By the end of this module the Clinical Scientist in Reconstructive Science will be able to analyse, synthesise, evaluate and apply knowledge of the clinical assessment, treatment and custom manufacture. This broad area of prosthetic work (whole body) is defined as Anaplastology. Prosthetic rehabilitation will be under the care of the Consultant Clinical Scientist Reconstructive Scientist/maxillofacial prosthetist responsible for treatment planning, the design, material selection and manufacture of prosthetic components for patients and long-term care and maintenance of the patient and the device. They will be part of the MDT, maintaining a safe, quality assured service for patients.
The Consultant Clinical Scientist in Reconstructive Science will deal with complex treatment options and advanced rehabilitation covering craniofacial implants autogenous reconstruction and facial transplantation. Clinical Scientists in Reconstructive Science will be expected to consolidate and extend the theoretical knowledge, clinical and technical skills gained during the initial STP facial and body prosthetic module and develop their judgement, decision-making, clinical and technical competencies to the level of expert.
The Clinical Scientist in Reconstructive Science will be able to interpret multiple strands of information gathered to produce a structured treatment plan for the patient. They will be expected to place the patient at the centre of care and discuss all options in partnership with the patient, suggesting the most appropriate treatment plan in respect of their functional needs, aesthetic concerns, social and environmental factors, the materials available and the retention options suitable for the patient. They should also consistently demonstrate the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist, placing the patient at the centre of care, treating them with courtesy and kindness, and maintaining the patient’s dignity at all times.
The Clinical Scientist in HSST will be expected to be able to contribute to national guidelines on the treatment of patients with facial, limb and trunk deformities.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to the broad specialism of anaplastology, including:
- structure of skin, anatomy of the face and orofacial skeleton. Recognition of post- surgical anatomical features, recognition of congenital anatomical features, e.g. ear appendages;
- gross anatomy of limbs and trunk, recognition of altered anatomical features;
- recognition of allergic reaction on the skin;
- current best evidence for effective treatment options, controversies and various treatment modalities and apply this in the best interest of the patient;
- relevant technical requirements in the provision of such prostheses;
- relevant microbiology and cross-contamination procedures in the provision of such prostheses;
- the indications for, success/failure criteria and biomechanical implications of any functional prosthetics, e.g. digit prostheses;
- how to apply specialist knowledge in the choice and execution of appropriate techniques for all stages of the planned treatment in conjunction with the MDT;
- a heightened awareness of colour, understanding hue, value and chroma;
- anatomical form in relation to sculpting techniques;
- the management of patients pre and post surgery for a wide spectrum of operative procedures facial, limb and trunk;
- reconstruction options for patients with facial, limb and trunk defects to be prosthetically reconstructed, e.g. composite free flaps, local flaps, or autogenous reconstruction;
- how to apply scientific, environmental and social criteria in the selection of the appropriate materials for prosthetic reconstruction, e.g. auricular patient who is physically compromised selecting magnetic implants for simplified placement;
- regulatory implications or medical device manufacture and guidelines and literature reviews, e.g. NICE and Cochrane reviews;
- monitor and evaluate the effectiveness of different prosthetic rehabilitation services.
- factors that affect implant integration following adjunctive treatment such as radiotherapy and success rates in various areas of facial skeleton;
- intra- and extra-oral implant systems, their indication and, contraindications when applied to specific patients, e.g. the use of intra-oral implants in the mid-face;
- the use of analogue and digital implant planning techniques and transfer of that data to theatre via surgical templates;
- the implant surgical technique and the surgical, clinical and laboratory components utilised at different stages of treatment, e.g. understand the surgical implant sequence in
- anatomy and physiology of the breast area;
- congenital malformations of the breast and chest wall;
- epidemiology, pathology and modes of invasion/spread of common breast malignancies;
- breast genetics, genomics and inheritance;
- common surgical techniques of breast reconstruction, pedicle and free tissue transfer flaps and fat grafts;
- common nipple reconstruction procedures, cervical visor (CV) flaps, nipple share techniques;
- use of tissue expanders and breast implants;
- alternatives to surgical reconstruction, breast prostheses: commercial and bespoke;
- breast conservation surgery;
- use of other reconstruction treatment modalities, i.e. micro pigmentation;
- appreciation of post-surgical problems such as limited limb movement, scarring and lymphoedema;
- role and responsibilities of breast care team.
Hand, finger and toes
- anatomy of the hands, feet and fingers;
- zones and planes of fingertip injuries;
- flaps used in finger and hand trauma, including terminalisation flaps;
- replantation techniques and reconstruction using digit/toe transfer options;
- use of osseointegrated implants in finger prosthesis retention with attention to functional opposition;
- pre-prosthetic surgery techniques, web deepening, desensitisation;
- role of the MDT in pre-prosthetic rehabilitation, e.g. physiotherapy and occupational therapy (OT);
- common circulatory and nerve problems associated with amputation of hands, feet and fingers.
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST will have a critical understanding of current evidence and its application to the performance and mastery of a range of technical skills and will:
- devise, plan and provide facial and body prostheses to include provisional post- surgical devices and the most complex craniofacial implant borne cases;
- devise, plan and provide limb and finger prostheses to include some functional aspects;
- devise and update treatment pathways for generic/specific groups of patients to best facilitate their treatment;
- utilise and incorporate innovative technologies in the custom manufacture process;
- design, make, supervise and quality assure the manufacture of the complex facial and body prostheses that may include attachments to implants.
By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills with respect to anaplastology. They will communicate effectively with patients, carers and the MDT and will:
- treatment plan based on the likely prognosis and outcomes of the various treatment options, in partnership with the patient, carers and the MDT, establishing a sequence of treatment while considering the relevant ethical and cost implication;
- assess the need for, design and prescribe aesthetically and biomechanically sound facial and body prostheses;
- recognise the future needs of the patient when determining their treatment;
- present treatment plans, including discussion of all options, advantages and disadvantages in the MDT environment;
- manage the long-term care of the most complex multifactorial cases, e.g. combined oro-nasal defect (obturator) and orbital defect;
- manage the soft tissue prosthesis interface atraumatically, e.g. in cases following radiotherapy where the skin management is very important;
- promote and help the patient and carers to manage the defect site in the long term, including direct clinical education and patient information leaflets;
- give expert opinion within the operating theatre on the operative site, the planned procedure in the best interests of the patient, e.g. whether to remove residual ear remnants.
Attitudes and behaviours
This module has no attitude and behaviours information.