Australasian Journal of Plastic Surgery <p>The<em> Australasian Journal of Plastic Surgery </em>publishes original research on all aspects of plastic and reconstructive surgery research and review including aesthetic, breast, burns, cleft lip and palate, craniomaxillofacial, experimental research, general reconstruction, hand, head and neck, history of plastic and military surgery, international collaboration, melanoma and skin cancer, paediatric, training and technical and preoperative investigations/imaging.</p> <p>Our aim is to be the premier platform for plastic and reconstructive surgery research and review in the region; to foster, encourage and support research excellence; and to make a key contribution to surgical practice worldwide in keeping with the prominent roles that Australian and New Zealand surgeons have played in the development of the specialty.</p> <p>The journal is published by the <a href="">Australian Society of Plastic Surgeons</a> with support from the <a href="">New Zealand Association of Plastic Surgeons</a>. Two issues are published per year, in March and September.</p> <p>The journal's audience includes specialist plastic and reconstructive surgeons, general surgeons, paediatric surgeons, vascular surgeons, trainee surgeons, specialist registered nurses, medical professionals and medical technologists.</p> <p>If you would like to submit a paper, we recommend that you read the <a href="" target="_blank" rel="noopener">About the Journal</a> section for our editorial policies, as well as the <a href="" target="_blank" rel="noopener">Author Guidelines</a>.</p> Australian Society of Plastic Surgeons en-US Australasian Journal of Plastic Surgery 2209-170X <p>This is an open access journal: all articles will be immediately and permanently free for everyone to read and download. Authors will retain copyright of their article and have a choice of publishing under the following Creative Commons Licence terms:<br /><br /><a href="" target="_blank"><span style="text-decoration: underline;">Creative Commons Attributio</span><span style="text-decoration: underline;">n (CC BY)</span></a> (recommended)<br />Lets others distribute and copy the article, create extracts, abstracts, and other revised versions, adaptations or <span>derivative</span> works of or from an article (such as a translation), include in a collective work (such as an anthology), text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honour or reputation.</p><p><span style="text-decoration: underline;"><a href="" target="_blank">Creative Commons Attribution Non-Commercial Licence (CC BY-NC)</a><br /></span>Lets others distribute, remix and build upon the work, but only if it is for non-commercial purposes and they credit the original creator/s (and any other nominated parties). <span style="text-decoration: underline;"><br /></span></p><p><span style="text-decoration: underline;"><a href="" target="_blank">Creative Commons Attribution-Non-commercial-NoDerivs (CC BY-NC-ND)</a><br /></span>For non-commercial purposes, lets others distribute and copy the article, and to include in a collective work (such as an anthology), as long as they credit the author(s) and provided they do not alter or modify the article. </p> Utility of parascapular flaps for regional reconstruction of upper back defects: a case series <p>The latissimus dorsi (LD) flap has classically been described for posterior upper quadrant trunk defects. Perforator flaps have gained popularity among reconstructive surgeons as the predictable anatomy and muscle-sparing nature of parascapular flaps make this an attractive reconstructive option. We describe the versatility of the parascapular flap for reconstruction of defects in the axilla, deltoid, scapula and paraspinal region performed in six patients over a two-year period. The history of the parascapular flap, technique, patient outcomes and technical pearls are also discussed. We recommend this flap be considered a workhorse flap for defects in the posterior upper quadrant.</p> Jemima J Dorairaj Gareth D Kiernan Rizwan Sheikh Richard Zinn Copyright (c) 2021 Jemima J Dorairaj, Gareth D Kiernan, Rizwan Sheikh, Richard Zinn 2021-03-30 2021-03-30 4 1 79 83 10.34239/ajops.v4n1.248 Airway complication associated with injection of phosphatidylcholine and deoxycholic acid into the neck: a case report <p>The practice of delivering cosmetic injectables in the outpatient setting continues to grow in Australia.