Angela Webb

Prospective comparison of routine and selective operative cholangiography.

Background:  In a rural centre with limited resources and no endoscopic retrograde cholangiopancreatography facilities, a prospective cohort study was established to compare policies of routine and selective intraoperative cholangiography (IOC) in order to develop a local protocol.

Epidermal stem cells.

Our understanding of adult epidermal stem cells has increased substantially over the last two decades especially; however even more detailed knowledge is imperative for realizing potential medical therapies. We need to know how to identify these cells and what regulates their function. In this review, we describe the literature to date and elucidate the clinical relevance of these findings.

First hand transplant procedure in Australia: outcome at 2 years.

Australia’s fi rst hand transplant procedure was performed in 2011. The recipient was a right-handed 65-year-old man who had had amputations of all four limbs. He was previously a self-employed plumber, who developed pneumococcal sepsis in 2006 on a background of a traumatic splenectomy 32 years earlier. Progressive gangrene of his extremities necessitated amputation of his hands at the transmetacarpal level bilaterally. A faux thumb on the left enabled rudimentary function of abduction and adduction (Box 1). He required full assistance with upper limb functional tasks. Both feet were amputated, necessitating prostheses. He had impaired glucose tolerance, osteoporosis of the left hip, a number of solar keratoses and was an ex-smoker. There was no evidence of cardiovascular disease. He was taking sulfamethoxazole–trimethoprim for prophylaxis after the splenectomy. He was a highly motivated, compliant and intelligent individual with a life history of stability and success, and was considered a suitable recipient for a hand transplant. Approval from St Vincent’s Hospital Melbourne Clinical Ethics Committee and informed consent were obtained. The family of a multi-organ male donor who was brain dead consented to limb donation. The blood group of the donor was compatible, but his human leucocyte antigen (HLA) was mismatched to the recipient. The recipient had two weak donor-specifi c anti-HLA antibodies (DSAs). The recipient’s panel reactive antibody score was low at 6% and the results of B and T cell crossmatch tests were negative. Both donor and recipient tested positive for Epstein–Barr virus and cytomegalovirus (CMV) IgG. The limb was matched for sex, size and colour. The right limb was disarticulated at the level of the elbow, the brachial artery was perfused with Custodial HTK organ preservation solution (Dr. Franz Köhler Chemie GmbH) and the limb packed in ice and transferred to our centre. Under general anaesthesia, the recipient’s right stump was opened and all structures were tagged and shortened to pre-planned lengths. On ice, the donor hand was attached with bone fi xation 5 cm proximal to the radiocarpal joints. After primary arterial and venous anastomosis and reperfusion (3 hours ischaemic time), the dorsal structures were repaired. Next, volar structures were repaired, including the nerves 3 cm proximal to the wrist, with specifi c motor fascicular repairs guided by intraoperative nerve stimulation. All tendons were repaired with attention to relative length and tension. The ulnar artery was anastomosed, but appeared to have a recanalised lumen with a poor intima and minimal patency. The total operating time was nine hours and coordinated by six primary and four assisting surgeons. Immunosuppressive therapy included induction with basiliximab followed by maintenance therapy with tacrolimus, mycophenolic acid and prednisolone. Therapy with low-dose aspirin was commenced and sulfamethoxazole–trimethoprim therapy was continued. Prophylaxis was initiated with valganciclovir (for 6 months) against CMV and posaconazole (for 3 months) against fungal disease. A First hand transplant procedure in Australia: outcome at 2 years

Are overweight and obese patients who receive autologous free-flap breast reconstruction satisfied with their postoperative outcome? A single-centre study.

INTRODUCTION Obese and overweight patients represent a challenging surgical group for autologous free-flap breast reconstruction. There is a paucity of information regarding post-operative patient-reported satisfaction in this increasingly prevalent cohort. This retrospective study aimed to determine using BREAST-Q patient-reported satisfaction amongst normal, overweight and obese patients receiving autologous free-flap breast reconstruction. METHODS BREAST-Q (post-reconstruction) module was sent to 174 autologous breast free flap reconstruction patients between 2001 and 2012. Clinical data were collated for patients who returned questionnaires. Post-operative complications and satisfaction scores were compared between normal versus overweight and obese patients. RESULTS A total of 101 patients (normal body mass index (BMI) = 27; overweight BMI = 48 and obese BMI = 25) completed BREAST-Q (response rate 66%). Obese and overweight patients are significantly more likely to develop major (44.8% and 31.1% vs. 29.6%) and minor (34.4% and 20% vs. 7.4%) complications in comparison to normal BMI patients (p < 0.02). Overweight and obese patients demonstrated similar levels of satisfaction compared with normal patients with the shape of their reconstructed breasts (73.2 and 72.1 vs. 71.2; p > 0.05) and overall surgical outcome (75.8 and 78.9 vs. 75.4; p > 0.05). CONCLUSIONS Patient post-operative satisfaction is gaining increasing relevance in assessing the outcomes from autologous breast reconstruction. Overweight and obese women benefit from autologous breast reconstruction, despite being at increased risk of post-operative complications, and eventually achieve comparable levels of post-operative satisfaction. This should be reflected in pre-operative counselling.

Prognostic markers in metastatic cutaneous squamous cell carcinoma of the head and neck

The minority of head and neck cutaneous squamous cell carcinomas (SCC) metastasize to regional lymph nodes. The purpose of this study was to describe the clinical outcomes and prognostic factors for patients with node‐positive head and neck cutaneous SCC who underwent lymphadenectomy.

Outcomes following management of squamous cell carcinoma of the scalp: A retrospective series of 235 patients treated at the Peter MacCallum Cancer Centre

Squamous cell carcinoma of the scalp is a common clinical problem in an aging population. Despite its high incidence, little has been documented regarding treatment or outcomes.

Funding analysis of bilateral autologous free-flap breast reconstructions in Australia

INTRODUCTION Bilateral breast reconstructions are being increasingly performed. Autologous free-flap reconstructions represent the gold standard for post-mastectomy breast reconstruction but are resource intensive. This study aims to investigate the difference between hospital reimbursement and true cost of bilateral autologous free-flap reconstructions. METHODS Retrospective analysis of patients who underwent bilateral autologous free-flap reconstructions at a single Australian tertiary referral centre was performed. Hospital reimbursement was determined from coding analysis. A true cost analysis was also performed. Comparisons were made considering the effect of timing, indication and complications of the procedure. RESULTS Forty-six bilateral autologous free-flap procedures were performed (87 deep inferior epigastric perforators (DIEPs), four superficial inferior epigastric artery perforator flaps (SIEAs) and one muscle-sparing free transverse rectus abdominis myocutaneous flap (MS-TRAM)). The mean funding discrepancy between hospital reimbursement and actual cost was

Melanoma in the very elderly, management in patients 85 years of age and over

12,137 ±

Retrospective audit of patients referred for further treatment following Mohs surgery for non-melanoma skin cancer.

8539 (mean ± standard deviation (SD)) (n = 46). Twenty-four per cent (n = 11) of the cases had been coded inaccurately. If these cases were excluded from analysis, the mean funding discrepancy per case was

Locally recurrent lentigo maligna within a skin graft: a case report: Images for Surgeons

9168 ±