Bruce R Johnstone Deputy Director - Clinical Operations

  • M.B.B.S., F.R.A.C.S.

    Plastics - Bruce Johnson

    Special Interests

    Paediatric Hand Surgery, Cerebral Palsy in the Upper Limb, Salivary Control Surgery, Reconstructive Microvascular Surgery,  Brachial Plexus Surgery, Peripheral Nerve Surgery

    Education

    1976-1981

    M.B.B.S - University of Melbourne

    1981-1982 Internship, General Surgery - Austin Hospital, Melbourne
    1982-1983 Junior Resident, General Surgery - Austin Hospital, Melbourne
    1983-1984 Senior Resident, General Surgery - Austin Hospital, Melbourne
    1984-1985 Registrar, General Surgery - Austin Hospital, Melbourne
    1985-1986 Registrar, Plastic Surgery - Peter MacCallum Hospital, Victorian Plastic Surgery Unit, Melbourne
    1986-1987 Registrar, Plastic Surgery - Royal Children's Hospital, Melbourne
    1987-1988 Registrar, Plastic Surgery - Royal Melbourne Hospital, Melbourne
    1989-1990 Fellowship, Plastic Surgery - Emory University, Atlanta, Georgia, USA
    1990-1991 Fellowship, Hand and Microsurgery, University of Utah, Salt Lake City, Utah, USA

    Certification

    1987 Foreign Medical Graduate Examination in Medical Sciences (USA)
    1990 Fellow, Royal Australasian College of Surgeons
    1990 Federal Licensing Examination (USA)

    Academic Appointments

    1998-2006 Examiner, Plastic and Reconstructive Surgery - Royal Australasian College of Surgeons
    2004 Associate Professor, Department of Paediatrics, University of Melbourne

    Hospital Appointments

    Deputy Director - Clinical Operations, Department of Plastic and Maxillofacial Surgery - Royal Children's Hospital, Melbourne
    Honorary Plastic Surgeon - Royal Melbourne Hospital
    Consultant Plastic Surgeon, Victorian Plastic Surgery Unit - Mercy Hospital, Melbourne
    Consultant Plastic Surgeon - Francis Perry House (Royal Women's Hospital), Carlton
    Consultant Plastic Surgeon - Cliveden Hill Hospital, East Melbourne
    Consultant Plastic Surgeon - Freemasons Hospital, East Melbourne

    Societies

    Australian Society of Plastic Surgeons
    Australian Hand Surgery Society
    Australasian Society of Aesthetic Plastic Surgery
    Australian Association of Surgeons
    Australian Medical Association
    American Society of Plastic Surgeons (corresponding member)
    Jurkiewicz Society, Atlanta Georgia U.S.A.

    Research projects

    1. Refinement of the vertical scar in Lejour mammaplasty, modifications and the management of large post lumpectomy and irradiated breasts as well
    as the contralateral breast in carcinoma.

    2. Proximal interphalangeal joint arthroplasty: Optimising the results, long term follow-up and first international notification of problems of loosening of uncemented
    implants. Ongoing prospective study since 1997 now with 55 implants

    3. Obstetric brachial plexus palsy in collaboration with David McCombe and Michael Johnson (Orthopaedic Surgery)
    a. Development and evaluation of preoperative MRI and neonatal spinal cord ultrasound with RCH Radiology.
    b. Standardization of cross-sectional histology, grading, axon counts, frozen section with RCH Anatomical Pathology and
    Sick Children's Hospital, Toronto.
    c. Systematic OBPP literature reviews with Physiotherapy at RCH and Melbourne University.
    d. Early intervention for shoulder dysfunction and deformity including role of botulinum toxin A treatment of co-contraction and contractures
    e. 3D Video movement analysis
    f. Database - Matched pain outcome and other studies.

    4. Upper Limb Surgery in Cerebral Palsy
    a. 'The Melbourne Assessment' further prospective evaluation with Occupational Therapy, RCH
    b. Botulinum toxin and aggressive splinting to lengthen spastic forearm muscles.

    5. Tongue tie and Z-plasty with Joyce Alley, Speech Pathology
    a. Prospective study of intra-operative tongue length measurement before and after release and Z-plasty with clinical outcome study.
    b. Normal tongue length in children: Ethics committee approved study in normal children undergoing general anaesthesia-20 children of each year of life up to 12 years
    required to produce a 'percentile chart' of normal tongue length.

