The Australian Society of Plastic Surgeons and NT Health collaborated to provide specialist plastic surgery services to the Northern Territory. Since 2020, this partnership has enabled some of Australia’s top plastic surgeons to work on a rotational basis at both Royal Darwin Hospital and Palmerston Regional Hospital. During their rotations, specialist plastic surgeons perform procedures and mentor local surgeons, helping them enhance their skills. One case is detailed below, sharing insights from a case involving a complex lower limb reconstruction.

Dr. Shahriar Raj Zaman, a specialist plastic surgeon has spent considerable time working in Darwin and continues to visit regularly. Dr. Zaman shares a complex lower limb reconstruction, highlighting the challenges of performing surgery in a regional area like Darwin.

Q1. Can you give us some background on your patient?

This case involved a 41-year-old male from a community outside Darwin. The patient sustained a foot injury after stepping on a sharp object, which led to a severe infection. Initially, a forefoot amputation was necessary to control the infection. Further tests then revealed the patient had undiagnosed Type II diabetes, which contributed to the severity of the infection.

Before surgery, I had several discussions with the patient about the extent of the injury and the complex lower limb reconstruction required to save the remainder of his foot. In cases like this the reality of a below knee amputation is real. The patient was highly motivated to preserve his foot, as using a prosthesis & a wheelchair in his community posed significant challenges.

Q2. What type of reconstructive surgery did the patient require?

The patient required a free flap reconstruction. A procedure typically used in complex cases where simpler methods aren’t sufficient due to the exposure of vital structures like bones and tendons. We began by thoroughly cleaning the infected wound and removing dead tissue to assess the size of the defect. Next, we performed a free tissue transfer. We used skin and fat from the patient’s other thigh to cover the exposed tendons and metatarsal bones. Finally, we completed microsurgery to reconnect the blood vessels to the remaining foot.

Q3. What were the unique challenges of performing this surgery in a regional area like Darwin?

Performing a complex lower limb reconstruction surgery in Darwin presented several challenges:

Patient Demographics & Cultural Awareness: In regional areas, it’s vital to tailor treatments to a patient’s understanding and cultural background. Patients need to fully comprehend and carefully follow post-operative care instructions for optimal outcomes. If there is doubt, alternative procedures may need to be considered. It is also important to form treatment and care in the context of a patient’s cultural needs where community roles and acceptance play a big part in successful outcomes after surgery.

Limited Specialised Nursing Staff: Free flap surgeries require vigilant post-operative monitoring, especially in the first 72 hours. In regional hospitals like those in Darwin, where these surgeries are not as common, nurses may need additional training to identify potential complications early.

Access to Specialised Services: Without sufficient plastic surgery services in Darwin, patients may be displaced from their home to pursue reconstructive surgery interstate, or they may face more drastic options, like amputation in this case, to remain close to home.

Q4. What was the outcome of the surgery on your patient?

The free flap reconstruction was successful. After a seven-day hospital stay and close follow-up, the patient’s reconstruction fully integrated, and he is now able to walk with modified footwear. Although the patient no longer has toes on his right foot, the procedure preserved his ability to function and walk without requiring a prosthetic leg.

Q5. What do you enjoy most about working in Darwin?

Darwin is a fantastic place to work! Aside from its stunning waterfront views, beautiful sunsets, and vibrant multicultural food scene, there’s a real sense of community among healthcare professionals. Many visiting medical officers, like myself, are drawn to the opportunity to make a meaningful contribution to the people of Darwin. I would highly recommend any healthcare professional considering it to take the leap – working in Darwin is both rewarding and fun!

For further information, please see: Whitton T, Zaman SR, Farrell G. The ASPS Darwin workforce project: past, present and future. Australasian Journal of Plastic Surgery. 2024;7(2).

The Australian Society of Plastic Surgeons Partners with NT Health to Bring Specialist Plastic Surgeons to the Top End. Read more about the program here.

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