The first 150 consecutive DIEP free flaps: Lessons learnt and a guide to efficiency for the junior plastic surgeon.

Introduction: The deep inferior epigastric artery perforator (DIEP) free flap is the gold-standard for breast reconstruction but is technically demanding, resource intensive and time-consuming, making it a daunting task for the junior surgeon. Aim: To report the lessons learnt from the experience of a single surgeon performing their first 150 DIEP reconstructions as a guide for junior surgeons. Methods: Data regarding patient demographics and surgical outcomes from April 2021 to October 2022 were collected retrospectively from medical records. Surgical outcomes were analysed using Microsoft Excel. Results: Over 17 months, 150 flaps were completed in 97 patients by the senior author (BS). Operative duration was negatively correlated with case number for unilateral DIEPs (r = -0.73, p < 0.05) and for bilateral DIEPs (r = -0.67, p = 0.14). Raise time and ischaemic time were also negatively correlated with case number (r = -0.82, p < 0.05 and r = -0.79, p < 0.05, respectively). There were 10 complications and no flap losses. Discussion: The data demonstrate an expected improvement in surgical efficiency with increased experience. We describe the key factors contributing to efficiency in our series, such as preoperative CT angiography, surgical markings prior to the day of surgery, a two-team approach with three diathermy sets, flap raise using monopolar diathermy, preference towards choosing a single dominant perforator and early commitment to perforator choice. This case series acts as a guide for the junior plastic surgeon in achieving safe, aesthetic and efficient results when completing free DIEP flap breast reconstructions.

Impact of societal restrictions and lockdown on trauma admissions during the COVID-19 pandemic: a single-centre cross-sectional observational study.

BACKGROUND: Societal restrictions and lockdown during the coronavirus (COVID-19) pandemic have had a significant impact on the volume and nature of trauma admissions. We assessed the impact of COVID-19 related societal restrictions and lockdown on trauma admissions to single level 1 trauma centre in Westmead, Australia. We hypothesized that the number of trauma admissions would decrease and number of admissions due to self-harm and assault (specifically domestic violence) would increase. METHODS: Data was collected from the prospectively maintained Westmead Hospital Trauma Registry. The primary outcome compared was the average number of trauma admissions during March and April during years 2016 to 2020. Analysis of variance was used to analyse means. Pairwise differences among group means were evaluated with Tukey's honestly significant difference test. Secondary outcomes compared were in-hospital interventions and patient outcomes. RESULTS: There was a 23-34% decrease (P = 0.018) in the mean monthly average trauma admissions during March/April 2020 compared with previous years 2016-2019. In addition, there was a 40-52% decrease (P = 0.025) and 13-29% decrease (P = 0.020) in admissions due to road traffic collisions and falls respectively. CONCLUSION: There was a significant decrease in the overall number of trauma-related admissions during the COVID-19-related period of societal restrictions and lockdown. This was due to a decrease in minor traumas, falls and road traffic collisions. There was no difference in the number of admissions secondary to major traumas, self-harm or assault.

Swipe-based dating applications use and its association with mental health outcomes: a cross-sectional study.

BACKGROUND: Swipe-Based Dating Applications (SBDAs) function similarly to other social media and online dating platforms but have the unique feature of "swiping" the screen to either like or dislike another user's profile. There is a lack of research into the relationship between SBDAs and mental health outcomes. The aim of this study was to study whether adult SBDA users report higher levels of psychological distress, anxiety, depression, and lower self-esteem, compared to people who do not use SBDAs. METHODS: A cross-sectional online survey was completed by 437 participants. Mental health (MH) outcomes included the Kessler Psychological Distress Scale, Generalised Anxiety Disorder-2 scale, Patient Health Questionnaire-2, and Rosenberg Self-Esteem Scale. Logistic regressions were used to estimate odds ratios of having a MH condition. A repeated measures analysis of variance was used with an apriori model which considered all four mental health scores together in a single analysis. The apriori model included user status, age and gender. RESULTS: Thirty percent were current SBDA users. The majority of users and past users had met people face-to-face, with 26.1%(60/230) having met > 5 people, and only 22.6%(52/230) having never arranged a meeting. Almost 40%(39.1%; 90/230) had previously entered into a serious relationship with someone they had met on a SBDA. More participants reported a positive impact on self-esteem as a result of SBDA use (40.4%; 93/230), than a negative impact (28.7%;66/230). Being a SBDA user was significantly associated with having psychological distress (OR = 2.51,95%CI (1.32-4.77)), p = 0.001), and depression (OR = 1.91,95%CI (1.04-3.52), p = 0.037) in the multivariable logistic regression models, adjusting for age, gender and sexual orientation. When the four MH scores were analysed together there was a significant difference (p = 0.037) between being a user or non-user, with SDBA users having significantly higher mean scores for distress (p = 0.001), anxiety (p = 0.015) and depression (p = 0.005). Increased frequency of use and longer duration of use were both associated with greater psychological distress and depression (p < 0.05). CONCLUSION: SBDA use is common and users report higher levels of depression, anxiety and distress compared to those who do not use the applications. Further studies are needed to determine causality and investigate specific patterns of SBDA use that are detrimental to mental health.