The future of the New Zealand plastic surgery workforce.

AIMS: The New Zealand (NZ) plastic and reconstructive surgery (PRS) workforce provides reconstructive plastic surgery (RPS) public services from six centres. There has been little analysis on whether the workforce is adequate to meet the needs of the NZ population currently or in the future. This study analysed the current workforce, its distribution and future requirements. METHODS: PRS manpower data, workforce activities, population statistics, and population modelling were analysed to determine current needs and predict future needs for the PRS workforce. The NZ PRS workforce is compared with international benchmarks. Regional variation of the workforce was analysed with respect to the population's access to PRS services. Future supply of specialist plastic surgeons is analysed. RESULTS: NZ has a lower number of plastic surgeons per capita than comparable countries. The current NZ PRS workforce is mal-distributed. Areas of current and emerging future need are identified. CONCLUSIONS: The current workforce mal-distribution will worsen with future population growth and distribution. Up to 60% of the NZ population will be at risk of inadequate access to PRS services by 2027. Development of PRS services must be coordinated to ensure that equitable and sustainable services are available throughout NZ. Strategies for ensuring satisfactory future workforce are discussed.

The rotating island pedicle flap: an aesthetic and functional improvement on the subcutaneous island pedicle flap.

BACKGROUND: The subcutaneous island pedicle flap is a useful closure in many areas on the face, particularly the cheek and upper lip. One disadvantage can be that the advancing edge of the flap leaves a scar at right angles to the local lines of relaxed skin tension. Tension on free edges such as the lid can also be a problem, but may be mitigated by incorporating an element of rotation into the closure. A variation on the subcutaneous island pedicle flap is described to help avoid the problems of the subcutaneous island pedicle flap while retaining its strengths. OBJECTIVE: Our experience with more than 120 rotating island pedicle flaps over 10 years is described to demonstrate the versatility of this subcutaneous island pedicle flap for facial and reconstructive surgery. METHODS: The technique is described and seven representative cases are presented with photographs. RESULTS: The flap is simple to perform, has minimal complications, and has good cosmetic results. Temporary alteration of sensation in the flap skin is a possible complication and can be largely avoided with a bipedicled dissection technique. CONCLUSION: Our experience shows the rotating island pedicle flap to be versatile, reliable, and aesthetic island pedicle flap for skin cancer surgery both on and off the face and a practical modification of the subcutaneous island pedicle flap.