Mark Ashton

Mark Ashton
University of Melbourne | MSD · Biomedical Sciences Academic Centre

Doctor of Medicine

About

185
Publications
29,443
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
5,321
Citations
Citations since 2016
25 Research Items
2861 Citations
20162017201820192020202120220100200300400
20162017201820192020202120220100200300400
20162017201820192020202120220100200300400
20162017201820192020202120220100200300400
Introduction
Skills and Expertise

Publications

Publications (185)
Chapter
This chapter presents an overview of the deep inferior epigastric perforator (DIEP) flap in breast reconstruction. The vascular basis of the DIEP flap and surgical technique are described in detail. Planning, preoperative investigations, and how to select the ideal perforator are discussed. Tips to avoid complications are also presented.
Article
Full-text available
From early on in the development of plastic surgery, it was quickly realized that utilizing locally adjacent tissue, or "matching like with like," yielded superior aesthetic reconstructions to those in which the tissue was derived from a distant location. In many cases, the use of a local perforator flap is a simpler procedure with less patient mor...
Article
Full-text available
It is not hard to list some of the profound effects COVID-19 has had on the specialty of plastic surgery. World-wide many of our colleagues have suffered serious illness and many have died. Even in countries like Australia and New Zealand, relatively spared from the ravages of the disease, we have all had significant disruptions to our lives and p...
Article
Full-text available
Background: It has been proposed that hyperperfusion of perforators and distension of anastomotic vessels may be a mechanism by which large perforator flaps are perfused. This study investigates whether increasing perfusion pressure of radiographic contrast in cadaveric studies altered the radiographic appearance of vessels, particularly by disten...
Article
Introduction: Blindness following facial filler procedures, although rare, is devastating, usually acute, permanent, and attributed to an ophthalmic artery embolus. However, blindness may be delayed for up to 2 weeks, sometimes follows injection at remote sites, suggesting alternative pathways and pathogenesis. Methodology: Seeking solutions, fr...
Chapter
This chapter provides a brief overview of the origins of plastic surgery and its evolution from the battlefields of the First World War. The chapter explains the basic principles fundamental to plastic surgery and explains the techniques used to close wounds and transfer tissue around the body.
Chapter
This chapter provides an overview of the fungal and bacterial infections of the extremities. The most common infections are described, along with the causative organisms, the relevant symptoms and signs, and the principles of management.
Article
Background: Vascularised composite allo-transplantation (VCA) is emerging as a tailored approach for complex tissue reconstruction. This study focuses on the quadriceps VCA as a potential solution for tissue repair, following trauma, necrotising fasciitis/myositis, or tumor ablation. Methods: Dissections were undertaken in 10 adult cadaveric low...
Article
Is our speciality vulnerable to "groupthink"? Probably so. We are a relatively small and cohesive group, from similar backgrounds, who believe in our own inherent morality. It is important to remember that some of the techniques we are using today may be modified or even totally reversed in time and so it is imperative that we, as a specialty, con...
Article
Background: Most target areas for facial volumization procedures relate to the anatomical location of the facial or ophthalmic artery. Occasionally, inadvertent injection of hyaluronic acid (HA) filler into the arterial circulation occurs, and unrecognised, is irreparably associated with disastrous vascular complications.Of note, the site of compl...
Article
Introduction: Due to a longstanding controversy over the perfusion reliability of zone IV current this area is routinely discarded despite the mechanism behind zone IV necrosis not being fully understood. The authors review and investigate the vascular anatomy of zone IV with the aim of outlining the reasons for necrosis.Methods: A literature searc...
Article
Full-text available
Introduction: Due to a longstanding controversy over the perfusion reliability of zone IV current this area is routinely discarded despite the mechanism behind zone IV necrosis not being fully understood. The authors review and investigate the vascular anatomy of zone IV with the aim of outlining the reasons for necrosis.Methods: A literature searc...
