Perf-Act BreCon: A Prospective Case-control Study to Compare Tissue Perfusion between RetrActors and Non-retractors during Immediate Breast ReConstruction

PROTECT is a national platform trial designed to deliver multiple multi-centre randomised and non-randomised comparisons in adult surgical patients. Individual trial components will span phase II to phase IV, depending on the specific research question.

The study will be conducted across NHS surgical services and will include patients aged 18 years and over undergoing care within an NHS surgical pathway.

In the complex world of vascular surgery, where “high risk” is basically our love language, one topic continues to spark the debate: the uncomplicated type B aortic dissection. “Uncomplicated” may sound reassuring, but don’t be fooled. In reality, “uncomplicated” may just mean not yet complicating your life. These patients represent the calm before the storm, leaving clinicians to weigh whether it’s better to follow a conservative approach or go in early and do something heroic (and preferably endovascular).

Once upon a time, all type B dissections were approached as ticking time bombs — open surgery, big incisions and lots of drama. Outcomes, however, were far from ideal. As evidence emerged that doing less often yielded better results, the field shifted direction. Medical therapy became the dominant approach; enter the era of “let’s control the blood pressure and hope for the best.” Today, medical therapy — mainly antihypertensives and analgesics — remains the cornerstone for managing uncomplicated type B dissections.

Short-term survival left everyone quite satisfied: in-hospital survival was about 90%. Long-term results, however, were less pleasing. Survival drops to around 79% at five years, with approximately one-third of these initially “uncomplicated” patients eventually requiring intervention – procedures that are technically more challenging in the chronic phase with higher procedural risks. Turns out, “uncomplicated” is more complicated than it sounds.

CLARITY is a cluster-randomised trial of a surgical education package to improve patient care in right iliac fossa pain. The trial will be jointly delivered by the West Midlands Research Collaborative (WMRC) and STARSurg. We have launched CLARITY at ten pilot sites in the UK and aim to enter the main phase of the trial in the UK and Republic of Ireland in September 2024.