Epidemiology of dog-related injuries within New Zealand.

AIM: To describe the epidemiology of DRIs in New Zealand. METHODS: A review of Accident Compensation Corporation (ACC) new claims for DRIs that required medical attention, and publicly funded hospital discharges identified from the National Minimum Dataset (NMDS) for the period of 1 July 2014 to 30 June 2019. ACC cases were identified using the TE60 READ code and relevant diagnosis or external agency descriptions; NMDS cases with an ICD-10-AM external cause of injury code of W540, W541, or W548 were included. RESULTS: There were 108,324 new ACC claims for DRIs and 3,456 hospitalisations during the five-year review period. The majority of injuries were dog bites (51%, n=54,754 ACC claims; 89%, n=3,084 hospitalisations). The all-age incidence of ACC claims for all DRIs significantly increased by 1.75% per year (p<0.001) during the period reviewed, with a significant increase in claims for dog bite injuries of 1.64% per year (p<0.001), a significant increase in DRI hospitalisations (2.43% per year, p=0.046), and a non-significant annual increase (p=0.217) in dog bite injury hospitalisations. Children aged 0-9 years had similar rates to adults of ACC claims for dog bite injuries; however, children 0-9 years were more likely to be hospitalised. Maori had a higher incidence of ACC claims and hospitalisations for dog bite injuries than non-Maori. ACC claims and hospitalisations for dog bite injuries were more likely to occur in areas of greater deprivation, with substantial regional variation across the country. CONCLUSION: The incidence of injury from dogs in New Zealand is increasing. Inequity exists with substantial regional variation, in higher rates among those living in areas of greater deprivation, and with Maori in the setting of the ongoing effects of colonisation. Children aged 0-9 years are no more likely than other age groups to present for medical attention but are more likely to be hospitalised. Reasons for these disparities require further investigation.

The incidence and risk factors of dog bite injuries requiring hospitalisation in New Zealand.

AIM: This retrospective cohort study aims to describe the incidence of dog bite injuries requiring hospitalisation across New Zealand in the 10-year period between 2004 and 2014. METHOD: The National Minimum Dataset (NMDS) was used to collate information from public and private hospital discharges for publicly funded events in New Zealand with the external cause of injury code W54.0 (Bitten by Dog) during the period of 1 July 2004 to 30 June 2014. Information regarding potential risk factors and indicators of severity was also collected. RESULTS: From 2004 to 2014 there were 4,958 dog bites requiring hospitalisation in New Zealand, giving an overall incidence of 11.3 (11.0-11.6) per 100,000 people per annum, representing 496 events per year on average. The average length of stay in hospital was 2.5 days (SD = 3.5 days). The overall incidence has been rising during this period from 9.7 (8.8-10.7) per 100,000 population per annum in 2004 to a peak of 12.3 (11.3-13.4) per 100,000 in 2013/14. The highest risk factors were identified as children under the age of 10 years, Maori and those with a higher deprivation score. In cases where the scene of injury was recorded, 69% occurred at a private residence or property. Head and neck bites were increasingly common in younger age groups, with 78% of the 0-4 year age group and 63% of the 5-9 year age group injured in the head/neck region. Upper and lower limb bites were increasingly common in older age groups. CONCLUSIONS: The incidence of dog bite injuries requiring hospitalisation has continued to rise in comparison with previously published rates in New Zealand. Additionally, more vulnerable population subgroups have been identified who are most likely to require hospitalisation.

Perforator anatomy of the ulnar forearm fasciocutaneous flap.

