Australasian Journal of Plastic Surgery最新文献

{"title":"Plastic surgery minor procedure room: a cost-effective way to operate","authors":"B. Sacks, Xinchen Gu, S. Shoukath, Nigel C Mann","doi":"10.34239/ajops.93016","DOIUrl":"https://doi.org/10.34239/ajops.93016","url":null,"abstract":"Introduction: Surgery using local anaesthetic without sedation outside of a formal operating theatre is particularly applicable to plastic surgery. This paper reviews the benefits and pitfalls of a minor procedure room as a novel solution to tackling the emergency and elective surgery caseload in a tertiary metropolitan plastic surgery unit. Methods: From February 2022 until February 2023 local anaesthetic only procedures were undertaken in a minor procedure room. Patients included ranged from 18 to 88 years of age. Outcomes included complications and procedure failure requiring repeat procedure in an operating theatre. Estimated cost savings were calculated according to staff wages and do not account for consumables. Estimated duration of minor procedure room operation was one hour per case. Results: Overall, 350 patients (285 male, 65 female) underwent local anaesthetic only procedures in the minor procedure room. The mean age of patients was 42. There were 309 hand/upper limb cases, 31 general plastic surgery cases, two skin cancer excisions and eight lower limb cases. There were no complications and no procedure failures. The average cost saved per procedure is estimated to be AU$486 with an average reduction of 44 theatre sessions per year. Conclusion: A minor procedure room for local anaesthetic only surgery can generate significant cost and time savings for a hospital when implemented and managed appropriately. This model has been successful in our institution and can likely be replicated in other centres.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"24 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of close/positive margins in cutaneous squamous cell carcinoma of the head and neck: a systematised review","authors":"Luke Martin, M. Cabalag, Anand Ramakrishnan, Andrew Martin","doi":"10.34239/ajops.88849","DOIUrl":"https://doi.org/10.34239/ajops.88849","url":null,"abstract":"Introduction: The authors reviewed close/positive margins in cutaneous squamous cell carcinoma of the head and neck, ensuing recurrence, regional or systemic metastasis, mortality and follow-up management. Methods: The design was a systematised review from January 2000 to July 2021. The MEDLINE database was searched with 15 articles out of 3104 meeting the inclusion criteria. Pertinent references underpinning the National Comprehensive Cancer Network’s Squamous Cell Skin Cancer Guidelines Version 2.2022 were reviewed. Results: Overall, there were 13,671 cutaneous squamous cell carcinoma lesions. We found pooled rates for positive excision (14.6% at 99% CI [12.97, 16.26]), ensuing recurrence (14.7% at 99% CI [13.51, 15.83]), regional or systemic metastasis (33.8% at 99% CI [33.77, 33.87]), and mortality (46.6% at 99% CI [42.53, 50.65]). Positive excisions most frequently involved the deep margin (73.7%), nose (34.5%) and ear (33.14%). Re-excision of positive margins appeared to confer worse recurrence (35.4%). We found pooled rates for close/positive excision (17% at 99% CI [15.22, 18.84]), ensuing recurrence (17% at 99% CI [15.76, 18.16]), regional or systemic metastasis (30.4% at 99% CI [26.15, 34.73]), and mortality (46.6% at 99% CI [42.53, 50.65]). Mean follow up was 51 months. Surgical re-excision with adequate margins appeared to be most efficacious, followed by radiotherapy. Chemoradiation and chemotherapy appeared less efficacious. Conclusion: Surgical re-excision with adequate margins remains the gold standard for close/positive margins in cutaneous squamous cell carcinoma of the head and neck, followed by radiotherapy.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"11 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The modified Stack procedure for central slip reconstruction: a case series","authors":"James Warbrick-Smith, Holly Morris, Shirley Collocott, Amy Wang, Karen L Smith","doi":"10.34239/ajops.92997","DOIUrl":"https://doi.org/10.34239/ajops.92997","url":null,"abstract":"There are many surgical techniques for reconstruction of the divided or incompetent central slip. Most rely upon postoperative immobilisation to protect the repair. We present our experience using a distally based flexor digitorum superficialis slip to reconstruct the central slip and allow early mobilisation in five patients with intact preoperative intrinsic function. Post-treatment, a mean recovery of 65 degrees of active extension was achieved, albeit at the cost of a mean 22-degree loss of active flexion. We suggest this relatively easy technique provides a useful surgical option in the management of this difficult problem.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"98 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141664191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of ward-based education in the postoperative assessment of free flaps","authors":"G. D. Dounas, J. Willet, Anton I Alvaro, Lucinda Van de Ven, Mjd Wagstaff","doi":"10.34239/ajops.90089","DOIUrl":"https://doi.org/10.34239/ajops.90089","url":null,"abstract":"Background: Despite the theoretical and practical advantages of adjunct-based free flap failure detection, the introduction of ultrasonographic techniques has not changed free flap failures rates and their use remains secondary to clinical assessment. Our study aims to develop an educational framework to improve the confidence of nursing staff caring for free flaps, with an emphasis on early detection of flap failure, thereby improving postoperative outcomes. Methods: Nursing staff in intensive care units and surgical wards caring for free flaps completed standardised questionnaires either before or after an educational seminar detailing clinical and Doppler assessment of free flaps. Differences between cohorts were summarised descriptively with frequencies and percentages. Overall confidence scores for pre-education and post-education cohorts were compared. Results: Overall, 173 responses were collected. Most staff were from intensive care units (n = 114) and almost one-third completed surveys following the educational intervention (n = 51). Microsurgical ward staff had more experience in the postoperative care of free flaps than intensive care unit staff (29% vs 18% had experience caring for > 50 free flap cases). Confidence in assessing a free flap by clinical, implantable Doppler or external Doppler ultrasound was universally increased among ward staff compared to intensive care unit staff (p ≤ 0.007). Altogether, 51 per cent of intensive care unit staff had never identified a failing flap compared with 35 per cent of ward staff. Education increased confidence in managing and escalating failing flaps unanimously. Most failing flaps were identified by clinical assessment alone or combined with adjunct-based methods (94%). Conclusion: This study demonstrates that the provision of targeted education for nursing staff, both in intensive care units and on surgical wards, is useful for increasing confidence in the clinical assessment and early detection of free flap compromise. Increased confidence and improved clinical assessment may allow for early intervention and improved salvage rates for a threatened free flap, thereby improving patient outcomes.