Australasian Journal of Plastic Surgery <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>Sponsored by the<a href="">&nbsp;Australian Society of Plastic Surgeons</a> with support from the <a href="">Australasian Foundation for Plastic Surgery</a>&nbsp;and the <a href="">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> en-US <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> (Jacqueline Spedding) (Jacqueline Spedding) Sun, 22 Mar 2020 00:00:00 +0000 OJS 60 Triquetral fractures—a retrospective, multi-centre study of management and outcomes <p><strong>Introduction</strong>: This study examines triquetral fracture data from six hospital centres between 2009 and 2018. The study focuses on elements of triquetral fracture management within these six centres, outlining common fracture patterns, the short-term and long-term outcomes and the common mechanisms of injury. To the authors’ knowledge, this is the largest cohort of triquetral fractures studied to date and outlines investigation recommendations for improved identification of these fractures.</p> <p><strong>Methods</strong>: Data was obtained by reviewing the charts of patients presenting to emergency departments within the Nepean and Blue Mountains local health district of New South Wales, Australia. (Nepean Hospital ethics approval no: NBM18/805)</p> <p><strong>Results</strong>: Triquetral fractures can be hard to identify with radiography and can be commonly mistaken as lunate fractures.<a href="#_ENREF_12"><sup>12</sup></a> Our results indicate that 18.9 per cent of patients required CT imaging to correctly diagnose triquetral fracture.</p> <p><strong>Conclusion</strong>: Where there are ongoing symptoms and a high clinical suspicion of a triquetral fracture, CT may be indicated and, in future practice, may be justified as a first line imaging modality. This study also demonstrates that short arm-wrist immobilsing casts are an effective option for managing triquetral fractures.</p> Alyse Hopkins, Sebastian RA Bowman, Angelo P Preketes, Michael B Dowd Copyright (c) 2020 Alyse Hopkins, Sebastian RA Bowman, Angelo P Preketes, Michael B Dowd Mon, 23 Mar 2020 00:00:00 +0000 Flying brevet: a technique for mastectomy in female-to-male gender reassignment <p><strong>Background: </strong>Several techniques are described for chest wall contouring in female-to-male (FTM) transgender patients, each with specific applications and limitations. Factors to consider are the aesthetic requirements of the male chest, elimination of anatomical female breast features, operative technique, scar minimisation and success of outcome. We describe the ‘flying brevet’ technique, named for the pattern of excised skin that resembles pilot’s wings. This procedure is tailored to FTM patients but can also be used for large gynaecomastia patients. We present a description of the technique with a retrospective review of outcomes and case series of patients who have undergone this procedure.</p> <p><strong>Methodology:</strong> This is a retrospective review of a single surgeon experience with 113 consecutive patients who have undergone the flying brevet technique. The approach involves a semicircular areolar incision, with superior skin resection and glandular resection. A planned second stage procedure may be performed for larger breasts if required.</p> <p><strong>Results:</strong> Seven per cent incidence of postoperative haematoma, one case of fat necrosis, one case of partial nipple-areolar-complex (NAC) necrosis and one case of full NAC necrosis in the series. There was one postoperative infection and six per cent incidence of hypertrophic scarring.</p> <p><strong>Conclusions:</strong> The flying brevet provides a consistent method of mastectomy for FTM chest wall reconstruction. It permits large glandular and skin resection in ptotic breasts with preservation of NAC circulation. The flying brevet is an additional technique that can be added to the current options for mastectomy in FTM chest wall reconstruction.</p> Jeannine Eva McManus Copyright (c) 2020 Jeannine Eva McManus Mon, 23 Mar 2020 00:00:00 +0000 Perth scoring system for assessment of the cleft lip <p><strong>Background</strong>: Currently, there is no standardised assessment tool to assess facial aesthetics in cleft lip and palate surgery. Inter-centre comparison is hampered by the use of different aesthetic indices with low intra- and inter-rater reliability.</p> <p><strong>Aim</strong>: The Perth scoring system is a new assessment tool for unilateral cleft lip which scores four key components of the cleft lip/nose repair: lip length, white roll, alar insertion point and vermillion. The aim of this study was to validate the Perth scoring system as a reliable and useful new assessment tool and to demonstrate the use of the scoring system to measure improvements after cleft lip revision.</p> <p><strong>Method</strong>: Nineteen patients who underwent cleft lip revision by the senior author were selected. Pre- and postoperative photos were presented to a panel of raters to score. Scores were analysed to determine the intra-and inter-rater reliability and to compare outcomes.</p> <p><strong>Results</strong>: Almost all patients (15/16) had improvement in scores (range 1.09–5.59) after cleft lip revision. Intra raters’ agreement scores from lowest to highest were: lip length (0.65), white roll (0.7), alar insertion point (0.78) and vermillion (0.78). The total intra-class correlation coefficient was 0.96 (0.94–0.98, 95% CI, P&lt;0.000).</p> <p><strong>Conclusion</strong>: This new scoring system is a valid and useful tool for assessment of the unilateral cleft lip. The high rate of intra- and inter-rater reliability allow it to serve as a useful tool to compare surgical outcomes both within and between centres. Further field testing with a larger cohort of patients is required.