gms | German Medical Science

Objectives/Interrogation: The evidence base for hand surgery is low quality. Most evidence is level III or below and there are few randomised controlled trials. The Reconstructive Surgery Trials Network (RSTN) was founded in 2013. It is the UK clinical trials network for hand and plastic surgery and part of the Royal College of Surgeons Clinical Trials Initiative. It is supported by the BSSH and BAPRAS. The aim was to review the progress of the RSTN after 5 years.

Methods: The review assessed the hand surgery studies supported by the RSTN. It focused on the experiences of collaborators involved in the studies, the study outputs and subsequent impact.

The RSTN has developed its own systems involving the early adoption of a range of technical innovations to support its work. These were reviewed to identify successes and challenges that might benefit other groups.

Results and Conclusions: The RSTN has supported eight hand surgery projects. It is developing a core pathway for the workup of studies, typically including systematic reviews, clinician and patient surveys, and prospective cohort studies before randomised controlled trials. Topics include: nail bed repair, antibiotics in hand surgery, splinting in hand conditions, hand trauma, placebo arm studies, use of Kirschner wires and trigger finger.

A national network of local representatives has been recruited to stimulate involvement, and these reps and study collaborators have been managed using videoconferencing and mailing list management programs. Annual national trials days have become a focus for new study ideas and provided trial methodology to surgical trainees.

To date the studies have generated over 20 publications and presentations. Over 100 collaborators have been PubMed cited and #1M grant money raised. One RCT is recruiting and a further three are in the pipeline. Two studies have an international component. Successes have included the involvement of a large number of trainees, delivering projects on small budgets and impact of studies. Challenges have included geographical location, maintaining engagement and lack of resources.

Trainees are willing to engage in clinical research. They are capable of setting up multicentre studies that attract funding. More needs to be done to support high quality multicentre clinical research that will make a positive contribution to the evidence base in hand surgery. We present this on behalf of the RSTN committee and our collaborators.