Australasian Journal of Plastic Surgery 2020-09-30T10:38:43+00:00 Jacqueline Spedding Open Journal Systems <p>The <em>Australasian Journal of Plastic Surgery </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>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> with a new issue released 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="" 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> New Zealand plastic and reconstructive surgery workforce: update and future projections 2020-05-21T13:25:55+00:00 Amanda Peacock Brandon Adams Swee Tan <p><strong>Objectives:</strong> Population growth in New Zealand (NZ) has occurred faster than previously forecast. As a result, previous workforce predictions are outdated and must be adjusted to ensure adequate access to plastic and reconstructive surgery (PRS) services. This paper presents an update of the PRS workforce and its projected needs, and the distribution of reconstructive surgeons (PRSn) in NZ.</p> <p><strong>Methods:</strong> The number of practising PRSn and trainees, and the total medical workforce were reviewed, along with population statistics modelling with a focus on the ageing population. Comparisons were made to previous data and forecasts from 2013.</p> <p><strong>Results:</strong> Previous population modelling predicted that NZ would reach five million by 2027. However, updated population data show that this figure was surpassed in 2020 and that the population will be approximately 5,374,655 in 2028. The PRS workforce has continued to grow in relation to overall population growth. The PRSn to population ratio (PRSPR) has improved since 2013 with a current ratio of approximately 1/69,000. However, a vast workforce maldistribution remains.</p> <p><strong>Conclusion:</strong> The overall PRSPR in NZ appears satisfactory for the ageing population. However, the vast workforce maldistribution remains unchanged and this presents a barrier to equitable access to public PRS services, especially in provincial NZ.</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Amanda Peacock , Brandon Adams, Swee Tan Quarantine 2020-08-05T03:00:36+00:00 Mark Ashton Mark Lee <p>n/a</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Mark Ashton, Mark Lee Review of the superficial circumflex iliac artery perforator flap: recommendations to the approach of a groin perforator flap 2020-06-24T15:06:27+00:00 Christopher Song Sandeep Bhogesha Colin Song <p class="p1"><span class="s1"><strong>Introduction:</strong> The superficial circumflex iliac artery perforator (SCIP) flap has gained in popularity due to its thinness and superior donor site scar. However, there exist inconsistencies in the description of the surgical anatomy of the SCIP flap. The aim of this quantitative review was to provide a summary of published evidence to the surgical approach to such flaps.</span></p> <p class="p1"><span class="s1"><strong>Methodology: </strong>A literature review of the MEDLINE<sup>®</sup> and Cochrane databases was conducted. Articles were assessed by two reviewers using predefined data fields and selected using specific inclusion criteria. The two authors independently reviewed the literature and discrepancies were resolved by consensus. </span></p> <p class="p1"><span class="s1"><strong>Results: </strong>Included for evaluation were 39 articles. Of these, 30 fulfilled the criteria for surgical dissection, 16 for surgical anatomy and nine for preoperative imaging. The arterial anatomy of the groin perforator flap is variable and in 0.9 per cent of cases the pedicle originates from the superficial inferior epigastric artery rather than the superficial circumflex iliac artery (SCIA). The flap pedicle length is probably dependent on patient build and the course of the source vessel, rather than which groin perforator it is based on. CT is the gold standard preoperative imaging and should be used given the anatomical unpredictability. Lymphatics under the inguinal ligament and medial to the femoral artery should be preserved.</span></p> <p class="p1"><span class="s1"><strong>Conclusion: </strong>This quantitative study provides a guide to safe groin perforator flap harvest and surgical pearls to consider for surgical planning. The usage of this flap remains novel and further long-term outcomes have yet to be established. </span></p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Christopher Song, Sandeep Bhogesha, Colin Song Postoperative management of lower limb split-thickness skin grafts in Australia 2020-07-03T00:24:31+00:00 Lisa Ellis Patricia Terrill George Miller Kin Seng Tong Miguel Cabalag <p><strong>Background:</strong> Evidence for postoperative management of split-thickness skin grafts (SSGs) to lower leg wounds has shown early mobilisation has no adverse effects on graft take, while improving patient outcomes and significantly reducing hospitalisation costs. The development of negative-pressure wound therapy (NPWT) for SSGs led to new options for bolster dressings. This study aimed to determine the current postoperative mobilisation and dressing choices of Australian plastic surgeons.