bluuebunny/crossref_metadata_2025_split huggingface dataset:
PR31P ESCHAROTOMY BY FACSIMILE
Authors: Avery G. J. 
Published: April 2009

Aim:   To determine what transmissible resources are available to Plastic Surgery Registrars to provide advice and direction to Surgeons outside of the four New Zealand Regional Burn units needing to perform escharotomies on burn patients. To produce a simple transmissible resource to provide assistance for surgeons performing escharotomies outside of a plastic surgery centre.Methods:   Regional Burn unit's in New Zealand were contacted via the on call Plastic Surgery registrar and asked to provide advice supported by diagrams in order to safely perform extremity and trunk escharotomy. Review of the available Burn, Plastic Surgery, General Surgery and Emergency Medicine text‐books was also undertaken.Results:   Readily transmissible guidelines are not currently in use and are not available in the majority of plastic surgery or burn text‐books.Conclusions:   Escharotomies will usually be performed in a Burn or Plastic and Reconstructive Surgery Centre. At times however, these will need to be performed outside of these centres by Surgeons with little or no experience with the procedure, under the distant guidance of the receiving centre. This can safely be achieved, and with the use of appropriate instructions the comfort and effectiveness with which they are performed can be optimised. A concise single A4 sheet indicating locations, indications and precautions for escharotomy incisions is not currently in use. The adoption of this simple resource would be a valuable supplement to telephone consultation and guidance to safely perform this potentially life and limb saving procedure where delay in transfer necessitates its performance.
PR32P EVALUATING ANATOMICAL RESEARCH IN SURGERY: A PROSPECTIVE COMPARISON OF CADAVERIC AND LIVING ANATOMICAL STUDIES OF THE ABDOMINAL WALL
Authors: Rozen W. M. , Chubb D. , Stella D. L. , Taylor G. I. , Ashton M. W. 
Published: April 2009

Background:   Cadaveric research has widely influenced our understanding of clinical anatomy. However, while many soft‐tissue structures remain quiescent after death, other tissues undergo structural and functional changes that may influence their use in predicting living anatomy. In particular, our understanding of vascular anatomy has been based upon cadaveric studies in which vascular tone and flow do not match the living situation.Methods:   An angiographic analysis of the abdominal wall vasculature was performed using plain‐film and computed tomography (CT) angiography in 60 cadaveric and 140 living (70 patients) hemi‐abdominal walls The deep inferior epigastric artery (DIEA) and all of its perforating branches larger than 0.5 mm were analysed for number, calibre and location.Results:   Both large, named vessels and small calibre vessels show marked differences between living anatomy and cadaveric specimens. The DIEA was of larger diameter (4.2 mm vs. 3.1 mm, p < 0.01) and had more detectable branches in the cadaveric specimens. Perforators were of greater calibre (diameter 1.5 mm vs. 0.8 mm, p < 0.01) and were more plentiful (16 vs. 6, p < 0.01) in cadaveric specimens. However, the location of individual vessels was similar.Conclusions:   Cadaveric anatomy displays marked differences to in‐vivo anatomy, with the absence of living vascular dynamics affecting vessel diameters in cadaveric specimens. Blood vessels are of greater measurable calibre in cadaveric specimens than in the living. Consequently, cadaveric anatomy should be interpreted with consideration of post‐mortem changes, while living anatomical studies, particularly with the use of imaging technologies, should be embraced in anatomical research.
PR38P PEDICLED ABDOMINAL FLAPS FOR LOWER TRUNK DEFECTS
Authors: Mahadik P. J. , Deva A. , Yadav P. S. , Quazi G. A. 
Published: April 2009

Introduction:   Large defects of the lower trunk after cancer resections pose a challenge for a reconstructive surgeon. Pedicled flaps based on the deep inferior epigastric artery provide a very simple but an effective way to cover them.Methodology:   9 patients from 24–58 yrs of age were studied at 2 hospitals over a period of 2 yr (2007&2008). Soft tissue defects after resections of SCCs, melanomas etc ranged from 6 × 10 cm to 15 × 28 cm. All were reconstructed with an inferiorly based Rectus abdominus flap.Results:   Almost all the patients had excellent results with no total flap loss. The average operative time was 2.5 hrs. Had a partial flap loss in one case and the average hospital stay being 7 days.Conclusion:   The rectus flap with skin is quite reliable and a simple option for such complex defects. It provides enough bulk and skin pliability needed in these areas and are pretty fast to learn and do.
PR46P THE ARTERIAL ANATOMY OF THE ACHILLES TENDON: ANATOMICAL STUDY AND CLINICAL IMPLICATIONS
Authors: Chen T. M. , Rozen W. M. , Pan W.‐R. , Ashton M. W. , Richardson M. D. , Taylor G. I. 
Published: April 2009

