A biodegradable polyurethane dermal matrix in reconstruction of free flap donor sites: a pilot study

We have developed a biodegradable temporizing matrix (BTM) capable of supporting secondary split-skin graft-take in animal studies. We report its first long-term implantation and use as a dermal scaffold in humans. This preliminary study assesses its ability to integrate, its ease of delamination, its ability to sustain split-skin graft in complex wounds, the degree of wound contraction, and ultimately the quality of the scar at 1 year postimplantation. Ten patients were recruited, each requiring elective free flap reconstruction. Free flap donor sites created were anterolateral thigh flaps, fibular osseocutaneous flaps, or radial/ulnar forearm (RF/UF) flaps. The BTM was implanted when the flap was detached from its donor site. Dressing changes were performed twice weekly. The time elapsed between implantation and delamination depended on the type of flap and thus the wound bed left. Once integrated, the BTMs were delaminated in theatre, and the surface of the "neodermis" was refreshed by dermabrasion, prior to application of a split-skin graft. The BTM integration occurred in all patients (100% in 6 patients, with 90%, 84%, 76%, and 60% integration in the remainder). Integrated BTM sustained successful graft-take in all patients. Complete take was marred in 2 patients, over areas of BTM that had not integrated and graft application was performed too early. The BTM can be applied into wounds in humans and can integrate, persist in the presence of infection, and sustain split-skin overgrafting, despite the trial group presenting with significant comorbidities.Marcus J.D. Wagstaff, Bradley J. Schmitt, Patrick Coghlan, James P. Finkemeyer, Yugesh Caplash and John E. Greenwoo

Thoracic outlet syndrome following breast implant rupture

Case ReportWe present a patient with bilateral breast implant rupture who developed severe locoregional silicone granulomatous lymphadenopathy. Poly Implant Prothese silicone implants had been used for bilateral breast augmentation 5 years prior. Extracapsular implant rupture and bilateral axillary lymphadenopathy indicated explantation, capsulectomy, and selective lymph node excision. Histology demonstrated silicone lymphadenopathy with no evidence of malignancy. Over the subsequent 12 months, she developed progressive locoregional lymphadenopathy involving bilateral cervical, axillary, and internal mammary groups, resulting in bilateral thoracic outlet syndrome. We report the unusual presentation, progression, and the ultimate surgical management of this patient.Raakhi Mistry, Yugesh Caplash, Pratyush Giri, Daniel Kearney, Marcus Wagstaf

A novel way to repair the earlobe after ear-gauging

LetterBroughton J. Snell, Yugesh Caplas

The triplicated inferior pedicle - A new method for breast reduction and mastopexy

First published online in 2009Robbins described the inferior pedicle breast reduction in 1977. Since this time it has proved to be a safe and reliable technique. Favourable results have been reported with regard to breast feeding and nipple sensation. A common criticism of the technique is its tendency to inferior descent (pseudoptosis or bottoming out). This can leave a significantly empty upper pole. By a series of evolutionary modifications over the last 20 years, a technique has developed that overcomes the shortfalls of the inferior pedicle technique. We describe a series of 50 cases using this definitive technique.J. Katsaros, I. Harvey, Y. Caplas

Relative active motion programs following extensor tendon repair: a pilot study using a prospective cohort and evaluating outcomes following orthotic interventions

Abstract not availableB. Svens, E. Ames, K. Burford, Y. Caplas

Approaches to routine handling of basal cell carcinoma re-excision specimens: a survey of Australian histopathologists

AimsTo investigate and assess variation in routine approaches to the handling of basal cell carcinoma (BCC) re-excision specimens by Australian histopathologists.MethodsA questionnaire was sent to 440 Australian histopathologists requesting details of their routine approach to the handling of BCC re-excision specimens. Responses were collated and compared to demonstrate any variation in approach.ResultsResponses received from 208 pathologists indicated that variation was present in most aspects of specimen handling, including cut-up, examination of the specimen and reporting.ConclusionsVariation demonstrated in the routine handling of BCC re-excision specimens may have important academic and clinical implications. It is important for pathologists to communicate their specimen handling approach to the surgeon. Further study should be conducted to specifically compare the various specimen handling approaches that were identified in this study. The development of evidence-based guidelines for the routine handling of BCC re-excision specimens may be appropriate.Leigh R. Warren, Richard Karoo, Yugesh Caplash and Sophia Ott

The medial sural artery as recipient vessel and the impact on the medial gastrocnemius

Microsurgical free tissue transfer is a valuable technique for the reconstruction of soft-tissue defects around the knee, and the medial sural artery (MSA) is an ideal recipient vessel for anastomosis. Previously, the vessel has been described as the dominant supply to the medial gastrocnemius, but no research has addressed the subsequent effect to the muscle after interruption of MSA. The volume of the postoperative medial gastrocnemius of 4 patients treated with free flap reconstruction using MSA as recipient, was assessed clinically and using magnetic resonance imaging, with muscle function assessed using a patient questionnaire, and measurement of ankle torque with concurrent electromyography. Magnetic resonance imaging volume assessment revealed the postoperative medial head of gastrocnemius proportional to its synergist of separate blood supply, the lateral gastrocnemius and functional assessment suggest little difference between limbs such that the MSA should be used with confidence as recipient vessel for free flap reconstruction of soft-tissue defects around the knee.Jesse D. Beumer, Richard Karoo, Yugesh Caplash, John G. Semmler and Jamie Taylo

In-transit metastasis from squamous cell carcinoma

BACKGROUND In-transit metastasis from cutaneous squamous cell carcinoma (SCC) is an uncommon form of metastasis through lymphatics and occurs more commonly in immunosuppressed patients. OBJECTIVE To identify cases of in-transit SCC and determine patient characteristics, tumor features, management, and prognosis. METHODS AND MATERIALS A multicenter case series treated by Australian and New Zealand clinicians. RESULTS In 31 patients, median age was 72 years (range 52-99) and 68% were immunocompetent. Tumors occurred on the head and neck in 94% of cases, with 71% of all tumors occurring on the scalp, forehead, or temple. The median time to presentation with in-transit SCC from treatment of the initial tumor was 5 months. Management included surgery (94%), radiotherapy (77%), chemotherapy (10%), and reduction of immunosuppression (3%). Median follow-up was 12 months. Overall survival at 3 and 5 years were 27% and 13%, respectively. CONCLUSION In-transit metastases are described in 31 patients, of whom the majority was immunocompetent. The scalp, forehead, and temple were the most common sites. New clinical and histological diagnostic criteria are proposed. Prognosis was poor with 5-year survival of 13%. Recommended management is a combination of surgery and adjuvant radiotherapy. Reduction of any iatrogenic immunosuppression should be considered. © 2016 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc