ANZ journal of surgery
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ANZ journal of surgery · Jun 2014
Review Case ReportsFree distal volar forearm perforator flap: clinical application in digital reconstruction.
Soft tissue defects of the digits can be a challenging problem for the hand surgeon. For non-graftable defects, numerous local, regional and free flaps have been described for resurfacing, each with their own limitations - bulk, colour, texture mismatch, donor morbidity. Perforator flaps increasingly provide the optimal option for reconstruction of digital defects as they are thin, pliable and with low donor site morbidity. ⋯ Dorsal digital soft tissue reconstruction requires thin, pliable, ideally hairless and sensate skin. Most locoregional options are limited by the need for multi-stage surgery, bulk, limited reach or donor site morbidity. In our patient, the reconstructive requirements were met with preservation of the radial artery. While it requires microsurgical skill and instruments, this flap provides another option for the reconstructive hand surgeon.
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ANZ journal of surgery · Jun 2014
Comparative StudyIncidence and outcomes of major trauma patients managed in the Australian Capital Territory.
To determine the incidence and characteristics of major traumatic injury treated in the Australian Capital Territory (ACT) over a 5-year period. ⋯ The largest demographic affected by major trauma in the ACT and surrounds is young people. Injury prevention should remain focused on road trauma but also target violence and high-risk recreation activities. Further investigation around the circumstances of major traumatic injury in young people is required. Funding and cross-border agreements should be reviewed to minimize financial disadvantage to the ACT.
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ANZ journal of surgery · Jun 2014
Comparative StudyDenver screening protocol for blunt cerebrovascular injury reduces the use of multi-detector computed tomography angiography.
Blunt cerebrovascular injury (BCVI) occurs in 0.2-2.7% of blunt trauma patients and has up to 30% mortality. Conventional screening does not recognize up to 20% of BCVI patients. To improve diagnosis of BCVI, both an expanded battery of screening criteria and a multi-detector computed tomography angiography (CTA) have been suggested. The aim of this study is to investigate whether the use of CTA restricted to the Denver protocol screen-positive patients would reduce the unnecessary use of CTA as a pre-emptive screening tool. ⋯ Application of the CTA to the Denver protocol screen-positive trauma patients can decrease the use of CTA as a pre-emptive screening tool by 95-97% and reduces its hazards.
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ANZ journal of surgery · Jun 2014
Comparative StudyEffect of handover on the outcomes of small bowel obstruction in an acute care surgery model.
An acute care surgery (ACS) model was introduced to manage emergency surgical presentations efficiently. The aim of this study was to evaluate the impact of patient handover in an ACS model on the outcomes of adhesive small bowel obstruction (SBO). ⋯ Management under an ACS team does not increase adverse outcomes for adhesive SBO. Patients can be safely handed over within an ACS framework. Other members of the ACS team may help facilitate continuity of care.
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ANZ journal of surgery · Jun 2014
Comparative StudyAre we getting necrotizing soft tissue infections right? A 10-year review.
The Alfred Hospital is a referral centre for necrotizing soft tissue infections (NSTIs) in the state of Victoria and receives around 20 such patients each year. We sought to compare our practice and outcomes against published data, and to examine management at referring hospitals to determine whether adjustments to current practices are required. ⋯ NSTIs remain a surgical emergency with high rates of mortality and resource requirements. The mortality rate at our institution compares well with other published series. Many patients experienced delays before undergoing debridement and in many cases were transferred without debridement. The trend towards transferring NSTI patients to centres accustomed to treating burns and major trauma seems logical, but should not delay life-saving surgical debridement. Timing of transfer does not seem to affect mortality.