Background:   The Achilles tendon is the most frequently ruptured tendon in the lower limb and accounts for almost 20% of all large tendon injuries. Despite numerous published studies describing its blood supply, there has been no uniformity in describing its topography. The current study comprises a detailed anatomical study of both the intrinsic and extrinsic arterial supply of the Achilles tendon, providing the detail sought from studies calling for improved planning of surgical procedures where damage to the vascularity of the Achilles tendon is likely.Methods:   A dissection, microdissection, histological and angiographic study was undertaken on 20 cadaveric lower limbs from 16 fresh and 4 embalmed cadavers.Results:   The Achilles tendon is supplied by two arteries, the posterior tibial and peroneal arteries. Three vascular territories were identified, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. The mid‐section of the Achilles tendon was markedly more hypovascular that the rest of the tendon.Conclusion:   The Achilles tendon is at highest risk of rupture and surgical complications at its midsection. Individuals with particularly poor supply of the mid‐section may be at increased risk of tendon rupture, and approaches to the tendon operatively should consider the route of supply by the peroneal artery to this susceptible part of the tendon.
PR48P THE GIRL WHO WANTED TO LOOK “NORMAL”: EXTREME FACIAL CONTOURING SURGERY IN SEVERE MCCUNE‐ALBRIGHT SYNDROME
Authors: Neary F. A. , Moaveni Z. 
Published: April 2009

McCune‐Albright Syndrome was first described in 1937. It is a rare condition with an estimated prevalence of between 1 in 100,000 and 1 in 1,000,000 and occurs sporadically in all races. It is defined by at least two features of: fibrous dysplasia, café au lait pigmentation and autonomous endocrine hyperfunction.This case presentation is of a young woman with McCune‐Albright Syndrome with severe cranio‐facial involvement. We discuss our management of this difficult problem thus far with staged surgical procedures to obtain both functional and cosmetic benefits.
PR53P TREATMENT OF PROBLEMATIC PROLIFERATING HAEMANGIOMA WITH PROPRANOLOL
Authors: Ngan N. C. , Tan S. T. , Leadbitter P. 
Published: April 2009

Aims:   The mainstay treatment for problematic proliferating haemangioma is pharmacologic with high dose steroid being the first line treatment. A dramatic response occurs in 30% of cases, equivocal in 40% and continued growth is observed in the remainder cases. Steroid therapy is associated with significant side effects. We report our experience in treating proliferating haemangioma with Propranolol, discovered serendipitously by Léauté‐Labràze et al recently.Methodology:   A 9‐week old boy was referred with a steroid‐resistant proliferating haemangioma involving the upper lip and nose causing feeding and breathing difficulties. The patient was commenced on Propranolol at 0.5 mg/kg twice daily for 24 hours increasing to 1 mg/kg twice daily. The treatment was administered as an inpatient with 4‐hourly heart rate and blood pressure and postprandial (30 minutes) blood glucose level monitoring, for the first 48 hours. The second patient was a 3‐month old boy with a similar rapidly proliferating lesion on the upper lip and nose. He was commenced on similar Propranolol regimen. Both patients were maintained on the original total daily dose of Propranolol.Results:   In both cases rapid reduction of the size and softening of the lesion was noted within 48 hours of treatment with on going accelerated regression observed during the follow‐up period of 4 and 2 months respectively. No cardiovascular or metabolic side effects were observed in both patients.Conclusion:   Accelerated regression is observed in 2 infants with problematic haemangioma following Propranolol therapy with no observed side effect. The possible mechanism of action of beta‐blocker on cell proliferation is discussed.
PR54P WHAT IS BIOFILM AND WHAT DOES IT HAVE TO DO WITH SURGERY?
Authors: Hadi R. , Vickery K. , Deva A. K. , Charlton T. S. 
Published: April 2009

