Publications, Presentations and Research

Microdialysis is one of several methods described for monitoring the anastomosis and blood flow to the donor tissue in microvascular-free tissue transfer for craniofacial reconstructive surgery. A case is presented where a microdialysis free flap monitoring system detected metabolic aberrations within the free flap secondary to a rise in intracranial pressure, which the intracranial pressure monitor had failed to detect.

 Conference - Birmingham

Utilising a tablet computer with pre programmed responses enabled patients to communicate whilst they had a temporary tracheostomy for major head and neck cancer surgery. After the successful pilot we increased our utilisation of this useful tool.

The Christie - National Oncologists conference 

Changes within functional aspects of speech and swallow and the impact on quality of life with often minimal social support influences coping mechanisms and means this cohort of patients require intensive psychological support. 

South African Maxillofacial Conference, Cape Town

1st prize winner Hospital Group Meeting

Evidence based management of traumatic facial soft tissue wounds wounds. (BAOMS process manual - NICE accredited) T Blackburn, W Allen, K Fan, S Clark, G Cousin, P Brennan, S Holmes

Following both surgical and technological progression, microvascular free flap reconstruction has a reported success rate of over 95%. Further, the utilisation of clinical based monitoring of free flaps has been shown that threatened flaps can be salvaged at a rate of 70 - 80%.This rate of flap salvaged is influenced by the early recognition of pending failure and early intervention.. Therefore, the intent of monitoring of free flaps should be to aid the early recognition of a potentially threatened flap. This can have life threatening consequences in the case of reconstructive craniofacial, maxillofacial, oropharyngeal and skull base surgery. Additional free flaps required where a free flap has failed can have significant impacts on patient related outcomes including quality of life, and leads to increase in hospital length of stay and cost when considering health economics.

Craniofacial surgery encompasses several disciplines and areas including craniosynostosis.

Craniosynostosis is the premature fusion of a cranial suture. 

There are metopic, coronal, sagittal and lamdoidal sutures, and these are affected in the frequency of

Craniosynostosis form part of both syndromic and non syndromic cases, and as such there are mixed genetic and environmental factors involved in the development of a craniosynostosis.

Treatment can be considered as mainly operative, though can be considered in the categories of conservative, or non operative, and operative. The rationale for operative treatment being considered as functional / pertaining to development and intracranial pressure and ocular/orbital concerns; and as cosmetic due to the affect on appearance as part of a facial scoliosis formation stemming from implications on the developing cranial base.

Progression of surgical treatment has led to development of endoscopic or minimally invasive approaches, with the consideration that this approach will mirror other aspects of surgery in improvements in patient related outcomes including importantly blood loss and need for blood transfusion. Other important factors include the extent of head shape improvement and the durability of this, the functional / neurodevelopmental progress, and cost to the both the health care system at to the patient, encompassing principally burden of care, length of stay and return to theatre.

The prognosis of oral squamous cell cancer is determined by many factors. For the purposes of disease stratification and direction of treatment each tumour sub-site is divided into early disease (stage one and two of the Union for International Cancer Control (UICC) and of the Tumour size, Node status, Metastasis status (TNM) classification of malignant Tumours) and advanced disease (stage three and four). Of note it is tumour size, not tumour thickness that is currently used for disease stratification. Lymph node status is an important factor in prognosis, with nodal neck disease in the clinically negative neck (cN0) being traditionally managed as an elective neck dissection or watchful waiting followed by a therapeutic neck dissection if required. Avoiding occult metastatic disease is of paramount importance, with correct staging of the neck being an important part of disease management and prognosis

Pilonidal Excision Versus Endoscopic Surgery (PEVES) Trial 


Principle Investigator Mr W Allen Chief Investigator Mr R Rajaganeshan


REC reference: 16/LO/0452 Protocol: RBN955/V2 IRAS: 200374

Royal College of Surgeons - Care of the Critically Ill Surgical Patient (CCrISP)

Injury Journal

Responsible for appraising, editing and advising on medical journal articles.