**Background:** Cutaneous mucormycosis is a rare yet severe fungal infection that affects immunocompromised paediatric patients. Although prompt diagnosis is essential, excisional tissue biopsy often necessitates general anaesthesia in the paediatric population, which presents risks in the unwell and immunocompromised patient. This study assessed the diagnostic value of the biopsy and associated outcomes in paediatric cutaneous mucormycosis. **Methods:** We retrospectively analysed 38 paediatric patients (aged 0–18 years) with suspected or confirmed mucormycosis at a tertiary hospital. Data on demographics, underlying conditions, clinical presentation, diagnostics, treatments and outcomes were collected. **Results:** Out of the 38 patients included, mucormycosis was confirmed in 10 cases. Most patients were immunocompromised, with 60.5 per cent having haematological malignancies and 47.4 per cent experiencing neutropenia. Cutaneous involvement was the exclusive manifestation in 90 per cent of confirmed cases. Biopsies were conducted in 73.7 per cent of patients; however, only 28.6 per cent yielded positive results. General anaesthesia is frequently required. Antifungal therapy was initiated in 89.5 per cent of cases, whereas surgical debridement was only required in 28.9 per cent of cases. The mortality rate was 20 per cent in confirmed cases and 39.3 per cent in suspected cases. **Conclusion:** Excisional biopsy plays a diagnostic role in suspected paediatric cutaneous mucormycosis but is associated with low yield and procedural risks. The development of improved non-invasive diagnostic alternatives may mitigate unnecessary procedural risks in this patient population.
Necrotising fasciitis (NF) is a life-threatening skin and soft tissue infection, often caused by _Streptococcus pyogenes_ (Group A _Streptococcus_). We describe three paediatric patients with NF within the right interpectoral plane. Despite severe systemic illness, classic cutaneous signs were absent in two cases. Imaging and intraoperative findings were consistent with extensive fascial necrosis and deep tissue infection, without a clear cutaneous portal of entry. Group A _Streptococcus_, including M1~UK~ strains, was identified in all cases, with clinical and radiological findings suggesting lymphatic spread from the oropharynx as a possible mechanism of infection migration. This case series highlights the importance of early recognition and prompt, aggressive management of NF, while also illustrating how awareness of skin perfusion can complement surgical planning.
**Introduction:** Skin cancer is the most prevalent cancer in Australia. Known challenges affecting rural populations include delayed diagnosis, limited access to healthcare and increased burden of disease. We investigated the outcomes of skin cancer excisions, focusing on excision completeness, between rural and metropolitan patients. **Methods:** We conducted a retrospective cohort study of melanoma and keratinocyte skin cancer excisions from August 2003 to November 2023, from a prospectively entered database. We identified 26,064 skin lesions excised in theatre. The primary outcome was the rate of incomplete excisions, defined by an involved histopathologic margin. Secondary objectives included assessing demographic and clinical factors influencing the rate of complete excisions. **Results:** The study included 14,996 specimens from 5522 patients. Keratinocyte-based cancers made up 96.3 per cent of specimens and in 13.0 per cent of excisions, patients lived in a rural postcode. Rural patients were 34 per cent more likely to have an incomplete excision of keratinocyte skin cancers compared with metropolitan patients (OR = 1.34, _p_ < 0.0001). Key factors associated with incomplete excisions included renal transplant recipients, younger age, head and neck location, and female sex. Notably, renal transplant recipients had a markedly lower risk of incomplete excision (OR = 27.6, _p_ < 0.05). We found excisions in the head and neck region were significantly more prone to incompleteness, likely due to anatomical challenges and cosmetic concerns. The overall incomplete excision rate at our centre was 8.1 per cent. **Conclusion**: These findings demonstrate the increased risks faced by rural populations, highlighting the need for tailored surgical approaches and vigilant follow-up. Clinicians should be aware of these clinical and demographic factors and consider adjusting excision margins to reduce rates of incomplete excision.