Purpose:   To present a review of biofilms and their significance in surgical practice.Aim:   To better understand the role biofilms play in in‐vivo infection, implantable medical device infection and transmission of infections by patient‐ready instruments.Methodology:   A review was of the biofilm literature was conducted using UNSW, USYD and RACS search engines. Studies were examined for a definition of biofilm and approaches to detection and removal. Subjects of particular relevance to surgical practice were considered to be the role of instrument cleaning in biofilm control and biofilm as a risk factor in viral and prion transmission and infection of implantable medical device. The standardisation of hospital cleaning protocols for medical devices is considered for biofilm control.Results:   From a medical perspective, biofilms may form on living tissues such as wounds, sinuses, native heart valves. Biofilms may also infect implantable and surface medical devices such as indwelling catheters, breast implants, prosthetic joints, as well as central lines and cannulas. Biofilms may also cause inter‐patient transmission of infections through inadequate cleaning regimes of endoscopes, nasoscopes, and surgical instruments particularly cannulated and hinged. Currently there are Australian Standards for disinfection and sterilisation, but no Australian Standard for removal of biofilm.Conclusions:   There needs to be an increased recognition of the role biofilms play in infections. Methods for assessment of biofilm removal need to be developed and adequate cleaning regimes implemented in the health care setting.
PR07 VOLUME DISPLACEMENT TECHNIQUES FOR BREAST CONSERVING SURGERY
Authors: Littlejohn D. R. 
Published: April 2009

Breast conserving surgery (BCS) is no longer limited to simple wide local excision. Simple and advanced volume displacement techniques and volume replacement techniques are now becoming more commonplace. These techniques extend the role of BCS and improve the cosmetic and functional outcome. Volume displacement is becoming the preferred technique for extending BCS. We aim to discuss the indications, surgical technique, outcomes and patient attitudes towards this surgery.In my audit 37 patients were treated with “therapeutic mammaplasty” 2000–2009 (8% of all patients having BCS). Mean tumour size was 24 mm, 50% LN +ve, mean specimen weight 346 g, margins of 14 mm and 1 contralateral cancer found. 4.4% of breast cancers have contralateral pathology. This is compared to other series. In our survey on attitudes to breast reduction surgery 76% of lay people felt breast reduction was appropriate for symptomatic women, 13% felt it appropriate for cosmetic reasons only and 91% felt it appropriate as part of their cancer treatment.In conclusion volume displacement techniques are here to stay, are safe, have functional and cosmetic advantages, oncological advantages, allow extensive histological assessment of the contralateral breast and can aid in the delivery of radiotherapy.
PR09 DYNAMIC SMILE RECONSTRUCTION USING THE MASSETER NERVE TRANSFER IN THE ELDERLY
Authors: Grinsell D. G. 
Published: April 2009

Purpose:   The nerve to masseter has long been used as a recipient to innervate free muscle flaps for facial nerve reconstruction in adults and children alike. This presentation demonstrates the effectiveness and utility of the masseter nerve to directly re‐innervate the native muscles forming a natural smile in an elderly population.Methodology:   Twelve patients aged 40 to 92 years underwent facial nerve resection for malignant disease. There were 11 immediate and one delayed reconstructions utilising the masseter nerve for reconstruction of the smile. The nerve to masseter was dissected and transposed to achieve a direct neurorrhaphy to the nerve to zygomaticus major without the necessity of a nerve graft.Results:   The earliest movement of the commissure of the mouth was detected at 10 weeks postoperatively. All patients reviewed at 6 months showed dynamic movement and were graded cosmetically as either good or excellent.Conclusion:   This is a fast, simple and reliable technique which achieves good cosmetic outcomes for facial reanimation in an elderly population and dispels the myth that dynamic reanimation of the smile is not achievable in patients over 50 years old.
AL03 ADVERSE EVENTS: OUR RESPONSIBILITY FOR REPORTING, REVIEWING AND RESPONDING
Authors: Collins J. 
Published: April 2009

