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Background Fireworks are often used to celebrate holidays and events. With novel designs and availability, there is potential for blast and burn injuries that can impact livelihood and function. This study aims to describe and analyse firework-related burns in adults across New South Wales and the Australian Capital Territory. Methods A retrospective statewide review was performed from January 2010 to December 2020 at the adult burns units. All firework-related burn injuries older than 18 years that attended or were referred to the burns unit were included. Results There were 203 patients with a firework-related burn injury. The male to female ratio was 4:1 with an average age of 32.2 years. Men were 5.2 years younger than women (31.2 vs 36.4, p = 0.010). Men were more likely to have firework-related injuries on non-holidays, whereas women were more likely on holidays (p = 0.050). Men were more likely to operate fireworks after consuming alcohol resulting in burns than women (34.4% vs 12.5%, p = 0.007). Sparklers were more common amongst women, whereas fireworks had higher proportions amongst men (p = 0.009). The most common site of injury was the hands. The most frequent type of injury was a mid-dermal burn (61.6%), followed by superficial (25.2%), and full thickness (13.2%) respectively. The operative rate was 17.7% with a mean total length of stay of 2.2 days (range: 1–12). Conclusions Firework-related burns have distinct patterns of use and injuries amongst men and women. Alongside legislation, awareness of the potential hazards for shopgood fireworks such as sparklers is critical for future prevention campaigns. Level of evidence: Level III, Risk/Prognostic.

High-velocity and high-impact forces can yield life-threatening injuries that are not only limited to the face but can involve other regions of the body. Associated injuries are more frequent in the elderly impacting management and outcomes. The primary objective was to study the association between associated injuries and age groups by identifying epidemiological trends and differences among the elderly and younger population.A retrospective review was conducted from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. A comparative analysis for elderly and younger controls was assessed for associated injuries, etiology, management, and length of stay.There were 355 elderly and 1884 younger controls for the study. There were differences between gender, alcohol, socioeconomic status, type of facial fracture, mechanism of injury, and associated injuries (p0.05). The elderly were 3.6 times more likely to have an associated injury compared to the younger cohort (p0.05). Total limb injuries were 2.2 times more likely in the elderly compared to the younger cohort, and neurological related injuries were 2.7 times more likely (p0.05). Neurological injuries were most frequent in fall-related injuries, limb injuries in RTA; and soft-tissue injuries for assault, sport, animal, and work (p0.001). The elderly had longer hospital stays as compared with younger controls (p0.05).Associated injuries are more frequent in the elderly and impact other bodily systems leading to a longer length of stay. In the assessment and management of facial trauma, anatomical and disciplinary boundaries may cross requiring interdisciplinary care.

Purpose The tobacco epidemic is one of the biggest global public health issues impacting quality of life and surgical outcomes. Although 30% of colon cancers warrant a right hemicolectomy (RH), there is no specific data on the influence of smoking on postoperative complications following RH for cancer. The aim of this study was to determine its effect on post-surgical outcomes. Methods Patients who underwent elective RH for colon cancer between 2016 and 2019 were identified from the ACS-NSQIP database. Propensity score matching (PSM) was used with a maximum absolute difference of 0.05 between propensity scores. Primary outcome was to assess the 30-day complication risk profile between smokers and non-smokers. Secondary outcomes included smoking impact on wound and major medico-surgical complication rates, as well as risk of anastomotic leak (AL) using multivariable logistic regression models. Results Following PSM, 5652 patients underwent RH for colon cancer with 1,884 (33.3%) identified as smokers. Smokers demonstrated a higher rate of organ space infection (4.1% vs 3.1%, p = 0.034), unplanned return to theatre (4.8% vs 3.7%, p = 0.045) and risk of AL (3.5% vs 2.1%, p = 0.005). Smoking was found to be an independent risk factor for wound complications (OR 1.32, 95% CI 1.03–1.71, p = 0.032), primary pulmonary complications (OR 1.50, 95% CI 1.06–2.13, p = 0.024) and AL (OR 1.66, 95% CI 1.19–2.31, p = 0.003). Conclusion Smokers have increased risk of developing major post-operative complications compared to non-smokers. Clinicians and surgeons must inform smokers of these surgical risks and potential benefit of smoking cessation prior to undergoing major colonic resection.