    6. The effects of the FRACS Part 2 Video on the preparation and success of candidates presenting for the exam with the Department of Academic Services RACS

    7. Botox for drooling with members of the Salivary Control Clinic. In a pilot series we confirmed, ,the efficacy in children of injecting the parotid and submandibular glands
    with botulinum toxin. Approximately 20% of patients do not obtain a satisfactory response from the surgery. We are investigating whether this group can be predicted by
    a preliminary trial of botulinum toxin. A prospective randomised controlled trial commenced at RCH in 2004.

    8. Long term outcome of profundus shortening in pollicisation

    9. Kirner's deformity surgery

    10. Carroll bone grafts Applications and donor site morbidity

    11. Splinting for camptodactyly

    12. Swan neck correction in the spastic hand

    13. Intra-operative bipolar nerve stimulation

    Contact details

    Royal Children's Hospital Private Rooms

    Department of Plastic and Maxillofacial Surgery
    4th Floor, Main Building
    Flemington Road
    Parkville VIC 3052

    Telephone: 03 9345 5391
    Facsimile: 03 9345 6585
    plastic.surgery@rch.org.au

    7th Floor, 766 Elizabeth Street
    Melbourne VIC 3000
    Telephone: 03 9340 5858

    Warringal Medical Centre
    Suite 10, Level 3, 214 Burgundy Street
    Heidelberg VIC 3084
    Telephone: 03 9459 7699

    Publications

    Journal articles

    1. Johnstone, B.R., Harding, D.L., Hocking, B. Telephone Related Lightening Injuries. Medical Journal of Australia 144: 706-709, June 1986
    2. Johnstone, B.R., Syme, R.R.A. Myonecrosis Complicating Epsilon Aminocaproic Acid Treatment of Traumatic Haematuria. British Journal of Urology. 60: 81-82, June 1987
    3. Johnstone, B.R., Waxman, B.P. Transverse Disruption of the Abdominal Wall- A Tell-Tale Sign of Seat Belt Related Hollow Viscus Injury. Australian and New Zealand Journal of Surgery. 57; 455-460, July 1987
    4. Johnstone, B.R., Buntine, J.A., Sormann, G.W., Slattery, P.G., Jordon, C.J., Phillip, K.M. Surgical Rehabilitation of the Upper Limb in Quadriplegia. Australian and New Zealand Journal Of Surgery. 57: 917-926, December 1987
    5. Johnstone, B.R., Buntine, J.A. Contributions of Plastic Surgery to the Care of the Spinal Cord Injured Patient. Paraplegia 26: 87-93, April 1988
    6. Johnstone, B.R., Buntine, J.A., Jordan, C.J. A Review of Surgical Rehabilitation of the Upper Limb in Quadriplegia. Paraplegia 26: 317-339, October 1988
    7. Johnstone B.R., Bennett, C.S. Lawn Mower Injuries in Childhood. Australian and New Zealand Journal of Surgery. 59: 713-718, September 1989
    8. Johnstone, B.R. Breast Tumourectomy and Irradiation - Review and Commentary. Plastic Surgery Outlook. 4: 4-5, March 1990
    9. Breidahl, A.F. and Johnstone, B.R. Innervated Posterior Thigh Flap for Defects of the Sole - A Case Report. Plastic and Reconstructive Surgery. 95:747-749, April 1995
    10. Penington, A., Johnstone, B.R. A Case of Local Tissue Necrosis Following a Bite by Australian Tiger Snake Notechis Scutatus. Australian and New Zealand Journal Of Surgery. 67:385-388, June 1997
    11. Shand, J.M., Breidahl, A.F., Hing, N.R., Johnstone, B.R., Weisenfeld, D. Ascending necrotising fasciitis as a result of odontogenic infection: a report of two cases. Australian Dental Journal. 46: (2): 134-138, 2001
    12. Johnstone, B.R. Proximal Interphalangeal Joint Surface Replacement Arthroplasty. Hand Surgery. 6:1-11, 2001
    13. Bartlett, G.R., Coombs, C.J., Johnstone, B.R. Primary Shortening of the Pollicized Long Flexor Tendon in Congenital Pollicisation. Journal Of Hand Surgery (American). 26A:595-598, 2001
    14. Johnstone, B.R., Peters, J. Carpal Tunnel Release. Current Therapeutics. July 2001 p 80.
    15. Johnstone, B.R., Richardson, P.W.F., Coombs, C.J. Duncan, J.A. Functional and Cosmetic Outcome of Surgery for Cerebral Palsy in the Upper Limb. Hand Clin 19 (2003) 679 - 686
    16. Richardson, P.W.F., Coombs, C.J., Johnstone, B.R. Toe -to-hand transfer in Symbrachdactyly. Hand Surgery 9(2004) 11-18
    17. Dieu, T., Johnstone,B.R., Newgreen,D.F. Genes and Nerves. Journal of Reconstructive Microsurgery 21(3) 179-186 April 2005.
    18. Greensmith, A.L., Johnstone, B.R., Reddihough, D., Johnson, H., Fergusson, E., Desai, M., Hazard, C., Reid, S. Prospective analysis of the outcome of surgical management of drooling in the paediatric population: a 10 year experience. Plastic and Reconstructive Surgery116:1233-1242, 2005
    19. Chin, T.Y.P., Duncan, J.A., Johnstone, B.R. and H.K. Graham Management of the Upper Limb in Cerebral Palsy. Current Concepts Review. Journal of Paediatric Orthopaedics B 14:389-404,2005
    20. Coombs, C.J., Richardson, P.W.F., Johnstone, B.R. and S.C. Tan The U-Ligament for Collateral Ligament Reconstruction in Duplicated Thumb. Hand Surgery 10: 237-241, 2005
    21. Coombs, C.J., Richardson, P.W.F., Dowling, G.J., Johnstone, B.R., Monagle, P. Brachial Artery Thrombosis in Infants: An Algorithm for Limb Salvage Plastic and Reconstructive Surgery117:1481-1488, 2006
    22. Dowling, G.J., Johnstone, B.R Coombs, C.J. Nerve Stimulation Made Easy: A Simple, Effective and Inexpensive Alternative to Standard Devices. Journal Of Hand Surgery (American).32A:1296-1298,2007
    23. Carpal Tunnel Syndrome in Children With Mucopolysaccaridoses Alex Yuen Guy Dowling Bruce Johnstone Andrew Kornberg Christopher Coombs Journal of Child Neurology, Vol. 22, No. 3, 260-263 (2007)
    24. S M Reid B R Johnstone C Westbury B Rawicki D S Reddihough A randomised trial of botulinum toxin injections into the submandibular and parotid glands to reduce drooling in children with cerebral palsy and other neurological disorders. Developmental Medicine and Child Neurology 50:123 - 128, 2008
    25. Nguyen A., Raymond S.,Morgan V., Peters J., Macgill K.A. Johnstone, B.R Lawn Mower Injuries In Children - A 30 Year Experience ANZJS Vol 78, Issue 9, P 759 - 763 Sept 2008
    26. Johnstone B.R., Fitzgerald M., Smith K.R, Currie, L.J. Cemented Versus Un-Cemented Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint with a Mean of Five Year Follow Up. J Hand Surg 2008;33A:726-732.