**Introduction:** Queensland is home to the highest incidence of non-melanoma skin cancer (NMSC) in the world. Consequently, referrals often exceed the treatment capacity of plastic and reconstructive surgery (PRS) resources concentrated in metropolitan centres. In response to prolonged outpatient wait times, a multi-consultant outpatient clinic was piloted at a tertiary Queensland PRS centre. **Objective:** To evaluate throughput, attendance, wait-time characteristics and surgical outcomes of a multi-consultant NMSC outpatient clinic. **Methods:** All patients with biopsy-proven NMSC who attended a dedicated, multi-consultant PRS clinic were included in the study. Seven consultants, each allocated two rooms, reviewed patients in parallel, with surgical trainees and nursing staff preparing the next patient in the adjacent room. A centralised queue allowed dynamic allocation to the next available consultant. Patient and lesion demographics, treatment decisions and surgical outcomes were recorded on a standardised proforma. **Results:** Of 166 scheduled patients, 155 attended (93.4%). Patients (n = 155; 209 NMSC lesions; 25.8% with multiple lesions) were predominantly elderly (median 74 years) and male (67.7%). Lesions were mostly basal cell carcinomas (135 lesions, 64.6%) over squamous cell carcinomas (56 lesions, 26.8%). The majority of lesions (169, 80.1%) were located on the head and neck. All patients were assessed within three hours and 15 minutes, equating to approximately 48 patients reviewed per hour. Median time from biopsy to PRS consultation was 150 days, while median time from consultation to surgery was 45 days. Complete excision was achieved in 95.8 per cent of cases. **Conclusion:** The multi-consultant clinic allowed rapid specialist assessment of 155 NMSC patients within a single session, addressing the outpatient consultation bottleneck in high-volume tertiary centres. This model warrants evaluation as a scalable strategy to reduce specialist outpatient waiting lists.
**Background:** Rhinoplasty is a surgical procedure aimed at improving the function and appearance of the nose. Evaluating the outcome of facial plastic surgery is crucial for patient satisfaction and quality of life. Standardised questionnaires are used to assess patient satisfaction, for example, the Rhinoplasty Outcome Evaluation (ROE) that measures physical, emotional and social factors. **Aim:** Our study aims to compare patient satisfaction with rhinoplasty three months after surgery between patients who viewed the results one week after surgery and those who viewed the results two weeks after surgery. **Method:** We used a previously validated version of the ROE questionnaire to evaluate patient satisfaction postoperatively. The ROE consists of six questions, each of which have five answer options graded from zero to four. After rhinoplasty, patients were randomly assigned into two equal groups. One group viewed their results one week postoperation, the other group viewed their results two weeks after the operation. Between the rhinoplasty and the viewing, patients wore excessive tape and were not allowed to see the outcome. A single physician performed tape changes during hospital visits, with no mirrors or photography allowed. All patients were evaluated using the ROE three months after the surgery. Descriptive and quantitative variables were analysed using RStudio. A _p_-value less than 0.05 was considered significant. **Results:** The study evaluated 60 consecutive patients in two equal groups. Patients were aged between 20–30 years and the groups had similar ages. The total ROE scores of the two groups were compared, and patients who viewed the rhinoplasty result two weeks after the operation had a higher level of satisfaction with their appearance, breathing and overall look after three months. **Conclusion:** Patients who underwent rhinoplasty reported higher levels of satisfaction three months after the surgery if they first viewed the results two weeks post-surgery compared to one week post-surgery.
Breast reduction is generally a safe and effective treatment of symptomatic macromastia. However, the rate of postoperative nipple inversion as a complication of more recent breast reduction techniques is not reported adequately in the literature. By way of a systematic literature search and a retrospective review of cases belonging to the senior author, this paper aims to evaluate and compare the rates of nipple inversion following modern techniques of breast reduction, compared to earlier published techniques.
**Background:** Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, often requiring carpal tunnel release surgery. Anatomical anomalies within the carpal tunnel, such as the palmaris profundus (PP) tendon, may contribute to symptomatology or complicate surgical management. The PP is a rare vestigial muscle, with a reported cadaveric incidence of 0.125 per cent. It may share a fascial sheath with the median nerve and increase local volume within the carpal tunnel, thereby contributing to CTS. This review provides the first systematic synthesis of published cases of CTS associated with the PP. **Methods:** A systematic literature search was conducted across MEDLINE, Embase, PubMed and Cochrane Library on March 22, 2025. Studies were included if the PP was associated with CTS and if they were published in English. Two independent reviewers screened titles, abstracts and full texts, with data extracted on patient demographics, diagnostic methods, surgical approach, intraoperative findings and outcomes. **Results:** Eighteen studies, reporting on 21 patients, met the inclusion criteria. The mean age was 59.0 years with 76.2 per cent of cases involving the right hand. The PP was most often found arising from the flexor digitorum superficialis fascia and inserting into the palmar aponeurosis. Open carpal tunnel release and PP resection was the predominant surgical intervention (95.2%), with symptom resolution in 85.7 per cent of cases. A bifid median nerve was observed in 33.3 per cent of patients. Preoperative imaging rarely identified the anomaly. **Conclusion:** The PP is a rare but clinically relevant anatomical variant that may cause or contribute to CTS. Surgical vigilance and resection when encountered are strongly recommended to improve outcomes and reduce recurrence.
