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Mr. N.B.Hart

FRCS

Consultant Plastic Surgeon

Personal Details
School Education Marist College, Hull (1960-65)

St. Michael’s College Leeds (1965-68)

Medical School Middlesex Hospital Medical School,University of London (1968-73)
Qualifications MBBS (London) 1973

FRCS (England) 1979

Accreditation in Plastic Surgery 1986

Position held (until 23-4-2010) Consultant Plastic Surgeon,Castle Hill Hospital,Cottingham, East Yorkshire
Speciality interests
  • Head & Neck Surgery
  • Cleft and Paediatric Surgery
  • Microsurgery
  • Hand and Lower Limb trauma
  • Burns
Previous Appointments:
Aug  73 – Jan  74 House Officer Orthopaedics Central Middlesex Hospital
Feb  74 – Jul  74 House Officer Gen. Medicine Cheltenham Gen Hospital
Aug  74 – Jan 75 House Officer Gen. Surgery York County Hospital
Feb  75 – Jul  75 A+E SHO Cheltenham General Hospital
Aug 75 – Jul  76 SHO General Surgery Cheltenham General Hospital
Sep 76-Feb77 SHO Plastic Surgery, Royal Naval Hospital, Plymouth Consultants: Mr. D.L. Harris, Cdr. Charles Chapman
Mar 77 – Aug 77 SHO General Surgery Plymouth General Hospital
Sep 77 – Feb 78 SHO Orthopaedics
Mar 78 – Feb 79 SHO General Surgery
Oct 79 – Sept 80 Registrar Urology Dudley Road Hospital Birmingham
Oct 80 – April 81 Registrar General Surgery
May 81 – July 84 Registrar Plastic Surgery Wordsley Hosp. Birmingham

Consultants:

  • Mr. J. North
  • Mr. F.Cort
  • Mr. J.H.Goldin
  • Mr. D.Murray
  • Mr. J.Nancarrow
Aug 84-Jan90 Senior Registrar in Plastic Surgery,The Ulster Hospital, Dundonald, Belfast

Consultants:

  • Mr. J. Colville
  • Mr. A.G.Leonard
  • Mr. M.Brennen
  • Mr. R.Millar
(Including Jul-Dec 86) Clinical fellow Hospital for Sick Children, Toronto, Canada

Consultants:

  • Dr.W.Lindsay
  • Dr. R.Zuker
  • Dr. H.Clark
  • Dr. H. Thomson
  • Dr. J.Posnick
Consultant Appointment
Feb 1990 – April 2010 Consultant Plastic Surgeon,Hull and East Yorkshire NHS Hospitals Trust

Castle Hill Hospital,Cottingham,East Yorkshire

Consultant colleagues
  • Mr. P. O’Hare (until 2005)
  • Mr. PRW Stanley
  • Mr. V. Ramakrishnan (until 2005)
  • Mr. AJ Platt
  • Mr. M.Riaz
  • Mr. A. Akali
  • Mr. J Heaney
Experience gained

Accident and Emergency (12 months)

 

Acute adult and paediatric medical and, surgical  emergencies

Fracture reduction & splintage

Major multiple trauma and resuscitation

Minor surgery

Burns

 

Orthopaedics (12 months)

 

Acute fractures including hip fractures in elderly

Elective orthopaedics including spinal surgery

Hand and foot surgery

 

General Surgery (3 years)

 

Acute abdomen (appendicitis, bleeding & perforated peptic ulcer, intestinal obstruction)

Acute abdominal trauma

Elective abdomen, especially cholecystectomy

Hernia surgery

Vascular surgery

Breast, thyroid and gastrointestinal cancer

 

Urology

Endoscopic urology including TUR

Retropubic prostatectomy

Nephrectomy

Urinary diversion

Plastic Surgery Experience

Congenital Anomalies

Cleft lip and Palate- primary and secondary surgery

Hypospadias

Congenital hand

 

Trauma

Multiple injuries

Burns

Facial trauma

Hand trauma including vascular, nerve and tendon repair and replantation

Lower limb trauma including free tissue transfer

 

Hand

Dupytrens contracture

Rheumatoid hand

Tendon transfer

 

Reconstruction

Local and distant skin, fasciocutaneous, musculocutaneous and free flaps

Tissue expansion

Pressure sores

Burn surgery

 