    Submitted publications

    1. Layt, C.W., Coombs, C.J., Johnstone, B.R. Currie, L.J Extended Trigger Digit - An unusual presentation in children. Journal Of Hand Surgery (American) Submitted 12/1/2002, to be resubmitted 2007 with additional cases awaiting further revision.


    In preparation

    1. Johnstone, B.R., Joyce Alley, Tamara Bonney. Tongue tie and Z-plasty -a prospective study of intra-operative tongue length measurement before and after release and Z-plasty with clinical outcome study.
    2. Johnstone, B.R., Joyce Alley, Tamara Bonney.Normal tongue length in children
    3. Johnstone, B.R., Duncan, J.A , Bade, S.A. The use of botulinum toxin with splinting in the management of contractures in the upper limb in cerebral palsy.
    4. Johnstone, B.R., McCombe , Bade, S.A The use of botulinum toxin in the management of obsetric brachial plexus palsy.

    Book Chapters

    1. Johnstone, B.R., Duncan, J.A. Hand Injuries in Children, Chapter 21. Atlas of Hand Surgery Publisher: Churchill Livingstone. Edited by W. Bruce Connolly. Published 1997
    2. Johnstone, B.R., Flood, S. Reconstruction of the Sternum, Chapter 16. "Ischaemic Heart Disease: Surgical Management". Edited by B. Buxton, B. Frazier, and S. Westerby. Published 1998
    3. Johnstone, B.R., Breidahl, A.F. Cleft Lip, Palate and Craniofacial Anomalies, Chapter 15. The Hand, Chapter 46. Vascular and Pigmented Naevi, Chapter 50. Soft Tissue Lumps, Chapter 51. Jones' Clinical Paediatric Surgery: Diagnosis and Management. Edited by J.M. Hutson, A.A. Woodward and S.W. Beasley. Blackwell Science Asia Pty Ltd 1999
    4. Johnstone, B.R. Chapter: Surgery for Drooling, A Practical Approach to Saliva Control 2nd Edition. Communication Skill Builders Tucson Arizona. Editors. H. Johnson and A. Scott. Submitted 24/2/2002, due for publication 2004.