Background The clinical presentations of diseases and the provision of global healthcare services have been negatively affected by the COVID-19 pandemic. Our study aimed to determine the impact of this global pandemic on presentations of necrotising fasciitis (NF). Methods A retrospective study was conducted of adult patients with NF in South West Sydney Local Health District from January 2017 to October 2022. An analysis of sociodemographic and clinical outcomes was performed comparing the COVID-19 cohort (2020–2022) and the pre-COVID-19 cohort (2017–2019). Results Sixty-five patients were allocated to the COVID-19 cohort, and 81 patients were in the control cohort. The presentation to hospitals of the COVID-19 cohort was significantly delayed compared to the control cohort (6.1 vs. 3.2 days, P P = 0.040), higher number of operations (4.8 vs. 2.1, P = 0.008), and longer total length of stay (LoS) (31.3 vs. 10.3 days, P = 0.035) during the pandemic. The biochemical, clinical, or post-operative outcomes of two groups were not significantly different. Conclusion This multi-centre study showed that the COVID-19 pandemic delayed presentations of NF but did not result in any significant overall changes in operative time, ICU admissions, LoS, and mortality rate. Patients aged less than 40 years in the COVID-19 group were likely to experience prolonged operative time, higher number of operations, and greater LoS.

Hibernomas are uncommon, benign, lipomatous tumours of brown fat. Although hibernomas may arise from any region where brown fat exists, common locations include thigh, shoulder, back and neck. We report a rare finding of a breast hibernoma in a 43-year-old male. The patient was managed surgically with an excision of the breast mass. This report will outline the pathology and clinical findings of breast hibernomas and review of the literature.

Biliary stent insertion during endoscopic retrograde cholangiopancreatography is used as a therapeutic intervention allowing flow of bile into the duodenum. In rare circumstances, distal gastrointestinal perforation can be attributed to a migrated biliary stent, with the most common site being the sigmoid colon. In these cases, surgical and/or endoscopic intervention may be required. We report a case of a 98-year-old male presenting with small bowel obstruction secondary to migrated plastic and metal biliary stents placed for acute biliary pancreatitis. Due to advanced age and high-risk multiple comorbidities, conservative management was undertaken. The patient was discharged after 5 days after ongoing pain and obstipation with palliative care services in place.

Groin lumps in females can be challenging due to unique anatomy and vast differential diagnostic pathologies. We report the case of a 39-year-old female presenting with a six-month history of painful left groin lump. Laparoscopic total extraperitoneal (TEP) hernia repair showed an incarcerated left indirect inguinal hernia sac containing part of the left fallopian tube and fimbrial cyst, a left fat-containing obturator hernia and associated with ectopic subcutaneous inguinal endometrioma. The anatomical differences in women suggest that individualized preoperative imaging modalities such as magnetic resonance imaging have a place before considering laparoscopic hernia repair, to successfully identify and synchronously treat any concomitant pathologies.

Central giant cell granuloma (CGCG) is a rare tumour. The aetiology remains controversial with immunohistological features suggestive of inflammatory, vascular and proliferative markers. It is most often diagnosed in children and young adults under the age of 30 years with a predilection for the mandible. We herein present a case in a paediatric age group of a maxillary lesion of CGCG with a novel genetic translocation. A combination of surgical intervention including enucleation and embolization produced a good result. The importance of long term follow up for facial growth and recurrence is terribly important for the child.

The role of bacteria and breast implant illness is an emerging area of interest for surgeons and clinicians. The most common cause of surgical readmission remains post-operative infectious complications. Cutibacterium acnes is an anaerobic, gram-positive organism that is part of the normal human microbiota. In certain circumstances, it may cause chronic infections and capsular contractures in breast implant-related complications. This case series outlines patients with bilateral capsular contractures and growth of C. acnes. The patients were managed surgically with the removal of bilateral breast implants with en bloc capsulectomy and oral antibiotics without complications. This report will outline the pathology of C. acnes, association with breast implant-associated anaplastic large cell lymphoma and review of the literature.

INTRODUCTION True isolated lambdoid craniosynostosis is rare. It requires corrective surgery to prevent intracranial pressure and aesthetic stigma by significant dyscrania. We summarize our case series for lambdoid craniosynostosis outlining the pathophysiology, clinical findings and surgical approaches and outcomes. METHODOLOGY A retrospective analysis of our data from 2010 to 2020 summarized our cases of true lambdoid synostosis. We have used the medical notes and the radiological findings from computed tomography scans to summarize a case series of isolated lambdoid synostosis. RESULTS Our case series demonstrated 7 patients with true isolated lambdoid craniosynostosis. In most cases surgical intervention in the form of posterior cranial vault remodeling utilizing a bandeau, based on occipital advancement techniques, has demonstrated the most consistently favorable aesthetic outcome. CONCLUSIONS Surgical referral to a craniofacial center should be sought early in difficult to diagnose cases. Although rare, surgical intervention is indicated to correct potentially increased intracranial pressure and to ameliorate cranial dyscrania.