</p> <p><strong>Methods:</strong> Australian plastic surgeons were invited electronically to participate in a questionnaire regarding their postoperative regimens for lower limb SSG in 2013, and again in 2018. A literature review was performed to establish whether surgeon-reported practice was in line with current evidence for early mobilisation of lower limb SSGs and also for NPWT on SSGs.</p> <p><strong>Results:</strong> In 2013, 119 responses were received and in 2018, 110 responses were received. Survey responses showed significant reductions in the numbers of patients kept immobilised for more than five days (30% to 9%, p = 0.001) between 2013 and 2018. Surgeons reported immobilising their patients longer with standard dressings than with NPWT dressings (p = 0.003 by multinomial logistic regression). More than two-thirds of surgeons reported NPWT use in both 2013 (66%) and 2018 (70%).</p> <p><strong>Conclusion:</strong> Between 2013 and 2018, NPWT use increased slightly and the percentage of surgeons mobilising their patients early significantly increased, in accordance with evidence in the literature. A link was noted between NPWT use and an increased tendency to early mobilisation. However, a large proportion of surgeons continued to prescribe bed rest postoperatively.</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Lisa Ellis, Patricia Terrill, George Miller, Kin Seng Tong, Miguel Cabalag Different collagenase delivery for Dupuytren disease in public hospitals 2020-06-24T14:31:32+00:00 Jessca A Paynter Vicky Tobin James CS Leong Warren Matthew Rozen David J Hunter-Smith <p><strong>Background:</strong> The delivery protocol of collagenase <em>Clostridium histolyticum</em> (collagenase) injection for Dupuytren’s disease is variable, due to limited evidence for any one approach and widespread ‘off-label’ delivery occurring in Australia. As such, this preliminary study aimed to assess whether different collagenase delivery protocols for treating Dupuytren’s disease have an impact on effectiveness and safety. It was hypothesised that different collagenase delivery would affect outcomes.</p> <p><strong>Methods:</strong> This preliminary, prospective study included a consecutive cohort of adult patients with Dupuytren’s disease being treated with collagenase within two Australian public hospitals to determine whether different collagenase delivery protocols impact on effectiveness and safety. The therapeutic effect was measured objectively using the total passive extension deficit (TPED), clinical success and clinical improvement. Three patient-reported outcome measures (PROMs) were used: Unité Rhumatologique des Affections de la Main (URAM), the Southampton Dupuytren’s Scoring Scheme and the Canadian Occupational Patient-Specific Functional Scale (PSFS).</p> <p><strong>Results: </strong>The delivery of collagenase was variable at both clinics. The number of patients treated with collagenase at Institute I and Institute II was 49 and 18, respectively. Clinical success was achieved in 42 per cent of the Institute I and 35 per cent of the Institute II cohort. A statistically significant reduction in all three PROMs was observed for both cohorts. No significant differences between effectiveness or safety was found when comparing the two cohorts.</p> <p><strong>Conclusion:</strong> The delivery of collagenase was variable at Institutes I and II, but these differences did not appear to impact the effectiveness or safety of collagenase delivery.</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Jessca A Paynter, Vicky Tobin, James CS Leong, Warren Matthew Rozen, David J Hunter-Smith Comparing preoperative mapping with reflectance confocal microscopy to surgical markings in lentigo maligna excision of the face: a pilot study 2020-06-24T14:49:36+00:00 Lipi Shukla Louise Photiou Alan Pham Catriona McLean Raquel Ruiz Victoria Mar John Kelly Ramin Shayan Frank Bruscino-Raiola <p><strong>Background:</strong> Lentigo maligna (LM) characteristically has an ill-defined margin and may require multiple excisions to achieve complete excision with 5mm margins. In vivo reflectance confocal microscopy (RCM) is a non-invasive tool recognised as useful in the management of LM. The authors aimed to determine whether the use of RCM prior to surgical excision reliably increased the rate of complete excision when compared with standard surgical excision.