BackgroundThere are numerous techniques for the reconstruction of cutaneous defects of the pinna. Many of these distort the auricle, and several are challenging and time-consuming to perform.MethodsAn illustrative case is presented to demonstrate a novel lobule rotational flap, which can be used to cover cutaneous defects of the middle third of the pinna.ResultsPostoperative photography illustrates that this simple one-stage technique causes minimal anatomical distortion and allows the final scar to be concealed within the inner helical rim.ConclusionsSmall local flaps can be raised from the lobule to cover challenging defects of the middle third of the pinna. In selected patients, with abundant lobular tissue, this technique can be as effective as more complex reconstructive options.

Background: Work-based assessments (WBAs) and the associated online feedback are fundamental parts of clinical training. Despite years of clinical use there is little evidence suggesting that they have a positive impact on learning or performance.Aims: This observational pilot study investigates the perceptions of online WBAs (OnWBAs) across specialties in an attempt to establish why these tools are not meeting their full academic potential.Methods: Structured questionnaires were given to 90 clinicians. Responses were analysed in EXCEL, and SPSS 17 was used to test for statistical significance.Results: All responders felt that OnWBAs were a poor reflection of clinical competency, and did not enhance learning significantly. Consultant OnWBAs rated poorly against those performed by other grades. Consultant OnWBAs were significantly more difficult to obtain and took significantly longer to complete than those from other grades. Several consultants were inadequately trained in the use of OnWBAs, and most were unaware of the number of assessments required by trainees.Discussion: This study highlights several issues that may detract from the functionality of OnWBAs. Pockets of consultants are inadequately trained in the use of OnWBAs, and many lack knowledge of trainee requirements. In addition the delay between assessment and completion of feedback is a concern that goes against current recommendations. Simple measures in the workplace and the involvement of educational bodies could remedy some of these issues. Further studies investigating a wider population would help to establish the true extent of the problem and isolate the main causative factors behind these issues.

The Clinical TeacherVolume 10, Issue 4 p. 277-277 Letter to the Editor Response to Online work-based assessments Indraneil Basu, Indraneil Basu Department of Surgery, Milton Keynes Hospital, Buckinghamshire, UKSearch for more papers by this author Indraneil Basu, Indraneil Basu Department of Surgery, Milton Keynes Hospital, Buckinghamshire, UKSearch for more papers by this author First published: 08 July 2013 https://doi.org/10.1111/tct.12089 Corresponding author's contact details: Mr Indraneil Basu, Department of Surgery, Milton Keynes Hospital, Buckinghamshire, MK6 5LD, UK. E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Hawkins E. Online work-based assessments. Clin Teach 2013; 10: 276. 10.1111/tct.12090 CASPubMedGoogle Scholar 2Miller A, Archer J. Impact of workplace based assessment on doctors' education and performance: a systematic review. BMJ 2010; 341: c5064. 10.1136/bmj.c5064 PubMedWeb of Science®Google Scholar 3Pereira EA, Dean BJ. British surgeons' experiences of mandatory online workplace-based assessment. J R Soc Med 2009; 102: 287–293. 10.1258/jrsm.2009.080398 PubMedWeb of Science®Google Scholar 4Overeem K, Faber MJ, Arah OA, Elwyn G, Lombarts KM, Wollersheim HC, Grol RP. Doctor performance assessment in daily practice: does it help doctors or not? A systematic review. Med Educ 2007; 41: 1039–1049. 10.1111/j.1365-2923.2007.02897.x CASPubMedWeb of Science®Google Scholar 5Basu I, Parvizi S, Chin K. The perception of online work-based assessments. Clin Teach 2013; 10: 73–77. 10.1111/j.1743-498X.2012.00609.x CASPubMedGoogle Scholar Volume10, Issue4August 2013Pages 277-277 ReferencesRelatedInformation

Reconstruction of soft tissue defects of the sole is a challenging problem. Bulky flaps interfering with footwear is common sequelae. Multiple operations are often required to achieve a functional foot. We describe the case of a motorcyclist who sustained degloving injury to his left sole when he was hit by a car. The defect was resurfaced by a free latissimus dorsi flap and a meshed skin graft. After a year partial flap thinning was done, as it was bulky. Though he was grateful for the reconstruction he still could not wear a shoe, the gait was affected and he felt the flap was wobbly. 8 months later he underwent a further flap thinning. At this stage lack of adherence of the flap to the undersurface was noted and a flap hitch 1 Horlock N. Grobbelaar A.O. Gault D.T. 5-year series of constricted (lop and cup) ear corrections: development of the mastoid hitch as an adjunctive technique. Plast Reconstr Surg. 1998 Dec; 102 (discussion 2333–5): 2325-2332 Crossref PubMed Scopus (31) Google Scholar , 2 Ranjan P. Dalela D. Goel A. Sankhwar S.N. Singh V. Scrotal hitch procedure to prevent apical necrosis of scroto-perineal flap for urethroplasty. Int Urol Nephrol. Mar 2007; 39 (0301-1623): 119-121 Crossref PubMed Scopus (1) Google Scholar , 3 Sullivan L.D. Masterson J.S.T. Wright J.E. Vesicopsoas hitch: a versatile procedure. Can J Surg. 1982; 25 (0008-428X): 26-29 PubMed Google Scholar was done. 3 looped nylon sutures were used to lift up the internal portion of the sole bearing part of the flap and suspended onto periosteum of the lateral malleolus, navicular and posteromedial calcaneum (Figure 1). The flap hitch promotes adhesion and permanent uplift of the flap. This also produced a good contouring of the flap. Though flap hitch has been described in various parts of the body we do think this is worth considering in combination with flap thinning especially for the wobbly sole flap.

Reconstructing skin defects of the volar aspect of fingers can be a challenging task due to a lack of local expendable tissue. The reverse digital artery flap is a versatile and reliable technique that can be used to manage such disabling injuries. Various authors have used this flap effectively, but most have used the digit itself as the donor site. This limits the size of the flap and also necessitates skin grafting to cover the donor site. Large reverse digital artery flaps can be raised from the radial and ulnar borders of the palm facilitating coverage of significant digital defects and primary closure of the donor site, resulting in minimal donor-site morbidity. We describe 3 illustrative cases to highlight the flaps versatility.

Flexor tendon rupture following a Colles' fracture is a rare complication with only a handful of cases reported since the initial report in 1932. We present a case in which all digital flexor tendons ruptured within 6 months of a Colles' fracture. Previous reported cases have demonstrated rupture of either the radial or ulnar digital flexors but this case is the first in which all the digital flexors have been involved. This case report highlights the clinical implications of this rare occurrence and stresses the importance of accurate reduction and thorough clinical examination following bony injuries to the wrist.

This article describes a variant of palmaris longus muscle resulting in median nerve compression in the mid forearm. Although the palmaris longus has several well-documented anomalies, these seldom lead to nerve compression. The dual tendon, central muscle belly variant observed in this case is the first of its kind to be reported causing compressive neuropathy at this level. This is of both anatomical and clinical interest as it reminds surgeons of the anatomical variations of this unique muscle and presents a new mechanism of nerve compression in the forearm.