Cancer surgery

Major head and neck block dissection, cancer resection and reconstruction

Malignant melanoma, including block dissection

Breast reconstruction after mastectomy including free flaps

BCC , SCC and sarcoma resection and reconstruction

Parotid surgery

 

Cosmetic

Rhinoplasty, otoplasty, face-lift, blepharoplasty

Breast augmentation and reduction

Abdominoplasty

Liposuction

Facial palsy

Administrative and Teaching Experience
  • Organising theatre lists, ward rounds and outpatients
  • Writing letters,discharge summaries, etc.
  • Arranging meetings, seminars and teaching sessions
  • Attending management meetings
  • Informal teaching and supervision of junior doctors and nurses
Meetings and courses attended
  • British Association of Plastic Surgeons    (1981,-2,-4,-7,1988,-9,1990,2004)
  • British Association of Aesthetic Plastic Surgeons      (1988)
  • British Burn Association   ( 1977, 84, 85, 88, 89)
  • 10th  Plastic Surgery Course, Canniesburn    (1982)
  • Microvascular Workshop, Norwick Park        (1983)
  • Craniofacial Society of Great Britain               (1983, 89)
  • British Postgraduate Medical Federation      (1984, -86, -87,88)
  • Canadian Society for Aesthetic Plastic Surgery, Toronto (1986)
  • Maxillofacial Workshop, Toronto          (1986)
  • North American Working Group on Cleft Palate and Craniofacial Anomalies, Toronto (1986)
  • Newcastle Head and Neck Conference      (2000, 2001,2006)
Membership of Societies
  • Royal College of Surgeons of England
  • British Association of Plastic, Reconstructive and Aesthetic Surgeons         (Senior Member)
  • British Burn Association                                                      (until 2010)
  • British Medical Association                                                 (until 2010)
  • British Association of Head and Neck Oncologists         (until 2010)
Publications

1) Hart NB,Lawrence JC

Tulle-gras dressings

Burns incl Therm Inj. 1984 Oct; 11 (1): 26-30.

 

2) Hart NB,Goldin JH

The importance of symmetry in forehead flap rhinoplasty

Brit J Plast Surg. 1984 Oct; 37 (4): 477-81.

 

3) Hart NB

The effect of absorbable gelatin sponge on experimental microvascular anastomoses

Br J Plast Surg. 1987 May; 40 (3): 300-4.

 

4) Hart NB

Hand injuries in children

Assoc. Paed. Chartered Physiotherapists Newsletter 1988; 40: 3

 

5) Thomson HG,Hart NB

Reconstruction of  cupid’s bow: a quadrilateral flap technique

Ann Plast Surg. 1989 Mar; 22 (3): 195-202.

 

6) Richie AJ, Small JO, HartNB, Mollan RA

Type III tibial fractures in the elderly: results of 23 fractures in 20 patients

Injury.1991Jul; 22 (4): 267-70.

 

7) Richie AJ, Hart NB.

Massive tissue necrosis can be induced by heparin or warfarin

Ulster Med J. 1991 Oct; 60 (2):248-50.

 

8) Richie AJ, Hart NB

Massive tissue necrosis can be induced by heparin.

Acta Haematol. 1992; 87(1-2): 69-70.

 

9) Dujon DG, Chatzis LA, Hart NB

Thromboembolic prophylaxis in plastic surgery : an appraisal

Br J Plast Surg. 1992 Aug-Sep; 45(6): 418-20

 

10) Carney SA, Cason CG, Giwar JP, Stevenson JH, McNee J, Groves AR, Thomas SS,

Hart NB, Auclair P

Cica-Care gel sheeting in the management of hypertrophic scarring.

Burns. 1994 Apr; 20 (2): 163-7

 

11) Papanastasiou S, Hart NB.

Multiple uses of the hypodermic needle.

Br J Plast Surg. 1995 Jul; 48 (5): 338

 

 

 

12) Soundarajan V, Hart NB, Royston CM.

Abdominoplasty following vertical banded gastroplasty for morbid obesity.

Br J Plast Surg. 1995 Sep; 48 (6):423-7.

 

13) Southern SJ, Hart NB, Venkataramakrishnan V, Niewoudt F, Villafane O.

