A Reflection on My Elective Placement

I would like to thank the Hospital Saturday Fund who funded the awards at the University of Nottingham. I would also like to thank my parents for their support, the administration at the Royal Adelaide Hospital (Antonietta), Nicholas Lam the leader of the Plastics/Burns Department, all of the registrars who let me scrub in and all the lovely University of South Australia medical students I met along the way.

I truly enjoyed my experience at Royal Adelaide Hospital (RAH). Both the Plastics and Burns Departments are friendly, small teams, so you get to know everyone. You can feel the Aussie laid-back vibe permeate through conversations between the staff and the patients. Though relaxed, quality is not compromised, training is competitive and the registrars are highly skilled and experienced. The hospital’s infrastructure is refreshingly modern and I would absolutely recommend going down under to experience the Australian healthcare system and witness medical professionalism at one of the most expensive hospitals to be constructed.

Below is a diary of what I learnt each day and some photos from my elective placement. Thank you.

Day 1 – Plastics Operations

Learning points:

• Graft vs flap
• How to document yourself and scrub in, in Australian theatres
• Imbidement, Inosculation, Vascular regrowth
• Surgeons here love Xeroform gauze dressing

Below:; Main entrance to the Hospital at 06.45am, staff heading to work

 

 

Day 2 – Spent the day with the Hand Team and in Emergency Plastics Theatre

Learning points:

• Hand anatomy!
• Space of Perona
• Tendon repair techniques (including the Adelaide repair!)

 

Day 3 – Burns Department

Learning points:

• First burns surgery ever – temperature was very warm
• Saw burns debridement for first time
• Learnt about Biodegradable Temporising Matrix (BTM)
• Met Dr Shanks who had come from Nottingham Plastics Department to do her Burn Fellowship at the RAH. Talked to her about my F1 job in plastics and tips for ST3

 

 

Day 4 –Weekend on call with Plastics Registrar

Learning points:

• Was told to practice sutures more
• Saw the proper digital nerves

Below: Theatre in between surgeries; The Registrar kindly bought lunch!

 

 

Day 5 –Weekend on call with Burns Registrar 

Learning points:

• Met and connected with local and international students from University of South Australia on their Burns Electives
• Whole day spent operating on two teenage boys who suffered burns from bonfire incident
• Learnt that for Skin mesh rations 5/1 is ideal
• Nurse gave us expired BioBrane to study
• Saw what they do after debriding and BTM

 

 

Day 6 – Plastics Department 

Learning Points

• Flap criteria for lower limb trauma
• The length of time a flap should be done in Godina study and faults in it
• VY flap technique
• Post-op notes layout
• Rounded corners on hypafix to prevent the corners from lifting

 

 

Day 7 – Plastics Department

Learning Points

• Team Teaching – facial fracture audit plastics, LeFort fractures
• Met Head of Plastics (Mr Y Caplash) & Prof of Neurosurgery (Prof A Abdou-Hamden)
• Big 9-hour surgery combo with Neurosurgeons
• Got to see my first free flap and saw microanastomosis with both coupler and sutures
• Learnt how to control OR screens and use them to display the MRI
• Lots of pushing glasses up for the consultant!

 

 

Day 8 – Plastics Department 

Learning Points

• Team Teaching – oral maxfax facial fractures trauma audit
• Difference between benign skin tumours and malignant skin cancers
• Learnt how to use skin meshing machine

 

 

Day 9 – Burns Department 

Learning Points

• Bonfire-related burns are much more common in winter as there is a ban during summer
• Reasons for meshing skin graft
• Hypafix (oil based adhesive) vs Mefix (water based adhesive)

 

 

Day 10 – Plastics Department

Learning Points

• BioBrane is porcine based, so some religions do not want it, alternative = EpiProtect
• BioBrane vs EpiProtect