The sustained production of competent surgeons in sufficient numbers to meet the increasing needs of society commences with recruitment and selection of the most able medical graduates. As the process begins through self‐selection, accurate information must be readily available to enable these graduates make an informed judgement on their career choice.Each surgical discipline aspires to use best practice selection in order to identify those who have the potential to acquire the necessary standard of technical and non technical skills and attributes required to practice as a surgeon.A selection system must rank applicants effectively and be reliable, valid, fair, defensible, cost effective and feasible. Best practice selection commences with an analysis of the relevant knowledge, skills, abilities and attitudes associated with successful performance in the particular target job. This information is used to construct a person specification in order to identify selection criteria at a level appropriate for entry to training. Selection methods are then chosen which will best elicit measurable applicant behaviour related to these selection criteria.A number of selection methods are used which include structured references, curriculum vitae and interviews. Other methods available although rarely used include tests of mental ability, aptitude tests and personality inventories. More recently selection or assessment centres (a selection method, not a place) involving a combination of selection techniques such as written exercises, interviews and work simulations have been shown to be highly effective. Eligibility criteria for application (long listing), shortlising for interview, scoring of items within each selection method and overall % weighting for each method are important variables in the selection process.
RS12P THE FIRST AUSTRALASIAN SCHOOL OF RURAL MEDICINE – HOW RURAL FELLOWS ADDRESSED THE “ANATOMY PROBLEM”
Authors: Stewart F. 
Published: April 2009

The first Australasian School of Rural Medicine opened in Armidale, in 2008. The curriculum is the University of Newcastle's problem‐based course. “Basic Sciences” relevant to the week's problem are taught by “overview”. Anatomy is taught by “problem‐relevant system overview”. Simultaneous curriculum‐delivery occurs at both universities.College Fellows among the School's “founding fathers”, concerned about anatomy “deficiency” in ‘new curricula’ courses, believing anatomy to be critical to rural medical practice, wanted their School's students taught regional anatomy by dissection, applied to physical examination, diagnostic image‐interpretation, rural surgery and pathology. Such teaching is not a part of the “joint curriculum”.Solution – establish a voluntary‐attendance, after‐hours course, ‘Evening Anatomy Club’. Launched, in March, “Club” teaching involved weekly preparatory study, completion of an assignment (marked and returned at the next class), a lecture, followed by surgeon‐facilitated practical sessions utilizing bones, images, prosections, surface anatomy and dissection.Three, surgeon‐facilitated, “Dissection Long‐weekends” followed – students were introduced to physical examination, anatomical “variation”, identifying pathology via documentation of features, findings, for the cadaver. Table groups proposed, and revised, contributory cause of death for their patient. Finally, their diagnosis of cause, by post‐mortem examination, was contrasted with the formal Death Certificate's cause.“Club” meetings concluded with a voluntary examination. A survey related to the course, its content, teaching, and student‐perceived relevance, was conducted.
RS13P TRANSURETHRAL RESECTION OF PROSTATE (MONOPOLAR VS BIPOLAR): A REGIONAL EXPERIENCE
Authors: Ponti B. T. , Teng H. S. 
Published: April 2009

Purpose:   Transurethral Resection of the Prostate (TURP) is widely considered to be the gold‐standard treatment for Benign Prostatic Hyperplasia (BPH). More recently, bipolar diathermy TURP has been used in preference to monopolar diathermy due to various technical benefits. This retrospective audit has been conducted to determine whether this technique has had any discernable effects on regional centres.Methodology:   All monopolar and bipolar TURP charts within a six month period were reviewed and consecutive cases of each were analysed to obtain the objective data presented. All TURPs were performed by the same consultant surgeon in the same hospital. The parameters to be defined were: Patient age, operation duration, duration of catheterisation post‐operatively, length of stay, weight of prostatic resection + histology and complications.Results:   21 consecutive monopolar TURP cases and 22 consecutive bipolar TURP cases were reviewed and the data collated. It was observed that bipolar TURP had advantages including a reduced length of stay (1.3 days vs. 2.4 days) and a reduced post operative catheterisation period (1.3 days vs. 2.1 days).Other parameters remained comparable and no difference was noted in complication rates.Conclusion:   Within the limitations of a retrospective audit, the above data can be said to demonstrate significant benefits for bipolar diathermy in TURP procedures in a rural setting. Long term cost benefits could be inferred, given reduced lengths of stay for individual patients.The authors would recommend regional hospitals conducting TURPs to consider a transition to the bipolar TURP system if possible, given that complication rates were unchanged.
RS03 DOES HPV PLAY A ROLE IN THE OUTCOME OF HEAD AND NECK CANCER AMONG INDIGENOUS PATIENTS
Authors: Janakiraman R. , Thomas M. E. 
Published: April 2009

