ANZ journal of surgery
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ANZ journal of surgery · Apr 2018
Associating Liver Partition and Portal vein ligation for Staged hepatectomy after pre-operative chemotherapy.
Recently a procedure termed 'Associating Liver Partition and Portal vein ligation for Staged hepatectomy' (ALPPS) was developed to increase the resectability of marginally resectable or locally unresectable liver tumours. This study focused on the application of ALPPS in patients with advanced colorectal liver metastases (CRLM) and pre-operative chemotherapy, with the aim to investigate whether the latter still allows for sufficient hypertrophy of the future liver remnant (FLR) following the first step of ALPPS. ⋯ Despite pre-operative chemotherapy, ALPPS seems to result in adequate liver hypertrophy, preventing post-operative small-for-size syndrome. However, there might be a high risk of tumour recurrence in patients with an aggressive tumour biology.
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ANZ journal of surgery · Apr 2018
Observational StudyImpact of atrial fibrillation on long-term survival following oesophagectomy: a 21-year observational study.
Post-operative atrial fibrillation (AF) is a common complication of oesophagectomy and thought to signal a complicated post-operative course. AF is associated with prolonged admissions, increased healthcare costs and inpatient mortality. However, the impact of post-operative AF on long-term outcomes remains uncertain. ⋯ Post-operative AF was associated with poorer long-term survival following oesophagectomy in this cohort. Further research should evaluate the influence of AF on cardiovascular and oncological outcomes following oesophagectomy.
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ANZ journal of surgery · Apr 2018
Mycobacterium ulcerans in the Daintree 2009-2015 and the mini-epidemic of 2011.
Mycobacterium ulcerans infection (Buruli ulcer) is the third most common mycobacterial disease in humans, with presentations ranging from self-limiting skin nodules and ulcers to aggressive infiltrative infections with extensive oedema, fat and skin necrosis. The two foci in Australia are in Victoria and Far North Queensland. We present the 2009-2015 case series for the Queensland focus with special reference to the 2011 spike of 64 cases. ⋯ Mycobacterium ulcerans infection (Buruli ulcer) is an endemic but uncommon infection in Far North Queensland with usually fewer than 10 cases per year. Small ulcers predominate. Most were excised and antibiotic treatment was frequently adjuvant rather than therapeutic. The 64 cases in 2011 was unexpected, not duplicated subsequently, and may relate to local climatic variations. Local awareness of the disease facilitated early presentation and diagnosis in most cases, enabling timely treatment while lesions were small and easily managed.
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ANZ journal of surgery · Mar 2018
Case ReportsMedial sural artery perforator free flap for the reconstruction of leg, foot and ankle defect: an excellent option.
The defects over the leg, foot and ankle are best covered with a thin pliable flap. The use of muscle flap for the reconstruction of these defects leaves a grafted, aesthetically inferior result. The medial sural artery perforator (MSAP) free flap gives a thin pliable tissue for the reconstruction with better aesthesis. ⋯ MSAP free flap is a reliable choice for leg, foot and ankle defect reconstruction.