The first successful free vascularised bone flap in a human was performed on 1 June 1974 (reported in 1975) using the fibula diaphysis supplied by the peroneal artery and vein to repair a tibial defect. This was followed by us with the iliac crest based on the superficial circumflex iliac artery in 1975 and then the deep circumflex iliac artery in 1978. On 29 November 1983, the fibula was transplanted for the first time on the anterior tibial vessels in a child to repair the tibia following tumour ablation. Finally on 7 May 1984 the growth plate in the proximal epiphysis of the fibula was transplanted successfully on the anterior tibial vessels, and especially its recurrent genicular branch, to repair the distal radius after a traumatic hand injury. The growth rate of this epiphysis matched that of the fibula in the opposite leg and fused at the same time. Fourteen cases of free vascularised fibula transfer are presented from a series of 397, including three unique transfers of the fibula diaphysis and epiphysis to repair the jaw, clavicle and long bones of the extremities. The blood supply to and within the fibula plus vascular anomalies are detailed following fresh cadaver India ink injection, bone histology and lead oxide radiography. Preoperative planning using angiography, computer-generated bone models of the donor and recipient bones to plan osteotomies for jaw reconstruction, trial runs in cadavers, Doppler perforator mapping for skin flaps and incision-marking before theatre are all prerequisites for success. Operative technique is outlined for each approach to the fibula and potential pitfalls are highlighted. The importance of protected stress on the fibula, especially in the lower extremity, is paramount. The fibula should be placed within the medullary cavity of the femur or tibia in the line of weight bearing and protected from rotational or angular stress by an external cast, a fixateur with pins placed before and beyond the fibula or, now it is becoming clear, transfixed with an intramedullary nail or rod. With large series worldwide, some in the thousands and with success rates in the high 90 per cents, the free vascularised fibula flap, especially when combined with skin and soft tissue, has emerged as the gold standard for reconstructing major congenital or acquired defects in the jaw and long bones of the extremities, facilitated by the large calibre of its supplying vessels. Now with the ability to transfer the fibula with the associated skin and deep tissues of its peroneal or anterior tibial angiosome, we have the ability in one day to replace the months and years of the multi-staged reconstructions that were endured by those that suffered the ravages of the two world wars.
**Introduction:** The aim of this study is to understand current practices in the use of computed tomography (CT) scans in the routine assessment and management of infants and children with craniosynostosis among surgeons in Australia and New Zealand. No consensus exists in the literature about the utility of CT scans in this patient population. **Methods:** A survey was distributed to craniofacial units across Australia and New Zealand, targeting nine paediatric craniofacial programs and requesting information about the routine use of CT scans in the management of craniosynostosis. **Results:** The response rate was 49 per cent with the majority (75%) of responding surgeons having more than 10 years of experience in craniofacial surgery. Input from all units was obtained. Ninety-five per cent of surgeons order preoperative CT scans for single-suture craniosynostosis, with the stated indication being confirmation of diagnosis (85%), characterisation of cranial morphology (70%), detection of raised intracranial pressure (65%) and screening for associated anomalies (85%). The majority (85%) of surgeons used standard radiologic protocols. Only 10 per cent of respondents do routine postoperative CT scans. In multiple-suture and syndromic craniosynostosis, the use of routine postoperative CT scans was greater. Access issues were a factor in many units due to rural locations. **Conclusion:** Routine CT scans are employed in the diagnosis and management of infants and children with craniosynostosis in craniofacial units in Australia and New Zealand. Variability in practice suggests an opportunity for standardisation of protocols. Accessibility to CT scans and ethical issues regarding radiation exposure are an issue in many units.
