bluuebunny/crossref_metadata_2025_split huggingface dataset:
PM03 TERMINAL CARE – PAIN RELIEF IN ADVANCED CANCER
Authors: Macleod A. D. 
Published: April 2007

Pain is the Fifth Vital Sign. Relief of pain should be achievable in up to 90% of cancer patients. Many patients however continue to suffer unnecessarily as a result of inadequate pain management. 75% of those with advanced malignancies experience severe pain caused directly by the disease and/or the treatment. Nocioceptive pain is most responsive to intervention, the control of visceral and neuropathic pains is more difficult.The mainstay of pain management in the terminally ill is opioid medication. Morphine remains the drug of first choice. Oxycodone, fentanyl and methadone are now available and alternative options. Though the oral route of administration is preferred, parenteral (particularly sub‐cutaneous administration) opioid may be necessary during the final days of life. The phenomenon of ‘wind‐up’ (the fading efficacy of an opioid) will be discussed as will the role of the anaesthetic agent ketamine in managing this complication of opioid therapy. The risk of iatrogenic addiction to medicinally prescribed opioid is miniscule. Analgesic adjuvant medications for neuropathic pain have a role as may spinal and intrathecal delivery systems of opioid medication.In cases of intractable pain in the terminally ill deep sedation is a medically, legally and ethically acceptable management option.
PM06 MODERNISING OUR APPROACH TO POST‐OPERATIVE PAIN
Authors: Jones D. 
Published: April 2007

Pain is not a single entity, but many complex biological processes combined with psychosocial responses. Therapies therefore have to be multimodal. Single analgesics suit only a few. Although promoting positive thoughts and interactions with team members is important, this presentation will bias towards biological factors.Reducing unnecessary postoperative pain suffering starts long beforehand in elective cases. Mounting evidence, of long‐lasting (‘chronic’) pain following procedures needs accurately portraying to patients for informed consent. Denial of these facts causes later problems. Appropriate preparation reduces beliefs that ongoing pain means an error.Once embarking on a procedure, measures prior to nociceptive surgical stimulus contribute to reduced postoperative pain, although robust evidence for pre‐emptive analgesia in many situations remains elusive. But lack of evidence does not mean evidence against. A perfect single solution does not exist. Illustrating with pathophysiology of pain and of nerve disturbance, pharmacology and genetic information, this presentation discusses rationalizing and combining common measures, why generous morphine doses don’t always work, and why some results are less than expected.
PR10 DUAL PLANE BREAST AUGMENTATION FOR TUBEROUS BREAST DEFORMITY
Authors: Connell A. F. , Luo D. Y. W. , Luo J. Y. B. 
Published: April 2007

The tuberous breast deformity is an uncommon congenital breast anomaly which affects young women unilaterally or bilaterally. It is associated with usually a constriction in the lower pole of the breast as a result of the constricting fibrous ring with hypoplasia of the breast gland and pseudo‐herniation of breast tissue into an enlarged areola.Several methods have been suggested to correct this deformity. A retrospective analysis has been undertaken of six consecutive patients with tuberous breast deformity using a dual plane breast augmentation via an inferior peri‐areolar approach creating a dual plane pocket and using Marionette sutures to control the lower pectoralis major edge. Surgical release of the constricting lower pole glandular tissue was undertaken with excellent aesthetic results. Either immediate or delayed areolar reduction was carried out if required.Results show excellent expansion of the lower pole with good soft tissue coverage of the implant by the pectoralis major in the supero‐medial aspect of the breast. The dual plane pocket combined with lower pole release assists lower pole expansion in a one stage procedure without requiring two stage tissue expansion.The results have been uniformly acceptable and compare favourably with those presented in the literature where other methods were used. The dual plane breast augmentation technique is a simple and reliable way to treat tuberous breast deformity.
PR13 THE USE OF PEDICLED LATISSIMUS DORSI FLAPS IN LARGE CHEST WALL RECONSTRUCTION
Authors: Luo D. Y. W. , Hanikeri M. , Savundra J. , Newman M. , Carey‐Smith R. , Wood D. 
Published: April 2007