<sup>1</sup> The increase in demand has seen a dramatic rise in the number of new cosmetic injectable clinics using telehealth prescribing services. Lipodissolve treatment is an example of a non-surgical procedure that aims to improve the appearance of a ‘double chin’ by injection of phosphatidylcholine (PC) and deoxycholic acid (DCA) into submental adipose tissue. We describe a case of an airway complication and hospitalisation secondary to the injection of Lipodissolve in the neck of a 23-year-old female.</p> Sanith Cheriyan Jacob Jervis-Bardy Copyright (c) 2021 Sanith Cheriyan, Jacob Jervis-Bardy 2021-03-30 2021-03-30 4 1 63 66 10.34239/ajops.v4n1.194 Biodegradable temporising matrix in severe meningococcal septicaemia: a case report <p>Expanding experience with NovoSorb Biodegradable Temporising Matrix™ (BTM, PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) for complex wounds encouraged its use in the following case, which required reconstruction of extensive soft-tissue defects with exposed bone resulting from the sequelae of meningococcal B infection with septic shock and disseminated intravascular coagulation.</p> Matthew Jennings Jake Willet Patrick Coghlan Nicholas S Solanki John E Greenwood Copyright (c) 2021 Matthew Jennings, Jake Willet, Patrick Coghlan, Nicholas S Solanki, John E Greenwood 2021-03-30 2021-03-30 4 1 67 70 10.34239/ajops.v4n1.226 Parotid mucoepidermoid carcinoma with extensive intravenous metastasis: a case report <p>Salivary tumours are uncommon, comprising only 2–5 per cent of head and neck neoplasms,<sup>1</sup> with mucoepidermoid carcinoma (MEC) being the most common salivary cancer in both adults and children.<sup>1–4</sup> Clinically, head and neck MEC can present variably from being asymptomatic to locally or metastatically aggressive.<sup>5,6</sup> Treatment is primary surgical resection with neck dissection. The use of adjuvant radiotherapy is indicated for patients at high risk of recurrence, such as those with a high tumour stage, positive resection margins and high histological grading.<sup>6–8</sup> </p> Alice Flavell-Birch Helen D Brasch Swee T Tan Copyright (c) 2021 Alice Flavell-Birch, Helen D Brasch, Swee T Tan 2021-03-30 2021-03-30 4 1 71 74 10.34239/ajops.v4n1.244 Carpal tunnel syndrome due to Mycobacterium szulgai infection: Australian report <p>Non-tuberculous mycobacterial tenosynovitis is a rare condition, more typically caused by <em>M. marinum</em> followed by <em>M. kansasii</em>.<sup>4</sup> Patients typically present with chronic swelling without signs of acute infection, and normal ESR/CRP inflammatory markers.<sup>4</sup> It is difficult to diagnose and is frequently misdiagnosed, which often results in delay to treatment (on average roughly six months).</p> Harrison Theile Ryan Beattie Libby Anderson Copyright (c) 2021 Harrison Theile, Ryan Beattie, Libby Anderson 2021-03-30 2021-03-30 4 1 75 78 10.34239/ajops.v4n1.228 Response to ‘Australia's contribution to the free abdominoplasty flap in breast reconstruction’ <p>Perhaps few realise that the development of what became known as the free transverse rectus abdominis myocutaneous (TRAM) flap was a race involving not one but two surgical teams, one in Sydney and the other, with the aid of the Australian Richard Hamilton, in Sweden</p> David George Pennington Copyright (c) 2021 David George Pennington 2021-03-30 2021-03-30 4 1 84 85 10.34239/ajops.v4n1.300 Light at the end of the tunnel <p>It is not hard to list some of the profound effects COVID-19 has had on the specialty of plastic surgery. <br />World-wide many of our colleagues have suffered serious illness and many have died. Even in countries like Australia and New Zealand, relatively spared from the ravages of the disease, we have all had significant disruptions to our lives and practices<br />Limitations on elective surgery during lockdown, reduced rates of screening for breast cancer and melanoma (Figure 1), consulting with masks—all affect our ability to provide a safe and effective service for our patients. Eminent plastic surgeons choosing to take early retirement is a great loss of institutional memory. Opportunistic governments and administrators taking advantage and using COVID-19 as an excuse to push through ‘urgent’ changes challenge our ability to provide a safe and effective service</p> Mark Lee Mark Ashton Copyright (c) 2021 Mark Lee, Mark Ashton 2021-03-30 2021-03-30 4 1 1 2 10.34239/ajops.v4n1.296 Innovation in rural workforce strategies by a national surgical society <p>Health services exist to address the health needs of the community. But in Australia at present there are not enough detailed data to tell us to what extent, community by community, our highly regarded health system is meeting those needs. We