bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS03P MASSIVE SKIN NECROSIS FOLLOWING COBRA BITE
Authors: Nor M. T. T. 
Published: April 2009

Introduction:   Local necrosis which needed debridement or amputation is common complication of a snake bite. On the other hand, large area of necrosis which need frequent debridement and skin graft is very uncommon.Case Report:   We present a case of 11 years old boy with an extensive back necrosis following a snake bite at his right shoulder. The incident happened while the boy is playing in paddy fields with his friends. He complained of pain at bitten subsequently become sleepy and drowsy. However he denied any shortness of breath. He was brought to the hospital and immediately anti‐tetanus toxoid and polyvalent (Antivenom) was given. He was noted to have respiratory distress subsequent morning and was ventilated promptly. Three days later he was referred to our team for extensive back necrosis. Clinical examination revealed normotensive blood pressure with stable pulse rate. Three was low grade fever noted and a snake bite mark at the right shoulder with extensive skin necrosis, estimated about 15% of body surface area. Multiple episodes of wound debridement was done on day 5, day 9 and day 13. Split skin graft was applied over the back and shoulder and he was discharged well on day 35. During follow up, a minimal area which is not cover by good skin however parents refused for another split skin graft.Conclusion:   Immediate treatment of cobra bite is very crucial in order to save patient's life. Early and extensive debridement of any skin necrosis should be emphasized to warrant patient's survival.
PR10 HELIX SWITCH FOR RECONSTRUCTION OF SEGMENTAL HELICAL RIM/SCAPHA DEFECT: A CASE REPORT
Authors: Farhadieh R. D. , Wong W. , Dickinson G. F. , Ee E. , Morrison W. A. J. 
Published: April 2009

A 35 year old man presented to clinic having lost the central two thirds of his left helix and lateral scapha following a human bite. A switch procedure using the root of the opposite helix and adjacent scaphoid cartilage was considered and performed secondarily.The right helix was harvested with a long pedicle length on the superficial temporal (ST) vessels. The vascular pedicle emerged posteriorly from the graft at its transferred site and was tunnelled under the ear to the preauricular ST vessels for anastomosis. Primary donor site defect was closed with a postauricular flap. Postoperatively leech therapy was commenced on day one for a total duration of 4 days. The patient was discharged and followed up in clinic with no complications.Ear reconstruction remains one of the most challenging aspects of reconstructive surgery. Here, we report of a novel alternative ear switch procedure for reconstruction of the helical rim.
PR11 *HEAD & NECK CUTANEOUS SQUAMOUS CELL CARCINOMA – UNDERSTANDING THE TUMOUR MICROENVIRONMENT
Authors: Ch’ng S. , Low I. , Brasch H. , Sullivan M. , Davis P. , Tan S. T. 
Published: April 2009

Background:   HNcSCC is common in Australasia. Recent advances have led to new paradigms in our understanding of the complex interactions between tumour, stromal and immune cells, and the extracellular matrix. The deranged interplay between tumour and its microenvironment eventually spirals towards irreversibility. The repertoire of gene expression in the tumour becomes increasingly abnormal, and results in metastasis.Purpose:   To examine the tumour microenvironment including, tumour immunosurveillance, angiogenesis and lymphangiogenesis, and investigate the expression of EGFR, which is fundamental to skin physiology, in HNcSCC.Methods:   Archived HNcSCC specimens were stratified into groups of primary lesions with and without metastasis. (Immuno) histochemical analysis was performed for the differential parameters of peritumoural mast cell, microvessel and lymphatic vessel densities, VEGF and EGFR expression. The effects of mast cells on cell cycle and apoptotic gene expression were studied using cell co‐culture and cDNA micro‐array. The mechanism of EGFR over‐expression in metastatic HNcSCC and its potential link with HER2 were assessed with fluorescence in‐situ hybridisation.Results:   Although mast cells demonstrate a tumour inhibitory effect by deregulating the cell cycle and apoptosis in vitro, this observation is not corroborated by study of tissue specimens. Lymphatic vessel density (but not microvessel density or VEGF expression) predicts metastatic potential. 75% of primary HNcSCC that subsequently metastasise over‐express EGFR, with the majority harbouring HER2 polysomy.Conclusion:   Improved understanding of the tumour microenvironment will hopefully lead to development of novel biologic therapy for HNcSCC.
PR13 INCIDENCE AND SUBSEQUENT NON‐MELANOMA SKIN CANCERS IN CANTERBURY RENAL TRANSPLANT RECIPIENTS –WHAT CAN WE LEARN?
Authors: Mackenzie K. A. , Wells E. , Currie M. , Simcock J. , Lynn K. , Robinson B. 
Published: April 2009