Article
Background: The angiosome is a three-dimensional block of tissue supplied by a source vessel with its boundary outlined either by an anastomotic perimeter of reduced-caliber choke vessels or by true anastomoses with no reduction of vessel caliber. This article focuses on the role of these anastomotic vessels in defining flap survival or the necrot...
Article
Background: As we enter an age with new approaches to tissue reconstruction, the emphasis on the adage "like for like" has become even more relevant. This study illustrates the potential for several tailored vascularized composite allotransplantation reconstructive techniques and, in particular, for the management of Volkmann contracture. Methods...
Article
Background: The lower limb is a source of many flaps both for closure of local defects and for free transfer. Fasciocutaneous flap techniques have been progressively refined, although the vascular basis for their success needs clarification. Methods: Archival studies of 48 lower limbs were reviewed and combined with 20 studies of lower limbs fro...
Article
Background: There are minimal data in the literature regarding the lymphatic drainage of the conjunctiva and lower eyelid and the relationship with postoperative chemosis and edema. Methods: Injection, microdissection, and histologic and radiologic studies were conducted on 12 hemifacial fresh cadaver specimens. Indocyanine green lymphography wa...
Article
Background: With the advancements in technology and microsurgical techniques lymphovenous anastomosis (LVA) has become a popular reconstructive procedure in the treatment of chronic lymphedema. However the long-term patency of these anastomoses is not clear in the literature. Methods: A systemic review of the MEDLINE and EMBASE databases was don...
Article
Background: The first successful free vascularized bone flap was performed on June 1, 1974 (and reported in 1975), using the fibula. This was followed by the iliac crest based on the superficial circumflex iliac artery in 1975 and then the deep circumflex iliac artery in 1978. Methods: A total of 384 transfers using fibula (n = 198), iliac crest...
Article
Over the past decade, lymph node transfer has rapidly gained popularity among plastic surgeons for the treatment of chronic lymphedema because of the initial promising results and its unique technical advantages compared with the other reconstructive options. However, its functional mechanism is still a matter of great debate, and some concerning r...
Article
Background: The superior thyroid artery perforator flap has been presented previously in this Journal as a locoregional flap that provides an excellent tissue match with minimal donor morbidity for lateral face and temple defects. In the current study, the authors aimed to describe the microvascular anatomy of this flap. Methods: The authors use...
Article
The course of the cutaneous lymphatic collectors of the abdominal wall in relation to the Scarpa fascia is unclear in the literature. Preserving the Scarpa fascia in the lower abdomen to reduce the seroma rate following abdominoplasty has been suggested based on the assumption that the lower abdominal lymphatics run deep to this layer along their e...
Article
Background: There are minimal data in the current literature regarding the depth of the superficial lymphatic collectors of the limbs in relation to the various subcutaneous tissue layers. Methods: Injection, microdissection, radiographic, and histologic studies of the superficial lymphatics and the subcutaneous tissues of 32 limbs from 15 human...
Article
Previous studies of venous anatomy lack the detail of their arterial counterparts due to (i) the technical challenge of retrograde perfusion against competent valves and (ii) anterograde venous perfusion that fails to capture significant portions of the area of interest. A novel technique, retrograde hydrogen peroxide (H2O2) priming, dilates veins...
Article
The fascial system of the breast has, to date, only been described in general terms. This anatomical study has developed two distinct methods for better defining existing breast structures such as the inframammary fold, as well as defining previously unnamed ligamentous structures. The authors harvested and examined 40 frozen, entire chest wall cad...
Article
In a comprehensive review of 17,096 deep inferior epigastric perforator (DIEP) flaps in 693 articles published between the first description of the DIEP flap in 1989 and August of 2011, the authors found that the methods used to categorize partial necrosis and fat necrosis were inconsistent. As a result, these surgical outcomes cannot be meaningful...