Lower limb salvage using parts of the contralateral amputated leg.

Injury. 1997 Sep;28 (7): 477-9.

 

14) Ramakrishnan V, Southern S, Hart NB, Tzafetta K.

Endoscopically assisted gracilis harvest for use as a free and pedicled flap.

Br J Plast Surg. 1998 Dec; 51 (8): 580-3.

 

15) Bahia H, Ahmed O, Hart NB.

A new tie-over dressing for hypospadias repair.

Br J Plast Surg. 1999 Dec; 51(8): 580-3.

 

16) Bahia H Platt A, Hart NB, Baguley P.

Anabolic steroid accelerated multicompartment syndrome following trauma.

Br J Sports Med. 2000 Aug; 34 (4): 308-9.

 

17) Erel E, Pleasance PI, Ahmed O, Hart NB.

Absorbable versus non-absorbable suture in carpal tunnel decompression.

J Hand Surg (Br). 2001 Apr; 26 (2): 157-8.

 

18) Ahmed O, Bahia H, Hart NB.

Free-flap debulking: the safe option.

Br J Plast Surg. 2001 Jul; 54(5): 464-5.

 

19) Ellaban MG, Ali R, Hart NB,

Subcutaneous metallic mercury injection of the hand.

Br J Plast Surg. 2003 Jan;56(1):47-9.

 

20) Ellaban MG, Hart NB.

Body contouring by combined abdominoplasty and medial vertical thigh reduction : experience of 14 cases

Br J Plast Surg. 2004; 57 (3): 222-7.

 

21) Ellaban MG, Hart NB.

Seat belt injury to female chest.

PRS 2004 May; 13 (6):1879-80.

 

22) Sillitoe AT, Thornton DJ, Srinivasan J, Hart NB.

Elevation of the umbilicus with skin hooks aids excision in abdominoplasty

(Letter) PRS 2005 Jan; 115 (1): 349

 

23) Hasham S, Matteucci P, Stanley P, Hart NB.

Necrotising fasciitis.

BMJ. 2005. Apr 9;330 (7495):830-3.

(Jounal Article. Review)

24) Rehman N, Kannan RY, Hassan S, Hart NB.

Thoracodorsal artery perforator (TAP) type I V-Y advancement flap in axillary hidradenitis suppurativa.

Br J Plast Surg. 2005 Jun; 58 (4) 441-4.

 

25) Govindan KS, Vadodaria S, Hart NB.

Subcutaneous staple granuloma may mimic recurrent squamous cell carcinoma.

PRS 2005 Jun ;115 (7): 2170-1

 

26) Matteucci, P, Hart NB, Fourie, LR.

Patient grounded by Facelift

Plast Reconstr Surg. 2006 Feb;117 (2):696-8

 

27) Iwuagwu OC, Walker LG, Stanley PW, Hart NB, Platt AJ, Drew PJ.

Randomized clinical trial examining psychosocial and quality of life benefits of bilateral breast reduction surgery.

Brit J Surg. 2006. Mar;93(3): 291-4

 

28) Iwuagwu OC, Platt AJ, Stanley PW, Hart NB, Drew PJ.

Does reduction mammoplasty improve lung function tests in women with macromastia? Results of a randomized controlled trial.

PRS 2006 Jul; 118(1): 1-6

 

29) Conroy FJ, Thornton DJA, Mather DP, Srinivasan J, Hart NB.

Thromboembolic prophylaxis in plastic surgery : a 12 year follow up in the UK

JPRAS. 2006; 59: 510-14.

 

30) Williams AM, Sillitoe AA, Hart NB.

An innovative technique for marking the donor site for full thickness skin grafts.

(Letter) JPRAS 2007; 60 (4): 453.

 

31) Bains R, Hart NB.

A simple technique to support the paralysed face with Gore-tex sutures using drain trocars under local anaesthetic.

JPRAS 2008 Jan; 61(1) 114.

 

 

32) Payne CE, Williams AM, Hart NB.

Lotus Petal flaps for scrotal reconstruction combined with Integra ™ resurfacing of the penis and anterior abdominal wall following necrotizing fasciitis.

