bluuebunny/crossref_metadata_2025_split huggingface dataset:
PR22 SKULL BASE RECONSTRUCTION WITH FREE FLAPS
Authors: Dunkin C. S. J. , Nabi H. , Carroll T. , McMahon J. , Fitzgerald A. M. 
Published: April 2007

Introduction & Aims  Microsurgical reconstruction in skull base surgery is not universally practiced. Current evidence suggests improved outcomes allowing more aggressive management of skull base pathology. We present our experience of free flaps in skull base reconstruction.Material & Methods  17 patients (10 male, 7 female, aged 30–72 years) required microsurgical reconstruction of skull base defects from 2004–2006. The anterior cranial fossa was involved in 10/17. Indications for surgery included malignancy (12/17) and benign neoplasia (3/17).Results  18 free flaps included 10 rectus abdominis, 5 radial forearm and 5 latissimus dorsi. Complications included one complete flap loss, one anastomotic revision, one CSF leak, one case of meningitis and one subdural empyema. There were no deaths.Conclusions  We recommend free flap reconstruction for significant skull base defects involving both skull and dura. Important factors determining outcome include adequate pedicle length, flap thickness, use of fascia and controlled lumbar drainage.
PR24 EFFECTS OF COMBINED TOPICAL NEGATIVE PRESSURE (TNP) AND ANTISEPTIC INSTILLATION ON PSEUDOMONAS BIOFILM
Authors: Ngo Q. , Vickery K. , Deva A. K. 
Published: April 2007

Purpose  TNP in the form of V.A.C. dressings have been successfully used to enhance chronic wound healing. An in vitro model of the chronic wound biofilm was created to test the effects of TNP with and without concurrent antimicrobial drug instillation on biofilms.Method  A P.aeruginosa biofilm model was constructed in vitro. Continuous TNP and TNP combined with varying frequencies of betadine instillation were tested on the biofilm model for 24 hours. Outcome parameters measured included viable bacterial count, fluorescent microscopy, confocal laser scanning microscopy, and electron microscopy. Statistical analysis was performed using ANOVA and MANOVA in SPSS 13.0.Results  Bacterial biofilms, when exposed to TNP alone, showed a 42% decrease in viable count; while exposure to betadine alone showed a reduction of up to 84%. Combined TNP and antiseptic instillation increased the bacteriocidal effect to 99.7% (p < 0.001).Exposure to TNP also resulted in a decrease in biofilm thickness, and diffusion distance, with an increase in surface area‐to‐volume ratio (p = 0.005, 0.002, and 0.009 respectively).Conclusion  TNP alone showed a modest effect on the reduction of bacterial biofilm. More importantly it appeared to compress and fragment the overall biofilm architecture. This physical deformity in turn led to more effective drug penetration into the highly resistant biofilm community. The result was an approximate 100 fold enhancement of bacteriocidal effect when betadine instillation was combined with TNP as compared to betadine alone.
PR25 SOFT TISSUE COVERAGE IN LOWER LIMB TRAUMA – ANNUAL AUDIT FROM A TERTIARY RECONSTRUCTIVE SURGERY UNIT IN INDIA
Authors: Varkey A. , Joseph V. M. , Guido N. , Ashok B. C. , Sriknath V. 
Published: April 2007

Purpose  To discuss the entire spectrum of injuries seen in lower limb trauma and choice of reconstructive options.Methodology  Retrospective review of 72 consecutive cases in one year.Data collected from individual case records and the department photo data base. Injuries were classified and analyzed based on bone and soft tissue involvement, associated vascular injuries, mechanism of injury as in crush, degloving, and combined. Bony injuries were classified according to Gustilo’s classification. Treatment options and outcome for bone and soft tissue are discussed separately.Results  Total of 72 cases. 95%of cases were two wheeler traffic accidents. Distribution of cases according to site involved: Leg‐39; Foot‐14; Leg and foot‐16; Thigh, leg, and foot‐3.