Purpose  to report a challenging case of reconstructing a massive chest wall defect. To demonstrate the usefulness of the pedicled latissimus dorsi flap to reconstruct massive sternal wounds.Methodology  Case Report – A 35 year old man presented 2 weeks after a chest wall resection for a primary amyloidoma and reconstruction using a combination of a titanium mesh and Gore‐tex soft tissue patch with primary skin closure. He was clinically septic, with the primary focus being the chest wound. The infected Gore‐tex and titanium mesh were removed, and the cavity debrided, resulting in a chest wall defect measuring 30 cm (subcutaneous width) × 20 cm (height) and a bony defect measuring 15 cm (width) × 18 cm (height). An initial attempt of reconstructing this with a free latissimus dorsi flap was abandoned prior to raising of the flap because of difficulty in finding a recipient vessel. The defect was finally reconstructed using a pedicled latissimus dorsi flap.Result  We describe a single stage technique for reconstructing a massive sternal defect. The use of a pedicled latissimus dorsi flap provided a reliable reconstruction in what can be a traditionally difficult reconstructive site.Conclusion  A pedicled latissimus dorsi flap is useful even in the reconstruction of large chest wall defects.
PR14 LATISSIMUS DORSI MYOCUTANEOUS FLAP WITH ANATOMICAL EXPANDER‐IMPLANTS FOR SINGLE STAGE BREAST RECONSTRUCTION – AN ACHIEVABLE GOAL?
Authors: Dunkin C. S. J. , Jeeves A. , Wiener M. , Mackie I. , Caddy C. M. 
Published: April 2007

Introduction  Implant‐based breast reconstruction has evolved from two‐stage methods using round smooth expanders to single‐stage using definitive textured biodimensional anatomical expander‐prostheses. The aim of this study was to assess if single‐stage reconstruction is achievable using McGhan 150 expander‐implants with latissimus dorsi (LD) myocutaneous flaps and if so, at what cost.Methods  Data was collected retrospectively on all women who underwent this type of breast reconstruction, between 1997–2005, with a minimum of 6 months follow‐up.Results  147 patients had 164 reconstructions (17 bilateral cases). Mean age 48 ± 9 years. The indications for reconstruction were mastectomy, breast asymmetry and Poland’s syndrome. 144 patients had pedicled flaps and 3 patients had contralateral free flaps. The majority were delayed reconstructions.Single‐stage reconstruction was achieved in 81/147 patients. The number of procedures per completed reconstruction was 2.2 or 1.9 if nipple‐areola reconstruction and contralateral surgery were excluded. The overall complication rate was 38%. Implants were removal for infection in 12% and exchanged for capsular contracture in 15%. LD/expander‐implant reconstruction failed in 3 patients.Conclusions  Single‐stage reconstruction is an achievable goal but patients should be counselled that further surgery might be required to complete the reconstruction.
PR20 PAEDIATRIC NASAL FRACTURES: PATIENT SATISFACTION FOLLOWING CLOSED REDUCTION
Authors: Love R. L. 
Published: April 2007

Introduction  Nasal trauma in childhood is a frequent occurrence. Management of resultant fractures in the paediatric age group presents a unique diagnostic and therapeutic challenge. The immature patient is less likely to be cooperative with examination, and clinical evaluation is difficult owing to facial oedema and lack of rigidity of the nasal bones. Subsequent nasal growth and development must be considered in determining the most appropriate treatment. Closed reduction of nasal fractures is usually undertaken at the Wellington Regional Plastic, Maxillofacial & Burns Unit at Hutt Hospital. Little exists in the form of follow‐up studies assessing patient satisfaction following this technique.Methods  A retrospective chart reviewed yielded 39 patients aged under seventeen years who underwent closed reduction of their nasal fracture during the two year period ending in July 2006 at Hutt Hospital. Follow‐up was between three and twenty‐seven months. A structured telephone interview was carried out to assess the degree of satisfaction with both functional and aesthetic outcome present in this group. Patients and their parents were invited to respond.Results  Most patients and their families are satisfied with nasal function and appearance following closed reduction. Few had subsequently sought or would consider a secondary open procedure in the form of septorhinoplasty.Conclusion  Closed reduction remains a satisfactory treatment in this age group. On the basis of patient satisfaction, it is successful in maintaining the function and appearance of the nose in most.
PR02 THE SPLIT THICKNESS SKIN GRAFT DONOR SITE; HAVE WE FOUND THE PERFECT DRESSING?
Authors: Terrill P. 
Published: April 2007