</p> <p><strong>Methods: </strong>This prospective pilot study included patients with biopsy-proven LM of head and neck region who sought consultation for surgical management from May 2017 to May 2019 at the Victorian Melanoma Service, Melbourne. Patients were randomised to two groups based on the availability of RCM — Group 1, RCM-guided surgical excision, and Group 2, standard surgical excision. Outcomes were measured based on clinical markings and histopathological margins achieved and reported as RCM or surgical margin excess or deficit. Ethics approval for the study was obtained from the Research Governance Unit of The Alfred Hospital, Melbourne.</p> <p><strong>Results: </strong>Results demonstrated that RCM marking of lesion margins was in excess in 69 percent of cases, in deficit in 22 per cent and accurate in nine per cent after histopathological analysis of the specimens. In comparison, lesions that were surgically marked were removed with margins in excess in 43 per cent of cases, in deficit in 11 per cent and accurate in 46 per cent.</p> <p><strong>Conclusion:</strong> This pilot study demonstrates that RCM did not increase the accuracy of LM surgical excision in comparison with standard surgically marked excisions.</p> 2020-10-15T00:00:00+00:00 Copyright (c) 2020 Lipi Shukla, Louise Photiou, Alan Pham, Catriona McLean, Raquel Ruiz, Victoria Mar, John Kelly, Ramin Shayan, Frank Bruscino-Raiola Cosmetic surgery treatment injuries: the New Zealand experience both at home and from cosmetic surgery tourism 2020-07-14T21:12:18+00:00 Jonathan Wheeler <p><strong>Objective:</strong> This article attempts to understand the number of complications arising in patients returning to New Zealand from cosmetic surgery tourism destinations with reference to the number of patients with complications from cosmetic surgery undertaken in New Zealand.</p> <p><strong>Methods:</strong> Data were requested under the New Zealand <em>Official Information Act 1982</em> from the Accident Compensation Corporation (ACC) regarding the number of claims for treatment injury following cosmetic surgery undertaken both in New Zealand and overseas for the period 1 July 2014 to 30 June 2019. Also, a prospective audit was conducted of patients admitted to Middlemore Hospital over the one-year period March 2018 to March 2019 for complications arising as a result of cosmetic surgery tourism. </p> <p><strong>Results:</strong> A total of 1048 claims were made to the ACC for treatment injuries arising from cosmetic surgery in New Zealand and from overseas treatment over the five-year period to 30 June 2019. Of these, 738 were accepted by the ACC, with the leading three events being breast reduction/reconstruction, breast implant/augmentation and septorhinoplasty. Bariatric surgery, vein treatment/sclerotherapy, orthodontics and isolated septoplasties were excluded by the ACC as not being ‘cosmetic surgery’. The ACC valued the total cost of treatment of these accepted claims at NZ$6.3 million dollars. </p> <p><strong>Conclusion:</strong> Data outlining the complications arising from cosmetic surgery in New Zealand and overseas indicate a concerning burden of care required for patients who have had cosmetic surgery overseas.</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Jonathan Wheeler Microsurgery training for plastic surgery trainees in Australia 2020-06-22T05:23:10+00:00 David Lu Courtney Hall Rodrigo Teixeira 2020-09-30T00:00:00+00:00 Copyright (c) 2020 David Lu, Courtney Hall, Rodrigo Teixeira Pitfalls of telehealth in the management of skin cancer: a COVID-19 perspective 2020-07-07T11:06:42+00:00 David Lu Angela Webb <p>n/a</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 David Lu, Angela Webb Aesthetic, cosmetic and reconstructive: why words matter 2020-08-05T02:52:15+00:00 Robert Sheen <p>n/a</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Robert Sheen Australas J Plast Surg. 2020.3(2) 2020-09-30T07:17:44+00:00 Journal Manager <p>Issue information for Australasian Journal of Plastic Surgery vol 3 no 2 2020</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Journal Manager Infrared imaging and prevention of skin flap necrosis in bilateral skin sparing mastectomies 2020-06-24T14:57:00+00:00 Alexa McNaught Amy O'Connor Ryan Livingston <p>N/A</p> 2020-09-30T00:00:00+00:00 Copyright (c) 2020 Alexa McNaught, Amy O'Connor, Ryan Livingston