Inguinal bladder hernia (IBH) is an uncommon occurrence in males with a groin mass. It may be present with lower urinary tract symptoms but is often asymptomatic, making it a diagnostic challenge. IBH is frequently an incidental finding during surgery, which increases the risk of iatrogenic injury of the bladder. This report examines the case of a 77-year-old male who experienced a painful, reducible right-sided groin mass with acute urinary retention. Investigations conducted through computed tomography exhibited a right indirect inguinal hernia containing omental fat and a portion of the urinary bladder. The patient underwent a right open herniorrhaphy with mesh repair. This report presents a systematic approach to differential diagnoses for a male groin mass and its relationship to IBH.

We report the case of a 53-year-old nulliparous female presenting with a 9-month history of recurrent mastitis and a retro-areolar lesion. Histological assessment showed an inflammatory infiltrate predominantly composed of eosinophils without evidence of malignant changes. The patient was diagnosed with eosinophilic mastitis and commenced on a course of oral steroids with good effect. This case will outline the pathology, clinical manifestations and diagnosis of eosinophilic mastitis alongside a review of the literature.

Organised and non-organised sports have shifted greatly over the past decade with variations in epidemiological trends for maxillofacial trauma. Our aim is to describe epidemiological trends of sport-related facial fractures in adults outlining the differences amongst gender, age groups, types of sports, and how this impacts clinical outcomes and management. A retrospective review was conducted from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. All sport-related facial fractures, aged 18 years and above, that attended or were referred to the unit were included in this study. Three hundred five sport participants presented with a facial fracture with a strong male predominance (7.5:1). Australian football league (AFL) was the most common sport (39.0%) to result in a facial fracture followed by cycling (13.1%). Younger men aged 18–45 years played AFL, whereas females aged 18–55 years engaged in cycling. Orbitozygomatic fractures were the most common facial fractures (33.1%). Associated injuries occurred in 6.9% of the cohort. There were significant differences between men and women for age, age groups, seasons, and type of sport (p

BACKGROUND Obturator hernia is a rare pelvic hernia associated with a high morbidity and mortality. It most commonly occurs in elderly, multiparous females with symptoms and signs of small bowel obstruction. We present an Australian hospital network experience on emergency presentations of obturator hernias highlighting differences between clinical profile and surgical management. METHODS A retrospective review of adult patients diagnosed with acute obturator hernia during a 10 year period (2010-2020) was conducted across 10 major Sydney hospitals in New South Wales, Australia. RESULTS Obturator hernia was diagnosed in 18 patients (mean 82.7 years, range: 60-96 years old), all confirmed on pre-operative computed tomography imaging. The most common presentations were elderly women demonstrating clinical features of a small bowel obstruction. The mean onset of symptoms from home to hospital admission was 49.4 h. Non-survivors had a significantly elevated urea level (15.6 vs. 7.8 mmol/L, p = 0.036) at presentation and a longer delay from onset of presenting symptoms to diagnosis (84.0 vs. 36.2 h, p = 0.028). Eleven patients underwent urgent laparotomy and six laparoscopic repairs. The mean operative time was 101.0 min. The average hospital length of stay was 16.2 days with a mortality rate of 27.8%. CONCLUSION Timely diagnosis and operative intervention for obturator hernia is the cornerstone of management.