Background/Objectives:   Race, ethnicity and social background can significantly affect outcomes in head and neck cancer. Part of the disparity is that the Indigenous patients tend to be younger and present with more advanced disease. These dramatic disparities cannot be completely explained by demographics, clinical characteristics, substance abuse or treatment modality. Increasing incidence rates are noted world‐wide for HPV‐ related cancers such as oro‐pharyngeal tumours and is significantly associated in non‐smokers/non‐drinkers. The burden of HPV incidence in Aboriginal Australians remains unstudied. This study evaluates the incidence and the role of HPV in the treatment outcome and survival in head and neck cancer patients in indigenous patients at Australia.Methods:   All indigenous patients treated for squamous cell carcinoma of the upper aero‐digestive tract from 2000–2008 at Royal Darwin Hospital, Darwin, NT, Australia, were included in the analysis. Formalin fixed, Paraffin embedded blocks were retrieved and HPV status was checked detected by L1 consensus polymerase chain reaction (PCR), followed by restriction fragment length polymorphism (RFLP) analysis. Demographic data, treatment details and survival statistics were included to complete the analysis.Results:   The incidence of HPV is very variable from other population studies. Interestingly, a very high prevalence of tobacco and alcohol abuse was also documented.Conclusion:   Results suggest that there may be interactions between positive serology and drinking and smoking along with ethnicity, suggesting that the pathogenesis of this subset of patients is different and the treatment has to be individualised.
RS07P DE GARENGEOT HERNIA‐ AN UNUSUAL FINDING IN A RIGHT GROIN MASS
Authors: Sharp D. A. , To P. 
Published: April 2009

The appendix in a femoral hernia is a rare and usually incidental finding at surgery, occurring in 0.5 to 3 per cent of femoral hernia cases [1]. Rarer still is the finding of an acute appendicitis in a femoral hernia, known as a de Garengeot hernia.We present the case of a 47 year old male who presented with a four day history of a painful right groin lump with surrounding erythema of the skin. Ultrasound scan suggested the presence of an incarcerated inguinal hernia, but at operation it was discovered that the appendix was incarcerated in the femoral canal with the tip of the appendix ischaemic. Histology confirmed the presence of an acute appendicitis.External compression of the appendix at the neck of the hernia is thought to be the cause of acute appendicitis within femoral hernias. The narrowness and rigidity of the femoral canal predisposes it to incarceration, but subsequently intraperitoneal spread of infection is limited. Thus the patient presents with local signs such as erythema and groin tenderness – usually excluding typical symptoms of peritonitis.While extremely rare, this case highlights the importance of considering a De Garengeot hernia in the differential diagnosis for a right groin lump. Diagnosis is often only made at the time of surgery.
RS09P FLEXIBLE CYSTOSCOPY: A MODEL FOR THE UTILIZATION OF A RURAL DISTRICT HOSPITAL WITH STATE GOVERNMENT FUNDING
Authors: Smith I. A. , Awad N. , Rashid P. 
Published: April 2009

Background:   Flexible cystoscopy (FC) is a well established lower urinary tract investigative tool. We describe the utilization of a rural district hospital to establish a FC service. Prior to this service, all FCs were performed at a regional base hospital proving inefficient. Establishing this service, via a NSW Government grant allowed for a more efficient use of operating theatre resources in a regional environment and permitted increased patient access to care.Aim:   To highlight the efficiency and cost effectiveness in utilizing a peripheral hospital to provide a FC bladder cancer screening service. To outline a model for establishing such a service, and to describe the implications for improved patient care.Method:   Funding for a day surgery FC service was not available via the state area health service. A grant application via the rural surgical enhancement programme was applied for and achieved. Equipment was purchased and the service commenced without difficulty.Results:   The transition to FC at a district hospital proved relatively straight forward and efficiency has increased. Since initiation 171 FCs have been performed. 155 FCs were performed to screen for TCC. 15% went on to have a rigid cystoscopy and biopsy. Patient and staff satisfaction have been achieved. There has been a significant cost benefit to the district hospital and a better utilization of resources at the regional base hospital. The additional throughput has aided teaching of urological trainees.Conclusion:   Via State Government grant funding, a rural district hospital has been utilized to create a model for FC. It has shown to be an efficient and effective model that can be utilized by other district hospitals.