    Book reviews

    1. The Australian & New Zealand Journal of Surgery 2000; 71:625. Author: Christopher Stone. Title: Plastic Surgery: Facts. Publisher: Greenwich Medical Media Ltd (First published 2001)
    2. The Medical Journal of Australia April 2002 P349. Author: Nadine Semer. Title: Practical Plastic Surgery for Nonsurgeons. Publisher: Hanley and Belfus (First published 2001)

    Other


    1. Understanding Brachial Plexus Palsy. An illustrated educational booklet for parents and other health professionals. Contributors: Jane Bartlett, Kirsty Kurilowicz, Josie Duncan and Bill Reid (Medical illustrator) Launched by Rev. Tim Costello 20/11/2003
    2. Saliva Control in Children. An illustrated educational booklet for parents and other health professionals. Contributors: Dinah Reddihough, Hilary Johnson, Mala Desai, Elizabeth Fergusson, Bill Reid
    3. Consensus recommendations for the diagnosis, treatment and control of mycobacterium ulcerans infection (Bairnsdale or Buruli ulcer) in Victoria, Australia. Paul Johnson, John Hayman, et al. Member of consensus conference team Melbourne. Medical Journal of Australia 186:64-68, January 2007

    Papers presented

    1. Surgical Rehabilitation of the Upper Limb in Quadriplegia at the Austin Hospital. Royal Australian College of Surgeons General Scientific Meeting, Perth, May 1987.
    2. Lawn Mower Injuries Treated at the Royal Children's Hospital, Melbourne. Royal Australasian College of Surgeons General Scientific Meeting, Melbourne, May 1989.
    3. Complications of Treatment of Breast Carcinoma by Lumpectomy and Irradiation. American Society of Plastic and Reconstructive Surgeons 59th Annual Scientific Meeting, Boston, October 1990.
    4. University of Utah Advanced Microsurgery Workshop, Salt Lake City, Utah, February 1991.
    a) Extending free flap pedicles with vein grafts.
    b) No veins: The use of leeches and intra replant heparin.
    c) Scapular fascial free flap.
    d) Free flap breast reconstruction.
    e) Free flaps for diabetic foot ulceration.
    5. Paediatric Second Toe to Hand Transfer. Video presentation prepared with G. Lister. American Society for Reconstructive Microsurgery Annual Scientific Meeting, Orlando, Florida, September 1991.
    6. Upper Limb Surgery in Cerebral Palsy. Royal Australian College of Surgeons Annual Scientific Congress, Perth May 1995.
    7. AHSS Annual Scientific Meeting Port Stephens, September 1995
    a) Upper Limb Surgery in Cerebral Palsy
    b) Reversed Dermal Graft Nailbed Reconstruction
    8. RACS Plastic Surgery Registrar's Training Course, Melbourne, February 1996
    a) Pollicisation
    b) Rheumatoid Hand
    c) Sternal Wound Infections
    9. Royal Australian College of Surgeons Annual Scientific Congress, Melbourne, May 1996
    a) Rural Surgery: Hand Injuries: What and When to Refer
    b) Case: Extensive Head, Neck and Chest BCC
    10. Reversed Dermal Graft Nailbed Reconstruction Update. AHSS Annual Scientific Meeting, Cairns, September 1996.
    11. Surgical Care of the Hand in Dystrophic Epidermolysis Bullosa. Asia-Pacific Federation of Societies of Surgery of the Hand, Perth, March 1997.
    12. AHSS Registrar Training Course, Melbourne, March 1998
    a) Hand Injuries in Children
    b) Congenital Thumb Anomalies and Radial Club Hand
    13. Percutaneous Release of the MPJ Collateral Ligaments and Dorsal Capsule. AHSS Annual Scientific Meeting, Tasmania, March 1998
    14. Royal Australian College of Surgeons Annual Scientific Congress, Sydney, May 1998
    a) Percutaneous Collateral Ligament and Dorsal Capsule Release of the MP Joint. Presented by Marie Rostek
