Otoplasty techniques in children: a comparative study of outcomes.

BACKGROUND: Numerous otoplasty techniques have been described in the literature to correct prominent ears; however, few have focused on the complication rates. We reviewed our experience aiming to assess peri-operative care requirements and complication rates. METHOD: We conducted a retrospective review of 207 otoplasty procedures performed in 119 patients over a 5-year period (2009-2014) at the Women's and Children's Hospital, Adelaide. Information pertaining to demographic details, length of stay, otoplasty technique and complications (early and late) were obtained. RESULTS: In the study period, 97% of the 119 patients had an overnight stay. There was an early complication of 2.2% (return to theatre for bleeding) in the modified Chongchet technique and 0.9% (wound infection) in the Mustarde technique. Late complications included suture extrusion (1.9%) with the Mustarde technique and hypertrophic scarring (2.2%) in the modified Chongchet technique. The recurrence rate requiring revision following modified Chongchet technique was 10% and Mustarde technique was 2.9%. The Mustarde otoplasty technique was associated with a slightly lower antiemetic requirement than the Chongchet technique (3.2 versus 14.3%, P = 0.032). Both techniques had comparable opioid analgesic requirement of 30-35% post-operatively (P = 0.248). CONCLUSION: Our results are comparable to the huge variation in available literature. We note the higher revision rate following modified Chongchet technique. Both techniques had a low and acceptable rate of post-operative analgesia and antiemetic requirement. We are considering either otoplasty technique as a day surgery procedure within our unit with the provision of adequate patient support as a safe and economical advance.

Palpation as a useful diagnostic tool for skin lesions.

INTRODUCTION: Early identification and accurate diagnosis of malignant pigmented skin lesions is essential for effective management and cost containment. The aim was to investigate the additional value of tactile descriptive information from lesion palpation on the diagnostic accuracy of pigmented skin lesions by medical students using computer-driven learning. METHODS: Sixth year medical students (n = 152) from the University of Adelaide were invited to participate in an online teaching module on pigmented skin lesions. Users were asked to describe, diagnose and manage 15 pigmented skin lesions in three separate case studies based on pertinent clinical history and visual images of the lesions. Tactile descriptive information was then provided and users were asked to reflect on their diagnosis and management. RESULTS: A total of 66 (43%) of the sixth year students successfully completed the online module. Diagnostic accuracy improved significantly with the provision of tactile descriptive information for seborrhoeic keratosis (p = 0.012), basal cell carcinoma (p = 0.001), squamous cell carcinoma (p = 0.02), and dysplastic naevi (p = 0.035). Tactile descriptive information was stated by 23% of medical students to be important in the clinical diagnosis of pigmented skin lesion. Students managed all malignant pigmented skin lesions with either appropriate biopsy or specialist referral. CONCLUSIONS: Palpation information about skin lesions offers useful information for improvement of diagnostic accuracy in an online computer learning setting for medical students.