Imaging plays an important role in the diagnosis of soft tissue sarcomas. 

Ultrasound:

• Identify the lesion
• Solid or Cystic
• Well circumscribed or irregular
• Uniform echogenicity or heterogeneous Size
• Superficial or deep to the fascia

MRI:

• Location, adjacent anatomy – vessels, muscle and bone involvement
• Size
• Tissue type

MRI Protocol Axial T1, Axial PDFS, Coronal T1, Coronal STIR (Sagittal T1, Sagittal STIR – depended on location.)

For patients who have under gone an excision of a lesion and have obtained a diagnosis of sarcoma as an addition we perform pre and post sequence with gadolinium. (Axial T1FS Pre and Post).

Ultrasound screening of soft tissue masses in the trunk and extremity

Ultrasound screening of soft tissue masses in the trunk and extremity (This document is located on REMEDY  BNSSG referral pathways and Joint Formulary).

SWAG region lipomatous tumour Pathway This document is located on REMEDY BNSSG referral pathways and Joint Formulary).

To contact the Enhanced Recovery team telephone 0117 4143610 or 0117 4143611.

Dawn Gane

 

 

 

 

 

 

 

 

 

Jodie Rogers

 

 

 

 

 

 

 

 

 

 

Engela Otto

 

 

 

 

 

 

 

 

 

 

 

The aim of Breast Reconstruction Enhanced Recovery Surgery is to get you back to full health as quickly as possible after your operation. There may be circumstances where the programme will not be appropriate for some patients and if this is the case, you will be fully informed.

Research indicates that after surgery your recovery will be quicker with fewer complications the earlier we get you out of bed, exercising, eating and drinking. In order to achieve this we need to work together to enhance your recovery.

Before surgery

The specialist breast care nurse will have already discussed appropriate lifestyle behaviour. It is important that you understand what you need to do in order to ensure you are fit and safely prepared for surgery. It is important to keep as active as you can before your operation. The nurse will discuss diet and exercise with you and returning to normal activities.

 

You will be given a choice of special nourishing supplement drinks called ‘fortijuce’ and ‘fortisip’, in a variety of flavours. These are nutritional supplements containing protein (to aid healing) and vitamins (to support your immune system). Regardless of your weight or appetite, you will be given some of these drinks to take home with you. Take them at the time discussed.

As you are likely to be in hospital for 4-5 days, it is important that you remember to bring a few things in with you, or get a family member to bring them in for you. Things you will need:-

• Night wear with buttons down the front
• Slippers/dressing gown
• Sports bra/support bra
• Support pants [Large enough to cover abdominal scar]
• Toiletries [Including dry shampoo]
• Comfortable clothes to wear in the ward and home
• IPod, MP3 magazines and books

Support/Sports bra will be fitted once your breast drains have been removed, you need to wear it for 4-6 weeks following surgery. After Diep surgery, whilst in hospital you will need to try and wear support [spanks] pants to help support your abdomen and reduce some of the abdominal swelling, for at least 4 weeks.

 

If you were told to take Preop drinks, take them at the time discussed. These drinks are a clear liquid ‘breakfast’ to ensure your body has fuel to work with whilst you are not eating. If you are diabetic we will not give you these as they can cause your blood sugars to rise.

Once you arrive for surgery

Upon arrival, a member of the surgical team looking after you will check that you are fully aware of your surgery.

In order to help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will need to measure your legs to obtain the correct size.

After your surgery

You will return to the ward after your operation. You will need to stay in bed for the first 24 hours positioned with your knees bent/flexed to help your abdomen relax. For the first 24-72 hours you will be closely monitored to ensure that your new breast[s] is healing and that you are recovering from the anaesthetic.

Following this progression chart will help improve your recovery. The nurses on the ward will assist you or if you have any questions.

