A novel lobule rotation flap for the reconstruction of middle third auricular defects.

BACKGROUND: There 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. METHODS: An 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. RESULTS: Postoperative 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. CONCLUSIONS: Small 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.

The perception of online work-based assessments.

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.

Rupture of all digital flexors following Colles' fracture.

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.

Reverse digital artery flap from radial and ulnar borders of palm.

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.

The dual tendon palmaris longus variant causing dynamic median nerve compression in the forearm.

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.