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.

The aims of this study are to audit the ordering of abdominal radiographs (AXR) in the emergency department (ED) and evaluate the current practices, knowledge and attitudes of emergency physicians with regard to ordering AXRs in patients presenting with acute abdominal pain. A retrospective study was undertaken at an ED of a tertiary hospital in Tasmania using clinical notes on patient presenting with acute abdominal pain who underwent an AXR. The study also included a short questionnaire, which assessed emergency physicians' knowledge of current imaging guidelines and clinical practice when ordering an AXR. During the study period, 108 patients satisfied the selection criteria, and the AXR was reported as normal in 76 % (n = 82; p value <0.05), non-specific in 12 % (n = 13; p value <0.05) and abnormal in 12 % (n = 13; p value <0.05) of patients. Of those patients, 25 % (n = 27) of the AXRs did not meet indications listed in the Diagnostic Imaging Pathways published by the Western Australia Department of Health and were found not to benefit patient care. Of the 19 doctors who completed the survey, only 16 % (n = 3) were aware of any clinical guidelines for imaging in this setting. Current guidelines should be followed when ordering imaging for patients with acute abdominal pain to minimise unnecessary patient radiation exposure, avoid delays in diagnosis and definitive patient management, reduce costs and therefore increase efficiency in ED.

Introduction: Burns fuelled by petrol are a major cause of injury in Australia and New Zealand. The same quality of explosive ignition that makes petrol so valuable as a fuel can cause injuries when handled carelessly or used for a purpose for which it was not intended. Methods: This was a retrospective cohort study that examined the epidemiology of patients admitted to the Victorian Adult Burns Service (VABS) based at the Alfred Hospital, Melbourne. Data were extracted from the VABS Database on patients presenting over a seven-year period, between 1st July 2009 to 30th June 2016.  Results: During the study period, 378 out of 1927 burns (19.6%) admissions were related to petrol use. Males aged 20 – 29 years were most at risk, contributing to 25.4% of petrol related burn injuries. A large portion of burns, 31.0%, occurred during a leisure activity. The mean total body surface area burnt in this cohort was 19.3% and surgery was required in 70.4% of cases. Petrol related burns injuries is estimated to cost AU$ 5,484,834 annually and had a mortality rate of 7.4%. Conclusion: Misuse of petrol contributed to a substantial injury burden to Victorians. Raising community awareness through preventive strategies targeted at high-risk groups of at-risk behaviours is warranted to reduce the incidence of petrol related burn injuries.

Introduction: The Australian healthcare system, including its management of cutaneous malignancies, has faced unprecedented challenges due to the COVID-19 pandemic. This study aimed to quantify the impact of the first wave of the pandemic on the diagnosis and management of cutaneous malignancies in Australia. Methods: Monthly service data was extracted from the Australian Medicare Benefits Schedule database for all cutaneous biopsies, non-melanotic skin cancer (NMSC) excisions and melanoma excisions performed between January 2017 and December 2019. Holt-Winters exponential smoothing forecasting models were developed for total biopsies, NMSC excisions and melanoma excisions. These models were used to predict monthly data between January 2020 and June 2020 with a 95 per cent confidence interval (p < 0.05). Absolute and percentage residual differences (RDs) between actual and predicted excisions for this time period were calculated. Results: There were statistically significant reductions in total NMSC excisions in March 2020 (RD: −6,943, −13.0%), April 2020 (RD: −8,954, −12.2%), May 2020 (RD: −17,667, −20.9%) and June 2020 (RD: −5,152, −6.9%). There were statistically significant reductions in melanoma excisions in April 2020 (RD: –695, –11.1%), May 2020 (RD: −1,982, –28.7%) and June 2020 (RD: –973, –16.0%). Conclusions: There was a significant reduction in skin cancer excisions in Australia during the COVID-19 pandemic. This observed reduction in skin cancer surgery has significant public health implications, highlighting the need for improved surveillance, diagnosis and treatment capacity of cutaneous malignancies during the recovery phase of the pandemic.

No abstract