Foot burns represent a small part of the body with many challenges. The impact of diabetes on clinical outcomes adds further issues in management that clinicians must consider in their management. These factors have serious implications on morbidity and long term sequelae. Our aim is to analyse epidemiological trends of foot burns and examine the differences between diabetic and non-diabetics at Concord hospital from 2014 to 2019.A retrospective audit from 2014-19 at Concord General Repatriation Hospital Burns Unit summarised patient demographics, burn injury, diabetic status, operations and length of stay. All foot burn injuries from 2014-19 of all ages and gender that attended Concord burns hospital were included in this study.We treated 797 patients who presented with foot burns, of which 16.2% were diabetic. The average age was higher in diabetics (60.72 years) than non-diabetics (39.72 years) and more males suffered burns compared to females in both groups (p0.001). There was a larger portion of elderly patients (greater than 65 years old, 15.1% of total) who sustained foot burns in the diabetic group compared to the non-diabetic group (p0.001). The most affected season was summer (27.0%), but diabetic patients were 1.7 times more likely to sustain injury in winter than non-diabetics. Diabetics were 3.8 times more likely to have contact burns compared to non-diabetic patients (p0.001). In a multivariable linear regression analysis, factors that contributed to increased length of stay included elderly status, place of event, diabetic status, number of operations, ICU admission, wound infection, amputation, and admission [F (16, 757 = 41.149, p0.001, RWith the increase of diabetes, our multidisciplinary approach to diabetic foot care should include nursing, medical and surgical disciplines to identify patients at risk. The data highlights that a focus on prevention and education for diabetes is central to optimize glycaemic control and burn management, whilst providing a multidisciplinary network on discharge.

Introduction Facial fractures of children are relatively infrequent compared to adults. There are variations in facial fractures depending on the socioeconomic, cultural, and educational factors of the country and time. Our aim is to describe epidemiological trends of facial fractures in the pediatric population, understand differences amongst the age groups, and the impact this has on clinical outcomes and management in South Australia. Methods A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hosptial, Adelaide. All facial fractures of children, aged 16 years and below, that attended or were referred to the unit were included in this study. Results A total of 265 pediatric patients presented with a facial fracture with a male predominance. Some 49.1% occurred from a sports-related injury with bicycle motocross as the single most common type of sport. The mandible was the common fracture type with 21.9% of the total cohort having an associated injury. There were significant differences between boys and girls for age, age groups, mechanism of injury, and type of sport (P Conclusions There are differences amongst boys and girls and an understanding of these differences can aid the diagnosis and management in a growing child's face.

With an ageing population, the elderly will increasingly represent a growing subgroup of trauma. A high-risk group with multiple comorbidities, decreased physiological reserves and frailty, this contributes to the complexity of management in facial trauma. Falls represent the most common presentation for facial-related injuries, but there are variations amongst gender that is important to aid diagnosis, management, and treatment plans. Our aim is to identify epidemiological trends of facial fractures in the elderly, understand differences amongst gender and elderly age groups, and the impact this has on clinical outcomes and management. A retrospective review was conducted from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. All facial fractures of the elderly, 65 years and above, that attended or were referred to the unit were included in this study. Three hundred fifty-five elderly patients presented with a facial fracture with falls (82.5%) as the most common mechanism of injury. The orbitozygomatic fracture was the most common type of facial fracture with 48.7% of the cohort sustaining an associated injury. There were differences between men and women for age, age groups, socioeconomic status, season, alcohol, mechanism of injury, and facial fractures (p

Omental infarction is a rare cause of an acute abdomen with nonspecific signs that can be easily mistaken with other more common intra-abdominal pathologies. The increased use of radiological imaging has brought this diagnosis to attention with respect to management plan. We present the experience of an Australian hospital network with the diagnosis and management of omental infarction to raise awareness of this uncommon pathology. A retrospective review of medical records of adult patients diagnosed with omental infarction from 2010 to 2020 was conducted across four major hospitals in South Western Sydney. Data relating to clinical presentation, investigations, management and outcomes were obtained. Omental infarction was diagnosed in 61 patients (mean 51.1 years, range: 19–76 years old). All patients presented with nonspecific abdominal pain with the most common sites being the right iliac fossa followed by the right upper quadrant, respectively, over an average period of 2.7 days. Computed tomography and/or diagnostic laparoscopy identified omental infarction in all cases. Forty-two patients (68.9%) had successful conservative management, six failed conservative management and 19 patients had emergency laparoscopic omentectomy. The average hospital length of stay was 3.4 days with no significant morbidity or mortality. Omental infarction generally presents with nonspecific clinical signs often masquerading as other more common abdominal diagnosis like cholecystitis or appendicitis. A trial of conservative management initially coupled with appropriate imaging should be recommended within the first 24–48 h before considering surgical treatment in refractory cases.

