bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of preoperative velar closing ratio and lateral wall movement on outcomes of Furlow palatoplasty for velopharyngeal incompetence
Authors: Muzaffar Arshad R , Rice Gale , Hubbard Bradley , Killion Elizabeth
Published: March 2018

Currently, there is no consensus regarding how to determine the optimal surgical procedure for a patient with velopharyngeal incompetence (VPI) post-primary palate repair. The purpose of the present study was to assess the effect of preoperative velar closing ratio (VCR) and lateral wall movement (LWM) on nasal emission and hypernasality after Furlow double-opposing Z-plasty. A retrospective analysis involving patients with VPI post-primary palatoplasty whose VPI was treated with double-opposing Z-plasty by a single surgeon was performed. Ten consecutive patients with VPI postpalatoplasty were reviewed. Videonasendoscopy, videofluoroscopy and perceptual speech examinations were performed preoperatively and postoperatively. VCR improved from an mean of 0.5 preoperatively (range 0.1 to 0.95) to 0.9 postoperatively (range 0.55 to 1.0). Postoperative mean LWM was 0.5 (range 0.3 to 0.9), unchanged from preoperative ratings. A trend toward an inverse relationship between preoperative VCR and improvement in hypernasality and resolution of nasal emission was observed. No relationship was noted between the degree of preoperative LWM and mean improvement in hypernasality. However, patients with worse preoperative LWM experienced better resolution of nasal emission postoperatively.
Third-degree burns caused by ignition of chlorhexidine: A case report and systematic review of the literature
Authors: Vo Anthony , Bengezi Omar
Published: March 2018

Ignition of chlorhexidine by an electrocautery unit is rare but can have devastating consequences for the patient and the surgeon. A case involving a 77-year-old man who underwent removal of an indwelling artificial urethral sphincter is presented. The chlorhexidine was ignited when the urologist activated the electrocautery unit, causing third-degree burns to the patient. A plastic surgeon treated the burns with surgical debridement and split-thickness skin grafting. A systematic review of the literature was performed with best practice recommendations. To the authors' knowledge, the present case is the ninth such case reported.
Accuracy and completeness of electronic medical records obtained from referring physicians in a Hamilton, Ontario, plastic surgery practice: A prospective feasibility study
Authors: Hong Chris Joon , Kaur Manraj Nirmal , Farrokhyar Forough , Thoma Achilleas
Published: March 2018

Objective

To assess the feasibility of auditing electronic medical records (EMRs) in plastic surgery for future large-scale research studies. The secondary objective was to ascertain the accuracy and completeness of EMRs accompanying referral requests by physicians for plastic surgery consultation between July and December 2013.

Methods

EMRs of 30 patients were reviewed and crosschecked independently by two reviewers and subsequently verified by a third reviewer using predefined criteria to determine whether they were accurate and/or complete. Descriptive analysis was performed to calculate the frequency of inaccuracies and incompleteness for each EMR information field. Information fields were compared to assess whether the frequency of inaccuracies and incompleteness varied.

Results

Of the 270 information fields reviewed, four (1.48%) were inaccurate and 66 (24.4%) were incomplete. The most common field of inaccuracy was current medications, followed by medical history and medical allergies. The most common field of incompleteness was history of presenting illness followed by surgical history.

Conclusion

Despite their purported benefits, inaccuracies and incompleteness are a frequently occurring problem in EMRs. A large-scale study may be beneficial in determining the efficacy of EMRs in the future.
Analysis of individualized education programs to quantify long-term educational needs following surgical intervention for single-suture craniosynostosis
Authors: Doshier Laura J , Muzaffar Arshad R , Deidrick Kathleen Km , Rice Gale B
Published: March 2018

Background

Single-suture craniosynostosis (SSC) is a common craniofacial condition with potential neurocognitive sequelae.

Objective

To quantify any long-term functional academic and behavioural difficulties of children with SSC as indicated by the need for individualized education programs (IEPs), despite having undergone surgical treatment.

Methods

Records of all school-age patients from 1992 to 2011 who underwent operative intervention for SSC were identified. Fifty-nine patients' guardians were contacted by telephone to provide informed consent for completion of a mailed standardized questionnaire querying demographic information as well as information regarding the patient's health, family and educational history; specifically whether the patient had ever been provided educational support as delineated in an IEP. The primary outcome measure was the history of the patient being assigned educational support as delineated in an IEP.