Day of Surgery, after your operation	Day 1 after your operation	Day 2 after your operation	Day 3 after your operation	Day 4 after your operation	Day 5 after your operation
Drink freely as tolerated	Eat and drink freely as tolerated	Eat and drink as tolerated	Eat and drink normally	Eat and drink normally	You will only be in hospital if your drains have not yet been removed
Drink Fortijuce/Fortisip	Drink 3 Fortisip/ Fortijuce	Drink 3 Fortisip/ Fortijuce	Drink 3 Fortisip/ Fortijuce	Drink 3 Fortisip/ Fortijuce	Eat and drink normally
Eat a light diet as tolerated as otherwise advised	You can sit up, between 45 and 60 degrees – a nurse will help you with this after you have seen your doctor	Try to get dressed into your day clothes	Get dressed into your day clothes	Get dressed into your day clothes	Drink 3 Fortisip/Fortijuce
Remain on bed rest	Start breathing exercises (the nurse & Physio will advise you)	Aim to sit out and mobilise as soon as you have seen your doctor – the nursing staff can help you	Mobilise normally – aim for 4 walks a day Maintain a slightly stooped position	Mobilise normally – aim for 4 walks a day Maintain a slightly stooped position	Continue to mobilise
		Continue breathing exercises	Ask for laxatives if your bowels have not opened	Ask for laxatives if your bowels have not opened	Practice stairs with physio
		have you opened your bowels? if not inform your nurse	Fitting of a sports bra	Ensure you are wearing your sports bra
		Start planning for discharge home	Plan for going home tomorrow	Discharge home today of your drains are out

You should try and be as mobile as you can once you are home. You will find that you will also need to take regular rests at intervals which may mean you have to go back to bed for a couple of hours each day. This surgery can be very tiring for the first couple of weeks and then improve slowly. The Physiotherapist will give you exercises to do once your are home, it is important to continue with the advice given to ensure you recover quickly and with full movement. We advise
no heavy lifting, washing clothes etc. for at least three to four weeks after surgery. This allows all wounds and scars to heal without any added stress to the area.

For further information:

• www.nhs.uk/conditions/enhanced-recovery

The aim of Urology Enhanced Recovery Surgery is to get you back to full health as quickly as possible after your operation.

Research indicates that after surgery your recovery will be quicker with fewer complcations the earlier we get you out of bed, exercising, eating and drinking. In order to achieve this we need to work together to enhance your recovery.

Before surgery

It is important to keep as active as you can before your operation and if you are a smoker you should stop now. Stopping smoking helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice to help you stop smoking.

Outpatients

Before you come into hospital for your surgery, your Consultant will see you in the outpatients department to explain your operation. Following this you will be sent a date to attend the pre-operative assessment clinic, where we will carry out routine tests to ensure you are fit and safely prepared for surgery. All patients are routinely screened for potential infections at this time.

Pre-operative assessment clinic

The specialist Enhanced Recovery Nurse will see you at the pre-operative assessment clinic and will explain the programme to you.                 

You will be given a choice of special nourishing supplement drinks called ‘fortijuce’ and ‘fortisip’, in a variety of flavours. These are nutrional supplements containing protein (to aid healing) and vitamins (to support your immune system). Regardless of your weight or appetite, you will be given some of these drinks to take home with you. Take them at the time discussed.

You will be provided with written information and given the opportunity to ask questions. If you have concerns about your appetite or diet before coming in for your operation please speak to the nurses at your pre-assessment visit.
If required, you will be referred to the anaesthetist and pharmacist.

If you were told to take Preop drinks, take them at the time discussed. These drinks are a clear liquid ‘breakfast’ to ensure your body has fuel to work with whilst you are not eating. If you are diabetic we will not give you these as they can cause your blood sugars to rise.

After your surgery

Mobilizing and exercising
Following your surgery, when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour as follows:

• Start in a comfortable position, ideally sitting upright in the bed or chair with your shoulders relaxed.
• Take a long, slow deep breath in, as much as possible. Hold this breath for 3 seconds.
• Slowly breath out.
• Take 3 more deep breaths in the same way. Then return to breathing normally.

For further information:

• www.nhs.uk/conditions/enhanced-recovery

The aim of Vascular Enhanced Recovery Surgery is to get you back to full health as quickly as possible after your operation.

Research indicates that after surgery your recovery will be quicker with fewer complcations the earlier we get you out of bed, exercising, eating and drinking. In order to achieve this we need to work together to enhance your recovery.

Before surgery

It is important to keep as active as you can before your operation and if you are a smoker you should stop now. Stopping smoking helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice to help you stop smoking.