BACKGROUND Animal-related facial fractures can affect livelihoods impacting the hard and soft tissues of the face. Animal husbandry and recreational sports have close relationships with animals, which can lead to injuries equivalent to those of road traffic accidents and assaults. Our aim is to describe epidemiological trends of animal-related facial fractures in the paediatric and adult age group across South Australia. METHODS A retrospective review from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital in Adelaide. All animal-related injuries that attended or were referred to the unit were included in this study. RESULTS There were 50 patients who presented with an animal-related facial fracture. There was an equal distribution of males to females with horses as the most common animal to cause injury from kicking. The orbit and orbitozygomatic fracture equally represented the most common type of facial fracture with 38% of all cases having an associated injury. The operative rate was 56% with four post-operative complications. There were differences between males and females for season, post-operative complications and length of stay (P

Hepatobiliary and pancreatic surgery is frequently complicated by surgical site infections (SSI) with significant postoperative morbidity and mortality rates contributing to the economic burden on healthcare. Advancements in operative techniques to prevent SSI are gaining traction in clinical practice. This study compares the effectiveness of the 'loop and drain technique (LDT)', a combination method utilizing a continuous subcutaneous vessel loop and subcuticular suture for surgical wound closure in patients undergoing upper gastrointestinal surgery at a Metropolitan Hospital in Sydney.A retrospective review of patients who underwent an upper gastrointestinal procedure was conducted at Bankstown-Lidcombe hospital between 2017 and 2019. There were 77 patients in the LDT group and 123 patients included in the control group. The primary outcome assessed was the rate of SSI. Secondary outcomes included length of stay (LOS) and drainage of surgical site infections.Two hundred adult patients were treated for an upper gastrointestinal procedure. The most common operation was a Whipple procedure (35.0%). The rate of SSI was 12.5% with all these patients receiving intravenous antibiotics. The LDT cohort had a significantly lower rate of SSI compared to their counterparts (3.9% vs. 17.9%, P = 0.004).The LDT method is associated with a decreased incidence of SSI and should be considered as a cost-effective operative technique to improve patient outcomes after upper gastrointestinal surgery.

Purpose Facial trauma in women is complex with physical, psychosocial, and cultural influences impacting clinical presentations. Although multifactorial, assaults and falls are principally reported as the main causes. Methods A retrospective review was conducted from January 2012 to January 2017 at the Women and Children’s Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures in women that attended or were referred to the unit were included in this study. The primary objective was to analyse epidemiological trends of facial fractures and clinical outcomes in the South Australian female population. Results There is a bimodal distribution of facial fractures at 25–35 years and 65 + years. Indigenous females were 19.5 years younger than non-indigenous females (30.5 vs 49.9, P P P Conclusions Young women disproportionately experience larger incidences of non-alcohol-related assaults requiring operative intervention of the mandible, whereas elderly women principally suffer fall-related facial fractures with higher rates of associated injuries.

Background: The impact of SARS-COV-2 virus (COVID-19) has been well documented in international settings with a reduction in overall emergency presentations both influenced by social distancing and lockdowns. This study focuses on several common acute general surgical pathologies exploring differences in presentations and clinical outcomes for appendicitis, cholecystitis, and incarcerated hernias during the first wave. Methods: A retrospective review of medical records of all patients was analysed in two groups: the non-COVID-19 group (combined 2017–2019) and the COVID-19 group (2020). Results: There were 3,316 acute emergency surgical presentations with an 8.2% decrease in total presentations in 2020. There were 477 appendicectomies, 224 cholecystectomies, and 121 repair of incarcerated hernias. All general surgical procedures demonstrated significant differences between non-COVID and COVID cohorts, including length of stay (LoS) (2.7 vs 2.1, p = 0.009) and onset of symptoms (1.6 vs 2.2, p = 0.018) for those aged less than 25 years. Patients with appendicitis aged less than 25 years had a significantly longer onset of symptoms before hospital presentation and shorter LoS in the COVID group (1.7 vs 2.5, p = 0.002; 2.9 vs 2.3, p = 0.016). Likewise, patients with cholecystitis had a significantly longer onset of symptoms in the COVID-19 cohort compared to their counterparts (2.0 vs 3.0 days, p = 0.025). There were no significant differences in biochemical, clinical or post-operative outcomes. Conclusion: The first wave of the COVID-19 pandemic significantly reduced acute general surgical presentations. For those less than 25 years in the COVID-19 cohort, overall LoS was shorter despite indicating significantly delayed presentations.