Article
Reports of more than two cutaneous perforator angiosome territories being raised successfully in distally based sural flaps are appearing in the literature. Previous anatomical studies have noted that cutaneous arteries, connected by true anastomosis without change in caliber, frequently parallel cutaneous nerves. Twenty-four (48 sides) total body...
Article
Cadaveric studies have revealed that cutaneous perforators are linked by either reduced-caliber "choke" arteries, or by vessels without change in caliber, the true anastomoses. These true anastomotic vessels are often found in parallel with the cutaneous nerves and accompanying veins, and are associated both experimentally and clinically with large...
Article
Full-text available
The supraclavicular flap has re-emerged as a feasible option for head and neck reconstruction where a thin, pliable donor tissue is required or where free flap techniques may impose too great a surgical risk in frail patients. Whilst our understanding of the vasculature of this flap has improved immensely, the microvasculature and in particular the...
Article
subject. Methods: The evidence supporting the use of various modalities of imaging was investigated by performing focused searches of the PubMed and Medline databases. The articles were ranked according to the criteria set out in March 2009 Oxford Centre for Evidence-Based Medicine definitions. Endpoints comprised objective outcome data supporting...
Article
Postoperative spinal wound dehiscence is a significant complication following the posterior midline approach. It is postulated that this approach disrupts the vasculature supplying the paraspinal muscles and overlying skin. Although the spinal vasculature has been investigated previously, the smaller arterioles have not been described in the contex...
Article
Despite the widespread use of autologous fat grafting in both reconstructive and cosmetic surgery, volume retention remains a significant problem. We aimed to critically appraise the current body of literature in fat grafting to provide a framework to guide application and comparison. Search of scientific databases and gray literature was conducted...
Article
Background: The recent advent in the surgical treatment of lymphedema necessitates a more detailed understanding of the anatomy of the lymphatic system. Lymphovenous anastomosis (LVA) requires a precise knowledge of the anatomy of the superficial lymphatic collectors in relation to the superficial veins. In vascularized lymph node transfer (VLNT),...
Article
In recent times, there has been evolving interest in the fascial structure of the ear, especially in relation to otoplasty techniques. Although the fascial tissues used in these procedures are referred to as "postauricular/retroauricular fascia," the sparse anatomical studies that exist use this terminology to describe what is the adjacent thicker...
Article
Full-text available
Background: Understanding of the temporal region remains confused, largely because of the ambiguous nomenclature. Aspects of the anatomy also remain unclear and are variably reported in the literature. The aim of this study was twofold: (1) to clarify details of the anatomy, using fresh cadaver dissections; and (2) to propose a standardized nomenc...
Article
Full-text available
Tumor metastasis to lymph nodes is a key indicator of patient survival, and is enhanced by the neo-lymphatics induced by tumor-secreted VEGF-C or VEGF-D, acting via VEGFR-3 signalling. These targets constitute important avenues for anti-metastatic treatment. Despite this new understanding, clinical observations linking metastasis with tumor depth o...
Article
We undertook a review of the anatomical changes of "choke" vessels between the internal thoracic artery (ITA) and deep inferior epigastric artery (DIEA), as highlighted by a case of aortoiliac occlusive disease (Leriche's syndrome), and discuss the physiological concepts observed with regard to surgical delay procedures within the abdominal wall pe...
Article
Background: Despite a plethora of monitoring techniques reported in the literature, only a small number of studies directly address clinical relevant end points, such as the flap salvage rate and false-positive rate. Method: We conducted a systematic review of current evidence regarding the postoperative monitoring of microvascular free-tissue t...
Article
Breast reconstruction plays a highly important role in the management of patients with breast cancer, from a psycho-social and sexual stand-point. Given that immediate breast reconstruction does not impair the oncologic safety of breast cancer management, with no increase in local recurrence rates, and no delays in the initiation of adjuvant chemot...
Article
Background: Despite improving outcomes, venous problems in the harvest of deep inferior epigastric artery perforator (DIEP) flaps remain the more common vascular complications. However, it is apparent that the venous anatomy of the anterior abdominal wall has not been described to the same extent as the arterial anatomy. Cadaveric dissection studi...