Outpatients

Before you come into hospital for your surgery, your Consultant will see you in the outpatients department to explain your operation. Following this you will be sent a date to attend the pre-operative assessment clinic, where we will carry out routine tests to ensure you are fit and safely prepared for surgery. All patients are routinely screened for potential infections at this time.

Pre-operative assessment clinic

The specialist Enhanced Recovery Nurse will see you at the pre-operative assessment clinic and will explain the programme to you.                 

What you eat is important, as good nutrition now will help you recover faster from your operation.

You will be given a choice of special nourishing supplement drinks called ‘fortijuce’ and ‘fortisip’, in a variety of flavours. These are nutrional supplements containing protein (to aid healing) and vitamins (to support your immune system ). Regardless of your weight or appetite, you will be given some of these drinks to take home with you. Take them at the time discussed.

You will be provided with written information and given the opportunity to ask questions. If you have concerns about your appetite or diet before coming in for your operation please speak to the nurses at your pre-assessment visit.
If required, you will be referred to the anaesthetist and pharmacist.

If you were told to take Preop drinks, take them at the time discussed. These drinks are a clear liquid ‘breakfast’ to ensure your body has fuel to work with whilst you are not eating. If you are diabetic we will not give you these as they can cause your blood sugars to rise.

After your surgery

Mobilizing and exercising
Following your surgery, when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour as follows:

• Start in a comfortable position, ideally sitting upright in the bed or chair with your shoulders relaxed.
• Take a long, slow deep breath in, as much as possible. Hold this breath for 3 seconds.
• Slowly breath out.
• Take 3 more deep breaths in the same way. Then return to breathing normally.

 

For further information:

• Vascular network
• www.nhs.uk/conditions/enhanced-recovery
• www.vascularsociety.org.uk

The aim of Colorectal Enhanced Recovery Surgery is to get you back to full health as quickly as possible after your operation.

Research indicates that after surgery your recovery will be quicker with fewer complications the earlier we get you out of bed, exercising, eating and drinking. In order to achieve this we need to work together to enhance your recovery.

If you are having a reversal of ileostomy you may benefit from our 23 hour programme. If you are eligible, you will be given all the relevant information prior to your surgery and will include pelvic floor exercises. 

If you go home with a stoma, and the output increases, please read the patient information leaflet. 

Before surgery

It is important to keep as active as you can before your operation and if you are a smoker you should stop now. Stopping smoking helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice to help you stop smoking.

Outpatients

Before you come into hospital for your surgery, your Consultant will see you in the outpatients department to explain your operation. Following this you will be sent a date to attend the pre-operative assessment clinic, where we will carry out routine tests to ensure you are fit and safely prepared for surgery. All patients are routinely screened for potential infections at this time.

Pre-operative assessment clinic

The specialist Enhanced Recovery Nurse will see you at the pre-operative assessment clinic and will explain the programme to you. 

What you eat is important, as good nutrition now will help you recover faster from your operation.

 

You will be able to eat and drink as normal although It may be suggested that you benefit from a low fibre or ‘low residue’ diet. For examples of a low fibre diet download                   

You will be given a choice of special nourishing supplement drinks called ‘fortijuce’ and ‘fortisip’, in a variety of flavours. These are nutritional supplements containing protein (to aid healing) and vitamins (to support your immune system ). Regardless of your weight or appetite, you will be given some of these drinks to take home with you. Take them at the time discussed.

You will be provided with written information and given the opportunity to ask questions. If you have concerns about your appetite or diet before coming in for your operation please speak to the nurses at your pre-assessment visit.
If required, you will be referred to the anaesthetist, pharmacist and stoma nurse.

If you were told to take Preop drinks, take them at the time discussed. These drinks are a clear liquid ‘breakfast’ to ensure your body has fuel to work with whilst you are not eating. If you are diabetic we will not give you these as they can cause your blood sugars to rise.

You may be required to take medication to clear the contents of your bowel, this will be discussed with you if required.

Once you arrive for surgery

Before your operation you may need 1 – 2 enema(s) to empty you bowel contents. Some patients may be required to take medication the day before in order to achieve this, this will be fully explained to you.

In order to help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will need to measure your legs to obtain the correct size.