Purpose:   The aim of our study was to determine the incidence of non‐melanoma skin cancers (NMSCs) in renal transplant recipients (RTRs) in the Canterbury population and investigate the subsequent history of NMSCs in RTRs.Methods:   We retrospectively reviewed the hospital notes of 96 RTRs who developed at least one NMSC. Survival analysis was used for the incidence of first NMSC following first renal transplant.Results:   Of the 384 RTRs, 96 developed at least one NMSC. We identified 4 single predictors of NMSC in RTRs: older age at first transplant (p < 0.0001), transplantation after 1998 (p < 0.0001), male sex (p = 0.002) and initial immunosuppression regime (prednisone, mycophenolate and cyclosporine) (p < 0.0001). The average time from renal transplant to first NMSC presentation was 8.2 years. The ratio of SCC to BCC was 1.2:1. 11% of patients died of metastatic cutaneous SCC. The average number of NMSC was 1.67/year after discovery of the first NMSC. Older age at first transplant (p = 0.009) or at discovery of the first NMSC (p = 0.01) was associated with a higher annual rate of new NMSC. The median time to the discovery of second skin cancer was 2.2 years. Based on survival analysis, 25% of RTR will develop a second NMSC within 10 months of the first NMSC, and 75% by 4.4 years.Conclusions:   NMSCs, especially SCCs are not a minor inconvenience of transplantation. We have quantified the clinical challenge of skin cancers in the RTR population and the particular subgroups at increased risk of developing skin cancers. We hope the size of the health burden of skin cancers carried by our RTRs will raise the awareness of this serious problem.
PR20 USE OF LOCAL PERFORATOR FLAPS IN PARTIAL MASTECTOMY DEFECTS
Authors: Brakovsky Y. , Buccimazza I. 
Published: April 2009

Purpose:   To demonstrate various possibilities of local pedicle perforator flaps use (mainly L‐ICAP and also A‐ICAP, LoTP and TAP flaps) for different types of partial mastectomy defects .Specific modifications are proposed to enhance aesthetic outcomes of these procedures. To determine suitability of these flaps as a method of choice for selected patients.Methodology:   On‐going study – to‐date 17 patients. Patients with breast cancers suitable for breast conserving surgery but with post‐resection defects too large to be reconstructed with parenchymal flaps. Immediate reconstructions in all patients. Choice of flap dictated by site /size of the defect and the availability of local perforators (confirmed preoperatively by Doppler probe). Modifications are devised to maintain /re‐create aesthetic units of the breast. Detailed documentation including patients’ oncologic data and pre‐, intra‐ and post‐ operative photographs as well as follow‐up photographs after completion of radiation therapy.Results:   These include: patients satisfaction, aesthetic results (using a panel of independent observers), complications, lessons learned and suggestions.
PR21 PLANNING GLUTEAL ARTERY PERFORATOR FLAPS FOR BREAST RECONSTRUCTION WITH PREOPERATIVE IMAGING
Authors: Grinsell D. G. , Rozen W. M. 
Published: April 2009

Background:   While autologous breast reconstruction is frequently sought, donor sites providing versatility in volume with low donor site morbidity other than the abdominal wall are limited. Gluteal artery perforator flaps have been described in this role, however variations in individual vascular anatomy have resulted in the difficult planning of flaps, and particularly selection of whether superior or inferior gluteal artery perforators should be utilized.Methods:   Five consecutive patients underwent a gluteal artery perforator flap for breast reconstruction. Preoperative imaging of the gluteal artery vasculature was undertaken with computed tomographic angiography (CTA). Both superior and inferior gluteal artery perforators were mapped on imaging, and the dominant system selected preoperatively. The anatomical basis, operative technique and outcomes are discussed.Results:   In all cases, CTA was able to demonstrate individual vascular anatomy, and select the optimal perforators supplying the gluteal integument. Either a superior gluteal artery perforator (SGAP) or inferior gluteal artery perforator (IGAP) flap was planned, and undertaken successfully in each case. There was a 100% flap survival, with low donor site morbidity.Conclusion:   With the use of preoperative planning, selection of either an SGAP or IGAP flap can be reliably made based on individual vascular anatomy. With low donor site morbidity and good aesthetic outcomes, gluteal artery perforator flaps are a good option in cases where the abdominal wall is not appropriate.
PR22 *THE STACKED DIEP FLAP FOR BREAST RECONSTRUCTION: A RELIABLE OPTION FOR COMPLEX CASES WITH THE USE OF PREOPERATIVE IMAGING
Authors: Rozen W. M. , Grinsell D. 
Published: April 2009

