ABSTRACT
BACKGROUND: The Wellington Regional Plastic, Maxillofacial & Burns Unit based at Hutt Hospital provides comprehensive reconstructive services to central New Zealand with a population of 1.1 million. Free tissue transfer procedures in the Unit were audited to determine the indications and rate of usage in our population, our success and complication rates, and how these compare with published series. METHODS: Prospectively collected data on all free tissue transfer procedures between January 2006 and September 2010 were analysed. RESULTS: Two hundred and seven free flaps including 17 flap types being performed on 186 consecutive patients including 199 primary and 8 salvage flaps. Eighty-three percent were elective and 17% were acute cases. The majority of the flaps were used for head and neck (48%) and breast (31.5%) reconstruction. Ulnar forearm flap was the most commonly used fasciocutaneous flap. 18.8% of patients had major complications requiring return to theatre. Microsurgical revision was performed in nine (4.3%) flaps of which six were successfully salvaged. Overall, 13 flaps (6.3%) failed completely, giving an overall success rate of 93.7%. Haematoma requiring formal drainage occurred in 12 (5.8%) cases. DISCUSSION: The wide variety of flaps used reflects the very broad range of defects requiring free flap reconstruction. We show a free flap success rate of 93.7% in our medium-sized regional unit. Our microsurgical revision rate of 4.3% is lower than the revision rate of 10% in reported series with high overall success rates. More consistent early detection of failing flaps is likely to further improve our overall success rate.
Subject(s)
Free Tissue Flaps , Microsurgery/methods , Plastic Surgery Procedures/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Congenital Abnormalities/surgery , Female , Free Tissue Flaps/statistics & numerical data , Graft Survival , Humans , Infant , Male , Medical Audit , Microsurgery/statistics & numerical data , Middle Aged , Neoplasms/surgery , New Zealand , Postoperative Complications/epidemiology , Plastic Surgery Procedures/statistics & numerical data , Reoperation , Salvage Therapy , Treatment Outcome , Wounds and Injuries/surgery , Young AdultABSTRACT
Hemangioma is the most common tumor of infancy, occurring mostly in the head and neck region. Intervention during the proliferating phase is indicated if the lesion poses a threat to life or function. Posterior head and neck hemangioma causing deformational plagiocephaly is a further indication for intervention.
Subject(s)
Hemangioma/complications , Hemangioma/surgery , Plagiocephaly, Nonsynostotic/etiology , Plagiocephaly, Nonsynostotic/surgery , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
We present a patient with locally advanced squamous cell carcinoma that had grown significantly during 16 months of intensive alternative therapy. The alternative medicine practitioner allegedly repeatedly reassured the patient that her condition was benign and advised against seeking conventional medical treatment. Due to the delayed presentation, the patient required extensive surgery and postoperative adjuvant radiotherapy. This case highlights the risks of alternative therapy in the place of proven conventional medical treatment and emphasises the limitations of current regulation of complementary and alternative medicine in New Zealand.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Complementary Therapies/legislation & jurisprudence , Diagnostic Errors , Skin Neoplasms/diagnosis , Aged , Anemia, Macrocytic/diagnosis , Carcinoma, Squamous Cell/therapy , Delayed Diagnosis , Dura Mater/pathology , Female , Hemoglobins/analysis , Humans , Leukocyte Count , Neoplasm Invasiveness , New Zealand , Radiotherapy, Adjuvant , Scalp/pathology , Scalp/surgery , Skin Neoplasms/therapy , Skin Ulcer/microbiology , Skin Ulcer/pathology , Skull/pathologyABSTRACT
A 71-year-old woman presented with obstructive hydrocephalus caused by a haemorrhagic pineal mass. A right ventriculo-peritoneal shunt was inserted with successful treatment of the hydrocephalus and resolution of symptoms and signs. Post-operative MRI both as an inpatient and at 5 and 18 months showed no contrast enhancement of the lesion and there was resolution of the radiographic abnormality. She remains symptom-free at 18 months. Previous reports have advocated resection of the pineal lesion, but this patient has done well with CSF shunting and MRI surveillance.