8 of them were of Gustilo’s IIIB and 7 of IIIC. 42 flaps done included

Gastrocnemius‐4, Soleus‐7, reverse sural‐7, Cross leg‐2, Fasciocutaneous‐5

Perforator based local flaps‐3Latissimus dorsi‐7, Gracilis‐6 Lateral thigh‐1

Intervention: Immediate: 12%. Early (less than 1 week): 36, Delayed (>1 week): 52%

Complications:Wound infection:Minor: 12; Major: 8 (3 Cases – Clostridia)

Partial flap loss: 6; Loss of SSG over flap/donor site: 5; Acute renal failure: 1

Amputations: Above knee: 4; below knee: 2

Conclusions  This series represents the spectrum of high velocity injuries in an overcrowded urban locality of developing country. Significant tissue loss is most often the rule. A judicious execution of reconstructive options can optimize results. Management protocols were adopted to avoid delayed referrals. This audit served as a benchmark to put together a dedicated trauma team in our hospital.
PR27 FRICTION AND CEMENT: CASE REPORT AND LITERATURE REVIEW OF FULL‐THICKNESS CEMENT BURNS
Authors: Gale K. L. , Milsom P.B. 
Published: April 2007

Case Report  A 40 year old policeman was referred to ED at Whangarei Base Hospital with a circumferential full‐thickness burn to the distal third of his right leg. He sustained this whilst helping a friend ‘cut concrete’ despite wearing gumboots. Because the experience was largely non‐irritating, he did not notice water and concrete filling his gumboot as he worked.The wound became increasingly red and painful, and his GP prescribed augmentin for a cellulitic burn. Ten days later, a green exudate developed over the area, prompting further consultation which resulted in a referral to the Base hospital for ‘debridement of slough’.On examination there was an almost circumferential full thickness alkali‐friction burn wound, 3cm in width around the distal third of his right leg. A 2 cm bridge of normal skin remained posteriorly.In theatre, the eschar was debrided to healthy bleeding fat and fascia and grafted with a meshed 1 : 2 SSG and a suction dressing placed. Placed on bedrest with wallsuction, prophylactic oral augmentin and subcutaneous clexane for 5 days. It was reviewed 5 days later with 100% graft take. Discharged home on day 7 with a graduated compression stocking for mobilisation.Discussion  Wet cement remains a poorly recognised cause of full‐thickness skin burns amongst the general population. The alkalinity of cement causes liquefactive necrosis in tissue, which initially may go unrecognised. Most burns affect the lower limb, and only half of those involved professional users. It is thought that more education and awareness of the potential hazards of cement should be publicised amongst the labouring, and DIY communities of NZ.
PR32 WHAT I’VE LEARNED IN HEAD & NECK SURGERY
Authors: Poole M. D. 
Published: April 2007

Over a long career in both ablative and reconstructive surgery in the head and neck, the author has identified certain factors which help in the management of these patients and has learned many lessons.Such lessons include the importance of multi‐disciplinary management, excellence in anaesthesia, the importance of anatomy, concepts of ablative surgery such as marginal mandibular resection, and many of the concepts of reconstructive surgery which have enabled rapid one stage reconstructions, such that palliative surgery for massive tumours can be sometimes worthwhile.These and other experiences will be discussed.
PR35 THE INCIDENCE OF NON‐MELANOMA SKIN CANCER IN NEW ZEALAND
Authors: Ch’ng S. , Brougham N. D. L. , Tan S. T. 
Published: April 2007

Background  It is estimated that skin cancers cost $33 million per annum to the New Zealand healthcare system. Basal cell carcinoma and squamous cell carcinoma are the commonest types of non melanoma skin cancers (NMSCs). Anecdotal evidence indicates that there has been a doubling in the incidence of NMSCs in New Zealand over the last decade. Because of the high incidence mandatory reporting of NMSCs to the National Cancer Registry is not required. This lack of accurate data has led to poor health care policies and strategies including funding and workforce planning.Aims  The aims of this study are to (1) present the latest statistics on NMSCs in New Zealand, including the incidence across different regions over the last decade, patient demographics, anatomic distribution of NMSCs, incidence and sites of metastasis, and disease‐specific survival; to (2) the histopathology of NMSCs, including surgical margins, histologic grade, and perineural, lymphatic, and vascular invasion; and (3) the relative role of different faculties treating NMSCs.Method  This project has been approved by the multi‐centre ethics committee. A retrospective review was conducted from patients’ histology records from public and private pathology laboratories within defined catchment areas. Criterion for analysis is a confirmed diagnosis of NMSC treated surgically. A Microsoft Access database is created that will facilitate subsequent data retrieval and analysis.Results and Conclusion  It is hoped that this up‐to‐date data will form the framework for the development of sound and sustainable healthcare policies of management of NMSCs including management strategies and workforce planning, and research direction on this common disease.
PR39P TREATMENT OF MITTEN HAND DEFORMITY IN A LONG TERM SURVIVOR OF EPIDERMOLYSIS BULLOSA
Authors: Lo M. , Donahoe S. , Brown T. 
Published: April 2007

EB is a recessive condition caused by a defect in collagen 7 production, such that epithelial cells do not adhere adequately to the underlying basement membranes. Minor mechanical trauma and stress forces will cause recurrent blistering of the skin and mucosal surfaces, which heal by scarring.The hand suffers particularly badly, and a characteristic mitten deformity of scar tissue is a common stigmata of the disease.We report a 51 year old survivor of EB with a bilateral mitten hand deformity that had been present since the age of 6 years.Extensive surgical release of the dominant left hand was undertaken, resurfacing the created defects with split skin grafts under regional anaesthesia. Fingers that had been buried for 45 years were straightened and held in place with k wires whilst the grafts were vascularising.Extensive post operative physiotherapy and splinting were undertaken, with functional improvement to the extent that the patient was able to hold a pen and write. Skin graft donor sites healed uneventfully.Extensive release of mitten hand deformity in long term survivors of EB is a worthwhile surgical procedure with good functional results. The problems of surgery and anaesthesia in this condition are discussed. Release of the second hand is planned.
PR40P METASTATIC CHONDROID SYRINGOMA
Authors: Carey Smith R. L. , Taylor P. , Zelei D. , Robbins P. , Wood D. 
Published: April 2007

A 51 year old man presented in 1975 at the age of 19 with a right hallux mass and underwent wide local excision, pathology revealing a chondroid syringoma. This was complicated by local recurrence within 12 months requiring 1st ray excision and a transposition flap. He was symptom free for 12 years and represented with pain on weight bearing. There was a 1 year delay in management as he refused amputation, and underwent “natural treatment by diet”. Subsequent above knee amputation was performed with radiographic evidence of chest metastasis. He represented in 2004 with an abdominal mass and had a nephrectomy for metastasis, and in 2006 with proximal femoral metastasis requiring allograft reconstruction of the hip.33 years from initial diagnosis with a documented 13 year history of thoracic metasteses we review the literature on chondroid syringoma.
PR44P MONITORING BURIED FREE FLAPS – NEW ZEALAND’S FIRST FOUR CLINICAL CASES OF FREE FLAP MONITORING WITH IMPLANTABLE 20 MHZ ULTRASONIC DOPPLER PROBE
Authors: Mistry Y. , James D. W. , Sinclair S. 
Published: April 2007

Purpose  Monitoring buried free flaps is difficult. Currently in NZ only standard methods of clinical examination and surface doppler are used. We review the first four cases of the Cook Swartz Doppler (CSD) blood flow monitoring system in monitoring free flaps.Method  Retrospective review of the first four clinical applications of the CSD in NZ between October 2006 to January 2007. The doppler was used by 3 different surgeons and interpreted by nursing and medical staff with no prior experience with the device. There were two cases of buried free flaps and two cases where a small skin monitor was utilised to allow clinical correlation with doppler signals.Discussions were held with respective surgeons and other relevant medical and nursing staff.Results  In the two buried flaps (vascularised fibula flap for femur reconstruction and an ALT flap for pharyngeal reconstruction) the probe was inserted downstream of the arterial anastomosis. In the two non‐buried flaps (latissimus dorsi to reconstruct a scalp defect and a free TRAM for breast reconstruction) the probe was inserted upstream of the venous anastomosis. There can be difficulty in interpreting the audible signal when the probe is attached to the vein. All surgeons found the technical aspects of inserting and securing the probe to be straightforward. It provided peri‐ and post‐operative assurance of flap viability. All four flaps were viable at one week at the time of probe wire removal.Conclusion  The CSD system is easily applicable to our clinical practice and requires minimal training for both the clinical and nursing staff. It provided peri‐ and post‐operative assurance of flap viability.
PR05 POST‐OPERATIVE HAEMATOMAS IN MICROVASCULAR FREE FLAP RECONSTRUCTION OF THE HEAD AND NECK: THE INCIDENCE, AETIOLOGY AND OUTCOME MODIFICATIONS
Authors: Kaplan E. D. , Rozen W. M. , Shayan R. , Bernard S. , Taylor G. I. , Ashton M. W. 
Published: April 2007

