Reducing Opposed Multilobed Flaps Results in Fewer Complications Than Traditional Repair Techniques When Closing Medium-Sized Defects on the Leg after Excision of Skin Tumor

BACKGROUND: The reducing opposed multilobed (ROM) flap involves a series of transpositions effected cephalic and caudal to the primary defect, sequentially mobilized toward and then into the primary defect. OBJECTIVE: To compare the ROM flap with other techniques to close defects below the knee after excision of skin tumor. METHOD: This retrospective study compares 140 defects closed with a ROM flap with 85 defects closed with traditional techniques. RESULTS: A total of 225 defects between 11 and 44 mm in diameter were excised over 3 years from July 1, 2002. There were 140 defects closed by ROM flap and 85 non-ROM closures including 29 "O-to-Z" flaps and 12 bilateral transposition flaps. A total of 111 squamous cell carcinomas, 64 basal cell carcinomas, and 11 melanoma were excised. ROM flap closures developed 20 complications (14.3%): 13 infections, 5 partial dehiscence, and 2 partial end flap necrosis. Non-ROM closures developed 27 complications (31.8%): 13 infections, 6 partial end flap necrosis, 4 partial dehiscence, 2 wound depression, 1 hemorrhage, and 1 persisting pain. Three ROM and 7 non-ROM cases suffered two complications. The total complication rate was significantly lower with ROM flaps (p=.003), including lower end flap necrosis incidence (p=.027). CONCLUSION: The ROM flap results in fewer complications than traditional techniques when closing defects 11 to 45 mm in size on the leg and foot. In particular, end flap necrosis incidence is lower with ROM flap closure.     

Overseas Visitor Deaths in Australia, 2001 to 2003

Background.  The health and safety of international visitors remain an important issue for Australia and other tourist destinations. The death of visitors remains an important indicator of safety. The aim of this study was to provide updated figures on deaths of overseas travelers in Australia.
Methods.  Data were sourced from the Australian Bureau of Statistics concerning deaths of overseas visitors for the years 2001 to 2003.
Results.  There were 1,068 overseas visitor deaths (701 males, 66%) during the study period 2001 to 2003. Death by natural causes increased with age, while deaths associated with accidents were more frequent among younger age groups. The majority of deaths were from natural causes (782, 73%), particularly ischemic heart diseases (26%). There were a total of 247 accidental deaths (23% of all deaths) with the main causes being transportation accidents (14% of all deaths) and accidental drowning/submersion (5% of all deaths). The countries contributing the most deaths were the UK (247, 23%), New Zealand (108, 10%) Melanesia/Micronesia (95, 9%), and the United States (57, 5%).
Conclusions.  Australia remains a relatively safe destination for international travelers, at least in terms of fatalities, which appear to be declining. Most deaths of overseas tourists in Australia are due to natural causes with cardiovascular disease being the predominant cause of death in this group. Accidents remain the most common preventable cause of death of travelers, with road and water safety being the major issues. It is important that tourism and travel medicine groups continue to advocate for improved health and safety of international travelers visiting Australia.