Calcium Alginate dressings have been used for many years as the standard dressing for donor sites. They require a secondary absorbent dressing which is not waterproof, will frequently leak blood and are difficult to remove and heal. Polyurethrane film dressings have also been used routinely with excellent healing rates, are waterproof, but highly prone to leakage.We present the results of a prospective randomized controlled trial using a new dressing, Tegaderm Absorbent, which provides all the regular benefits of a Polyurethrane film dressing but with absorptive capacity. Tegaderm Absorbent (TA) consists of a conformable acrylic pad enclosed between 2 layers of transparent film. The film in contact with the wound surface is perforated to allow uptake of the wound fluid by the absorptive acrylic pad.Forty patients were randomized to receive either Tegaderm Absorbent (3M) or Kaltostat Alginate dressing (Convatec)/gauze/combine/Mefix dressing.Twenty females and 16 men, with a mean age of 72 years (11–94 years), 19 with TA and 17 with Kaltostat, completed the trial. TA dressings were significantly easier to apply (89% vs. 31% very easy to apply), less painful on the first two days postoperatively (mean pain score 0.3 vs. 1.9 at Day 1 and 0.2 vs 2.7 Day 2), were easier and less painful to remove (mean pain score 0.5 vs. 2.9), healed quicker (99.7% vs. 58.9% healed at 10–16 days) and were more convenient for the patients to manage. Eight dressings leaked in the Kaltostat group and 5 in the TA group. To avoid this a dressing change may be required.
PR23 ALTERATIONS IN THE LYMPH STRUCTURE OF THE UPPER LIMB FOLLOWING AXILLARY DISSECTION – RADIOGRAPHIC STUDY IN A HUMAN CADAVER
Authors: Suami H. , Pan W‐R. , Taylor G. I. 
Published: April 2007

Purpose  There have been very few anatomical reports on the changing lymph structure of the upper limb after axillary dissection despite its clinical significance for predicting skin cancer recurrence in the limb and secondary lymphoedema. We used both upper limbs harvested from a fresh human cadaver who had undergone unilateral right radical mastectomy and radical axillary dissection for breast cancer.Methodology  Hydrogen peroxide was used to identify and inflate the lymphatic vessels. Individual channels were injected with a radio‐opaque lead oxide mixture and recorded on X‐ray film.Results  Results from the left normal upper limb were similar to results from our previous studies. However, the right limb from the mastectomy side showed remarkable differences as well as revealing that the lymph node clearance in the axilla had been incomplete on that side. The major difference was the almost complete absence of the superficial lymph collecting vessels in the right arm, proximal to the elbow, due to fibrosis and blockage of the lymphatic channels. A circuitous pathway was identified that by passed the blocked lymphatics in the arm to reach the deep system. This was often facilitated by backflow through precollectors and avalvular lymph capillaries in the dermis of the forearm, to eventually reach the few remaining lymph nodes in the axilla.Conclusions  Previously undetected lymph channels connecting the superficial and the deep lymphatic system had opened up due to the blockage of superficial lymphatic vessels caused by axillary dissection. It is presumed that these channels prevented lymphoedema in this case.
PR26 FACIAL RE‐ANIMATION
Authors: Poole M. D. 
Published: April 2007

The author will cover the various methods he has had experience with in facial re‐animation over the years including free vascularised muscle transfers, cross face nerve grafting and temporalis and masseter transfers. The long term results of some of these techniques and the pitfalls associated with them and the lessons learned by the author over the years will be discussed.In summary, free vascularised transfers have now been abandoned in favour of temporalis and masseter muscle transfers using a modified technique to avoid facial scars.
PR03 AN ALTERNATE MODEL FOR LEARNING MICROSURGICAL SKILLS
Authors: Varkey A. , Cigna E. , Tan N. C. 
Published: April 2007