    b) Pectoralis Major Flap and the Treatment of Infected Median Sternotomy Wounds. Presented by Nicholas Houseman
    15. Spastic and Reconstructive Surgery - Upper limb and drooling in C.P. Jurkiewicz Society Meeting, Atlanta, Georgia, June 1999.
    16. AHSS Annual Scientific Meeting, Portsea, April 2000
    a) PIPJ Surface Replacement Arthroplasty
    b) Two Simple Dynamic Extensor Splints
    c) Tendon Suture to Bone
    d) Percutaneous Osteotomy in Kirner's Deformity
    17. Modifications of the Lejour Vertical Mammaplasty. Royal Australian College of Surgeons Annual Scientific Congress, Melbourne, May 2000.
    18. Lejour Vertical Mammaplasty. Australasian Society of Aesthetic Plastic Surgery, Sanctuary Cove, Qld, July 2000.
    19. PIP Joint Surface Replacement Arthroplasty. Asian Pacific Federation of Societies for Surgery of the Hand, Chennai, India, August, 2000.
    20. Paediatric Hand Trauma. Australian Hand Therapy Association National Conference, Melbourne, October 2000.
    21. Proximal Interphalangeal Joint Surface Replacement Arthroplasty. International Federation of Societies for Surgery of the Hand, Istanbul, Turkey, June 2001.
    22. AHSS Annual Scientific Meeting, Gold Coast, March 2002
    a) Primary Shortening Of The Flexor Tendon In Pollicisation.-Mini Paper
    b) Avanta Pip Joint Arthroplasty
    c) The Extended Trigger Digit In Children-Mini Paper
    d) Outcomes Of Surgery For The Upper Limb In Cerebral Palsy
    23. Royal Australian College of Surgeons Annual Scientific Congress, Adelaide, May 2002
    a) Dealing with Deformity- Aesthetic Issues
    b) Avanta Pip Joint Arthroplasty
    c) Surgery for Drooling
    d) Outcomes of Surgery for the Upper Limb in Cerebral Palsy
    24. Royal Australian College of Surgeons Annual Scientific Congress, Brisbane, May 2003
    a) Video Assessment Of Upper Limb Cerebral Palsy
    b) Obstetric Brachial Plexus Palsy For Beginners
    c) Radial Nerve Palsy Tendon Transfers - What Works - Meet The Experts
    d) Flexor Tendon Repair - Kessler
    e) PIPJ replacement - Dorsal Approach
    25. 13th International Congress of IPRAS, Sydney, August 2003
    a) Sternal Dehiscence and Wound Infection (+Session Chairman)
    b) Avanta Pip Joint Arthroplasty
    c) Surgery for Drooling
    26. Victorian Hand Surgery Society Annual Scientific Meeting, November 2003. That Sinking Feeling - Preliminary Report on Intermediate Follow-up on Uncemented Avanta PIP Joint Arthroplasty.
    27. Royal Australian College of Surgeons Annual Scientific Congress, Melbourne, May 2003. That Sinking Feeling -Intermediate Follow-up on Uncemented Avanta PIP Joint Arthroplasty.
    28. American Association for Hand Surgery/Reconstructive Microsurgery Meeting Puerto Rico January 2005
    a) Avanta PIPJ arthroplasty
    b) Upper Limb Cerebral Palsy Surgery
    29. AHSS/NZHSS Queenstown March 2005
    Avanta PIPJ Arthroplasty 30 mins as part of arthroplasty seminar
    30. AHSS Adelaide March 2006
    Minimal margin excision for Mycobacteriun Ulcerans
    31. APFSSH Bangkok November 2006
    PIPJ Surface Replacement Arthroplasty
    Botulinum Toxin A in Obstetric Brachial Plexus Palsy
    32. World Congenital 2007 Sydney March 2007
    Extended Trigger Digits
    33. IFSSH 2007 Sydney March 2007
    PIPJ Surface Replacement Arthroplasty
    Botulinum Toxin A in Uppper Limb Cerebral Palsy
    International Federation of societies for surgery of the hand
    34. Royal Australian College of Surgeons Annual Scientific Congress, Christchurch May 2007
    Botulinum Toxin A in Uppper Limb Cerebral Palsy
    Botulinum Toxin A in Obstetric Brachial Plexus Palsy