The ulnar forearm fasciocutaneous flap (UFFF) is a favourable alternative to the radial forearm flap when thin and pliable tissue is required. The precise anatomy of the cutaneous perforators of UFFF has not been previously reported. The position of cutaneous perforators>0.5 mm was recorded while raising 52 consecutive free UFFFs in 51 patients at our Centre. Three (6%) UFFFs in two patients demonstrated direct cutaneous supply through a superficial ulnar artery, a known anatomic variance. There was no cutaneous perforator>0.5 mm in one flap. Among the remaining 48 dissections, an average of 3 (range, 1-6) cutaneous perforators were identified. Ninety-four percent of these forearms demonstrated at least one perforator>0.5 mm within 3 cm, and all had at least one perforator within 6 cm of the midpoint of the forearm. Proximal perforators were more likely to be musculo-cutaneous through the edge of flexor carpi ulnaris or flexor digitorum superficialis, while mid- to distal perforators were septo-cutaneous. UFFF skin paddle designed to overlie an area within 3 cm of the midpoint between the medial epicondyle and the pisiform is most likely to include at least one cutaneous perforator from the ulnar artery, without a need for intra-operative skin island adjustment. This novel anatomic finding and other practical generalisations are discussed to facilitate successful elevation of UFFF.

Donor site morbidity of free ulnar forearm flap.

BACKGROUND: The purpose of this study was to evaluate the donor site morbidity of the free ulnar forearm flap (UFF). METHODS: Consecutive patients undergoing free UFF between 1982 and 2009 were retrospectively reviewed. In addition, detailed assessment of hand function and donor site cosmesis was performed in the most recent 50 patients followed up for at least 12 months. RESULTS: In all, 62 of the 242 free UFF donor sites (26%) were closed directly and the remainder required split thickness skin grafting. Donor site complications included total (n = 1) and partial (n = 17) skin graft loss and persistent hypertrophic scarring (n = 4). There was minimal incidence of cold intolerance, parasthesia, and pain; no reduction in joint mobility, grip and pinch strength, and sensory dysfunction, with excellent donor site cosmesis. CONCLUSIONS: UFF has several advantages, including the possibility of direct closure of the donor defect, and reduced morbidity and excellent donor site cosmesis.

Patient satisfaction after zygoma and mandible reduction surgery: an outcome assessment.

An ovoid and slender face is considered attractive in Oriental culture, and facial bony contouring is frequently performed in Asian countries to achieve this desired facial profile. Despite their popularity, critical analyses of patients' satisfaction after facial-bone contouring surgery is lacking in the current literature. Questionnaires were sent to 90 patients who had undergone zygoma and/or mandibular contouring by a single surgeon at the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan. The number of patients who had mandibular angle reduction and zygoma reduction were 78 and 36, respectively. The questionnaire contained 20 questions, concerning aesthetic and surgical results, psychosocial benefits and general outcome. Medical records were also reviewed for correlation with the questionnaire findings. The survey response rate was 52.2% (47 patients). A total of 95.7% were satisfied with the symmetry of their face after surgery, and 97.9% felt that there was improvement in their final facial appearance. As many as 61.7% could not feel an objectionable new jaw line or bony step and 66.0% could not detect any visible deformity. A total of 87.2% could not detect bony regrowth after surgery. Complication after surgery was experienced by 17.0% of patients, but all of these recovered without long-term consequences. All patients noted a positive psychosocial influence, and 97.9% of patients said that they would undergo the same surgery again under similar circumstances and would recommend the same surgery to friends. The majority of patients with square face seeking facial bone contouring surgery are satisfied with their final appearance. Of equal importance is the ability for this type of surgery to have a positive influence on the patient's psychosocial environment.

Aesthetic facial skeletal contouring in the Asian patient.

In response to facial skeletal differences across race, and cultural differences in what patients feel to be aesthetically desirable, surgical procedures continue to evolve. Mandibular angle reduction and zygoma reduction are powerful procedures for affecting facial skeletal change to achieve a softer, less angular, facial contour. Achieving a safe and satisfying result relies equally on success in preoperative evaluation and in intraoperative execution. The following considerations are particularly important during initial evaluation: patient age, skeletal relative to soft tissue contribution to facial prominences, asymmetries, and a clear understanding of the patient's perception of the deformity. Intraoperatively, complications are avoided through the careful planning of osteotomies to avoid adjacent structures.