The general public's understanding of plastic surgery is poor. This may be linked to the misunderstanding of specialist titles and lack of education regarding this field.

This study presents a lower incidence of painful post-amputation neuroma to those published in the literature. This may be attributed to improved methodology. The described associations require further investigation into central factors leading to neuroma sensitization.

While timely recognition and re-exploration of the compromised free flap in the early postoperative setting is important in determining the flap salvage success, it is demonstrated that salvage rates are poorer for muscle only flaps compared with flaps with a skin paddle.

The long-term outcomes of osseointegration for digital amputations are not well established, and it is not known whether osseointegration can achieve similar function and patient satisfaction to conventional surgical options such as replantation and microsurgical toe transfer. We compared the long-term outcomes after digital osseointegration and replantation. Six patients treated by osseointegration and seven patients treated by replantation were included, with median follow-ups of 8 years and 4.6 years, respectively. Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, grip and pinch strength, range of motion, two-point discrimination, Semmes-Weinstein tests, Jebsen-Taylor Hand Function Test and clinical photography. Osseointegration was associated with poorer sensibility and range of motion than replantation; no other differences reached statistical significance. Long-term osseointegration is a safe and effective reconstructive option that can deliver excellent outcomes in appropriately selected patients. Level of evidence: IV

Necrotising soft tissue infection (NSTI) is a rapidly progressing disease that presents a surgical emergency. Timely antibiotics, radical debridement of infected tissues and adjuvant hyperbaric oxygen therapy are the foundations of its treatment. Split-skin graft (SSG) is the main reconstruction technique due to its simplicity and dependability. Dermal substitutes, as well as creating a suitable wound bed for grafting, aim to recreate the inherent thickness and pliability of skin. One innovation, Novosorb™ (produced by PolyNovo Ltd, Port Melbourne, Australia), is a biodegradable temporising matrix (BTM) that is an entirely synthetic implantable dermal matrix that creates a neo-dermis in complex wounds.

BackgroundUpper limb amputation is a devastating injury. Patients may choose to use a passive prosthesis, a traditional body‐powered prosthesis or a myoelectric prosthesis driven by electromyography (EMG) signals generated by underlying muscles. Targeted muscle reinnervation (TMR) aims to surgically create strong and reliable signals to permit the intuitive use of a myoelectric prosthesis with the greatest number of movements possible. We review the Alfred Hospital experience of using TMR to improve upper limb prosthesis control.MethodsA retrospective review of all cases of TMR performed at the Alfred Hospital was undertaken. Patient demographics, injury, surgical complications and outcomes were examined. Comparison was made to preoperative prosthesis use.ResultsSeven patients have undergone TMR to improve upper limb prosthesis control at the Alfred Hospital between 2015 and 2018. Within the patient group, pre‐TMR EMG signal numbers ranged from 1 to 2, and post‐TMR signal numbers ranged from 3 to 5. Six patients were able to achieve six degrees of freedom post‐operatively, and one patient achieved four degrees. No patients required the use of co‐contraction to switch function post‐operatively. There were no significant surgical complications.ConclusionThe use of TMR to improve and increase the number of EMG signals has been successful in generating more degrees of freedom for upper limb amputees with myoelectric prostheses.

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Background: The anterolateral thigh flap is a workhorse reconstructive flap. Versatility in design is a key strength but perforator anatomy can be variable. Inability to locate perforators prompts consideration of contralateral thigh exploration. However, such exploration would be futile if the absence of perforators proves symmetrical. This study assesses the symmetry of anterolateral thigh flap vasculature using computed tomography angiography (CTA). Methods: A retrospective analysis of 20 bilateral thigh CTAs was performed. Each limb was assessed for number, course, location and size of perforators. Only vessels >0.5 mm in size at origin were included. Location was standardized between patients using perforator distance/thigh length ratio. Results were analysed using Wilcoxon signed-rank test. Results: In each thigh, the average number of perforators was 3.58 and average perforator distance/thigh length ratio was 0.358 AE 0.08. Between both limbs of the same patient, the mean difference in number of perforators was 0.55 (P = 0.002), and difference in average perforator size was 0.3 mm (P < 0.001). Average perforator location differed by a mean of 3% of thigh length (P < 0.001) between thighs. Conclusion: While average vessel size and location appear similar, there does not appear to be symmetry in the number of perforators. Surgical exploration of the contralateral thigh in an absence of perforators should be considered. In patients where abnormal anatomy is expected, mapping with CTA could be considered to reduce morbidity associated with unsuccessful surgical exploration and dissection.