know that demand for health care services is growing faster than the overall economy, and that we no longer have a general shortage of doctors, but most problematically there is a significant geographic maldistribution of those doctors away from rural and regional areas.i<br />For plastic surgery services, there is very little understanding of what the aggregate needs of rural communities are, or how these needs vary by community. We know by anecdote that there is significant inequity in plastic surgery services and that rural and regional locations often have unfilled positions and diminished services. We note that 80 per cent of specialist plastic surgeons live and work wholly within the five largest Modified Monash level 1 (MM1) Australian cities.1 Only 8.5 per cent of specialist plastic surgeons are permanently based outside those five cities. We also note that this is a more serious negative divergence than other comparable surgical specialties.<br />While we briefly explore the basis for some ‘innovative’ solutions in this paper, we are constantly reminded that a prerequisite of any ‘solution’ should be an in-depth study of what Australian rural communities need or want in terms of plastic surgery services. </p> Keith Bryant Nicola R Dean Copyright (c) 2021 Keith Bryant, Nicola R Dean 2021-03-30 2021-03-30 4 1 3 5 10.34239/ajops.v4n1.299 The times they are a-changin' <p>n/a</p> David K Chong Copyright (c) 2021 David K Chong 2021-03-30 2021-03-30 4 1 6 8 10.34239/ajops.v4n1.298 Australas J Plast Surg. 2021.4(1) <p>Issue information for <em>Australasian Journal of Plastic Surgery</em> vol 4 no 1 2021</p> Journal Manager Copyright (c) 2021 Journal Manager 2021-03-30 2021-03-30 4 1 i ii Caregiver satisfaction survey results in a multidisciplinary cleft clinic <p><strong>Introduction</strong>: Orofacial clefts have a wide range of severity and can create functional and aesthetic issues for the affected individuals as well as influence their social interactions and general happiness. Our aim was to investigate how parents/caregivers score functional and aesthetic aspects of their child’s cleft and their child’s social interactions and happiness. <br /><strong>Method</strong>: Parents/caregivers attending the Christchurch Cleft Clinic in New Zealand between 2016 and 2019 completed a survey covering eight items—hearing, look of face, look of teeth, speech, teeth issues, food or liquid coming out of the nose, social interactions, general happiness and a free-text comment section. Items were scored using a visual analogue scale. Descriptive statistics were performed on the data and qualitative analysis of the free-text comments was conducted via thematic categorisation.<br /><strong>Results</strong>: A total of 226 completed surveys from 154 parents were assessed. Surveys that had any incomplete question (24) and/or had repeat submissions (72) were excluded, reducing the sample to 130 surveys. ‘Speech’, ‘look of the teeth’ and ‘teeth issues’ had the lowest (worst) mean scores. Negative functional issues relating to speech and fistulas were the most common free-text themes. <br /><strong>Conclusion</strong>: Speech was a common concern for parents, emphasising the importance of speech language therapy as a key component in cleft treatment. Parental concerns regarding the look of their child’s teeth and teeth issues highlight the need for an interdisciplinary treatment approach. The inclusion of otolaryngology and psychology services to improve issues that arise from hearing, social and emotional challenges is also recommended. </p> Zoe Berryman Peter Fowler Michelle Shand Martin Lee Kirk Williams (III) Copyright (c) 2021 Zoe Berryman, Peter Fowler, Michelle Shand, Martin Lee, Kirk Williams (III) 2021-03-30 2021-03-30 4 1 22 29 10.34239/ajops.v4n1.212 Firework and sparkler burns in paediatric patients <p><strong>Background</strong>: While the consumer sale of fireworks is illegal in New South Wales, the sale of sparklers is legal—however, both still pose a significant risk of harm in the paediatric population. Anecdotally, burns services are aware that the misuse of sparklers can result in burns but there appears to be a paucity of studies examining this incidence in the paediatric population in Australia.