JPRAS 2009; 62(3):393-397

 

 

The Ulnar Cantilevered Bone graft for Augmentation of the Nasal Dorsum in Severe Saddle Deformity

D Sylvester, P Matteucci, N Hart

Accepted by European Journal of Plastic Surgery

Overview of Plastic Surgery Career

Decision to embark on a career in Plastic Surgery

 

SHO Post-Plymouth

Until my first Plastic Surgery appointment in 1976, I wanted to be an orthopaedic surgeon. David Harris was inspirational, and a great teacher despite being almost single-handed. I could still use the orthopaedic experience I had acquired in the management of acute lower limb and hand trauma.

 

I told David Harris I wanted to be a plastic surgeon, and he advised me to see Mr. RLG Dawson at Mount Vernon, who advised me to do another three years general surgery.

This was the climate of opinion in those days, that plastic surgery was applied general surgery; hence my SHO and Registrar posts in Plymouth and Birmingham respectively.

These were not wasted years, even the urology post; there were often times in the future when I could rely on my experience.

 

Plastic Surgery Registrar Post -Birmingham

I met Frank Cort towards the end of my general surgery appointment, and was extremely lucky as there was a registrar vacancy at Wordsley, for which I successfully applied.

I was attracted to Frank’s radical approach to head and neck surgery. John North very patiently took me through my first cleft lip and palate cases. Henry Goldin was just starting his craniofacial team with Tony Hockley and Mike Wake, and Douglas Murray was inspirational with his enthusiasm. Jeff Nancarrow was a great hand surgery teacher.

My fellow registrar, Aivar Bracka, was, of course, interested in hypospadias reconstruction. Simon Kay joined us later, and introduced us to the relatively new concept of free tissue transfer.

I also spent six months with John Gowar in the burns unit at Birmingham Accident Hospital.

 

Senior Registrar Post- Belfast

At the time, Belfast was the last place on would think of going in the early eighties, but fortunately I had visited the city as a student, and liked the people. I was totally unprepared for the warm welcome I received, and for the enthusiasm of the unit.

As can be expected from a city which was still in a state of war in some places, life was extremely busy, especially as there were only two Senior Registars in Plastic Surgery  in the whole province, and all the junior staff were rotational and had no prior experience in plastic surgery.

 

My Senior registrar colleague James Small was at the time pioneering the Belfast Regime for early active motion after tendon repair, and many advances were being made in the management of compound fractures of the lower limb; there was no shortage of patients with these problems!

 

I learned a lot of general plastic surgery from Ronnie Slater, hand surgery from John Colville and Mike Brennen (who also did many free flaps), and burn management from Roy Millar; but it was again head and neck surgery which really took my interest, and especially the way Alan Leonard managed his cases. He was always ready to try the latest development, and achieved superb results. He had previously been in Buffalo for a clinical fellowship (he had sailed the Atlantic to get there!), and I became interested in going to North America myself.

I had applied to do a clinical fellowship in craniofacial surgery in Toronto with Ian Munro, but by the time I arrived at the Sick Children’s Hospital in 1986, he had already gone to the USA. Jeff Posnick took his place, but not until some time later; however, I enjoyed what I saw.

 

My interest in cleft lip and palate was strengthened by Bill Lindsay’s immense experience, and by the extremely well-run cleft clinics and high input from Bruce Ross in Orthodontics and Mary-Anne Witzel in Speech Pathology.

Hugh Thomson was a specialist in costochondral cartilage grafting for microtia.

Ron Zuker was working with Ralph Manktelow in facial reanimation.

A new consultant, Howard Clark, was very enthusiastic.There was a wealth of postgraduate activity, and I had plenty of time to use the library and write up some papers.

 

On returning to Belfast, James Small went to do his clinical fellowship in the States, and Jeff Ashall joined us as a locum Senior Registrar. He later became a consultant, but tragically died shortly after I left Belfast.

 

Our time in Northern Ireland was a great experience for the whole family, and we became interested particularly in the traditional music of the region. The family loved Canada as well, and we made many lasting friendships.

 

 

Consultant Post- Hull

I took over from Bob Heycock, who was a superb cleft surgeon and was a hard act to follow.

Moving from  Northern Ireland was quite a culture-shock, but Peter and Pat O’Hare and their family did their best to make us feel at home.

