Targeted ordering of investigations reduces costs of treatment for surgical inpatients.

Background: Laboratory testing forms an important part of diagnostic investigation in modern medicine; however, the overuse of 'routine blood tests' can result in significant potential harm and financial cost to the patient and the healthcare system. In 2018, a new protocol targeting the ordering of investigations was implemented within the General Surgical Teams of Wollongong Hospital in New South Wales, an Australian tertiary referral hospital, to reduce the number of 'routine blood tests' as a quality improvement initiative.

Objective: To identify whether there was a reduction in the number of 'routine blood tests' and associated costs following implementation of the new protocol.

Thulium oxide nanoparticles as radioenhancers for the treatment of metastatic cutaneous squamous cell carcinoma.

Metastases from cutaneous squamous cell carcinoma (cSCC) occur in 2%-5% of cases. Surgery is the standard treatment, often combined with adjuvant radiotherapy. Concurrent carboplatin treatment with post-operative radiotherapy may be prescribed, although it has not shown benefit in recent clinical trials in high-risk cSCC patients.

Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following Radical Parotidectomy.

Background: Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors' experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy.

Methods: A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database.

Sentinel Node Biopsy in 105 High-Risk Cutaneous SCCs of the Head and Neck: Results of a Multicenter Prospective Study.

Background: Regional nodal metastases from cutaneous squamous cell carcinoma (cSCC) is strongly associated with a poor prognosis, but these metastases are difficult to predict clinically. Sentinel node biopsy (SNB) has been used for a wide range of malignancies to assess for regional nodal metastasis, but is not widely used for cSCC.

Methods: Patients presenting with high-risk cSCC of the head and neck with clinically N0 necks were offered SNB at the time of primary cSCC excision or secondary wide local excision.

Predictive value of the 8th edition American Joint Commission Cancer (AJCC) nodal staging system for patients with cutaneous squamous cell carcinoma of the head and neck.

Background: The 8th edition American Joint Committee on Cancer (AJCC8) provides the same nodal staging system for mucosal and cutaneous squamous cell carcinoma of the head and neck (HNcSCC) and includes extranodal extension (ENE) as an adverse prognostic criterion. This study evaluates the prognostic efficacy of the AJCC8 pathologic nodal staging system (pN) for HNcSCC.

Methods: Univariate analysis of 382 patients with metastatic HNcSCC staged according to both the 7th (AJCC7) and the 8th edition staging systems.

Laparoscopic harvest of the gastro-omental free flap for reconstruction after total pharyngolaryngectomy: Operative technique.

Circumferential defects following salvage pharyngolaryngectomy present significant challenges in reconstructive surgery. The gastro-omental free flap has been shown to reduce the incidence of major fistula and catastrophic complications. The current technique for harvest of the flap requires laparotomy, which is potentially associated with significant post-operative complications.

Reviewing the genetic alterations in high-risk cutaneous squamous cell carcinoma: A search for prognostic markers and therapeutic targets.

Cutaneous squamous cell carcinoma (SCC) is second only in incidence to basal cell carcinoma (BCC), effecting up to 500 000 people in the United States annually. Metastasis to regional lymph nodes occurs in approximately 5% of cases and imparts significant morbidity. Standard treatment in this group involves a combination of surgery and adjuvant radiation.

Prospective study of sentinel node biopsy for high-risk cutaneous squamous cell carcinoma of the head and neck.

Background: Nodal metastasis from cutaneous squamous cell carcinoma (SCC) is poorly predicted clinically and is associated with a high mortality rate.

Methods: From 2010 to 2013, patients with high-risk cutaneous SCC were assessed with sentinel node biopsy (SNB) either at the time of primary cutaneous tumor resection or at secondary wide local excision.

Results: Of 57 patients, 8 (14%) had nodal metastasis.

"The Practical Perforator Flap": the sural artery flap for lower extremity soft tissue reconstruction in wounds of war.

Background: Sural artery perforator flaps have been described for use as both local flaps and in free tissue transfer. We present the use of this flap for compound soft tissue defects of the lower limb in civilian casualties of armed conflict in Afghanistan.

Methods/results: Detailed description of the management of blast and high-velocity projectile wounds of the lower extremity with the use of local sural perforator flaps and a review of literature.

Improved survival with elective neck dissection in thick early-stage oral squamous cell carcinoma.

Background: Management of the node-negative neck in T1 to T2 oral squamous cell carcinoma (SCC) remains controversial. The purpose of this study was to determine if elective neck dissection improves outcomes in thick primary tumors since this reflects current practice in most institutions and has not been specifically addressed in the literature.

Methods: Retrospective analysis comparing elective neck dissection versus observation in 153 patients with T1 to T2 N0 oral SCC ≥4 mm thick.

Reconstruction of post-radical parotidectomy defects.

Background: Radical parotidectomy presents a unique combination of reconstructive challenges. The high visibility of the region and the specialized structures involved create an interdependence between aesthetics and function. This article describes the authors' surgical concepts and experience in post-radical parotidectomy reconstruction.

Double helix flap to close a massive circular soft-tissue defect.

The closure of a circular defect resulting from excision of large soft-tissue tumours may pose a considerable surgical challenge. We have described a successful result from the use of modified double helix rotation flaps following resection of a fungating 15-cm interscapular basal cell carcinoma. Our technique necessitated a single operation only.

Advances in temporomandibular joint reconstruction.

Purpose Of Review: This article reviews the reconstructive techniques commonly employed in temporomandibular joint (TMJ) surgery with an emphasis on recent developments in the field.

Recent Findings: TMJ reconstruction remains one of the most challenging tasks faced by surgeons who operate in the head and neck, with a variety of autogenous and alloplastic techniques available. The role of alloplastic TMJ reconstruction needs to be reassessed in light of recent literature showing excellent long-term functional outcomes, which reflect advances in prosthetic materials and surgical technique.

Internal mammary artery perforator flap for head and neck reconstruction.

Background: The internal mammary artery perforator (IMAP) flap is a useful modification of the classic deltopectoral flap that has a number of important roles in head and neck reconstruction.

Methods And Results: In this report, we describe the technique used to plan and raise the flap and demonstrate its use in three different clinical scenarios.

Results And Conclusions: The IMAP flap is a pedicled fasciocutaneous flap that is based on single or multiple internal mammary artery perforators.

Cricotracheal reconstruction following external beam radiotherapy for recurrent thyroid cancer.

Tracheal resection for invasive thyroid cancer is well described. Segmental tracheal or cricotracheal resection and reconstruction is an uncommon but established method in the treatment of invasive thyroid cancer. This has seldom been reported in a recurrence following external beam radiotherapy.