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"61 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141688319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The obesity paradox in patients with major burn injuries: a single tertiary burn centre review","authors":"Michaela Pollock, Eldo Paul, Cheng Hean Lo","doi":"10.34239/ajops.90090","DOIUrl":"https://doi.org/10.34239/ajops.90090","url":null,"abstract":"Introduction: The obesity paradox is a phenomenon described in medical literature where overweight and obese patients have improved survival and better health outcomes. The obesity paradox is of curiosity to many clinicians as the general consensus in medicine has been that a higher body mass index results in poorer health outcomes in both medical and surgical conditions. The aim of this study is to determine whether the obesity paradox exists in our patients with major burn injuries. To our knowledge, this has not been previously investigated in the Australian major burn population. Methods: This is a retrospective study involving patients with major burn injuries > 20 per cent total body surface area admitted to the Victorian Adult Burns Service (Melbourne, Australia) from 1 January 2016 to 31 December 2020 (five-year period). Information collected included patient demographics, weight and height, and nature of burn injuries. Primary outcome of interest was inpatient mortality, and secondary outcomes included hospital length of stay, intensive care unit length of stay, duration of ventilation support required and presence of bacteraemia. Results: A total of 1704 patients were admitted, of whom 165 patients met inclusion criteria for analysis. The vast majority of 31 patients (18.8%) who died during admission were palliated. The obesity paradox did not exist in this study population. Furthermore, although not statistically significant, higher levels of body mass index showed increased risk of mortality. There was no significant association between body mass index and hospital length of stay (p = 0.16), intensive care unit length of stay (p = 0.72), duration of ventilation support (p = 0.62) nor bacteraemia (p = 0.68). Conclusion: The emerging evidence regarding the obesity paradox in the burn surgery literature is inconsistent. We contend that differences in burn management, including palliation of patients with major burn injuries, contribute to these findings.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"8 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141356293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-stage eyebrow reconstruction with a double opposing forehead flap: a case report","authors":"B. Sacks, Elizabeth Concannon, Michael Findlay","doi":"10.34239/ajops.89259","DOIUrl":"https://doi.org/10.34239/ajops.89259","url":null,"abstract":"The authors describe an alternative option for reconstructing an eyebrow defect following excision of a squamous cell carcinoma using a single-stage, double opposing forehead flap.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘The left behind syndrome’—surgical equipment errors in plastic surgery","authors":"David G Pennington","doi":"10.34239/ajops.115366","DOIUrl":"https://doi.org/10.34239/ajops.115366","url":null,"abstract":"The author discusses surgical items accidentally left behind in patients after plastic surgery, things that increase the risk of this happening and ways to reduce the risk.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"121 27","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Art, pharmacy and history of skin marking and surgical inks in plastic surgery","authors":"Tzong-Yang Pan, Irene Heng, Brian Sommerlad, Nicola R Dean","doi":"10.34239/ajops.88850","DOIUrl":"https://doi.org/10.34239/ajops.88850","url":null,"abstract":"Plastic surgeons can be distinguished in pre-planning much of their surgery by drawing on the skin. The history of marking the body with ink in plastic surgery goes back to the 1400s. The Sommerlad pen was originally developed at the London Hospital in the 1970s. Sommerlad pens and Bonney’s blue ink allow for a consistent weight of the pen in hand, a reliable source of ink, and an ability to vary the thickness of the line drawn. There has been a suspicion that gentian violet, a component of Bonney’s blue ink, is a carcinogen, resulting in supply problems. Animal models have demonstrated the carcinogenic properties of gentian violet, but evidence to support the carcinogenic potential of gentian violet in humans is sparse. In the surgical setting, we must adhere to using published and described ink formulas. Proprietary formulations lack standardisation, and the compounds used are not always disclosed. The concerning findings of in-vitro and animal models are a valuable addition to our knowledge about these compounds; however, to over-extrapolate and restrict its use on humans as a topical skin marker takes away an important component of a plastic surgeon’s armamentarium.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"31 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140727654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on gender-affirming surgery","authors":"William Blake","doi":"10.34239/ajops.92498","DOIUrl":"https://doi.org/10.34239/ajops.92498","url":null,"abstract":"William Blake looks at advances in the provision of gender-affirming surgery and how plastic surgeons in Australia can respond to the need for better surgical care for gender-diverse people.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"54 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140723890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Breast implant-associated anaplastic large cell lymphoma diagnosis six months post breast reconstruction: a case report\"","authors":"Teagan Fink, Siddhartha Deb, David Clouston, Michael Weymouth, Chantel Thornton, A. Chakrabarti","doi":"10.34239/ajops.88486","DOIUrl":"https://doi.org/10.34239/ajops.88486","url":null,"abstract":"The authors report the earliest time frame (six and a half months) between exposure to textured breast implant and the development of breast implant-associated anaplastic large cell lymphoma.","PeriodicalId":264055,"journal":{"name":"Australasian Journal of Plastic Surgery","volume":"11 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140720767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}