Background The prefabricated fibula flap is an advanced method of occlusal-based reconstruction that combines placement of osseointegrated dental implants with prelamination, using a split skin graft on the fibula, weeks prior to the definitive reconstruction. This approach is resource intensive but has several advantages including eliminating the delay from reconstruction to dental rehabilitation. Methods A retrospective cohort study of all prefabricated fibula flaps used for mandible and maxillary reconstruction from 2012 to 2020 was performed. Outcome measures were implant survival, implant utilization and functional dental rehabilitation. Results A total of 17 prefabricated fibula flaps were performed including two analogue and 15 digital plans. There were nine maxillary and eight mandibular reconstructions, of which 11 were primary and seven were secondary. There were no free flap failures. A total of 65 implants were placed (average 3.8, median 3 implants). There was one implant failure at 6 years giving a 1.5% failure rate. There was 91% implant utilization and 94% functional dental rehabilitation. Conclusion The prefabricated fibula flap provides outstanding dental rehabilitation in well-selected patients.

Barbecue devices can be classified into several categories, including electrical, gas-fuelled and charcoal-based devices. Recreational outdoor burns are a preventable cause of morbidity and disability. This study aims to describe and analyse contact-related barbecue coal burns in the paediatric age group across New South Wales and the Australian Capital Territory. A retrospective review from January 2010 to January 2019 at The Children’s Hospital at Westmead. All barbecue coal burn injuries in children less than 16 years that attended or were referred to the Burns Unit were included. There were 48 patients whom presented with a contact burn barbecue coal-related injury. The male to female ratio was 5:3 with an average age of 2.5 years. Most injuries occurred in the home setting. The most common site of injury were the hands. The most frequent type of injury was a mid-dermal burn, followed by deep and superficial, respectively. Charcoal barbeque burns in children were uncommon, usually occurred at home and most commonly involved critical burn areas such as the hands, with the potential for long-term functional impairment. This case series highlights the importance of understanding prevention campaigns around barbecues Level of evidence: Level IV, risk/prognostic study.

The purpose of this study was to determine the impact of coronavirus disease 2019 (COVID-19) on the delayed presentation of necrotising fasciitis (NF). A retrospective study was conducted of adult patients (≥16 years old) diagnosed with NF at a hospital from 2017 to 2020. A quantitative comparative analysis for the COVID-19 group and control group between 2017 and 2019. Structured interviews were conducted to examine the impact of COVID-19 on patients. There were 6 patients in the COVID-19 group and 10 patients in the control group. The COVID-19 group had a longer mean onset of symptoms till hospital presentation of 4.1 days and a longer mean operative time. The COVID-19 group was more likely to be admitted to intensive care unit. Three patients in the COVID-19 group did not survive compared to survival in the counterparts. Participant responses indicated the COVID-19 pandemic did not prevent them from presenting to ED.

Cyst of the canal of Nuck is a rare abnormality of the female inguinal canal that can present similarly to a hernia. If incompletely obliterated, the patent canal of Nuck may predispose to an inguinal hernia or hydrocele due to direct communication with the abdominal cavity. Such defects are normally detected and repaired in early childhood but can also present later in adult life. We report the case of a 44-year-old woman who presents with a fluctuant, mobile and irreducible left-sided groin mass. Ultrasound of the groin identified a cystic structure in the canal of Nuck. The patient underwent successful open herniorrhaphy with excision of the cyst and mesh repair of the inguinal canal. Subsequent histopathological examination also revealed concurrent endometriosis of the canal of Nuck. A systematic approach to differential diagnoses for a female groin mass, further investigations and management are discussed.

Alcohol outlet density and unrestricted trading hours are strongly predictive of domestic and non-domestic assault rates, respectively. international studies report a strong male predominance for facial fractures. Harm minimization policies such as lockout laws have gained considerable attention to reduce accessibility of alcohol consumption and drinking patterns.A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures that attended or were referred to the unit were included in this study. The primary objective was to determine the impact of facial fracture presentations, particularly assaults, for the pre- and post-lockout periods.From 2012 to 2017, there was a 5.1% decrease in assaults per year ( P = 0.002). Assaults increased by 11.7% for women and alcohol related assaults decreased by 10.2% for men ( P 0.05). Assault and alcohol related assault rates decreased by 9.3% and 10.5%, respectively, between lockout periods ( P 0.001). Comparative analysis between Adelaide and control (inner regional city) showed assaults decreased by 9.8% between lockout periods (51.2% versus 41.4%, P 0.001). Multivariate analysis showed alcohol, open reduction internal fixation and men were associated with a lower risk of assault related fractures, but women and night time presentations had a higher risk ( P 0.05).The influence of lockout laws contributed to an overall decrease in assaults and operative interventions, particularly alcohol related incidences amongst men. Ongoing longitudinal surveillance should guide current evidence for policy developers to reduce the risk of harm.

