bluuebunny/crossref_metadata_2025 huggingface dataset:
Reflex Sympathetic Dystrophy of the Upper Limb: Treatment Using a Series of Stellate Ganglion Blocks
Authors: Al-Qattan Mm , Wahood A
Published: February 2017

Fourteen consecutive patients with reflex sympathetic dystrophy of the hand were studied. Their conditions were diagnosed based on clinical features alone and confirmed by a positive symptomatic response following a stellate ganglion test block. Treatment for all patients was a series of stellate ganglion blocks combined with a physiotherapy program. The number of blocks performed per patient ranged between three and nine blocks, and the blocks were performed at two- to 10-day intervals. Subjectively, patients were asked to rate pain before and after treatment on a scale of 0 (no pain) to 10 (unbearable pain). Objectively, the average total active motion of the fingers (ATAM) was compared before and after treatment. Before treatment, pain was rated between 7 and 10, and the ATAM of the fingers was 83°. After treatment, pain was rated between 0 and 2, and motion improved to 260°. It was concluded that stellate ganglion block is an effective and safe method of treating reflex sympathetic dystrophy as long as the diagnosis is made early, the block is given by an experienced physician and multiple blocks are performed along with a physiotherapy program.
Scrotal Reconstruction Using Tissue Expanders
Authors: Iconomou Thomais Gina , Zuker Ronald M
Published: February 2017

Tissue expansion has been used successfully for reconstruction following many congenital and acquired deformities. This report outlines the use of tissue expansion for reconstructing the scrotum in a pseudohermaphrodite with undescended testes and a hypoplastic scrotum. Tissue expanders were placed in the scrotum to create space for the testes. Relative to other reconstructive options in the scrotum, tissue expansion resulted in an excellent cosmetic appearance with the advantage of providing the desirable space for the testes with no donor site morbidity.
Recovery of Ulnar Innervated Intrinsic Muscles following Anterior Transposition of the Ulnar Nerve
Authors: Stuebe Alison M , Novak Christine B , Mackinnon Susan E
Published: February 2017

A chart review of 26 patients who underwent anterior transmuscular transposition of the ulnar nerve and had a preoperative nerve conduction velocity less than 40 m/s across the elbow was completed. Patients with intrinsic muscle wasting before surgery were contacted for follow-up. One patient returned for follow-up evaluation. Preoperatively, this patient had complete numbness in the small and ring fingers, and severe intrinsic muscle wasting; left hand pinch and grip strengths were 4.5 kg and 34 kg, respectively. At the final evaluation, 67 months following surgery, left hand pinch and grip strengths were 10.9 kg and 54.5 kg, respectively. The patient had good intrinsic muscle reinnervation; his intrinsic hand muscle mass appeared to be equal to the uninvolved hand and there was no evidence of a Wartenberg's sign. This long term patient follow-up suggests that ulnar nerve transposition can facilitate the return of intrinsic muscle mass and function among patients with cubital tunnel syndrome.
Thumb Avulsion Injury during Pregnancy: Caution When Using Oxytocin
Authors: Archibald Jason David , Bendor-Samuel Richard
Published: February 2017

A pregnant patient sustained a near complete degloving injury to her left thumb during the end of her third trimester. Surgical revascularization was successfully performed. Ten days after revascularization, the patient was induced into labour with oxytocin. Four hours after delivery, she experienced ischemic pain in the revascularized thumb, with subsequent failure and necrosis of the digit. The vasoactive properties of oxytocin are discussed, in particular, its role as a vasoconstrictor. The importance of sustaining adequate blood flow to newly revascularized tissue is stressed, as well as the need to be cautious when using vasoconstrictive agents during microvascular surgery.
A novel method of grafting facial nerve defects resulting from parotidectomy
Authors: Ching Shim , Thoma Achilleas , Archibald Stuart , Jackson Stanley
Published: February 2017

The sacrifice of the facial nerve is an uncommon consequence of parotidectomy for cancer resection. In the cases described here, the facial nerve was necessarily resected due to an infiltrating tumour. Seven cases of facial nerve sacrifice that were reconstructed with a novel, sural nerve construct are presented.