Results

Thirty-seven consenting guardians completed and returned the standardized questionnaire (response rate 62.7%). Twenty-one patients were male and 16 were female, with an age range of five to 14 years (mean age 10.2 years). Eleven (29.7%) patients had a previous history of or currently were receiving educational support delineated in an IEP. CONCLUSIONS: A higher proportion of school-age patients with a history of SSC (status postsurgical intervention) in the present study received educational support delineated in an IEP than the proportion of IEPs in the general student population of the United States (11.3%).
Exposure to plastic surgery during undergraduate medical training: A single-institution review
Authors: Austin Ryan E , Wanzel Kyle R
Published: March 2018

Background

Applications to surgical residency programs have declined over the past decade. Even highly competitive programs, such as plastic surgery, have begun to witness these effects. Studies have shown that early surgical exposure has a positive influence on career selection.

Objective

To review plastic surgery application trends across Canada, and to further investigate medical student exposure to plastic surgery.

Methods

To examine plastic surgery application trends, national data from the Canadian Resident Matching Service database were analyzed, comparing 2002 to 2007 with 2008 to 2013. To evaluate plastic surgery exposure, a survey of all undergraduate medical students at the University of Toronto (Toronto, Ontario) during the 2012/2013 academic year was conducted.

Results

Comparing 2002 to 2007 and 2008 to 2013, the average number of national plastic surgery training positions nearly doubled, while first-choice applicants decreased by 15.3%. The majority of Canadian academic institutions experienced a decrease in first-choice applicants; 84.7% of survey respondents indicated they had no exposure to plastic surgery during their medical education. Furthermore, 89.7% believed their education had not provided a basic understanding of issues commonly managed by plastic surgeons. The majority of students indicated they receive significantly less plastic surgery teaching than all other surgical subspecialties. More than 44% of students not considering plastic surgery as a career indicated they may be more likely to with increased exposure.

Conclusion

If there is a desire to grow the specialty through future generations, recruiting tactics to foster greater interest in plastic surgery must be altered. The present study suggests increased and earlier exposure for medical students is a potential solution.
Impact of liposome bupivacaine on the adequacy of pain management and patient experiences following aesthetic surgery: Results from an observational study
Authors: Edwards Michael C , Sorokin Evan , Brzezienski Mark , Nahai Farzad R , Scranton Richard , Wall Holly , Wall Simeon , Finical Stephan , Smith Kevin
Published: March 2018

Background

Despite the efficacy of opioid analgesics for postsurgical pain, they are associated with side effects that may complicate recovery. Liposome bupivacaine is a prolonged-release formulation of bupivacaine approved for intraoperative administration at the surgical site for postsurgical analgesia.

Objectives

To evaluate the effect of a single intraoperative administration of liposome bupivacaine on postsurgical pain, opioid use and opioid-related side effects in subjects undergoing breast surgery and/or abdominoplasty.

Methods

In the present phase IV, multicentre, prospective observational study, subjects received a single intraoperative administration (266 mg) of liposome bupivacaine. Rescue analgesia was available to all subjects as needed. Outcome measures, assessed through postoperative day 3, included postsurgical pain intensity (11-point numerical rating scale), opioid consumption and overall benefit of analgesic score. Results were evaluated comparing investigators' previous experience with similar surgeries.

Results

Forty-nine subjects entered the study: 34 underwent breast surgery only and 15 underwent abdominoplasty with or without breast surgery (six underwent breast surgery in addition to abdominoplasty). Mean numerical rating scale pain scores remained ≤4.3 from discharge through postoperative day 3. Median daily oral opioid consumption was approximately 1.0 tablet postoperatively on the day of surgery and was approximately 2.0 tablets by postoperative day 3. Mean overall benefit of analgesic score ranged between 2.8 and 4.9 throughout the study.

Conclusion

In this particular subject population, liposome bupivacaine was associated with low pain intensity scores and reduced opioid consumption compared with the investigators' previous experiences. Subjects' satisfaction with postsurgical analgesia was high, with a low burden of opioid-related side effects.
Long-term outcomes and patient satisfaction following wrist ganglion aspiration
Authors: Head Linden , Allen Murray , Boyd Kirsty U
Published: March 2018

Background

There is a strong body of evidence addressing short-term outcomes following wrist ganglion aspiration; however, few studies have investigated long-term outcomes and patient satisfaction.

Objective

To evaluate patient satisfaction and the long-term rate of recurrence following wrist ganglion aspiration.

Methods

Charts of all patients with a wrist ganglion treated by a single surgeon from 2001 to 2011 were reviewed. Demographic and clinical data were retrieved from patient charts. Patients were contacted by telephone and asked to complete a questionnaire addressing recurrence, satisfaction and symptom improvement. Improvement was assessed using a Likert scale, with 1 indicating ‘significantly worse’ and 5 indicating ‘significantly improved’. Statistical analysis was performed using Pearson x2, Mann-Whitney-Wilcoxon and Fisher's exact tests.