<br /><strong>Method</strong>: A retrospective review of all burns related to the use of fireworks or sparklers referred to the Children’s Hospital at Westmead (CHW) Burns Unit (BU) from January 2004 to December 2019. <br /><strong>Results</strong>: 96 patients were referred to the CHW BU with a burn as a result of a firework or sparkler. Sparklers accounted for 69 (72%) of burns, compared with 27 (28%) from fireworks. The mean age of those injured by sparklers was five years compared with eight years in the firework group. Average total body surface area (TBSA) affected for both mechanisms was similar—for sparkler burns (2.0%) firework burns (2.4%), with a range of 0.1–15 per cent. Hands were the most common area burnt in both groups comprising 41 (59%) of sparkler burns and 13 (48%) of firework burns. Twenty patients required a total of 32 visits to the operating theatre for acute management of their burns.<br /><strong>Conclusion</strong>: This study demonstrates the potential for significant injuries as a result of fireworks and sparklers. These findings can be used to raise awareness regarding their dangers, direct targeted educational campaigns and guide safety advice regarding their use. </p> Daniel Ricciardello Nam Kyu Yang Kira Chamberlain Andrew Holland Copyright (c) 2021 Daniel Ricciardello, Nam Kyu Yang, Kira Chamberlain, Andrew Holland 2021-03-30 2021-03-30 4 1 30 34 10.34239/ajops.v4n1.240 Characteristics and assessment of children undergoing upper limb surgery for management of cerebral palsy <p><strong>Background: </strong>Surgical intervention for improvement of upper limb function in children with cerebral palsy is reported to be of benefit where careful patient selection is taken into consideration. Currently there are no clinical guidelines to help determine selection of individuals best suited for operative management, nor does research exist that identifies characteristics of the patient cohort currently being selected as appropriate for surgery. The aim of this study is to determine the current trends in selection, assessment and management of patients with cerebral palsy undergoing upper limb surgery.</p> <p><strong>Methods</strong>: This retrospective study included data from 102 individuals with cerebral palsy who had undergone upper limb surgical management during a 10-year time period at the Royal Children’s Hospital, Melbourne, Australia. There were 138 separate surgical events involving 579 procedures during this period. Data regarding the characteristics of the individuals and their perioperative assessment was collected and analysed. <br><strong>Results: </strong>The cohort was 56.9% male, the median age at time of surgery was 14.2 years old. Motor involvement was 51.0% bilateral and 49.0% unilateral and 96.0% of individuals had a spastic component. The most common surgical goal was position care (50.4% of cases), followed by activity and participation (47.9% of cases). Preoperative outcome measures were used in 69.6% of cases.<strong><br></strong><strong>Conclusions: </strong>Currently, individuals are selected for surgery using variable preoperative assessment. Selection has great potential to differ between clinicians. These compounding issues provide rationale for initiating further research into understanding the characteristics of this patient group and promoting better standardisation of perioperative assessment.</p> Danielle Sabella Adam Scheinberg Bruce Johnstone David McCombe Monika Hasnat Copyright (c) 2021 Danielle Sabella, Adam Scheinberg, Bruce Johnstone, David McCombe, Monika Hasnat 2021-03-30 2021-03-30 4 1 35 47 10.34239/ajops.v4n1.235 Mallet fractures: a prospective comparison of treatment outcomes <p>Background: The optimal management of mallet fractures is controversial. Currently, published evidence does not clearly define the role of surgery in managing these fractures or identify when splinting alone is suitable.<br />Methods: An observational, prospective cohort study was undertaken between 2012 and 2015 evaluating patient experience, and radiological and functional outcomes following mallet fractures managed with splinting alone or surgery combined with post-operative splinting. This study was registered with our local research facility and ethical approval was granted by the New Zealand Northern B Health and Disability Ethics Committee Health and Disability Ethics Committee (HDEC) #13/NTB/202. All patients provided formal written consent. <br />Results: A total of 109 adult patients with 113 mallet fractures were enrolled in the study and 85 patients with 89 fractures completed follow-up. Mean follow-up was 190 days. Fractures initially associated with subluxation of the distal interphalangeal (DIP) joint treated with splinting alone were five times more likely to fail to meet a minimum standard of success than those fixed with surgery. When the fracture fragment occupies between one and two thirds of the joint surface, even in the absence