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We estimate the minimum median cost incurred by our department of vascular surgery in treating a diabetic foot wound to be NZD 30,000 and identify wound treatment modality to be a significant determinant of cost. While readily acknowledging our study's inherent limitations, we believe it provides a real-world representation of the minimum total cost involved in treating diabetic foot lesions in a tertiary center. Given the increasing rate of diabetes, we believe this high cost reinforces the need for the establishment of a multidisciplinary diabetic foot team in our region.

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First bite syndrome (FBS) is characterized by unilateral pain in the parotid region after the first bite of each meal, usually following ipsilateral neck surgery. The proposed mechanism is sympathetic denervation of the parotid gland, from iatrogenic injury to the sympathetic trunk supplying this gland. Local botulinum toxin injection has emerged as a promising treatment option with favorable results. To date, there are 3 published cases in the literature describing FBS after carotid endarterectomy. We present a case of a 75-year-old gentleman who developed FBS after carotid endarterectomy, to raise the awareness of this unusual and uncommon complication.

This is the first study which demonstrates that second toe systolic pressures are interchangeable with those of the first toe. Second toe pressures can be used in diabetic patients whose first toe pressures cannot be assessed.

Background: Vascular trauma is a complex and evolving area. Unlike internationally, the epidemiology of vascular trauma is not well documented in Australia; the most recent study was published in 2013. Gold Coast University Hospital (GCUH) is a level 1 trauma centre in Queensland, Australia. The aim of this study was to describe the epidemiology and outcomes of vascular trauma at a level 1 trauma centre, and compare these with the Australian and international literature. Methods: All individuals who presented to GCUH between January 2014 and December 2019 with vascular injury were retrieved from the GCUH prospective trauma database. A descriptive analysis was undertaken on this cohort. Results: The incidence of vascular trauma as a percentage of total trauma remained stable over the study period. The study included 5454 trauma admissions to GCUH, of which 213 sustained vascular injuries. Males were more likely to be injured and blunt trauma was more common than penetrating. Blunt trauma was associated with increased injury complexity. The mortality rate was 8.5% and 10 patients required amputation. Conclusions: The proportion of vascular injuries as a percentage of total trauma in Australia is higher than in previous studies. Vascular trauma causes significant injuries and has a higher mortality rate than general trauma.

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A 62-year-old woman was found incidentally to have a right carotid body tumour (CBT) during investigation for a transient ischemic attack. Computed tomography angiography confirmed a tumour measuring 1.5 ¥ 3 cm splaying the carotid bifurcation (see Fig. 1). The patient underwent preoperative embolization, with penetration of the tumour bed, 2 days before surgical resection (see Figs 2,3). After initial neck dissection, a lymph node was removed. Frozen section revealed the node to be benign. The tumour was successfully resected off the internal carotid artery (ICA) with ease. The patient made an uneventful recovery. Post-operative histology revealed the lymph node to contain metastatic deposits and as such the patient was confirmed as having metastatic malignant paraganglioma. Staging investigations showed no further evidence of metastatic disease. The patient underwent adjuvant radiotherapy. She experienced hoarse voice, dysphagia, radiation dermatitis, skin erosion and reduced hearing as a consequence.Our understanding of the behaviour and management of CBTs continues to grow, albeit at a slow rate given the relative uncommonness of these lesions. It is generally agreed upon that surgical treatment is the optimal management of these tumours in order to prevent long-term neurological sequelae that accompany tumour growth keeping in mind the not insignificant complications and difficulties encountered with these operations.The case described did not sustain residual post-operative neurological/nerve-related deficits; however, a multicentre review has shown significant post-operative morbidity of 35% and mortality of 1% -the risks being higher for larger tumours. 1 As a result, the concept of radiation therapy as an effective alternative to surgery has been explored and a series of 121 paragangliomas in a single institution managed with radiation therapy demonstrated a local control rate of 94% at 10 years. 2 Conclusive evidence required to publish a significant result is currently lacking because of the infrequency with which these lesions are encountered; however, it may not be entirely unreasonable to consider this option in elderly patients, those with significant co-morbidities and 'surgically unresectable' tumours. 3 Radiation is not without risks however, and this patient who received it post excision reported hoarse voice, dysphagia, radiation dermatitis, skin erosion and reduced hearing as a consequence.Preoperative embolization remains controversial, and despite the available literature a general consensus is not agreed upon. It remains a useful adjuvant option in large tumours (greater than or equal to 3 cm) and where the tumour is adherent and partially or completely surrounds the carotid vessels (as is the case with Shamblin classification I and II). 4-6 This procedure is not without risk, Fig. 1. Computed tomography angiogram demonstrating an enhancing mass lesion in the carotid bifurcation splaying the right external carotid artery and internal carotid artery. The lesion is 3 cm in craniocaudal dimen...