Results

Forty-one consecutive patients were identified using hospital records; 21 (51%) consented to the telephone questionnaire. There were no differences in demographic or clinical data between patients who completed the telephone questionnaire and those who did not. The mean age at treatment was 45.3 years, mean time to follow-up was 6.3 years and 52.4% of ganglions recurred. Overall, 95% (20 of 21) of patients were satisfied with their treatment and would proceed again given the option; satisfaction was independent of recurrence. Following treatment, there was improvement in pain, function, range of motion and appearance; improvement in symptoms was independent of recurrence.

Conclusions

Long-term recurrence of ganglions treated with aspiration appeared to be similar to the short-term rates reported in the literature. Independent of recurrence, patients remained satisfied with aspiration and reported improvement in symptoms.
A technique for intraoperative creation of patient-specific titanium mesh implants
Authors: Sunderland Ian Rp , Edwards Glenn , Mainprize James , Antonyshyn Oleh
Published: March 2018

Prefabricated, patient-specific alloplastic implants for cranioplasty reduce surgical complexity, decrease operative times, minimize exposure and risk of contamination, and have resulted in improved aesthetic results. However, in creating a prefabricated custom implant using a patient's computed tomography data, a stable, unalterable defect must be clearly defined before surgery. In the event that an intraoperative modification of an exiting skull defect is required, or in cases of tumour resection in which the size of the skull defect is unknown preoperatively, these prefabricated implants cannot be used. The ideal method for alloplastic cranioplasty would enable cost-effective creation of a patient-specific implant with the capacity for intraoperative modification.

The present article describes a novel technique of cranioplasty that uses a patient's computed tomography data to create a custom forming tool (ie, mold), enabling intraoperative creation of a patient-specific titanium mesh implant. The utility of these implants in creating a custom reconstructive solution in cases in which the size of the skull defect is unknown preoperatively will be demonstrated using two case presentations.
Development of an Acute Care Plastic Surgery Service in the Saskatoon Health Region: Effects on flexor tendon management
Authors: Wilgenbusch Chelsea S , Dust Peter W , Sunderland Ian R
Published: March 2018

Background

The acute care surgery model has gained favour in general surgery, but has yet to be widely adopted in other specialties. An Acute Care Plastic Surgery (ACS) Service was recently implemented in the Saskatoon Health Region in an effort to improve trauma care.

Objective

To evaluate the impact of ACS on the management of flexor tendon lacerations. The authors hypothesize that ACS has resulted in more timely intervention, improved outcomes and decreased ‘after hours’ surgery.

Methods

A retrospective review of patients treated for flexor tendon lacerations from 2007 to 2013 was performed. Patients were stratified into two groups based on whether they received treatment before (group A) or after (group B) ACS implementation. Variables included dates and times of patient referral, consultation and tendon repair; postoperative complications; and admissions. A surgeon survey was administered on the perceived impact of ACS.

Results

Group A was more likely to have surgery performed after hours (P=0.0019) and be admitted to hospital (P=0.0211) compared with group B. Time from referral to consultation and injury-to-surgery interval were slightly increased post-ACS (Group B). Surgeons were highly satisfied with the new system, citing benefits to patients and surgeons.

Conclusion

ACS was designed to improve trauma care, while favourably impacting surgeon workload. Surprisingly, the injury-to-surgery interval was slightly increased. However, this was not clinically significant and did not lead to increased postoperative complications. This finding was likely due to a favourable change in practice patterns observed after ACS implementation. ACS has resulted in fewer hospital admissions, decreased after-hours surgeries and improved surgeon satisfaction.
Repositioned lateral crural flap technique for cephalic malposition in rhinoplasty
Authors: Mohebbi A , Azizi A , Md S Tabatabaiee
Published: March 2018

Background

Cephalic malposition of the lower lateral cartilage (CMLLC) is a relatively common anatomical variant, particularly in Middle Eastern patients. The characteristics of CMLLC include long alar creases, a boxy and ball-shaped nasal tip, parenthesis tip deformity and external valvular incompetence. The gold standard for correcting CMLLC is the lateral crural strut graft (Gunter graft), but many patients experience problems after this technique.

Objective

To evaluate the efficacy of the repositioned lateral crural flap (RLCF) technique in correcting CMLLC, and to discuss the cosmetic and functional results.

Methods

In the present study, 123 primary septorhinoplasty operations using the RLCF technique were performed between May 2012 and March 2013. The mean follow-up period was 11.4 months (range nine to 24 months). Four parameters were measured and compared pre- and postoperatively: the angle between the line connecting the maximum convexity of the lower lateral cartilage (LLC) to the tip-defining point and midline on each side (angle of rotation); the total distance between the maximum convexity of LLC right and left to midline (representing the size of the parenthesis deformity); satisfaction scale rating of the patients' nasal tip appearance; and the satisfaction scale rating of patients' breathing through their nostrils.