Background:   Autologous reconstruction with the deep inferior epigastric artery (DIEA) perforator (DIEP) flap is increasingly utilized for breast reconstruction. However, situations arise in which the DIEP flap is not an appropriate option, including the presence of a midline abdominal scar or an inadequate volume of abdominal tissue. While other donor sites may be considered, the stacked DIEP flap, in which the perforators of both hemi‐abdominal walls are utilized in a single vascular pedicle, provides a safe technique to utilize the integument of both hemi‐abdominal walls.Methods:   Five consecutive patients underwent a stacked DIEP flap for breast reconstruction. Preoperative imaging with computed tomographic angiography (CTA) of the abdominal wall was undertaken, with each DIEA, its branching pattern, and all musculocutaneous perforating branches mapped using three‐dimensional software reconstructions. The anatomical basis, operative technique and outcomes are discussed.Results:   In all cases, CTA was able to demonstrate individual vascular anatomy, and guide planning for a stacked DIEP flap. Unique anatomy between individuals required a range of variations in flap anatomy, with the contralateral DIEA, SIEA, or perforators each used to perfuse the contralateral hemi‐abdominal wall. There was a 100% flap survival, with no donor site morbidity reported.Conclusion:   The stacked DIEP flap is a safe and reliable technique for augmenting the perfusion of the abdominal wall in cases where the single pedicle DIEP flap is limited. The anatomical basis of the flap can be planned preoperatively with CTA, facilitating faster operating times and good outcomes.
PR23 *AN ULTRASONOGRAPHIC AND CLINICAL EVALUATION OF RECTUS MUSCLE FUNCTION – FOLLOWING DIEP AND MUSCLE‐SPARING TRAM BREAST RECONSTRUCTION
Authors: Fullarton A. C. , Ngan N. C. , Armstrong J. , Tan S. T. 
Published: April 2009

Background:   An advantage of breast reconstruction with a deep inferior epigastric perforator (DIEP) flap compared with the standard or muscle‐sparing transverse rectus abdominis muscle (TRAM) flap is preservation of the entire rectus muscle. However this purported advantage has not been fully evaluated.Aim:   This study evaluates rectus muscle morphologically and clinically following unilateral breast reconstruction with DIEP and muscle‐sparing TRAM flaps.Methods:   The rectus muscle was examined ultrasonographically in 20 patients, at least 18 months after following breast reconstruction. Rectus muscle thickness was measured at three points along its length when relaxed and when contracted; the un‐operated side was used as a control.Results:   Rectus muscle at or below the umbilicus was thinner after muscle‐sparing TRAM but was unchanged after DIEP reconstruction. However, its contractility (measured as a ratio of contracted and relaxed muscle thickness) was unchanged by either operation. Clinically, there is no difference in abdominal wall function between the two types of operation.Conclusion:   The purported advantage of DIEP flap over muscle‐sparing TRAM breast reconstruction, with regard to abdominal wall integrity, requires further investigation.
PR24 POST OPERATIVE MONITORING IN 23 MICROVASCULAR FREE‐FLAP OPERATIONS UTILISING THE IMPLANTABLE DOPPLER FLOW SYSTEM
Authors: James D. W. , Langley S. J. 
Published: April 2009

Purpose:   The Cook‐Swartz Implantable Doppler has been used to provide continuous feedback on the vascular status of free flaps and has been reported to improve flap salvage. We review our experience of this device, its efficacy and suitability for ongoing use in free flap monitoring.Methodology:   All patients who were monitored following free flap reconstruction using the Cook Swartz Implantable Doppler in two Hospitals in Christchurch, NZ were retrospectively reviewed from its first use in December 2006 to December 2008.Results:   In total 43 probes were used on 23 flaps (4 buried, 7 intraoral) in 21 patients (range 17–83 yrs). The probes were placed on the artery in all cases and the vein in 21 cases. 21 (91.3%) flaps survived. 20 flaps had reliable Doppler signals. Overall there were 2 flap failures (8.7%) and these were not salvageable. There were no technical difficulties with application or removal of the probes and it was well received by junior medical/nursing staff. It provided peace of mind to surgeons performing free flap surgery outside the base hospital (6 cases).Conclusion:   The implantable Doppler probe is a useful tool in monitoring free flaps where clinical evaluation is difficult especially when flaps are buried. Our current experience supports its ongoing use as a free flap monitoring tool at our institution.
PR25 TRAINING EXPERIENCE WITH BREAST REDUCTION AND OTOPLASTY
Authors: Avery G. J. 
Published: April 2009

