Australasian Journal of Plastic Surgery http://ajops.com/index.php/ajops <p>The <em>Australasian Journal of Plastic Surgery&nbsp;</em>is a peer-reviewed, online-only journal covering 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, PRS Board of Training and technical and preoperative investigations/imaging.</p> <p>Established by the<a href="http://www.plasticsurgery.org.au/">&nbsp;Australian Society of Plastic Surgeons</a>&nbsp;the&nbsp;<a href="http://www.plasticsurgeryfoundation.org.au/">Australasian Foundation for Plastic Surgery</a>&nbsp;and the <a href="http://plasticsurgery.org.nz/">New Zealand Association of Plastic Surgeons,</a> the journal is published twice a year, in March and September.</p> <p>If you would like to submit a paper, we recommend that you read the <a href="/index.php/ajops/about" target="_blank" rel="noopener">About the Journal</a> section for our editorial policies, as well as the <a href="/index.php/ajops/about/submissions" 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="https://creativecommons.org/licenses/by/4.0/" 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="https://creativecommons.org/licenses/by-nc/4.0/" 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="https://creativecommons.org/licenses/by-nc-nd/4.0/legalcode" 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> Vol 2 No 2 (2019): AJOPS issue information http://ajops.com/index.php/ajops/article/view/181 Journal Copyright (c) 2019 http://creativecommons.org/licenses/by/4.0 2019-10-18 2019-10-18 2 2 1 10.34239/ajops.v2n2.181.5 Holier than thou: are we all biased? http://ajops.com/index.php/ajops/article/view/164 <p>n/a</p> Mark Ashton Mark Lee Copyright (c) 2019 Mark Ashton, Mark Lee http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 1 3 10.34239/ajops.v2n2.164 Guidelines and tips for getting your abstract accepted: ASPS PSC http://ajops.com/index.php/ajops/article/view/169 <p>N/A</p> Darrell Perkins Copyright (c) 2019 Darrell Perkins http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 4 6 10.34239/ajops.v2n2.169 Biopsy! Biopsy! Biopsy! http://ajops.com/index.php/ajops/article/view/170 <p>N/A</p> Ramin Shayan Copyright (c) 2019 Ramin Shayan http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 7 9 10.34239/ajops.v2n2.170.2 Epidemiological trends of dermal sarcoma in Australia http://ajops.com/index.php/ajops/article/view/127 <p><strong>Background</strong>: Sarcomas comprise a heterogenous group of malignant tumours of mesenchymal origin and can arise in the skin. Definitive management of skin sarcoma usually entails surgical resection with wide margins, often requiring reconstruction. The incidence and demographics of these neoplasms in Australia are poorly understood. <br><strong>Method</strong>: Incidence, gender and age distribution data for skin sarcomas for the period 1982–2009 were obtained from the Australian Cancer Database (ACD). Morphology and topographical region coding via the International Classification of Diseases for Oncology third edition (ICD-O-3)1 were used to identify the data.<br><strong>Results</strong>: A total of 5453 cases of skin sarcoma in the Australian population were identified over the 28-year period. Anatomically, 1610 cases (29%) occurred on the limbs, 1416 (26%) on the head and neck area, 957 (18%) on the trunk and 1470 (27%) had an unspecified skin origin. Overall incidence was 2.09 per 100,000 population. Males were more commonly affected (70%), most commonly in the 30–49 years and 70+ years age groups. The most common pathological subtypes were fibromatous sarcoma (including dermatofibrosarcoma protuberans), Kaposi’s sarcoma and pleomorphic dermal sarcoma.<br><strong>Conclusion</strong>: The Australian Cancer Database data used to describe the pattern and epidemiological trends for skin sarcoma in Australia demonstrated variation from international trends and highlight the need for further research into the aetiology of these tumours.