 

Being a two- Consultant Unit with (initially) one Registrar and one SHO was very busy, but I had been used to that in Ireland. Peter was an excellent hand surgeon, so I concentrated on head and neck surgery, using the techniques I had learned from Alan Leonard in Ireland, using routine free flaps. This was difficult, as our Unit was in the small Kingston General Hospital and the ICU was in the Hull Royal Infirmary. This meant transferring the anaesthetized patient in an MRU ambulance across town (thankfully with no complications).

 

Later I was able to do the same work (against some opposition from the theatre manager!) at the Hull Royal Infirmary, and with co-operation from my maxillofacial and ENT colleagues, this has developed into a very successful Head and Neck Multidisciplinary Unit led by Professor Nick Stafford , and covering the whole of East Yorkshire and North Lincolnshire, with academic links to the Hull York Medical School.

 

 

 

My experiences with Cleft Lip and Palate were not so happy.

I was eventually doing the majority of clefts (about 18 new cases a year) when the CSAG report came out. Despite having an average rating in the Audit, and having developed the Cleft Unit with my Orthodontic, Maxillofacial, Paediatric , ENT and Speech Therapy colleagues and specialist Nurses,  I was informed that I was not doing enough new clefts annually (despite my doing about 50 per year in Pakistan –see below) to allow the unit to continue, and it was transferred to Leeds. It was a bitter blow. Children and their families, whom I had become very attached to, were now having to travel sixty miles to be operated on by a maxillofacial surgeon, from whom subsequently I have had hardly any contact, but who would not let any of my Hull trainees observe his operations!

 

In 1997, a locum Plastics registrar called Mr. Aman Raja asked me if I would join him in a regular Cleft Camp he was running in Gujrat, Pakistan. The following year I went with an anaesthetist, scrub nurse and an ODP. We operated on more clefts in a week than I had done in a year back home. Since then, we have established our own Registered Charity (OPSA) and together with my Plastic Surgeon colleague Mr. Muhammad Riaz and many medical and nursing volunteers we now run two visits a year, operating on about 230 disadvantaged children with clefts and burns contractures  each time. Our hosts run the hospital on the profits from their furniture-manufacturing business, and we have almost become part of their family. We are having a new hospital built for us (with a very generous donation from the Japanese Government) and I think this has done a great service to international relations between Pakistan and Britain.

Our Charity has also made similar visits to India.

 

In addition to the general elective and emergency work of the Unit, my other interests included  lower limb reconstruction, breast and gynaecological reconstruction and the management of pressure sores.

 

When our original rat-infested base at Kingston General Hospital was closed, an attempt was made by management to re-locate us to a similarly aged building on the other side of town. We managed to successfully resist this, and had a new ward and theatres developed at Castle Hill Hospital, which is now larger than Hull Royal Infirmary.

 

We now have a superb unit comprising six consultants and a full complement of junior staff, and full involvement in a number of multidisciplinary groups including the Head and Neck MDU.

 

I retired from the NHS in  April 2010. I stopped my private practice, apart from medicolegal work, which I still find intellectually stimulating.

This has given me more time to devote to the cleft charity, which now goes to Pakistan twice a year, and involves a lot of speaking and fund-raising activities.

I also have more time for gardening, sailing, and music, mainly playing the bagpipes, and spending time with my family, which now includes two grand-daughters

The Future

I still keep an active interest in the Plastic Surgery world, and I am anxious about its future.

Unfortunately, the NHS managers in Hull have not appreciated the contribution plastic surgery has made in the city, and have just closed our main plastic surgery ward! Plastic surgery now has to be a day-case or 5-day ward specialty. Patients who have to stay longer are farmed out to other wards. Many of the specialist staff we have tried so long to nurture and keep have been dissipated.

The impression I have had from management all through my career has been that they consider plastic surgery as unnecessary and plastic surgeons as cosmetic surgery millionaires. It has taken a great deal of effort to dispel this myth, and we have not always been successful.

Many other specialities owe their very existence to the clinical input of their plastic surgery colleagues, a contribution which is  often not remunerated by the purchasers, who are guided only by the name of the consultant or department the patient is in.

 

Just as Plastic Surgery arose from other specialities at a time of crisis at the beginning of the last century, I fear that it may be absorbed back into them at the beginning of this one, if we are not vigilant and keep the profile of Plastic Surgery in this country as high as possible.