Introduction and aims. We present a series of patients who have had secondary reconstruction of war injuries to the upper and lower limbs, sustained during the Iraq and Afghanistan conflicts. Material and Methods. All patients were seen at the combined Peripheral Nerve Injuries Clinic at the Defence Medical Centre for Rehabilitation, Headley Court. All surgery was performed at Odstock Hospital. Procedures include scar excision and neurolysis (all patients), release of scar contractures, tenolysis, tendon transfers, revision nerve grafts, excision of neuroma, and soft tissue reconstruction using pedicled or free flaps. Results. 24 patients have been treated at the time of submission. We have used 13 free flaps (1 free groin flap, 9 anterolateral thigh, 3 parascapular, with 4 as through-flow flaps) and 1 pedicled groin flap, with no flap losses. There were 6 amputation stump revisions (1 above elbow, 5 below knee). The majority (n=23) have had nerve recovery distal to the level of injury following revision surgery. Conclusions. Nerve repairs recover following neurolysis (and revision nerve graft if necessary) with provision of good soft tissue cover. Release of scar contractures with flap cover allows healing of chronic wounds and permits mobilisation of joints. Thin fascio-cutaneous flaps provide good contour and can be elevated more easily than skin grafted muscle flaps for secondary surgery. Free or regional flaps are preferable to local flaps in high energy-transfer military wounds. Immediate complex reconstruction is not always appropriate in multiply-injured patients

The Rotator Cuff Registry is a unique initiative of the New Zealand Shoulder & Elbow Society. The aim of the study was to enrol nationwide all patients undergoing rotator cuff repair over a 22 month period to provide best practice guidelines for management of rotator cuff tears. To qualify for the Registry patients have to undergo surgical repair of either a partial or full thickness rotator cuff tear. Prior to surgery patients fill out a registration document as well as a pain score and Flex-SF function score. The Surgeon completes an operating day questionnaire detailing operative findings and repair methods. Follow-up is by pain and Flex-SF function scores returned at six, twelve and twenty-four months from surgery. By the 31st December 2010 3000 patients had been recruited. Analysis of the first 2684 patients for the purpose of this abstract showed 70% Male and 30% female. The dominant arm was involved in 65%. 19% of patients were in high demand occupations, 27% in medium demand and 33% low demand occupations. 16% of patients were treated with all arthroscopic repair, 40% were mini-open and 44% open. Comparing pre-op and one year post-op activity scores by surgical approach the Flex-SF improved by 12.97 points in the arthroscopic group, 13.3 in the mini-open and 12.72 in the open (NSS). Pre-op, 6 mth and 12mth pain scores were arthroscopic 4.60, 1.81 and 1.57, mini-open 4.34, 2.15 and 1.52 and open 4.82, 2.27 and 1.86. Preoperatively, the open approach had statistically more pain than the mini-open. At 6 months the arthroscopic group had statistically less pain than the open and at twelve months the mini-open had statistically less pain than the open group. For all tear sizes significant improvements in Fex-SF were seen both from preoperative levels to 6 month follow-up and from 6–12 month follow-up. A labral tear was present in 12% and repaired in 25% of these. No difference was seen in outcome between these groups Biceps tenolysis was undertaken in 27% and tenodesis in 23%. A single row repair was selected in 44% and a double row in 56%. Double row repair resulted in better Flex-SF scores in the large tears. Six, twelve and some twenty-four month data will be presented. Outcome was unaffected by the surgical approach with arthroscopic, mini-open and open results essentially identical