</p> Edward Gibson Roger Woods Alexa Potter Jessica Leigh Reid Jennie Louise Gelareh Farshid Taryn Bessen Susan Neuhaus Copyright (c) 2019 Edward Gibson, Roger Woods, Alexa Potter, Jessica Leigh Reid, Jennie Louise, Gelareh Farshid, Taryn Bessen, Susan Neuhaus http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 10 16 10.34239/ajops.v2n2.127 Local anaesthetic-only upper blepharoplasty: a viable alternative? http://ajops.com/index.php/ajops/article/view/150 <p><strong>Introduction</strong>: Local anaesthetic-only upper blepharoplasties are not routinely performed in the clinic in Australia. There is a lack of data to demonstrate whether they are any less safe or efficacious compared with upper blepharoplasties performed with sedation or general anaesthesia (GA) in theatre. Perioperative and postoperative antibiotics may also be administered for surgical site infection (SSI) prophylaxis. This paper aims to determine whether local-only upper blepharoplasties are safe and efficacious compared with upper blepharoplasties performed with sedation or GA, and whether prophylactic antibiotic use is indicated.</p> <p><strong>Method</strong>: A retrospective analysis of patients undergoing upper blepharoplasties from a single surgeon’s private clinic was performed from March 2014 to October 2018. The clinic’s database was interrogated and patient age, anaesthetic type, operative site, use of peri- or postoperative antibiotics, and complications were recorded including infection, return to theatre, chemosis and asymmetry noted by the patient and requiring revision surgery.</p> <p><strong>Results</strong>: A total of 97 patients were included for analysis. Complication rates of local-only upper blepharoplasties performed in the clinic were not higher than when performed under sedation or GA in theatre. When analysing antibiotic use, although 32 of the 97 patients (33%) were not prescribed antibiotics preoperatively, postoperatively, or pre- and postoperatively, no patients developed infections.</p> <p><strong>Conclusion</strong>: When performed by a qualified surgeon with appropriate equipment, local-only upper blepharoplasties carried-out in the clinic are as safe and efficacious as those performed with sedation or GA in theatre. Prophylactic antibiotic use demonstrated no advantage in SSI prevention for patients undergoing upper blepharoplasties.</p> Robert Phan Frank Lin Copyright (c) 2019 Robert Phan, Frank Lin http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 17 20 10.34239/ajops.v2n2.150 Reconstructing ‘dual-defect’ pressure sores in spinal patients http://ajops.com/index.php/ajops/article/view/107 <p><strong>Background</strong>: Recurrent pressure sores and unstable scars over the bony prominences of the greater trochanter and ischium are a troublesome sequela of spinal injury. A reliable reconstruction is needed for patients with ‘dual-defect’ pressure sores in these locations. We modified the pedicled anterolateral thigh (ALT) flap to fit the reconstructive requirements of ‘dual-defect’ pressure sores.<br><strong>Methods</strong>: Eleven consecutive patients with concurrent pressure sores (&gt; grade III) or unstable scar in one of the ‘dual-defect’ areas and an active pressure sore in the other were identified from the Victorian state tertiary referral centre for spinal injuries. We describe the technique and clinical experience of pedicled ALT flaps for reconstruction of ‘dual-defect’ pressure sores in this patient cohort. Preoperative status and minor and major postoperative complications were recorded. <br><strong>Results</strong>: Eleven consecutive pedicled myocutaneous ALT flaps were performed for reconstruction of ‘dual-defect’ pressure sores. Several key variations in the anatomical landmarks and the intra-operative flap raise technique that are integral to the use of the ALT flap for this application are described herein. The average dimensions of the cutaneous pressure sore defects were 6 x 4.9 cm (greater trochanter) and 8.2 x 6.7 cm (<strong>ischial</strong>). The average dimensions of the cutaneous paddle of the flaps raised were 27.3 x 8.4 cm. Two postoperative complications necessitated return to theatre but no incidences of flap loss were recorded. <br>Conclusions: The modified pedicled myocutaneous ALT provides a robust reconstructive solution for resurfacing ‘dual-defect’ pressure sores in spinal patients. Further recommendations for future technical adaptations are made.