Background  Free tissue transfer using microvascular surgery has become a safe a reliable means to repair soft tissue and/or bony defects of the head and neck. Operative success reaches 98%, however the incidence of significant post‐operative complication is also relatively high (32%). One common and often severe complication is haematoma formation at either donor or recipient sites. The incidence of recipient site haematoma is reported at 6%, however the causes and outcomes of haematomas have not been well investigated. A retrospective historical analysis of both donor and recipient site wound haematoma was performed to identify causative factors and the effect on patient outcome.Methodology  A five year review was conducted for microvascular free tissue transfer to defects in the head and neck at The Royal Melbourne Hospital, for the period from February 2001 until February 2006. The medical records of these 150 patients were reviewed for donor and recipient site wound haematoma and outcomes.Results  Significant factors for the development of post‐operative haematomas included lood pressure control during the first post‐operative, correlating with the likelihood of developing either a donor or recipient site haematoma (p value < 0.001), drain‐tube outputs (both high and low), smoking and the use of pre‐operative NSAIDs.Conclusion  There are significant reversible factors that contribute to the development of post‐operative haematomas in head and neck surgery. Close monitoring of patient blood pressure by theatre and recovery nursing staff, close monitoring of drain outputs, and pre‐operative counselling on the use of NSAIDs and smoking may all be useful in the prevention of haematoma formation.
PR06 NECROTISING FASCIITIS OR PYODERMA GANGRENOSUM – AN INTERESTING CASE
Authors: Luo D. Y. W. , Love R. 
Published: April 2007

Purpose  Using a case study, to raise awareness of the diagnosis of Pyoderma gangrenosum in the clinically septic patient with a rapidly deteriorating wound. To support the use of VAC dressings in patients with pyoderma gangrenosum.Methodology  Case Study – Mr DL is a 30 yo man who presented 7 days after an angle grinder injury to his left thigh. He was clinically septic with a rapidly expanding area of necrosis over the injury site. His other presenting problem was a platelet count of 14 × 10−9/L, which was later diagnosed as myelodysplasia.Cultures grew coagulase negative staphylococcus, and initial biopsies showed extensive necrotic tissue and suppurative inflammation. Despite multiple wound debridements and appropriate intravenous antibiotics, the patient was still clinically septic with a deteriorating wound. It was only on the second biopsy that pyoderma gangrenosum was diagnosed. He was then treated with steroids and a vacuum assisted dressing.Results  Mr DL responded well to treatment. The VAC dressing was very successful in promoting healthy granulation tissue. This granulation tissue was later skin grafted with good success.Conclusion  Pyoderma gangrenosum is an important differential diagnosis in wounds that do not seem to improve after debridement, even if the patient appears clinically septic. It is often not easy to diagnose even on histopathological grounds. The Vac dressing is a useful adjunct in the treatment of pyoderma gangrenosum.
PR07 A SYSTEM FOR QUANTIFYING LYMPHATIC VESSEL ABNORMALITIES IN LYMPHEDEMA MODELS, AND LOCO‐SYSTEMIC EFFECTS OF PRO‐LYMPHATIC TUMOR GROWTH FACTORS
Authors: Shayan R. , Karnesis T. , Paavonen K. , Achen M. G. , Taylor G. I. , Stacker S. A. 
Published: April 2007