Purpose  To highlight a suitable option in training and optimizing microsurgical skills in situations without access to an animal laboratory. The rat model has been the standard model but stringent laws on experimental animals and rising cost of this model necessitate alternative models.Methods  Tissues obtained from the operating room which would otherwise be discarded We practiced microsurgical anastomosis of vessels and nerves using the operating microscope. Over a one year period, 86anastomosis were done on various vessels of different caliber. The patency was evaluated using colored colloidal solution to flow through from a height creating a pressure gradient. Transecting the vessel beyond the anastomosis was subsequently done to examine the anastomosis in greater detail.Results  86 anastomosis performed were evaluated. The anastomosis performed are summarized:Upper limb‐Radial artery10; Cephalic vein‐10. Lower limb‐Peroneal artery‐6. Dorsalis pedis‐3; Vena commitantes‐5; Digital vessels on toes 3 arteries 3 veins; Umbilical cord‐artery‐12; Umbilical vein‐12; Lymphedematous tissue‐vein‐4; Derma‐lipectomy specimen‐Unnamed veins‐5, arteries‐5; Intestine‐Mesenteric vessels veins‐4; arteries‐4.Conclusion  The use of tissue which would otherwise be discarded proved to be a suitable alternative in training basic microsurgical skills with specific advantages of allowing for practice of all steps including adventectomy which is not possible on synthetic models. It offered the novice a first hand experience with vessels of various characteristic attributes and enables the trainee to get the life like experience of the feel of the vessel and its specific characters as one would encounter.
PR31 A LITTLE GIRL WITH A GIANT NAEVUS. A CASE REPORT
Authors: Mackenzie K. A. , Langley S. J. 
Published: April 2007

Purpose  The treatment of congenital giant hairy naevi remains controversial and it can present a challenge for the reconstructive surgeon. Recent publications promote the use of curettage and laser treatment, however they show incomplete clearance. In this atmosphere we present a case of surgical resection involving serial excision, skin grafts and tissue expansion with early good cosmetic results.Methodology  Now aged 2 year old girl was born with extensive congenital melanocytic naevi of her face, involving lower forehead, glabella, medial eyelids, nasal bridge and medial cheeks bilaterally. Lower back and right calf were also involved. No associated anomalies were recorded. At one week of age she had curettage of the facial naevus, when the surface naevus containing most of pigment and naevus cells was removed in London. She was left with the left eye ectropion due to a small scar. She moved to NZ and underwent further treatment. There was no role for laser treatment so surgical excision at the age of 12 months was performed, followed by insertion of tissue expanders, bilateral cheek and forehead advancement and full thickness graft to defects post serial excisions. A literature review was performed and our findings compared with historical results from other centres.Results  Multiple treatment techniques have been used over the last few decades. Surgical approach provides stable long term results in terms of cosmesis and function and early good results are shown in our case. We will continue further reconstructions in the future to achieve the best appearance and function.
PR37 EVOLUTION OF SURGERY FOR CRANIOSYNOSTOSIS IN CHRISTCHURCH – A REVIEW OF 67 CHILDREN
Authors: Mackenzie K. A. , Langley S. , Davis C. , MacFarlane M. R. 
Published: April 2007

Purpose  The treatment of craniosynostosis has continued to evolve over the last few decades. Techniques from linear strip craniectomies through osteotomies, orbital bandeau fashioning, craniotomies and immediate calvarial remodelling to the latest spring‐mediated dynamic reshaping have been used to achieve ongoing improvements in facial and skull shape. This paper discusses the timing, long‐term results and recent advances of surgical techniques based on our experience. We also aim to identify factors which could affect the outcome.Methodology  We performed a retrospective analysis of 67 patients surgically treated for craniosynostosis over a 24 year period in Christchurch Hospital. The craniofacial team consisted of a Plastic Surgeon and a Neurosurgeon. We analyzed results based on type of sutural involvement, cosmetic outcome, complications, blood transfusions and surgical technique.Results  There were 20 females and 47 males. 62 had a non‐syndromic craniosynostosis and 5 had a syndromic craniosynostosis. The non‐syndromic cases comprised: sagittal (n = 30), metopic (n = 17), unilateral coronal (n = 9), bicoronal (n = 2) and multiple (N = 4). The 5 syndromic cases comprised: Crouzon’s/bilat coronal (n = 2), Apert’s (n = 2, 1 bilateral coronal, 1 unilateral coronal)) and Klippel‐Feil/unilateral lambdoid (n = 1). The median age at first operation was 8 months. Complications and outcomes will be presented and our conclusions will highlight the evolving surgical techniques and that a multidisciplinary approach (including neurosurgeon, plastic surgeons and paediatric team) provides the best outcome for children with craniosynostosis.
PR42P RISK FACTORS AND SAFETY OF IMMEDIATE BREAST RECONSTRUCTION
Authors: Mackenzie K. A. , Nye B. J. 
Published: April 2007