The sural nerve construct facilitates facial nerve reconstruction, especially in the case of multiple branch involvement and a short, proximal nerve stump. Evaluation of these cases shows acceptable facial nerve function following this technique. The use of this technique may prove advantageous in any instance of nerve grafting where multiple nerve branches are encountered.
Part III: Reformers in medical education and practice
Authors: Entin Martin A
Published: February 2017

Background

Part I (Can J Plast Surg 2000;8:25–29) established that standards of professional practice shift constantly. When a standard falls short of professional expectation, or when a physician becomes more concerned with financial gain than patient care, society needs the action of a reformer. Part II (Can J Plast Surg 2001;9:59–68) continued the study with the contribution of reformer John Hunter (1728–1793), followed with the contributions of seven other reformers, and concluded with Wilder Penfield (1891–1976). Part III extends this project through the greater part of the 20th century.

Study Design

Reformers were scientists who were selected because they conformed to the definition of ‘reformer’; namely, a person whose action restored, reshaped or changed the structure or ideology of medical practice.

Results

This survey demonstrated that the reforms were accomplished by scientists who possessed critical judgement and analytical qualities that enabled them to influence the direction of medical education and practice.

Conclusion

Reforms have been achieved through intuitive leaps, alterations of conventional practice, painstaking research and administrative restructuring.
Atypical mycobacterial flexor tenosynovitis presenting as carpal tunnel syndrome: Presentation of three cases and review
Authors: Brutus Jp , Nikolis A , Baeten Y , Chahidi N , Kinnen L , Ledoux P , Moermans Jp
Published: February 2017

Three patients with carpal tunnel syndrome secondary to atypical mycobacteria flexor tenosynovitis are presented. Aggressive surgical debridement combined with long term antitubercular pharmacotherapy resulted in a good outcome, but the lag time to diagnosis and course of disease were long. Diagnosis of these infections requires a high suspicion index, adequate surgical biopsy and appropriate cultures. Atypical mycobacteria infections must be considered in the differential diagnosis in any patient with evolving chronic tenosynovitis, even if the patient has no history of immunosuppression, and especially if environmental risk factors are present.
Giant dentigerous cyst occupying the right hemimandible
Authors: Koçer Uğur , Aksoy H Mete , TiftikçioğLu YiğIt Ö , Ertoy Dilek , Karaaslan Önder
Published: February 2017

Dentigerous cysts are the second most common odontogenic cysts of the mandible. They may vary in size from 2 cm to more than 10 cm. In the present report, a dentigerous cyst with massive involvement of the right half of the mandible in a young patient is presented. For cosmetic reasons and long term risks these cysts must be treated. Surgical removal is the preferred modality and a submandibular route should be chosen in large lesions. Bony cavities may be decreased in volume by using osteoperiosteal flaps, but there is no need for primary bone grafting, even for large defects.
An assessment of the anatomical basis of the thoracoacromial artery perforator flap
Authors: Geddes Christopher Robert , Tang Maolin , Yang Daping , Morris Steven F
Published: February 2017

Background

Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options. Perforator flaps are becoming increasingly popular for many applications. In the present study, we set out to examine the various perforators of the thoracoacromial axis through the pectoralis major (PM) muscle with respect to their suitability for transfer to the head and neck region as a pedicled flap.

Methods

A series of 10 fresh cadavers were injected with lead oxide, gelatin and water (250 mL/kg) through the femoral vessels. The cadavers were cooled and the integument was removed. Perforating vessels from the underlying muscles were marked and the resulting angiograms of the integument and deep tissues were compared with the dissection notes describing the course, size and distribution of the perforating vessels.

Results

The perforators through the PM muscle to the overlying skin included three regional groups: perforators of the thoracoacromial axis; perforators of the medial intercostal vessels; and perforators of the lateral thoracic artery. The major group of perforators supplying the overlying skin was from the intercostal vessels. However, the thoracoacromial axis did consistently give rise to perforators in the upper portion of the PM muscle. In particular, there were reliable perforators from the clavicular and deltoid branches of the thoracoacromial artery.