Purpose  Lymphatic vessels are critical in interstitial fluid balance, and congenital or acquired derangements lead to accumulation of lymph fluid (lymphedema). Further, when induced by pro‐lymphatic growth factors in tumors, they facilitate lymph node metastasis(1). While histological vessel density is counted on tissue sections, there is no method for quantifying lymphatic morphology and patterning in 3‐D; key elements in fluid dynamics and cellular interactions that underlie lymphatic function and diseases resulting from alterations to them. We have developed a method to quantify important biological and functional parameters in lymphatics, to help distinguish subtle phenotypic differences and patterning defects.Methods  Apical images were taken of whole‐mounted mouse ears that were immunofluorescently stained for the lymphatic marker LYVE‐1. Key lymphatic parameters were quantified using a computer program we developed.Results  Mice with gross lymphedema were found to have significant derangements of many of the key morphological and patterning characteristics assessed. Subtle yet statistically significant lymphatic abnormalities were also identified in less obviously lymphedematous animals. We were also able to assess loco‐systemic effects of the pro‐lymphatic growth factors.Conclusions  Increasing emphasis on lymphatics in disease demands quantification methods that assess key biological and functional parameters. Our method allows comparison and identification of abnormal lymphatic phenotypes and allows assessment of the effects induced by pro‐lymphatic growth factors.
RS01 THE VALUE AND EFFECT ON CLINICAL OUTCOMES OF PAEDIATRIC SURGICAL SUPPORT TO SMALLER CENTRES
Authors: Beasley S. W. , Maoate K. , Blakelock R. , Azzie G. 
Published: April 2007

Purpose  Until 1996 the South Island of New Zealand had limited access to specialist paediatric surgical services. The establishment of a comprehensive paediatric surgical outreach service has allowed children to receive specialist advice and treatment close to home. This study outlines the structure of the service, its effect on the smaller hospitals and on patient outcomes.Methodology  Trends in the referral patterns and effects on outcome for indicative conditions (including hernia, undescended testis, pyloric stenosis, Hirschsprung disease) were analysed.Results  Since 1996 there has been a steady increase in the number of children being treated by the service in all the region’s public hospitals. Regular clinics and day surgical lists are held according to local demand, and organised locally. Audit has demonstrated improvements in clinical outcome.Conclusion  The advantages of a well‐organised and funded paediatric surgical outreach service include: 1. improved access to quality treatment for children close to their home; 2. fewer complications of surgery and less unnecessary surgery; 3. better identification of cases that require transfer; and 4. better support to the rural surgeon and paediatrician who still have to cope with acute paediatric surgical problems.
RS10P ‘SURGICAL TRAINING FOR THE OVERSEAS TRAINED DOCTORS’, STILL AN UNCHARTED SEA
Authors: Ashrafi M. W. 
Published: April 2007

Purpose  To show that a little has been done to optimize the surgically trained work force in Australia.Methodology  Personal experience, media reports, the very sad & unfortunate Bundaberg incidence and its aftermath and conversation with a few hundred OTDS prepared me for this submission. The number of OTDs is increasing in rural areas of Australia and New Zealand. There are many hospitals which can not run a single day without these doctors. Training these doctors is without a doubt an important part of health authorities’ commitment towards community. Unfortunately general public has little chance to know the facts about the OTDs. Many doctors with their skills are lost in the convoluted pathways of career building in the existing practice.This is a waste and needs to be addressed immediately.OTDs are under scrutiny by many areas, but no one care about their concerns and needs.RACS could identify those who are partially trained and accommodate them in the necessary level.Results  Increasing need of rural surgeons under the present circumstances dictates that OTD surgical trainees be streamlined. The situation is unique and easiest solution in foreseeable future is very clear.Conclusions  Surgically trained OTDs should be assessed and trained by RACS only. Training should be decentralised to smaller hospitals.
RS02 BEST PRACTICE MANAGEMENT OF INTUSSUSCEPTION IN RURAL CENTRES: HOW TO MINIMISE MORBIDITY AND MORTALITY
Authors: Beasley S. W. 
Published: April 2007

Purpose  In recent years there have been a number of refinements in the management of intussusception (INT) that have led to an increase in the success rate of enema reduction, and reduced morbidity. This study proposes guidelines for the management of children with suspected INT in centres that do not have a specialist paediatric surgeon.Methodology  Analysis of clinical indicator data for INT and review of the outcomes of treatment in the South Island of New Zealand have been used to develop an algorithm for use in regional centres.Results  INT reduced non‐operatively has a lower morbidity and costs less to treat than those requiring surgery. In the region reviewed, management guidelines appear to have contributed to an overall success rate of enema reduction using Barium improving from 25% to 75%, and with air enemas from 75% to 86%. Discussion of cases between the rural centre and tertiary centre has become the norm.Conclusion  In smaller centres, an initial enema (barium or gas) should be performed if the child is in reasonable clinical condition. Sick infants, and those in whom an initial enema has failed, are best transferred to a paediatric surgical institution. Good communication is an essential element in developing and implementing clinical pathways that improve outcomes for children with INT.