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Introduction Thyroid lobectomy is recommended with total laryngectomy in the National Comprehensive Cancer Network guidelines. However, it is associated with a 32% to 89% risk of hypothyroidism, which is a problem for patients without access to thyroid hormone monitoring and replacement. A number of studies have reported a low incidence of thyroid gland involvement and recommended preserving the thyroid gland in favorable cases. Yet there are no studies that report whether thyroid preserving laryngectomy for laryngeal cancer adversely affects oncologic outcomes compared to patients who have undergone thyroid lobectomy. Objectives To determine whether patients who underwent thyroid gland preserving laryngectomy had higher local recurrence rates or poorer disease-free survival. Method A retrospective folder review of patients who underwent a total laryngectomy over a 12-year period was conducted. Local recurrence and disease-free survival were determined for patients who had both their thyroid lobes preserved and compared with those who had a thyroid lobectomy. Results Sixty-nine patients had thyroid preserving laryngectomy and 73 patients had a thyroid lobectomy. The duration of follow-up was 18 to 132 months (median, 30; IQR, 30). There was no significant difference in local recurrence rates (P = .76) or survival curves between the two groups. Conclusion Thyroid preserving laryngectomy in selected patients with advanced laryngeal carcinoma does not increase local recurrence rates, nor does it negatively affect disease-free survival. Thyroid preservation is appropriate when intraoperative inspection of the larynx shows no extralaryngeal extension or when paratracheal nodal metastases are not a concern. Level of evidence Level 4 Laryngoscope, 130:1465-1469, 2020.

Although general principles of pressure wound management begin with optimisation of patient and wound factors to promote healing, refractory cases may require surgical intervention. Compared with other areas, ischial tuberosity (IT) wounds tend to occur in wheelchair-bound patients and may respond well to surgical debridement and flap reconstruction where added tissue bulk is preventative for further pressure ulcer formation. IT ulcers may occur in patients with some degree of ambulatory potential or those who have a temporary impairment. While the most commonly used flap for typical IT ulcers is the musculocutaneous hamstring flap, for these patients, this is not suitable due to the sacrifice of muscle function. We designed a combined posterior thigh flap with pedicled gracilis to provide robust coverage and vascularised muscle bulk, while preserving hamstring function and potential for re-advancement in ulcer recurrence. Patients were selected for their grade of ulcer, compliance with physiotherapy, and their need to preserve muscle function. Each underwent surgical debridement and reconstruction using the combination flap. End-points included wound coverage, post-operative mobility, and complications. Follow-up was 3 months post-surgery. All patients achieved complete coverage of their wound. In the follow-up period, there were no wound complications or ulcer recurrence. We describe a novel reconstruction method for IT pressure ulcers that maintains patient mobility. This combination perforator-based fasciocutaneous and gracilis flap is a superior reconstructive option that has reduced donor site morbidity and relatively simple operative technique and can be reutilised in ulcer recurrence. Level of Evidence: Level V, therapeutic study.

The Australasian Students' Surgical Association (ASSA) is a not-for-profit, student-run organization supporting the 26 student surgical societies across Australia and New Zealand. It fosters interest in surgery through positive surgical experiences, insight into surgical careers and by developing technical and non-technical skills. Further background about the history and activities of ASSA are detailed elsewhere.1 The year 2020 has seen many societal challenges, notably the COVID-19 crisis, declared a pandemic by the World Health Organization on 11 March 2020.2 There have been significant downstream ramifications for medical students as learning opportunities in the operating theatre, at the bedside and in formal institutional settings become limited.3 In addition, travel restrictions and social distancing recommendations have led to the cancellation or postponement of many face-to-face courses and conferences.3 ASSA has responded to these changes to provide surgically inclined students with opportunities to learn about surgery, in turn serving as models of organizational adaptability in rapidly evolving times.

Protein C circulates in human plasma to regulate inflammation and coagulation. It has shown a crucial role in wound healing in animals, and low plasma levels predict the presence of a wound in diabetic patients. However, no detailed study has measured protein C levels in patients with severe burns over the course of a hospital admission. A severe burn is associated with dysfunction of inflammation and coagulation as well as a significant risk of morbidity and mortality. The current methods of burn assessment have shortcomings in reliability and have limited prognostic value. The discovery of a biomarker that estimates burn severity and predicts clinical events with greater accuracy than current methods may improve management, resource allocation and patient counseling. This is the first study to assess the potential role of protein C as a biomarker of burn severity. We measured the plasma protein C levels of 86 patients immediately following a severe burn, then every three days over the first three weeks of a hospital admission. We also analysed the relationships between burn characteristics, blood test results including plasma protein C levels and clinical events. We used a primary composite outcome of increased support utilisation defined as: a mean intravenous fluid administration volume of five litres or more per day over the first 72 h of admission, a length of stay in the intensive care unit of more than four days, or greater than four surgical procedures during admission. The hypothesis was that low protein C levels would be negatively associated with increased support utilisation. At presentation to hospital after a severe burn, the mean plasma protein C level was 76 ± 20% with a range of 34–130% compared to the normal range of 70–180%. The initial low can be plausibly explained by impaired synthesis, increased degradation and excessive consumption of protein C following a burn. Levels increased gradually over six days then remained at a steady-state until the end of the inpatient study period, day 21. A multivariable regression model (Nagelkerke’s R2 = 0.83) showed that the plasma protein C level on admission contributed the most to the ability of the model to predict increased support utilisation (OR = 0.825 (95% CI = 0.698-0.977), P = 0.025), followed by burn size (OR = 1.252 (95% CI = 1.025–1.530), P = 0.027), burn depth (partial thickness was used as the reference, full thickness OR = 80.499 (1.569–4129.248), P = 0.029), and neutrophil count on admission (OR = 1.532 (95% CI = 0.950–2.473), P = 0.08). Together, these four variables predicted increased support utilisation with 93.2% accuracy, 83.3% sensitivity and 97.6% specificity. However if protein C values were disregarded, only 49.5% of the variance was explained, with 82% accuracy, 63% sensitivity and 91.5% specificity. Thus, protein C may be a useful biomarker of burn severity and study replication will enable validation of these novel findings.