Article
Perforator flap nomenclature continues to evolve, with many classification schemes reported. Each of them focuses on the fascial penetration pattern of perforators, which has no impact on flap perfusion. With the advent of advanced imaging technologies, the subcutaneous course of perforators can be highlighted for the first time, offering new insig...
Article
Historically, dissection of the temporoparietal fascia immediately above the zygomatic arch has been avoided due to the risk of transection of the temporofrontal rami of the facial nerve. A total of 8 fresh cadaveric hemi-faces have been dissected to investigate the relationship of the temporofrontal rami of the facial nerve to the fascial layers i...
Article
Although preoperative imaging of perforator vasculature in planning microvascular reconstruction is commonplace, there has not been any clear demonstration of the evidence for this practice, or data comparing the many available modalities in an evidence-based approach. This article aims to provide an objective, evidence-based review of the literatu...
Article
Aims: Important prognostic factors in patients with cutaneous melanoma include primary tumour thickness/depth of invasion, ulceration and mitotic rate, and the presence of tumour cells in regional lymph nodes. More recently, features of stromal components, such as blood and lymphatic vessel density, have been suggested as additional indicators of...
Article
Muscle (M) and fasciocutaneous (FC) free flaps are frequently used options in the reconstruction of traumatic lower limb injuries. The use of one flap over another has remained the topic of controversy in the literature. With a large experience, we sought to evaluate key outcomes of M versus FC free flap reconstructions in lower limb trauma in a si...
Article
Although a surgical insult may substantially alter local vascular anatomy within tissues, studies that have clearly demonstrated these changes as being dynamic phenomena have not been widely reported. The current study aimed to explore the changes in abdominal wall vasculature after a surgical insult. The arterial and venous anatomy of both the dee...
Article
Full-text available
Mastectomies are one of the most common surgical procedures in women of the developed world. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. This study quantifies the...
Article
Lore's fascia and the platysma-auricular ligament are discreet fascial structures anterior and inferior to the auricle respectively. The nomenclature and descriptions of these structures have been presented inconsistently in the literature. There is also concern that placement of platysma suspension sutures into these structures may risk damage to...
Article
Unlabelled: The redundant tissues of the anterior neck are well suited as a donor site for fasciocutaneous flaps in head and neck reconstruction, with similar skin quality and numerous underlying perforators. However, historic cadaveric research has limited the use of this as a donor site for the design of long and/or large flaps for fear of vascu...
Article
Full-text available
The internal thoracic (IT) vessels (otherwise known as the thoracica interna or internal mammary vessels) are widely used as recipient vessels in autologous breast reconstruction. Despite this, normal and pathological variations in IT artery architecture have been described, and these have the potential to complicate dissection and the selection of...
Article
To identify possible avenues of sparing the internal mammary artery (IMA) for coronary artery bypass grafting (CABG) in women undergoing autologous breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. Optimal autologous reconstruction of the breast and coronary artery bypass grafting (CABG) are often mutually exclusiv...
Article
Since the birth of reconstructive microvascular surgery, attempts have been made to shorten the operative time while maintaining patency and efficacy. Several devices have been developed to aid microsurgical anastomoses. This article investigates each of the currently available technologies and attempts to provide objective evidence supporting thei...
Article
The deep circumflex iliac artery (DCIA) is rarely used as a perforator flap, despite a clear clinical need for thin osteocutaneous flaps, particularly in head and neck reconstruction. The poor adoption of such a flap is largely due to a poor understanding of the perforators of the DCIA, despite recent publications demonstrating suitable vascular an...
Article
The timing of soft tissue reconstruction for severe open lower limb trauma is critical to its successful outcome, particularly in the setting of exposed metalware and pre-existing wound infection. The use of negative pressure wound therapy (NPWT) may allow a delay in soft tissue coverage without adverse effects. This study evaluated the impact of d...