Results

The mean angle of the LLC to the midline significantly increased and the mean distance between the maximum convexities was significantly reduced, indicating correction of the malposition and reduction of the parenthesis deformity, respectively. The mean satisfactory scale ratings of nasal tip appearance and breathing quality were also significantly improved.

Conclusion

CMLLC can be corrected using the RLCF technique, resulting in both aesthetic and functional improvements.
Goal-directed fluid therapy for microvascular free flap reconstruction following mastectomy: a pilot study
Authors: Funk Duane , Bohn James , Mutch Wac , Hayakawa Tom , Buchel Edward W
Published: March 2018

Background

Fluid management of the surgical patient has undergone a paradigm shift over the past decade. A change from ‘wet’ to ‘dry’ to a ‘goal-directed’ approach has been witnessed. The fluid management of patients undergoing free flap reconstruction is particularly challenging. This is typically a long operation with minimal surgical stimulation, and hypotension often ensues. The use of vasopressors in these cases is contra-indicated to maintain adequate flow to the flap. Hypotension is often treated with intravenous fluid boluses. However, aggressive fluid administration to maintain adequate blood pressure can result in flap edema, venous engorgement and, ultimately, flap loss.

Objective

The primary objective of the present study was to determine whether goal-directed fluid therapy, titrated to maintain stroke volume variation ≤13%, with the use of an arterial pulse contour device results in improved postoperative cardiac index (CI) and stroke volume index (SVI) with reduced amounts of intravenous fluid. The primary end points studied were CI, SVI and cumulative crystalloid/colloid administration.

Methods

Twenty female patients undergoing simultaneous microvascular free flap reconstruction immediately following mastectomy were studied. Preoperative and intraoperative care were standardized. Each patient received intra-arterial blood pressure monitoring. In all patients, cardiac output measurement occurred throughout the intraoperative period using the arterial pulse contour device. Control patients had their fluid administered at the discretion of the anesthesiologist (blinded to results from the cardiac output device). Patients in the intervention group had a baseline crystalloid infusion of 5 mL/kg/h, with intravenous colloid boluses to maintain a stroke volume variation ≤13%.

Results

There was no difference in heart rate or mean arterial pressure between groups at the end of the operation. However, at the end of the operation, the intervention group had significantly higher mean (± SD) CI (3.8±0.8 L/min/m2 versus 3.0±0.5 L/min/m2; P=0.02) and SVI (51.4±2.4 mL/m2 versus 43.3±2.3 mL/m2; P=0.03). This improved CI and SVI was achieved with similar amounts of administered intraoperative fluid (5.8±0.5 mL/kg/h versus 5.0±0.7 mL/kg/h, control versus intervention). The intervention group required less postoperative fluid resuscitation during the early postoperative period (total fluid administered from end of operation to midnight of the operative day, 6.4±1.9 mL/kg/h versus 10.2±3.3 mL/kg/h, intervention versus control, respectively, P<0.01).

Discussion

Goal-directed fluid therapy using minimally invasive cardiac output monitoring resulted in improved end-operative hemodynamics, with less ‘rescue’ fluid administration during the perioperative period.
Intraoperative pulmonary function dynamics in adolescents undergoing reduction mammoplasty: A prospective case series
Authors: Wiser Itay , Mahon Krity , Yaniv Shirley , Mha Ella Ziv , Carmel Narin Nard , Heller Lior
Published: March 2018

Background

Improvement of lung function following reduction mammoplasty has been previously reported among adult populations in the medical literature.

Objectives

To evaluate the intraoperative dynamics of pulmonary function in adolescents undergoing reduction mammoplasty.

Methods

The present study is a prospective case series of female patients 13 to 18 years of age who underwent inferior pedicle reduction mammoplasty between November 20, 2006 and April 4, 2011. Documented variables included patient baseline characteristics, operation duration, muscle relaxant use and total breast tissue removed. Intraoperative pulmonary function data documented included: tidal volume, respiratory rate, peak inspiratory pressure, positive end-expiratory pressure, oxygen saturation percentage and pulmonary compliance. Differences in pulmonary function data were calculated as ratio between final and initial intraoperative values.

Results

Twenty-six patients were included in the analysis. Mean (± SD) age was 16.9±1.1 years and mean body mass index was 28.9±6.1 kg/m2. Mean operation time was 218±52 min, with average total bilateral breast tissue removal of 1810±1065 g. Improvement in lung compliance was observed in 24 patients (92.3%; P<0.0001). Mean intraoperative lung compliance improvement was 23.92% (95% CI 8.3% to 37%; P=0.001).