of initial DIP joint subluxation, 13/35 (37%) joints subluxed during splint treatment. <br />Conclusion: This study aids clinicians by highlighting where splinting is likely to fail and providing a means of identifying injuries in which surgery must be considered</p> Jessica A Savage Clara Miller Shirley Collocott Devlin Elliott Karen Smith Copyright (c) 2021 Jessica A Savage , Clara Miller , Shirley Collocott , Devlin Elliott, Karen Smith 2021-03-30 2021-03-30 4 1 48 55 10.34239/ajops.v4n1.222 Osseointegrated prostheses for lower limb amputees <p><strong>Background</strong>: Traditional socket-based prostheses are an important rehabilitation tool in lower limb amputation, however, patients often experience skin-related problems, pain, stump volume fluctuations and poor suspension. Osseointegration offers a suitable alternative by providing direct skeletal attachment for limb prosthesis. This study aims to review the complications following osseointegration for lower limb amputation, with attention to mechanical abutment failure. <br /><strong>Method</strong>: A retrospective chart review was undertaken of all patients who underwent transfemoral osseointegration between January 2000 and June 2019 through the osseointegration and targeted muscle reinnervation surgical and rehabilitation program at The Alfred in Victoria, Australia. Ethics approval was obtained through The Alfred’s ethics committee (414/16). In 2016 this program was redesigned and in 2017 the osseointegration implant system was modified. Patients underwent a two-stage surgical procedure followed by a rehabilitation protocol that gradually increased their activity. <br /><strong>Results</strong>: A total of 19 limbs were osseointegrated in 18 patients during the study period. Two patients had their implant removed due to failure of osseointegration. The most common complication was a mechanical abutment failure, occurring 46 times in 11 patients. Patients who suffered an abutment failure reported higher levels of postoperative activity. Soft-tissue infections occurred in five patients: three superficial skin infections and two collections. There were no mechanical abutment failures noted in the updated program.<br /><strong>Conclusion</strong>: Osseointegration is a good option for patients who may have difficulties with traditional socket prosthesis. However, complications such as abutment fracture can occur, and appropriate patient selection and counselling are required</p> Sadhishaan Sreedharan Steven Gray Frank Bruscino-Raiola Copyright (c) 2021 Sadhishaan Sreedharan, Steven Gray, Frank Bruscino-Raiola 2021-03-30 2021-03-30 4 1 56 62 10.34239/ajops.v4n1.199 Diagnosis, investigation and management of breast implant illness <p><strong>Introduction</strong>: An increasing pool of literature proposes a link between silicone implants and autoimmune-related symptoms known colloquially as breast implant illness (BII). We describe the history of BII, reported symptoms, risk factors and previously published diagnostic criteria to aid clinicians in the diagnosis, investigations and management of patients presenting with symptoms that they attribute to their silicone breast implants. <br /><strong>Methods</strong>: A literature search was performed using MEDLINE®, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effect (DARE) and PubMed in September 2018. The search terms ‘autoimmune inflammatory syndrome induced by adjuvants’, ‘breast implants’ and ‘silicone’ were used alone and in combination. <br /><strong>Results</strong>: Thirty-four studies were reviewed including three case reports, 12 case series, 14 retrospective cohort studies, four case control studies and one prospective cohort study. Within this cohort, 18 studies were found regarding the explantation of implants relating to BII. <br /><strong>Conclusion</strong>: Studies have demonstrated no association between silicone breast implants and any known autoimmune diseases, but there exists a pool of literature suggestive of a relatively undefined condition colloquially known as BII. Serological testing and imaging play an important role in the assessment of patients to exclude other pathology, but these tests remain non-diagnostic for BII. Although medical treatment has shown promise, there is no established treatment for patients. The surgical explantation of implants appears to have positive outcomes for patients; however, the exact nature of the surgery required to achieve this remains unclear. </p> Daniel WH Wong Tai K Lam Copyright (c) 2021 Daniel WH Wong, Quoc Lam 2021-03-30 2021-03-30 4 1 9 21 10.34239/ajops.v4n1.210