Facial fractures of children are relatively infrequent compared to adults. There are variations in facial fractures depending on the socioeconomic, cultural, and educational factors of the country and time. Our aim is to describe epidemiological trends of facial fractures in the pediatric population, understand differences amongst the age groups, and the impact this has on clinical outcomes and management in South Australia.A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hosptial, Adelaide. All facial fractures of children, aged 16 years and below, that attended or were referred to the unit were included in this study.A total of 265 pediatric patients presented with a facial fracture with a male predominance. Some 49.1% occurred from a sports-related injury with bicycle motocross as the single most common type of sport. The mandible was the common fracture type with 21.9% of the total cohort having an associated injury. There were significant differences between boys and girls for age, age groups, mechanism of injury, and type of sport (P 0.05). Boys were 2.3 times more likely to have a sport-related facial fracture than girls. Early adolescence were 5.2 times more likely to have an orbitozygomatic fracture than children of early childhood (P 0.05). Age, associated injuries, and sport-related facial fractures were independently associated with increased length of stay (P 0.001).There are differences amongst boys and girls and an understanding of these differences can aid the diagnosis and management in a growing child's face.

INTRODUCTION The mandible is one of the most common facial bones to be injured with great clinical variability across countries caused by assaults, road traffic accidents, and falls. METHODS A retrospective review was conducted for adult mandibular fractures from January 2012 to January 2017 at the Royal Adelaide Hospital, Adelaide. Our aim was to describe epidemiological trends of mandibular fractures, differences for sex and age, and clinical outcomes. RESULTS Five hundred sixty five adult patients presented with a mandibular fracture with a male predominance (4.5:1). The mean age was 34.2 years with men 11.9 years younger than females (32.0 versus 44.1 years, P

Introduction: With the increase of lithium battery devices, including electronic cigarettes and battery power banks, there has been a steady rise in burn injuries secondary to device malfunction. These devices may cause chemical or flame burns. Our aim was to identify and classify epidemiological trends of explosions from lithium battery devices across the state of New South Wales (NSW), Australia. Methods: A review of the NSW Burn Injury Service (SBIS) database from January 2005–December2019, together with medical records from the burns units at the Children’s Hospital at Westmead (CHW), the Concord Repatriation General Hospital (CRGH) and the Royal North Shore Hospital (RNSH) was conducted. All patients who suffered a burn secondary from a lithium battery device were included and data was extracted on mechanism of injury, severity of injury and management. This study was approved by the ethics committees of CHW, RNSH and CRGH [2020/PID00179]. Results: Of the 24 patients identified, six were paediatric and 18 were adults. The majority were male (7:1) with a mean age of 29.0 (+/- 16.6 years). The mean total body surface area burnt was 2.5% (+/- 0.9) [range 0.1–21.0%]. The majority occurred after 2014 and involved spontaneous explosions. Their injuries ranged from partial to full thickness burns with flame being the most common type (n=15). Three quarters of the cases (n=18) occurred in a home setting. Conclusions: Lithium battery device explosions can result in a mix of burn depth injuries from flame, contact and electrical, or chemical burns. Consumers need to be made more aware of the potential risks associated with use of lithium battery powered devices.

Perivascular epithelioid cell tumours, known as PEComas, are a family of tumours with immunoreactive melanocytic and smooth muscle markers. They are a rare heterogeneous group in adulthood and childhood with primary osseous PEComas representing an even rarer subgroup. The clinical behaviour is not well understood and the treatment options vary. We present an index case of a primary osseous PEComa of the craniofacial skeleton in a 3-year-old girl. Level of evidence: Level V, diagnostic; therapeutic; risk/prognostic study.

Background: Optimal management of patients with gallstones and concomitant choledocholithiasis has been a longstanding dilemma. Advancements in laparoscopic and endoscopic techniques have enabled multiple options for management. This study aims to compare the effectiveness of different procedures for choledocholithiasis in patients requiring laparoscopic cholecystectomy in the emergency setting of a large tertiary Australian hospital.Methods: A retrospective review of patients requiring emergency laparoscopic cholecystectomy who were also treated for choledocholithiasis was conducted at Liverpool Hospital, New South Wales. Patients were allocated into three groups: pre-operative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecyst-ectomy at index admission, or laparoscopic cholecystectomy with intraoperative biliary stent placement followed by interval ERCP and stent removal, or laparoscopic cholecystectomy with intraoperative bile duct exploration. The primary outcome assessed was bile duct clearance rate. The secondary outcomes included complication rates, number of procedures performed, total operative time, length of stay (LOS) and cost.Results: A total of 96 patients were included. Primary outcome was no different between the three groups and there was no significant difference between post-operative complications. However, LOS was shorter in the laparoscopic cholecystectomy with intraoperative bile duct exploration by three days compared to the other two groups.Conclusions: Laparoscopic cholecystectomy with intraoperative bile duct exploration has similar outcomes and complication rates to other techniques and may be associated with a shorter LOS and lower costs.