Conclusion

Intraoperative improvement in lung compliance was observed in adolescent patients undergoing reduction mammoplasty.
Operating room waste reduction in plastic and hand surgery
Authors: Albert Mark G , Rothkopf Douglas M
Published: March 2018

Background

Operating rooms (ORs), combined with labour and delivery suites, account for approximately 70% of hospital waste. Previous studies have reported that recycling can have a considerable financial impact on a hospital-wide basis; however, its importance in the OR has not been demonstrated.

Objective

To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery.

Methods

The authors identified disposable supplies and instruments that are routinely opened and wasted in common plastic and hand surgery procedures, and calculated the savings that can result from eliminating extraneous items. A cost analysis was performed, which compared the expense of OR waste versus single-stream recycling and the benefit of recycling HIPAA documents and blue wrap.

Results

Fifteen total items were removed from disposable plastic packs and seven total items from hand packs. A total of US$17,381.05 could be saved per year from these changes alone. Since initiating single-stream recycling, the authors' institution has saved, on average, US$3,487 per month at the three campuses. After extrapolating at the current savings rate, one would expect to save a minimum of US$41,844 per year.

Discussion

OR waste reduction is an effective method of decreasing cost in the surgical setting. By revising the contents of current disposable packs and instrument sets designated for plastic and hand surgery, hospitals can reduce the amount of opened and unused material.

Conclusions

Significant financial savings and environmental benefit can result from this judicious supply and instrument selection, as well as implementation of recycling.
Use of tranexamic acid in craniosynostosis surgery
Authors: Martin Justin P , Wang Jessica S , Hanna Kasandra R , Stovall Madeline M , Lin Kant Y
Published: March 2018

Background

Intraoperative tranexamic acid (TXA) administration has been used to abate blood loss in a variety of surgical procedures. Several recent studies have supported its efficacy in reducing transfusion requirements in pediatric cranial vault reconstruction (CVR).

Objective

To conduct a retrospective chart review to determine whether a significant reduction in packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusions exists when TXA is used.

Methods

A retrospective cohort study of 28 patients who underwent CVR for sagittal craniosynostosis was performed. Transfusion requirements for 14 patients who did not receive TXA were compared with 14 patients who did. Predictors of increased blood product transfusion were also studied.

Results

Total volume of PRBC transfusion was reduced by 50% with the use of TXA (P=0.004) with a 34% reduction in intraoperative PRBC transfusion (P=0.017) and a 67% reduction in postoperative PRBC transfusion (P<0.001). Total volume of FFP transfusion was reduced by 46% (P=0.002) and postoperative FFP transfusion was reduced by 100% (P=0.001). The use of TXA was associated with a lower total volume of PRBC (P=0.003) and FFP (P=0.003) transfusions. Older patient age was associated with lower total volume of PRBC transfused (P=0.046 and P=0.002), but not with FFP (P=0.183 and P=0.099) transfusion volumes. Increasing patient weight was associated with lower PRBC (P=0.010 and P=0.020) and FFP (P=0.045 and P=0.016) transfusion volumes.

Conclusion

TXA decreased blood product transfusion requirements in patients undergoing CVR for sagittal craniosynostosis, and should be a routine part of the strategy to reduce blood loss in these procedures.
Experiences with pins and rubber band traction in the treatment of proximal interphalangeal joint contracture
Authors: Cahill Kevin C , Theopold Christoph , O'shaughnessy Michael
Published: March 2018

Background

Proximal interphalangeal joint (PIPJ) contracture is a difficult problem to treat regardless of etiology. Although numerous interventions have been recommended, published results are mediocre at best.

Objective

The authors describe their experience and results of using a modification of pins and rubber band traction (PRBT) – applying a dynamic extension apparatus to a contracted PIPJ using the constant traction force in a stretched rubber (elastic) band.

Method

A retrospective review of patients treated with this method was performed, and the results are presented. The technique itself is described, and clinical photographs illustrate the method.

Results

Mean PIPJ flexion contracture before PRBT was 82° (range 60° to 110°). The full correction of eight contracted PIPJs in seven patients was achieved, in a mean of 17.8 days (range 14 to 31 days). At one month postremoval of PRBT, the mean PIPJ flexion contracture was 22.8° (range 0° to 46°).

Discussion

The method is compared with previously described methods of PIPJ contracture correction, whether surgical or splinting; the latter may be static, dynamic or a combination of the two. The results of previously published studies are discussed and compared with the method described.

Conclusion

The present method is a powerful and effective simplification of a previously described method of correcting PIPJ contractures. This technique is simple, ‘low-tech’ and can be applied under local anesthetic; the authors believe it offers a useful adjunct to surgical release.
Laser-assisted lipolysis for arm contouring in Teimourian grades III and IV: A prospective study involving 22 patients
Authors: Leclère Franck Marie , Alcolea Justo M , Vogt Peter M , Moreno-Moraga Javier , Casoli Vincent , Mordon Serge , Trelles Mario A
Published: March 2018

Background

Upper arm deformities secondary to weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures.