Purpose  Indications for immediate breast reconstruction (IBR) vary depending on many factors, including clinical stage of carcinoma, age, diabetes, hypertension, obesity and smoking. This paper seeks to assess the risk factors and complications in patients undergoing immediate breast reconstruction and define selection criteria for IBR based on the local population.Methodology  A retrospective review of 94 immediate breast reconstructions over a 5‐year period was carried out. Patients were divided into subgroups based on the type of reconstruction: TRAM (n = 36), latissimus dorsi myocutaneous flap with implant (n = 28), autologus latissimus dorsi myocutaneous flap (n = 3), subpectoral saline implant (n = 8) and tissue expander (n = 19). Review of risk factors and complications in all groups was performed and our findings compared with results from other centres.Results  Results including complications and outcomes will be presented and the conclusions used to provide recommendations for patient selection for immediate breast reconstruction. Statistical analysis will be performed to compare the rate of complications with respect to the surgical procedure and risk factors.
PR45P AN IMPROVED ALTERNATIVE TO VACUUM‐ASSISTED CLOSURE (VAC) AS A NEGATIVE PRESSURE DRESSING IN LOWER LIMB SPLIT SKIN GRAFTING: A CLINICAL TRIAL
Authors: Rozen W. M. , Shahbaz S. , Morsi A. 
Published: April 2007

Background  The use of negative pressure in the dressing of split skin grafts has been shown to promote healing by a variety of mechanisms, including a decrease in interstitial oedema, an increase in perfusion and a decrease in bacterial colonisation. Vacuum‐assisted closure (VAC) dressings have, until now, been used as the archetype for negative pressure dressings and have been reflected as such in the literature. However, patient mobility and cost are still an issue with these dressings, and alternatives have been keenly sought. We describe an alternative method of negative pressure dressing, which we have found to be a safe and successful alternative, in the setting of lower limb split skin grafts.Method and Materials  A prospective cohort investigation was performed at a Melbourne major metropolitan teaching hospital on 9 consecutive patients undergoing split‐skin grafting for a lower limb soft tissue defect. The dressing comprised a single cut foam sheet, a conventional disposable closed‐system suction drain and an adhesive dressing.Results  In all 9 patients, there was a 100% take of the graft, with no partial or complete loss. There were no complications encountered. Cost analysis demonstrated a minimum treatment cost of $577 over 5 days compared to $3180 for commercial VAC dressed wounds: a net saving of $2603 per patient.Conclusions  The use of a simple suction drain is a cheap and safe alternative to commercial VAC dressings for the treatment of lower limb split skin grafts. Length of hospital stay and cost are superior to VAC, with no diminished clinical outcome.
PR08 LYMPHATIC MALFORMATIONS AND THE MOLECULAR BASIS OF LYMPHANGIOGENESIS
Authors: Ch’ng S. , Tan S. T. 
Published: April 2007

This paper reviews the clinical features of lymphatic malformations and the molecular basis of embryonic lymphangiogenesis.Lymphatic malformations are classified as microcystic, macrocystic, or combined. Most commonly found in the axilla/chest and cervicofacial region, they can be localised or diffuse. The commonest complications are intralesional bleeding and infection. Other significant complications are due mainly to their mass effect on nearby anatomic structures including the airway and eyeball, and soft tissue and skeletal overgrowth including macrocheilia, macroglossia, macrotia, macromala and mandibular prognathism, resulting in functional problems in feeding, speech, occlusion, oral hygiene, and disfigurement. The characteristic radiological finding of a LM on gadolinium‐enhanced T1‐weighted MRI is a low‐density lesion with septation or rim enhancement. Histologically, LMs are cystic lesions that contain eosinophilic proteinaceous fluid whose walls are composed of smooth and skeletal muscle fibres, collagen and lymphocytes. Management options range from observation, comfort cares, empirical antibiotic treatment for LM cellulitis to sclerotherapy, surgical excision and Nd:YAG laser for selected cases.Lymphangiogenesis is believed to occur in four sequential but overlapping stages: lymphatic endothelial cell competence, bias and specification, and finally lymphatic vessel terminal differentiation and maturation. Multiple genes are involved in this process including Lyve1, Nrp2, podoplanin, Prox1, VEGFR3, VEGFC and Ang2. Developmental defects during embryonic lymphangiogenesis result in lymphatic malformations.