Background Burns injuries are dynamic and evolve over time. Burn injuries to the feet present with seasonal variation, affecting clinical outcomes for certain high-risk groups. Although they affect a very small percentage of the body, burn injuries to the feet can affect mobility, morbidity and rehabilitation, particularly in patients with diabetes. Objective The aim of this article is to provide an understanding of seasonal variation in foot burns for high-risk groups and how to manage them appropriately. This article provides a comprehensive analysis on epidemiology, pathology and management, with the aim of providing guidance for general practitioners (GPs). Discussion The management of foot burns is multidisciplinary, involving GPs, allied health specialists, nurses, medical and surgical specialties. The epidemiological variations of these injuries have shown differences in clinical outcomes among high-risk groups such as the elderly and people with diabetes. Education and prevention are crucial in reducing the rate of injury in the rising number of patients in high-risk groups.

Facial trauma in women is complex with physical, psychosocial, and cultural influences impacting clinical presentations. Although multifactorial, assaults and falls are principally reported as the main causes.A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures in women that attended or were referred to the unit were included in this study. The primary objective was to analyse epidemiological trends of facial fractures and clinical outcomes in the South Australian female population.There is a bimodal distribution of facial fractures at 25-35 years and 65 + years. Indigenous females were 19.5 years younger than non-indigenous females (30.5 vs 49.9, P 0.001). Approximately half the cohort had a fall-related facial fracture, followed by assault (26.2%), and sports (10.3%). There was a higher proportion of non-alcohol-related trauma from assaults than alcohol-related assaults (72.5% vs 27.5%, P 0.001). Over half (58.0%) of the cohort had a midface fracture. The elderly had increased odds of 1.9 fold for facial fractures in winter, largely from falls, compared to younger women. Associated injuries were present in almost half the elderly women with 2.6 times the risk compared to younger women. Younger women had higher incidences of surgical intervention (52.6% vs 14.3%, P 0.05).Young women disproportionately experience larger incidences of non-alcohol-related assaults requiring operative intervention of the mandible, whereas elderly women principally suffer fall-related facial fractures with higher rates of associated injuries.

Vesicocutaneous fistulas (VCF) are abnormal tracts formed between the bladder and the cutaneous surfaces of the body. Although rare, it has been reported following radiotherapy to the pelvic region, surgery and trauma. We present a case of a 70-year-old male who underwent neoadjuvant chemoradiotherapy for the treatment of rectal cancer metastatic to the perineum prior to definitive abdominoperineal resection (APR). Six months later, he developed urinary retention secondary to bladder obstructive outlet disease. This was managed with urinary catheterisation and a month later with transurethral resection of the prostate (TURP). At outpatient follow-up, he complained of urinary leakage in the perineal region approximately 10 months post-chemoradiotherapy. He underwent a computer tomography (CT) cystogram which confirmed the findings of a VCF extending to his perineum scar. He was managed conservatively with successful outcomes using a multidisciplinary team approach. This is the first case of delayed VCF reported arising after chemoradiotherapy for locally advanced rectal colorectal cancer.

Background and Objectives: Advantage of the total extraperitoneal (TEP) technique over open inguinal hernia repair allows for exploration of other anatomical regions in search for occult hernias (OH). Methods: Our institutional practice is to routinely explore the obturator and femoral regions for occult hernias. In addition to this technique, we routinely expose the psoas muscle extensively to perfect mesh placement followed by fibrin glue fixation on both ‘triangles of doom and pain’. The use of this technique has led to the identification of three incidental occult para-psoas hernias (PPH) out of a total of 800 TEP repairs performed in a high-volume specialist hernia center. Conclusions: The purpose of this article is to demonstrate that occult parapsoas hernias (PPH) can be easily identified and safely repaired with mesh glue fixation, using the standard TEP technique during inguinal hernia repair.