Objective

To objectively assess whether, in Teimourian high-grade upper arm remodelling, laser-assisted lypolysis (LAL) alone could result in patient satisfaction.

Methods

Between 2012 and 2013, 22 patients were treated for excessive upper arm fat (Teimourian grade III and IV) solely with LAL. The laser used in the present study was a 1470 nm diode laser (Alma Lasers, Israel) with the following parameters: continuous mode, 15 W power and transmission through a 600 μm optical fibre. Previous mathematical modelling suggested that 0.1 kJ was required to destroy 1 mL of fat. Patients were asked to complete a satisfaction questionnaire. The arm circumference was measured pre- and postoperatively. Treatment parameters, adverse effects and outcomes were recorded.

Results

Pain during the anesthesia and discomfort after the procedure were minimal. Complications included ecchymoses and prolonged edema. The mean (± SD) arm circumference decreased 5.5±1.0 cm in the right arm (P<0.01) and 5.2±1.1 cm in the left arm (P<0.01) in grade III patients and 4.9±1.1 cm in the right arm (P<0.01) and 4.9±1.1 cm in the left arm (P<0.01) in grade IV patients. Although the circumference of both arms significantly decreased in grade III and grade IV patients, the skin tightening remained incomplete. Overall, the average opinion of treatment was poor for both patients and investigators. Of the 22 patients, only nine (41%) would recommend this treatment.

Conclusion

LAL for upper arm remodelling is not sufficient to ensure full skin tightening for patients with Teimourian grades III and IV upper arm deformities. A complementary surgery is mandatory for grades III and IV.
Effect of botulinum toxin a and nitroglycerin on random skin flap survival in rats
Authors: Ghanbarzadeh Kourosh , Tabatabaie Omid Reza , Salehifar Ebrahim , Amanlou Massoud , Khorasani Ghasemali
Published: March 2018

Background

A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive.

Objective

To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model.

Methods

The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline.

Results

BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45).

Conclusions

BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.
An evaluation of accessibility and content of microsurgery fellowship websites
Authors: Hu Jiayi , Zhen Meng , Olteanu Cristina , Avram Ronen
Published: March 2018

Background

Websites for residency and fellowship programs serve as effective educational and recruitment tools.

Objective

To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development.

Methods

A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive ‘Google’ search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics using t tests and ANOVA (two-tailed; P<0.05 was considered to be statistically significant).

Results

A list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed ‘eligibility criteria’ (87%) and ‘general information’ (87%). ‘Evaluation criteria’ were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on ‘extremity’ versus ‘breast’ (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process.

Conclusion

Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process.
Triangular lipodermal flaps in Wise pattern reduction mammoplasty (superomedial pedicle): A novel technique to reduce T-junction necrosis
Authors: Khalil Haitham H , Malahias Marco , Shetty Geeta
Published: March 2018

Background

Although Wise pattern reduction mammoplasty is one of the most prevalent procedures providing satisfactory cutaneous reduction, it is at the expense of inevitable lengthier scars and wound complications, especially at the inverted T junction.

Objective

To describe a novel technique providing tension-free closure at the T junction through performing triangular lipodermal flaps. The aim is to alleviate skin tension, thus reducing skin necrosis, dehiscence and excessive scarring at the T junction.

Methods

One hundred seventy-three consecutive procedures were performed on 137 patients between 2009 and 2013. Data collected included demographics, perioperative morbidity and resected breast tissue weight. The follow-up period ranged from three to 30 months; early and late postoperative complications and patient satisfaction were recorded.

Results

Superficial epidermolysis without T-junction dehiscence was experienced in eight (4.6%) procedures while five (2.9%) procedures developed full-thickness wound dehiscence. Ninety-four percent of patients were highly satisfied with the outcome.

Conclusions

The technique is safe, versatile and easy to execute, providing a tension-free zone and acting as internal dermal sling, thus providing better wound healing with more favourable aesthetic outcome and maintaining breast projection.
Spontaneously Resolved Macrocystic Lymphatic Malformations: Predictive Variables and Outcomes
Authors: Phang Michael J. , Courtemanche Douglas J. , Bucevska Marija , Malic Claudia , Arneja Jugpal S.
Published: March 2018

Introduction:

Lymphatic malformations are benign, low-flow vascular malformations that typically present at or near birth. Due to morbidity associated with operative treatment, nonoperative treatment with injection of sclerosant has become the mainstay of therapy. Over the past 15 years, several patients at our centre with macrocystic (>2 cm cyst size) lymphatic malformations have seen their lesions resolve spontaneously while awaiting treatment. In this study, we review features of these patients that may contribute to spontaneous resolution.