</p> Linda Monshizadeh, Vijith Vijayasekaran Copyright (c) 2020 Linda Monshizadeh, Vijith Vijayasekaran Mon, 23 Mar 2020 00:00:00 +0000 Incisional negative pressure wound therapy in bilateral breast reductions patients <p>Introduction: Incisional negative pressure wound therapy (iNPWT) has been applied to bilateral breast reduction patients and shown a reduction in surgical complications. However, its effects on opioid use and hospitalisation length in this patient group has not been investigated.<br>Methods: In this single surgeon retrospective cohort study, 52 patients who underwent bilateral breast reduction were analysed, with 23 patients in the iNPWT cohort and 29 in the standard-of-care (SOC) wound dressing cohort. Hospitalisation length, postoperative opioid use and surgical site complications were compared between cohorts. Mean (range) follow-up time was 369.15 (77-1329) days.<br>Results: Hospitalisation length in days was significantly less in the iNPWT cohort (1.35) than the SOC cohort (2.03). Total ward opioid use was significantly reduced in the iNPWT cohort (45.50mg) compared to the SOC cohort (62.50mg). Discharge opioid prescription was significantly reduced in the iNPWT cohort (125.50mg) compared to the SOC cohort (230.00mg). The number of surgical site complications was significantly different between the groups (p=0.014).<br>Discussion: This study suggests the use of iNPWT in bilateral breast reduction provides significant benefit through the reduction of hospitalisation, complications and opioid use. <br>Conclusion: This is the first study to provide evidence for iNPWT in bilateral breast reduction in reducing postoperative opioid use and hospitalisation. It supports current literature showing a reduction in surgical site complications using iNPWT in bilateral breast reduction.</p> Nicholas Savage, Mohit Jain, Robert Champion, Broughton Snell Copyright (c) 2020 Nicholas Savage, Mohit Jain, Robert Champion, Broughton Snell Mon, 23 Mar 2020 00:00:00 +0000 Outpatient pedicle avulsion in DIEP free flap breast reconstruction successfully salvaged: A case report <p>Not required</p> Andrew J Davidson, Jeremy W Simcock Copyright (c) 2020 Andrew Davidson, Jeremy Simcock Mon, 23 Mar 2020 00:00:00 +0000 The contribution of Australian research to Dupuytren’s disease <p><strong>Introduction:</strong> While the history and epidemiology of Dupuytren's disease (DD) is well documented, its aetiology and risk factors, pathogenesis and treatment to this day are still being studied. This paper explores and summarises the significant contributions Australian researchers have made to the understanding of DD and its treatment methodologies.&nbsp;</p> <p><strong>Methods:</strong> We performed a systematic search on EMBASE from 1947 until March 2019 to identify all English literature using keywords: ‘Dupuytren/Dupuytrens/Dupuytren’s disease’ and ‘Australia/Australian/Australasian’. Relevant articles were also identified through bibliographic links. A separate search was conducted using Google Scholar, Research Gate and PubMed using the same keywords. In total, 40 articles were identified. A library search was also conducted, with one book identified with an Australian author. The Royal Australasian College of Surgeons <em>Journal of Surgery</em> was also analysed for published abstracts pertaining to DD from conference presentations between 2014 to 2019.</p> <p><strong>Results and discussion:</strong> We present a narrative discussion of Australian research that has contributed to the understanding of DD from its aetiology to treatment methodologies.&nbsp;</p> <p><strong>Conclusion:</strong>&nbsp;Numerous Australians have made significant contributions to the understanding of DD, its pathogenesis, development and multiple treatment modalities, both non-surgical and surgical. Dupuytren’s disease is a progressive disease that reoccurs despite our best efforts and will continue to be a topic of focus for some time to come.</p> Robert Phan, David Hunter-Smith, Warren Rozen Copyright (c) 2020 Robert Phan, David Hunter-Smith, Warren Rozen Mon, 23 Mar 2020 00:00:00 +0000 Australas J Plast Surg. 2020; 3(1) <p>N/A</p> Journal Copyright (c) Mon, 23 Mar 2020 00:00:00 +0000 Conservative treatment of subcapital phalangeal fracture malunions <p>Displaced subcapital phalangeal fractures of the middle or proximal phalanges occur primarily in children. The degree and direction of displacement, patient age and time since injury influence treatment decisions and patient outcomes. Delayed presentation with malunion and reduced joint motion is common. This paper presents a case series of displaced subcapital phalangeal fracture early malunions managed conservatively. Near complete remodelling of dorsal angular deformity was seen in all patients. Conservative management of phalangeal subcapital fracture malunions is a viable alternative to the complex procedure of corrective osteotomy.&nbsp;</p> David McCombe, Brinkley K Sandvall, Christopher J Coombs Copyright (c) 2020 David McCombe, Brinkley Sandvall, Christopher Coombs Mon, 23 Mar 2020 00:00:00 +0000 Ikigai: a balanced life in plastic surgery <p>n/a</p> Mark Lee, Mark Ashton Copyright (c) 2020 Mark Lee, Mark Ashton Mon, 23 Mar 2020 00:00:00 +0000 An update on the management of nerve gaps <p>No abstract required</p> William Alexander, Christopher Coombs Copyright (c) 2020 William Alexander, Christopher Coombs Mon, 23 Mar 2020 00:00:00 +0000 How can AHPRA improve compliance of health practitioner advertising? <p>n/a</p> Jodie Atkin Copyright (c) 2020 Jodie Atkin Mon, 23 Mar 2020 00:00:00 +0000