Microinvasive Carpal Tunnel Release Using a Retractable Needle-Mounted Blade.

We report 166 microinvasive ultrasound-guided carpal tunnel releases using the MICROi-Blade (Summit Medical Products, Inc, Sandy, UT), a needle-based tool for cutting under ultrasound guidance. The 6-month follow-up of the first 21 cases, including 5 bilateral releases, showed a progressive reduction in median pain scores, Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale scores, and BCTQ Functional Status Scale scores. The median return to work was 7 days. The 3-month follow-up of 62 subsequent cases showed similar improvement in the BCTQ scores and return to work. There were no complications. This report supports the effectiveness of the technique.

Torsion of Fatty Appendage of Falciform Ligament: Acute Abdomen in a Child.

Torsion of the fatty appendage of the falciform ligament is an extremely rare condition that leads to severe abdominal pain and raised inflammatory markers. It can be recognised on ultrasound or CT scan. The pathophysiology is the same as that involved in the more common torsion and/or infarction of the greater omentum or epiploic appendages. The condition is best managed conservatively with anti-inflammatory analgesia, and the early recognition of this type of torsion may prevent unnecessary operative intervention to look for a source of abdominal pain. There have been five reported adult cases of a torted fatty appendage of the falciform ligament identified on ultrasound and CT scan, but no paediatric cases. We report a case of torsion of the fatty appendage of the falciform ligament in a ten-year-old boy and describe its imaging characteristics on CT scan.

Outreach surgical consulting services in North East Victoria.

OBJECTIVE: There is a paucity of data regarding the provision of consultative outreach specialist surgical services to rural areas. This paper aims to describe a model of outreach consultative practice to deliver specialist surgical services to rural communities. DESIGN: Analysis of prospectively collected data for consultations in a three month period for two surgeons based in Wangaratta. SETTING: Two surgeons in regional Victoria based in Wangaratta, North East Victoria, conducting outreach consultations to Beechworth, Benalla, Bright and Mansfield. PARTICIPANTS: All patients seen in consultations over a 3-month period. MAIN OUTCOME MEASURES: Patient workload, casemix of presenting complaint, consultation outcome including plan for surgical procedure. RESULTS: Outreach surgical consulting was associated with a higher proportion of new consultations, and there was trend towards being more likely to result in a surgical procedure than consultations in the base rural centre. CONCLUSIONS: Outreach surgical consulting provides surgeons with a larger referral base and provides communities with better access to local specialists. Outreach practice should be encouraged for surgeons in regional centres.

Caseload of general surgeons working in a rural hospital with outreach practice.

BACKGROUND: There is little published data regarding the caseloads of general surgeons working in rural Australia conducting outreach services as part of their practice. It remains difficult to attract and retain surgeons in rural Australia. This study aims to describe the workload of surgeons working in a rural centre with outreach practices in order to determine the required skills mix for prospective surgeons. METHODS: A retrospective review of surgical procedures carried out by two surgeons over 5 years working from a base in Wangaratta, Victoria, with outreach services to Benalla, Bright and Mansfield was undertaken. Data were extracted from surgeon records using Medicare Benefits Schedule item numbers. RESULTS: A total of 18 029 procedures were performed over 5 years, with 15% of these performed in peripheral hospitals as part of an outreach service. A full range of general surgical procedures were undertaken, with endoscopies accounting for 32% of procedures. In addition, vascular procedures and emergency craniotomies were also performed. The majority of procedures undertaken at peripheral centres were minor procedures, with only two laparotomies performed at these centres over 5 years. CONCLUSION: General surgeons working in rural centres are required to have broad skills and be able to undertake a large number of procedures. Trainees should be encouraged to consider rural practice, and those who are interested should consider the needs of the community in which they intend to practice. Outreach work to surrounding communities can be rewarding for both the surgeon and the community.