Method:

A retrospective chart review was conducted from our Vascular Anomalies Clinic database (1999-2014) of all macrocystic lymphatic malformations; characteristics of patients with spontaneous resolution were reviewed.

Results:

Of 61 patients with macrocystic lymphatic malformations, 7 cases (11.5%; 4 females, 3 males) resolved spontaneously. Median age at malformation appearance was 2 years (range: 0-6.5 years), with median age at resolution of 4 years (range: 10 months-7 years). Median time from appearance to resolution was 24 months (range: 3-43 months), with a median follow-up time of 4 years (range: 1-15 years). All but 1 case was associated with local or upper respiratory tract infection antecedent to resolution. Six of the 7 lesions were located in the neck.

Conclusion:

Among the cases reviewed, there was a common theme of upper respiratory tract or local infection antecedent to spontaneous lesion resolution. Compared to the literature, our proportion of malformations presenting after birth and the proportion of malformations presenting in the neck region were higher than those of other series. Although side effects associated with treatment are generally mild and/or rare, risks related to sclerotherapy and the accompanying requirement for general anesthesia in pediatric populations nevertheless exist. As the median time from lesion appearance to resolution was 24 months, it may be reasonable to observe these malformations for up to 24 months before proceeding with treatment if the lesion does not impair function and disfigurement is not considerable, particularly if the lesion presents after birth and/or is located in the neck region.
The Use of Platelet-Rich Plasma for Storage of Surplus Harvested Skin Grafts
Authors: Keskin Ilknur , Ayturk Nilufer , Sutcu Mustafa , Keskin Mustafa , Mudok Tangul
Published: March 2018

Background:

There is a need for improved methods and storage media to sustain the tissue viability of autologous skin grafts.

Objective:

To compare histological changes in human skin grafts stored in platelet-rich plasma (PRP) with those of grafts stored in saline.

Methods:

Eight circular, 3-mm full-thickness skin graft samples were harvested from the abdominal skin of each of 5 patients scheduled to undergo an abdominoplasty procedure. Four of these graft samples were stored in saline, and the other 4 were stored in saline mixed with PRP prepared from the patient’s own venous blood. Histological assessment of the microscopic appearance of the samples was performed on days 5, 8, 11, and 14. The integrity of the epidermal–dermal junction, number of keratinocytes with perinuclear halos, collagen organization, and number of fibroblasts per field were assessed. The cellular apoptosis rate was also measured on these same days.

Results:

On day 5, significant differences were observed microscopically between the PRP- and saline-stored grafts ( P < .05). The grafts preserved in saline exhibited early marked cellular and nuclear swelling with pleomorphism, as well as early nuclear halo formation. The cell viability rate of the PRP group was significantly higher than that of the saline-stored group on day 8 ( P < .05).

Conclusion:

Platelet-rich plasma and its inherent growth factors supported longer graft survival; however, its effect lasted only until day 8. Platelet-rich plasma may be beneficial if grafts need to be stored for delayed application(s).
Immediate Nerve Transfer for the Treatment of Peroneal Nerve Palsy Secondary to an Intraneural Ganglion: Case Report and Review
Authors: Ratanshi I. , Clark T. A. , Giuffre Jennifer L.
Published: March 2018

Intraneural ganglion cysts that occur within the common peroneal nerve are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presents with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to the flexor hallucis longus to a motor branch of the anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, and no evidence of recurrence and was able to weight bare without the need of orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.
Comparison of Resorbable Mesh (Poly L-Lactide/Glycolic Acid) and Porous Polyethylene in Orbital Floor Fractures in an Experimental Model
Authors: Aral Ali Mubin , Özmen Selahattin , Uygur Safak , Kaya Basar , Coskun Neslihan , Ömeroglu Suna , Kılıc Koray
Published: March 2018

Background:

Resorbable mesh and porous polyethylene are frequently used alloplastic materials for the treatment of the orbital blowout fractures. The literature lacks reports comparing their long-term effects on experimental models.

Objective:

Our aim was to radiologically and histologically evaluate the effectiveness and safety of porous polyethylene and resorbable mesh in a rabbit orbital blowout fracture model.

Methods:

Twelve New Zealand white rabbits (24 orbits) were randomized to 4 groups. In group 1, only orbital floor dissection was done. In group 2, following orbital floor dissection, a 10-mm defect was created without any extra procedure. In group 3, following a 10-mm defect creation, a 12-mm-round cut porous polyethylene was placed on the defect. In group 4, following a 10-mm defect creation, a 12-mm-round cut resorbable mesh was placed on the defect. Computed tomographic analysis was performed during follow-up period. Orbital floors were evaluated histologically at month 6.