After your surgery

Mobilizing and exercising
Following your surgery, when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour as follows:

• Be in an upright position
• Take a deep slow breath in (feel your stomach gently rise)
• Hold the breath for 3 seconds
• Breathe out slowly

Following this progression chart will help improve your recovery. The nurses on the ward will assist you or if you have any questions.

Day of surgery, after your operation	Day 1, 2, 3 and 4 after your surgery
Drink freely as tolerated	Get dressed in your day clothes
Eat a light diet 6 hours after surgery	Sit out of bed for 6-8 hours
Sit out of bed for at least 1 hour	Eat and drink freely as tolerated
Fortisip or Fortijuce drinks as tolerated	X3 Fortisip or Fortijuce during the day
Complete daily progression diary	Walk approximately  60 metres 4 times a day
	Complete daily progression diary
	Do you know your planned discharge date? Plan for discharge (ask your nurse if you are unsure)

For further information:

• www.nhs.uk/conditions/enhanced-recovery

Referrals are processed by the Joint infection Co-ordinator and triaged by the orthopaedic surgeons for further action.

Prosthetic Joint Hip Infection Clinic

To make a referral, please complete the following form and email it to hipinfectionclinic@nbt.nhs.uk.

Prosthetic Knee Infection Clinic

To make a referral, please complete the form below and email it to AvonMRCKneeAdministrator@nbt.nhs.uk and call the Joint Infection Services Co-Ordinator in-hours on 0117 414 1633 or 0117 414 1611 to confirm referral.

Urgent advice and referrals

If urgent advice is required or a patient requires urgent referral with acute sepsis to North Bristol NHS Trust, contact Southmead switchboard on 0117 950 5050 and ask for the on call Orthopaedic Doctor.

Please ensure radiology images are transferred to North Bristol NHS Trust PACS by the time of referral. PACS telephone 0117 414 3508.

Out-of-hours a ‘pushed’ image package will automatically be accepted by NBT.

The following documents provide guidance on the specialised AAC services' eligibility specification and referral criteria.

• Guidance for commissioning AAC services and equipment (LINK guid-comms-aac.pdf - Information about the remit and specification of the local and specialised AAC services
   
• Specialised AAC Services Eligibility Criteria (full document with additional guidance) 2025(PDF) 
   
• Specialised AAC Services Eligibility Criteria (abridged) 2025 (PDF)
   
• Flow chart - Decision Tree 2025 (PDF)

Quality Trauma Discharge (QTD)

Initiated by the Major Trauma Centre at Southmead Hospital, QTD allows for the mitigation and avoidance of patient / carer concerns following discharge. Comprising of a comprehensive discharge consultation with a trained Major Trauma Practitioner, provision of a personalised discharge pack and post discharge follow up, these interventions have been shown to educate and empower patients / carers to better manage the sometimes difficult move back to a local hospital or home.

Major Trauma / Intensive Care Bereavement Charity Services

A stand-alone service developed by the team at the Adult Major Trauma Centre: a member of the Major Trauma Team will call to follow up with the patient's relatives/carers following bereavement, allowing some time for you to begin to come to terms with your loss. Unintrusive in nature, this is a good opportunity to talk to those involved in your loved one's care and for them to talk through anything with you or answer any questions you may have. This service is tailored to the needs of the families of our patients and being mindful of how trauma can have different effects on different people, we can offer ongoing support and telephone contact; we want you to fully understand your loved one's care while they stayed with us.

Get involved with the Adult Major Trauma Centre

Patient representatives attend the twice yearly Major Trauma Centre board meeting and provide a valuable insight to their care from a patient/relative perspective. We find this feedback very beneficial in developing our services and delivering training to our clinical staff. Should you be interested in getting involved, or want to find out more, please contact us.

Citizen’s Advice Bureaux (CAB)
www.citizensadvice.org.uk

Organ Donation
www.organdonation.nhs.uk

Blood Donation
www.blood.co.uk

Aftertrauma 
A charity which aims to provide a community for patients and families to rebuild lives and support each other after experiencing a traumatic injury. www.aftertrauma.org

Major Trauma Network Services  

The regional Major Trauma Network ensures that patients who suffer a serious injury within the Severn area are transported safely and quickly to an appropriate service, returned closer to home as soon as is possible (whilst maintaining specialist input into their care) and receive care of the highest quality irrespective of where they live and whenever they suffer a serious injury.