</p> Ramin Shayan Aoife Margaret Hurley Derek Neoh Dr Stephen Flood Michael Weymouth Copyright (c) 2019 Ramin Shayan, Aoife Margaret Hurley, Derek Neoh, Dr Stephen Flood, Michael Weymouth http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 21 27 10.34239/ajops.v2n2.107 Petrol-related burn injuries presenting to the Victorian Adult Burns Service http://ajops.com/index.php/ajops/article/view/153 <p><strong>Introduction: </strong>Burns fuelled by petrol are a major cause of injury in Australia and New Zealand. The same quality of explosive ignition that makes petrol so valuable as a fuel can cause injuries when handled carelessly or used for a purpose for which it was not intended.</p> <p><strong>Methods: </strong>This was a retrospective cohort study that examined the epidemiology of patients admitted to the Victorian Adult Burns Service (VABS) based at the Alfred Hospital, Melbourne. Data were extracted from the VABS Database on patients presenting over a seven-year period, between 1st July 2009 to 30th June 2016.&nbsp;</p> <p><strong>Results: </strong>During the study period, 378 out of 1927 burns (19.6%) admissions were related to petrol use. Males aged 20 – 29 years were most at risk, contributing to 25.4% of petrol related burn injuries. A large portion of burns, 31.0%, occurred during a leisure activity. The mean total body surface area burnt in this cohort was 19.3% and surgery was required in 70.4% of cases. Petrol related burns injuries is estimated to cost AU$ 5,484,834 annually and had a mortality rate of 7.4%.</p> <p><strong>Conclusion: </strong>Misuse of petrol contributed to a substantial injury burden to Victorians. Raising community awareness through preventive strategies targeted at high-risk groups of at-risk behaviours is warranted to reduce the incidence of petrol related burn injuries.</p> Sadhishaan Sreedharan Hana Menezes Heathe Cleland Stephen Goldie Copyright (c) 2019 Sadhishaan Sreedharan, Hana Menezes, Heathe Cleland, Stephen Goldie http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 28 32 10.34239/ajops.v2n2.153 The composite extensor retinaculum cutaneous flap: an anatomical cadaveric study http://ajops.com/index.php/ajops/article/view/101 <p><strong>Background</strong>: Complex digital extensor tendon injuries are difficult to manage when adhesion formation and stiffness prevail. Vascularised tissue to reconstruct the skin and extensor defect would be the ideal reconstruction in both the acute and delayed settings. This anatomical study evaluates vascular supply to a suitable composite flap comprising skin, subcutaneous tissue and extensor retinaculum.<br><strong>Methods</strong>: An anatomical study of 18 cadaveric upper limbs was conducted to investigate the technical feasibility of a composite flap prior to its clinical application. The anterior (n = 9) or posterior (n = 9) interosseous artery was exposed and selectively injected with a coloured dye. Specimens were then dissected to raise the proposed composite flap of extensor retinaculum and the overlying integument. Specimens were subsequently assessed by digital subtraction angiography to evaluate the corresponding microvascular supply to the composite flap. <br><strong>Results</strong>: The anterior and posterior interosseous arteries supplied the extensor retinaculum through a dense network of vessels with choke anastomoses. The skin overlying the extensor retinaculum was predictably supplied by either artery through the perforator vessels between the fourth and fifth extensor tendon compartments.<br><strong>Conclusion</strong>: A composite unit of skin and extensor retinaculum can be harvested on either the anterior or posterior interosseous arteries. It can be employed for simultaneous vascularised tendon and skin reconstruction.</p> Sadhishaan Sreedharan Richard J Ross Jens J Froelich William A Cuellar Siddharth Karanth Copyright (c) 2019 Sadhishaan Sreedharan, Richard J Ross, Jens J Froelich, William A Cuellar, Siddharth Karanth http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 33 39 10.34239/ajops.v2n2.101 Prevention of surgical fires in facial plastic surgery http://ajops.com/index.php/ajops/article/view/140 <p><strong>Introduction</strong>: The objective of this review is to draw attention to the risk factors, causes and prevention of surgical fires in facial plastic and reconstructive surgery performed under local anaesthesia and sedation using a review of the literature.