Stephen Kyle

Skin grafts: a rural general surgical perspective.

Background:  Skin grafts are a common method of closing skin defects. The literature comparing methods of graft application and subsequent outcomes is poor, but reports indicate a graft failure rate between 2 and 30%. The aim of this study was to audit our current skin graft practice.

Why Taranaki women choose to have a mastectomy when suitable for breast conservation treatment

Background:  Breast conservation treatment (BCT) rate is recognized as a marker of surgical practice. An historically low BCT rate may reflect the requirement for Taranaki women to travel for adjuvant radiotherapy. The aim of this study was to determine the reasons Taranaki women with breast cancer choose mastectomy or BCT.

The Incidence and Risk Factors for Lower Limb Skin Graft Failure

Lower limb skin grafts are thought to have higher failure rates than skin grafts in other sites of the body. Currently, there is a paucity of literature on specific factors associated with lower limb skin graft failure. We present a series of 70 lower limb skin grafts in 50 patients with outcomes at 6 weeks. One-third of lower limb skin grafts went on to fail with increased BMI, peripheral vascular disease, and immunosuppressant medication use identified as significant risk factors.

Risk-adjusted general surgical audit in octogenarians.

Background:  Surgical admissions in patients more than the age of 80 years are increasing. Age‐related comorbidities place this group at particular risk of complications and death. The aim of this study was to specifically document our current outcomes in patients more than 80 years old admitted to a surgical unit, in particular, to assess the risk‐adjusted scoring tool used to predict outcomes in this patient population for operative and non‐operative patients.

PAEDIATRIC SURGERY CARRIED OUT BY GENERAL SURGEONS: A RURAL NEW ZEALAND EXPERIENCE

Background:  There are increasing moves towards centralization in paediatric surgery. With only four paediatric tertiary centres in New Zealand, many general surgeons still routinely carry out paediatric surgery. We present an audit of paediatric surgical patients admitted to our general surgical unit.

Prospective audit of colorectal resections in a peripheral public hospital.

Background:  Colorectal disease requiring surgery is common in New Zealand where there is no established national colorectal screening programme. We established an audit to review our current practice in colorectal surgery.

Time delays in presentation and treatment of acute scrotal pain in a provincial hospital

Acute scrotal pain is a urological emergency due to the possibility of testicular torsion and subsequent testicular loss if correction is not carried out in a timely manner.

Outcomes of endoscopic retrograde cholangiopancreatography: a series from a provincial New Zealand hospital.

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential tool in the management of pancreaticobiliary pathology. It is technically demanding and has the potential to cause significant morbidity and mortality. Several trials have identified small centres and lower hospital volume as risk factors for lower success rates and higher complication rates. Taranaki Base Hospital (TBH) is a provincial hospital with a catchment of 100 000, providing its population with an on‐site ERCP service. Transporting patients to the nearest tertiary centre would incur significant costs to both the patient and district health board.

Adult intussusception: a rare but important clinical entity

tion/infection. We caution surgeons to consider tumours, particularly desmoids and sarcomas (neurofibromas, lymphoma, metastases). An abdominal wall endometrioma is characterized by a mass within a surgical (caesarean) scar that has cyclical pain. Histopathology is required for confirmation of the diagnosis, with biopsy best coordinated through an appropriate multidisciplinary team meeting. The track of biopsy should be through tissue intended to be resected. Wide surgical resection is gold standard treatment for the management of EAAWC. Removal of significant portions of the abdominal wall is often required for adequate margins and reconstruction often includes mesh and/or tissue flaps. Adjuvant radiotherapy and chemotherapy has been reported, particularly for node positive disease, but they have been mostly ineffective. Carboplatin and paclitaxel are the most common agents. Prognosis of reported patients is poor, with a median survival time of 30 months. This is unlike endometriosis-associated ovarian cancer which is typically of low-grade with favourable outcomes. EAAWC is often locally advanced at the time of diagnosis and 10% of patients present with metastases. Whilst EAAWC is a rare clinical entity, this case demonstrates the importance of considering a broad differential diagnosis for a mass arising in the anterior abdominal wall of young women. Management is best provided by a multidisciplinary specialist service.

GS23P PAEDIATRIC SURGERY PERFORMED BY GENERAL SURGEONS IN A PROVINCIAL NEW ZEALAND (NZ) HOSPITAL

Purpose  To perform an audit of paediatric surgical patients in a provincial general surgical unit.