MC, et al. Effectiveness of collagen-gentamicin implant for treatment of “dirty” abdominal wounds. World J Surg 1999 Feb;23(2):123e6. 5. Stemberger A, Grimm H, Bader F, Rahn HD, Ascherl R. Local treatment of bone and soft tissue infections with the collagengentamicin sponge. Eur J Surg Suppl 1997;578:17e26.
Rita Valenc ¸a-Filipe Joana Costa Jorge Carvalho Ricardo Horta Teresa Burnay ´ lvaro Silva A Anto ´nio Costa-Ferreira Department of Plastic, Reconstructive and Aesthetic Surgery, Maxillofacial Surgery and Burn Unit, Centro Hospitalar de Sa˜o Joa˜o Porto Medical School, Porto, Portugal E-mail address: [email protected] ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.10.005
International masters degree in reconstructive microsurgery: Studying at the European School of Reconstructive Microsurgery Dear Sir, During 2011e2013 I was enrolled in the Masters programme of the European School of Reconstructive Microsurgery, together with 24 other fellow students from Europe, South America and Asia. The Masters programme, starting every year in October, is arranged in monthly clinical modules from October to March the following year. The primary teaching venue is Hospital Sant Pau in Barcelona, apart a few modules in other locations in Europe. The teaching covers basic principles of reconstructive surgery, as well as more clinically oriented reconstructive surgery in different anatomical areas of the body. There is also a course in supermicrosurgery focusing on lymphatic reconstructive procedures and one module teaching microsurgical-suturing technique. Each clinical module includes theoretical lectures, in combination with live surgery, during three to four days. At the end of most modules there is a theoretical exam to sum up the topic of the week. Having finished the theoretical modules, there is a period of clinical immersion, during which time the students are supposed to visit at least two different plastic surgery units for at least two weeks per location, but many of my fellows chose to spend much longer time in each unit. At the end of the Masters program all students meet in Barcelona for a final oral exam, including a presentation of clinical cases. In general my impression of the Masters program is very good. The faculty of well-experienced “masters” in microsurgery share a “state-of-the-art” knowledge in each topic and the atmosphere is very friendly and supportive. The programme is perfectly led by dr. Jaume Masia at the Hospital Sant Pau, together with an efficient team of local co-workers. There is also a web site available to each class, with information on the forthcoming modules, reference articles, correspondence with the faculty and some “home-work”. The main problem was the difference in clinical experience among the students, as some of us would have years of microsurgical experience whereas others were in the beginning of their training. With a more homogenous group, the complexity of the curriculum would have been easier to adjust to the audience, as some of the lectures now seemed to be somewhat too basic and possibly not what one would have expected from a teaching programme at this level. However, the faculty is constantly improving the content of the Masters programme and a growing number of applicants have made the selection of students easier, in order to achieve a less diverse group. Other aspects of the Masters programme are the cost and the time spent. The whole teaching programme costs 10 000 Euro, with the possibility to complete only parts of the program at a lower price. The students completing the full programme are awarded a Master’s degree,
Correspondence and communications equivalent of Master of 78 ECTS (European Credits Transfer System) points. This degree is recognized by the Universitat Autonoma de Barcelona, but to my understanding not yet recognized an official MSc degree in the European community in general. The students completing a shorter programme or single modules will be awarded a Postgraduate diploma or a Certificate respectively. All in all, the teaching modules take close to seven weeks, after which at least four weeks will be spent during clinical immersion. Despite of the differences in clinical experience and background my impression was that the vast majority of the students were very pleased with the Masters programme and would happily recommend it to others. From a personal point of view, the clinical immersion was maybe the most rewarding part of the training. In addition there is a great value in the “net-working” between students and faculty, for help and support with future microsurgical challenges long after the Masters programme is finished. This is an educational program well worth considering, and at its best at the end of one’s training in reconstructive microsurgery. Further information of the Masters programme and registration is found at www.rmes.es.
435
Conflict of interest None.
Funding None. T.K. Sjo ¨berg Department of Plastic and Hand Surgery, University hospital of North Norway, Sykehusvn 1, 9038 Tromsø, Norway E-mail addresses: [email protected], [email protected] ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2013.10.038