<br><strong>Method</strong>: Comprehensive search terms were developed, and PubMed and MEDLINE® searches were performed, including articles published in the last 25 years (1993–2018). Reference review was also undertaken. Eligible manuscripts described surgical fires involving patients undergoing surgical procedures under local anaesthesia in the head and neck region.<br><strong>Results</strong>: Risk factors forming the three arms of the fire triangle are detailed. High oxygen concentration in proximity to the surgical field where electrocautery is being used is the most common combination leading to surgical fire accidents. <br><strong>Conclusion</strong>: Summary recommendations for the prevention of surgical fires are presented. Preventing the development of an oxidiser-enriched environment is the main risk-reducing measure. Identifying high-risk cases and improving communication between the surgical, anaesthetic and nursing staff who control the arms of the fire triangle are very important measures in avoiding theses catastrophic events.</p> Harith Alani James Southwell-Keely Elias Moisidis Roger Haddad Frederick Clarke Michael Kernohan Copyright (c) 2019 Harith Alani, James Southwell-Keely, Elias Moisidis, Roger Haddad, Frederick Clarke, Michael Kernohan http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 40 49 10.34239/ajops.v2n2.140 Reporting quality of systematic review abstracts in articles hand and wrist pathology: a review http://ajops.com/index.php/ajops/article/view/141 <p><strong>Background</strong>: An increasing number of systematic reviews are published on an annual basis. Although perusal of the full text of articles is preferable, abstracts are sometimes relied upon to guide clinical decisions. Despite this, the abstracts of systematic reviews have historically been poorly reported. We evaluated the reporting quality of systematic review abstracts within hand and wrist pathology literature. <br><strong>Methods</strong>: We searched MEDLINE®, EMBASE and Cochrane Library from inception to December 2017 for systematic reviews in hand and wrist pathology using the 12-item PRISMA-A checklist to assess abstract reporting quality. <br><strong>Results</strong>: A total of 114 abstracts were included. Most related to fracture (38%) or arthritis (17%) management. Forty-seven systematic reviews (41%) included meta-analysis. Mean PRISMA-A score was 3.6/12 with Cochrane reviews having the highest mean score and hand-specific journals having the lowest. Abstracts longer than 300 words (mean difference [MD]: 1.43, 95% CI [0.74, 2.13]; p &lt;0.001) and systematic reviews with meta-analysis (MD: 0.64, 95% CI [0.05, 1.22]; p = 0.034) were associated with higher scores. Unstructured abstracts were associated with lower scores (MD: –0.65, 95% CI [–1.28, –0.02]; p = 0.044). A limitation of this study is the possible exclusion of relevant studies that were not published in the English language. <br><strong>Conclusion</strong>: Abstracts of systematic reviews pertaining to hand and wrist pathology have been suboptimally reported as assessed by the PRISMA-A checklist. Improvements in reporting quality could be achieved by endorsement of PRISMA-A guidelines by authors and journals, and reducing constraints on abstract length.</p> Amanda Yang Shen Robert S Ware Tom J O'Donohoe Jason Wasiak Copyright (c) 2019 Amanda Yang Shen, Robert S Ware, Tom J O'Donohoe, Jason Wasiak http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 50 57 10.34239/ajops.v2n2.141 Current evidence for outcomes of free-flap reconstruction in factor V Leiden patients http://ajops.com/index.php/ajops/article/view/136 <p><strong>Background</strong>: Factor V Leiden is the most common form of inherited thrombophilic syndrome, affecting five per cent of caucasians. While increased rates of venous thromboembolic complications have been regularly reported in factor V Leiden patients, little is known about their risk of microvascular complications or flap failure rates in free-flap surgery. The aim of this review is to qualitatively review the published literature on outcomes of free-flap surgery in patients with factor V Leiden.