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Clinical applications of these findings are currently limited to genetic testing for some of the common craniosynostosis syndromes, but the hope is that these conditions will one day be treated with a combination of minimally invasive procedures and gene therapy.

In a similar way, the complex cascade that determines upper-limb development is being unravelled. A number of important protein signals have been discovered and their role in upper-limb growth may provide therapeutic options in prevention of upper-limb anomalies.

Diagnosis. Malignant melanoma is one of the most common cancers in Australia, with the estimated risk of developing a melanoma before the age of 75 years in Australia being one in 26 for men and one in 36 for women. Management of melanoma saw dramatic changes through the 1990s, in particular with regard to safe excision margins. However, it remains an intense area of research. Studies are now in progress to look at the role of sentinel-node biopsy. This technique, first described in 1992,2 involves identification of the first draining lymph node from the primary melanoma site using a combination of radioactive tracer and patent blue dye. The technique has already been shown to be a good indicator of spread of melanoma to draining lymph nodes. This could provide prognostic information and direct adjuvant therapies, potentially treating early disease spread. It has the advantage of causing less morbidity than traditional block dissections. Currently, sentinel-node biopsy should be considered for any melanoma thicker than 1 mm, but only in the context of a controlled clinical trial.

Intervention. Chronic and other difficult-to-manage wounds remain a huge treatment challenge and cost burden to the community. One of the greatest advances has been the development of low-pressure dressings.3 These dressings consist of a non-collapsible evacuation tube connected to a sub-atmospheric pressure system, which is embedded within medical-grade reticulated polyurethane ether foam dressing.

This technique removes excess interstitial fluid, increases vascularity, decreases bacterial colonisation and aids the natural tendency of the wound to contract. Additionally, it is only changed every 72 hours, thus decreasing labour costs and patient discomfort.

Another area of wound care that is being developed and used by plastic surgeons is the determination of the precise biochemical processes that control wound healing. Already, the roles of a number of growth factors and cytokines have been defined. It is envisaged that during the 21st century new treatments will be developed to change cell function in a favourable way with the addition of positive growth factors and the removal or inhibition of negative growth factors. Some clinical trials have already been conducted using platelet-derived growth factor. Biochemical modification of wounds will have implications not only for treating chronic wounds, but also in preventing or controlling scarring.

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