Aim:   To identify the experience, expectations and accessibility of breast reduction and otoplasty for current trainees and how this compares to the experiences and expectations of current practising Plastic Surgeons.Methods:   All New Zealand advanced Plastic Surgery trainees and vocationally registered Plastic Surgeons in New Zealand were emailed or posted a questionnaire regarding their experience performing otoplasty and breast reduction surgery. Trainee questionnaires were repeated at an interval of three years. Participants were asked to quantify the number of procedures trainees should perform to become proficient and their view as to whether conditions exist at present to achieve this. A review of the number of cases performed within the four Plastic Surgery units was also undertaken.Results and Conclusions:   Training in Plastic Surgery has no quotas for any procedures as exists in other specialty programs. This means that with changes in waiting list pressures and health priorities there is no safeguarding of procedures for trainees or the community alike. The results of these questionnaires will be presented in an attempt to formalise current opinion on these important issues. The Plastic Surgery community has an obligation to provide a service to the community and also to train its future providers and hence has a responsibility to be actively involved in addressing these topical and important issues.
PR26 *TESTING BIOFILM REMOVAL
Authors: Hadi R. , Vickery K. , Deva A. , Charlton T. 
Published: April 2009

Purpose:   Currently there are no standards for testing efficacy of medical device cleaners. With fears of prion transmission, reliable protein on medical devices needs to be minimised.Aim:   To develop a reliable test to detect efficacy of biofilm removal which can be used as an industry standard.Methodology:   A bioreactor model was used to grow a characterised Pseudomonas aeruginosa strain on Teflon coupons. The coupons were subjected to various cleaners. Residual biofilm was detected by either a crystal violet assay (CV) or protein assay (PA). The % reduction of biofilm was compared to controls including analysis of variance and student t‐tests. Each experiment was repeated three times. Inter and intra‐experimental comparisons were made. Visual confirmation of the results was by confocal microscopy and scanning electron microscopy.Results:   NaOH 1% 40C for 30 min: CV 87.3% ± 5.4, PA 92.0% ± 2.3; NaOH 0.01N 70C for 5 min: PA 28.4% ± 2.7; Tween20 40C for 30 min: CV 25.1 ± 2.7, PA 14.5 ± 5.7 (not significant). Some representative commercial cleaners were tested. Matrix: CV 10.5% ± 3.7, PA 27.9% ± 3.0; RMEC 70500: CV 69.0% ± 4.5, PA 85.9% ± 2.9; Zen: PA 105.8% ± 1.5 (i.e. treatment coupons were cleaner than background coupons). All treatments were significant p < 0.05 except for Tween20, which was not consistently significant. There was no significant inter‐experimental difference for % reduction.Conclusions:   We have developed a reproducible method for testing efficacy of cleaning products against biofilm incorporating the use of crystal violet or protein assay to measure residual biofilm protein.
PR27P A CUT ABOVE: COMPARING THE ADEQUACY OF SKIN CANCER EXCISIONS PLASTIC, GENERAL AND CLINIC
Authors: Sharp D. A. , Magnusson M. 
Published: April 2009

Purpose:   The reported rates of incomplete excision of non‐melanoma skin cancers varies widely (5–25%) among published literature. This study aims to compare the rate of incomplete excision of non‐melanoma skin cancers performed by a plastic surgeon, skin cancer clinic and general surgery department in Toowoomba, Queensland. It also evaluates factors that affect the rate of incomplete excision.Methodology:   Consecutive primary excisions of non‐melanoma skin cancers were analysed for a six month period between 1 January 2008 and 30 June 2008 for three separate groups: plastic surgeon, skin cancer clinic and the general surgery department. The variables studied were age and gender of patients, histology, tumour site and size, adequacy of excision and method of repair.Results:   A total of 663 skin cancers were excised between the three groups consisting of 392 basal cell carcinomas and 271 squamous cell carcinomas. The incomplete excision rates for the three groups were: plastic surgeon (6.1%), skin cancer clinic (5.2%) and general surgery department (12.9%). The incomplete excision rate between the general surgery department and other two groups was statistically significant (p < 0.03).Conclusions:   Although the rate of incomplete excision was higher in the general surgery department, all three groups compare favourably with reported figures in the literature. Given that Queensland has one of the highest incidences of skin cancer in the world, the disparity between the groups could be examined further, with consideration given to the complexity of excisions being performed in the hospital setting.
PR35P KAPOSIFORM HAEMANGIOENDOTHELIOMA IN AN ADULT FEMALE: CASE REPORT AND LITERATURE REVIEW
Authors: Yang Y.‐T. , Al‐ANI S. , Mills S. 
Published: April 2009