</p> <p><strong>Methods</strong>: MEDLINE®, PubMed, EMBASE and Cochrane were searched from their dates of inception to March 2017. Nine studies of level IV evidence were included in this qualitative review. In total, these studies included 22 patients who underwent 24 free-flap operations.</p> <p><strong>Results</strong>: Nine flap failures were reported due to thrombotic complications. Even heterozygous factor V Leiden patients had a relatively high risk of free-flap failure (3/15 free flaps), and patients who were heterozygous for factor V Leiden and had other coexistent thrombophilias had an even higher failure rate (5/6 free flaps). However, the small sample size across the nine studies, as well as the inevitable publication bias, means that definitive conclusions cannot be drawn.</p> <p><strong>Conclusion</strong>: Despite factor V Leiden being a relatively common condition in Australia, current evidence for outcomes of free-flap reconstruction in this patient population is lacking.</p> Isobel Yeap Chris Ahn Stuart Hoffman Rowan Gillies John Vandervord Copyright (c) 2019 Isobel Yeap, Chris Ahn, Stuart Hoffman, Rowan Gillies, John Vandervord http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 58 66 10.34239/ajops.v2n2.136 Large-volume liposuction in acquired partial lipodystrophy http://ajops.com/index.php/ajops/article/view/14 <p>N/a</p> Yasiru Gehan Karunaratne Marc Langbart Jerry R Greenfield James Southwell-Keely Copyright (c) 2019 Yasiru Gehan Karunaratne, Marc Langbart, Jerry R Greenfield, James Southwell-Keely http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 67 69 10.34239/ajops.v2n2.14 Palmaris profundus causing carpal tunnel syndrome: a rare anatomical variant http://ajops.com/index.php/ajops/article/view/105 <p>N/A&nbsp;</p> Tam Thanh Quinn Dean White Copyright (c) 2019 Tam Thanh Quinn, Dean White http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 70 72 10.34239/ajops.v2n2.105 Ethical dilemmas in the surgical management of body integrity identity disorder http://ajops.com/index.php/ajops/article/view/142 <p>N/a</p> Nicholas Tang Nicholas Burgess Hye-Sung Park Anand Ramakrishnan Copyright (c) 2019 Nicholas Tang, Nicholas Burgess, Hye-Sung Park, Anand Ramakrishnan http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 73 75 10.34239/ajops.v2n2.142 Primary cutaneous gamma-delta T-cell lymphoma masquerading as severe soft tissue infection http://ajops.com/index.php/ajops/article/view/108 <p>N/A- Case report</p> Nilay Gamze Yalcin Rodrigo Teixeira Copyright (c) 2019 Nilay Gamze Yalcin, Rodrigo Teixeira http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 76 78 10.34239/ajops.v2n2.108 A keystone solution for major head and neck reconstructions http://ajops.com/index.php/ajops/article/view/154 <p>This ‘How to do it’ lists a range of cases, demonstrated by supplementary video discussion, that explain the refinements of the keystone perforator island flap (KPIF) technique applied to specific sites of the head and neck, with a focus on the elderly.</p> <p>When the <strong>P A C E</strong> acronym is applied (<span style="text-decoration: underline;">p</span>ain-free, <span style="text-decoration: underline;">a</span>esthetic outcome, minimal <span style="text-decoration: underline;">c</span>omplications, <span style="text-decoration: underline;">e</span>conomical) the KPIF technique is a respectable alternative to microvascular surgery, particularly in the elderly, with minimal returns to theatre for vascular impedance problems which are not infrequent in microvascular reconstructions.</p> <p>&nbsp;</p> Felix Behan Copyright (c) 2019 Felix Behan http://creativecommons.org/licenses/by/4.0 2019-09-28 2019-09-28 2 2 79 83 10.34239/ajops.v2n2.154 Australia's contribution to the free abdominoplasty flap in breast reconstruction http://ajops.com/index.php/ajops/article/view/185 <p>N/a</p> Richard Hamilton Ingemar Fogdestam Copyright (c) 2019 Richard Hamilton, Ingemar Fogdestam http://creativecommons.org/licenses/by/4.0 2019-12-02 2019-12-02 2 2 84 89 10.34239/ajops.v2n2.185