Results:

No clinical complications were observed during follow-up period. In radiological evaluation, there was no statistically significant difference between groups regarding bone formation. In histological evaluation, the connective tissue was denser, and organized and better bone formation was observed in group 3 and 4 when compared with other groups.

Conclusion:

Although no significant radiological changes were present, porous polyethylene and resorbable mesh performed better histologically. They were effective and well tolerated for reconstruction of the isolated orbital floor defects.
The Superficial Femoral Artery Flap: A 3-Dimensional Anatomical Study
Authors: El-Hadi Hadal , Morris Steven , Alkhawaji Ali
Published: March 2018

Background:

The superficial femoral artery perforator (SFAP) flap offers advantages for pedicled transfer including consistent perforators and vascular territory, well-hidden donor site scar, and hairless flap skin. This article provides a historical overview of the SFAP flap and describes the vascular anatomy of the SFAP by 3-dimensional analysis and angiography.

Methods:

Ten fresh cadavers were injected using the lead oxide technique through the femoral artery. Spiral computed tomographic scanning and 3-dimensional evaluation were used to describe the SFAP number, diameter, length, type, and location.

Results:

A total of 288 perforators in 15 cadaver limbs were identified; 19 ± 8 perforators per thigh ≥0.5 mm in diameter, with an average diameter of 0.8 ± 0.3 mm and a range of 0.5 to 2.1 mm; the mean length of each perforator was 68 ± 31 mm; 45% were septocutaneous and 55% were musculocutaneous. The medial thigh region was divided into 6 areas (anterior and posterior halves, then the proximal third, middle third, and distal third of each). The majority of the perforators were located in the middle and distal thirds of the anteromedial thigh (33% each).

Conclusions:

Using 3-dimensional vascular anatomical analysis, the number, location, length, type, and diameter of the SFAP were documented. In the literature, relatively few reports of the use of the SFAP flap are available, however, this is a valid donor site with consistent cutaneous perforators suitable for harvest as a local or regional flap transfer. This is the first 3-dimensional vascular anatomical study to comprehensively document the vascular anatomy of the SFAP flap.
Factors Influencing the Rate of Post-Mastectomy Breast Reconstruction in a Canadian Teaching Hospital
Authors: Karunanayake Mihiran , Bortoluzzi Patricia , Chollet André , Lin Jenny C.
Published: March 2018

Background:

Post-mastectomy breast reconstruction (PMBR) improves psychosocial well-being, quality of life, and body image. Reconstruction rates vary widely (up to 42% in the United States), but the few Canadian studies available report rates of 3.8% to 7.9%. We sought to evaluate the current state of breast reconstruction in 1 Canadian teaching hospital and factors determining patients’ access to reconstruction.

Methods:

We performed a retrospective chart review of all patients with breast cancer undergoing mastectomy alone or mastectomy and reconstruction at a Canadian hospital between 2010 and 2013. We calculated rates of breast reconstruction and compared patient characteristics between the 2 groups, and then performed a multiple logistic regression to determine factors increasing the odds of receiving breast reconstruction.

Results:

A total of 152 patients underwent 154 total or modified radical mastectomies. We obtained a rate of PMBR of 21%, 14% immediate reconstruction, and 8% delayed. Statistical analysis showed that compared to patients with mastectomy alone, patients who received PMBR were significantly younger, with a larger percentage having bilateral mastectomies, non-invasive breast cancer, and residing further from the hospital. Patients less than 50 years old and those with bilateral mastectomies had significantly greater odds of having a reconstruction.

Conclusions:

Our Canadian tertiary care institution has a high volume of breast surgery and an active breast reconstruction team. However, the rate of immediate reconstruction remains low compared to similar centers in the United States. We recommend a united effort to increase awareness regarding PMBR and address common misconceptions hindering patients’ access to breast reconstruction.

Level of Evidence:

Epidemiologic study, Level III
How Many Trigger Fingers Resolve Spontaneously Without Any Treatment?
Authors: McKee Daniel , Lalonde Jan , Lalonde Don
Published: March 2018

Introduction:

There is very little information in the literature evaluating the natural history of adult trigger fingers and their rate of spontaneous resolution over time.

Methods:

A consecutive case series of patients with trigger finger was generated. For each patient, we recorded whether the patient’s disease resolved from either no treatment versus active treatment options and over what time period.

Results:

Three hundred forty-three patients with trigger finger were included in the study. Fifty-two percent of patients resolved without any treatment whatsoever after waiting a mean (and median) of 8 months from initial consultation. The thumb was the most frequent digit to resolve without treatment (72%).

Conclusions:

We found that just over half of patients with trigger fingers who are referred to our office resolve spontaneously without any intervention.