Kaposiform haemangioendothelioma (KHE) is a rare vascular tumour that can be locally aggressive.While KHE is commonly associated with Kasabach‐Merritt syndrome and lymphangiomatosis, it predominantly occurs in infancy and early childhood. To date, only ten adult cases of KHE have been reported in literature.We report a case of KHE associated with lymphangiomatosis in the breast and axilla of an 18–year old, otherwise well female.Literatures on the clinical presentations, histopathological findings, differential diagnoses, behaviour and treatment of Kaposiform haemangioendothelioma in adults are reviewed.KHE may occasionally be encountered in adults. Clinical diagnosis and management can be a challenge due to the rarity of this disease. Knowledge of KHE and its associated complications should lead to a prompt diagnosis and early initiation of treatment.
PR37P PAEDIATRIC DUPUYTREN'S DISEASE: CASE REPORT AND CLINICAL REVIEW
Authors: Usmar S. J. , Peat B. , Beagley M. 
Published: April 2009

Purpose:   This paper presents the first documented case of paediatric Dupuytren's Disease in Australasia and performs a clinical review of paediatric cases world‐wide in children under ten years of age.Case Report:   An eight year old boy was referred with a six month history of nodular mass in the right palm. On examination, there was a 7 mm mid‐palmar mass adherent to the overlying skin. Finger range of movement was preserved. Surgical excision was performed and histology confirmed palmar fibromatosis. Post‐operative course was unremarkable.Methodology:   Six cases of histologically proven Dupuytren's Disease have been reported world‐wide in children under ten years of age. Publishing clinicians were contacted to obtain current data for these patients.Results:   The mean age at presentation was 4.8 years in the above group (range = 6 months to 9 years). Most commonly involved sites were the palm or little finger. Fixed flexion deformities were present at the proximal interphalangeal joint in 66% and the distal interphalangeal joint in 16%. All cases were treated surgically. Follow‐up data revealed three recurrences in one patient over a 5 year period. No other recurrences were reported with follow‐up ranging from 18 months to 5 years.Conclusion:   Although this paper collates the most complete data to date, information is still limited owing to the rarity of paediatric disease. Long‐term outcomes remain to be seen as these patients progress through to adulthood.
PR39P PERIOPERATIVE ANTICOAGULATION IN LOCAL ANAESTHETIC PROCEDURES FOR CUTANEOUS LESIONS
Authors: Yang A. S. , Moaveni Z. 
Published: April 2009

Patients on long‐term aspirin and warfarin are not infrequently encountered in local anaesthetic cutaneous surgeries, which could potentially give rise to bleeding related problems post operatively. Encounters with a newer generation of antiplatelets, such as clopidogrel, may also become more prevalent with their use in cardiology and following endovascular procedures. While recommendations from studies in timing or even the need for preoperative discontinuation of aspirin in local anaesthetic procedures have been numerous, they continue to be questioned and the practices can vary significantly from surgeon to surgeon. The study is designed to retrospectively review peri‐operative management for aspirin, warfarin, and clopidogrel in the local anaesthetic cutaneous surgical cases performed at Waikato Hospital Plastic and Reconstructive Surgery Unit, and to gauge their impact on post‐operative complications.Case records from the plastic surgery local anaesthetic operating unit and clinics between January and December 2008 are reviewed. Information on the management of long‐term aspirin, warfarin and clopidogrel are gathered along with other significant co‐morbidities and coagulopathies, the type of surgical procedure, and significant complications necessitating further interventions in the hospital.We wish to report our experiences in Waikato Hospital on the management of aspirin, warfarin and clopidogrel peri‐operatively for local anaesthetic cutaneous procedures and their impact on complications with comparisons to findings in the available literatures.