Discussion

The present study illustrates the potential clinical applications of a series of perforator flaps based on the thoracoacromial axis, which may be useful in head and neck reconstructive surgery.
Applied anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery
Authors: De Araujo Netto Belmino Corrêa , Ferreira Lydia Masako , de Oliveira Santos Ivan Dunshee Abranches
Published: February 2017

A study of the anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery was performed to help the elaboration of a fasciocutaneous flap for the reconstruction of skin and subcutaneous and deep fascia of the knee and popliteal region. Forty thighs in 27 fresh cadavers were dissected. In all of the thighs, the third perforator artery was found to arise from the deep femoral artery and reach the posterior aspect of the thigh after perforating the adductor magnus muscle. At that point it was also found that the third perforator artery gives off a branch that emerges through the intermuscular septum between the vast lateral muscle and the long head of the biceps femoral muscle, then crosses the posterior cutaneous nerve and moves directly on to perforate the deep fascia and then to bifurcate into two other branches: one ascending and one descending. The cutaneous area of the flap of the thigh's posterior region, nourished by the fasciocutaneous branch, was evaluated through the injection of dye. Dying of the upper medial, middle medial, lower medial and lower lateral areas of the flap was not successful in all of the dissected thighs. Nevertheless, the upper lateral and the middle lateral areas were dyed successfully in all 40 dissected thighs of the 27 cadavers.
Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects
Authors: Zhong T , Gullane PJ , Pc Neligan
Published: February 2017

Background

The reconstruction of large scalp defects is occasionally required. Several methods of scalp reconstruction have previously been described. This paper presents the authors' experience with two patients in whom traditional methods were not sufficient and in whom bilateral latissimus dorsi free flaps were required.

Objectives

To evaluate the effectiveness of a new technique in reconstructing extensive scalp defects.

Methods

Two case histories are presented. These include the rationale for the choice of reconstruction used as well as a discussion on the technical features of the surgery.

Results

Reconstruction was effective in both cases. However, one patient died in the early postoperative period from a pulmonary embolus.

Conclusions

Bilateral latissimus flaps can be safely and effectively used in closing massive scalp defects in selected cases.
Part IV: Reformers in medical education and practice: Effect of managed care organization in the United States
Authors: Entin Martin A
Published: February 2017

Background

Part I (Can J Plast Surg 2000;8:25–29) established that standards of professional practice shift constantly. When a standard falls short of professional expectation or when a physician becomes more concerned with financial gain rather than patient care, society needs the action of a reformer. Parts I, II (Can J Plast Surg 2001;9:59–68) and III (Can J Plast Surg 2002;10:103–108) covered 500 BC to 1970 AD and comprised 31 physicians who introduced innovations in medical knowledge or medical philosophy. Part IV deals with a time in which new conditions have been imposed on medical practice. In the United States, medical education and practice felt the repercussions of financial institutions participating in health care management.

Study Design

The reformers were scientists who conformed to our definition of ‘reformer’: a person whose action restored, reshaped or advanced the structure or ideology of medical practice.

Results

This survey demonstrated that the reforms were accomplished by scientists possessing critical judgement and analytical qualities that enabled them to influence the direction of medical education and practice. In the last 20 years, financial institutions imposed different criteria that may require future reformers to reestablish lost objectives.

Conclusion

Reforms have been achieved through intuitive leaps, alterations of conventional practice, painstaking research or administrative restructuring. The present health management in the United States requires new solutions.
Simultaneous breast augmentation and mastopexy
Authors: Whidden Peter G
Published: February 2017

The results of combining breast augmentation and mastopexy are less predictable than those associated with mastopexy or augmentation mammoplasty alone. A method of breast skin envelope reduction is presented that allows the surgeon performing mastopexy to preview the final breast shape before committing to skin resection. This method, first described in 1978, has proven to be technically versatile and reproducible, and applicable not only to moderate (second degree) and severe (third degree) ptosis but also to simultaneous breast augmentation and mastopexy. For the combined procedures, the practical strategy proposed is first the implant placement through a periareolar incision, and a vertical transglandular incision, usually submusculofascial; second, restoring the gland anatomy by closing the muscularis and the vertical transglandular incision; third, skin envelope adjustment using the Tailor-Tack maneuver to accurately assure the best position of the nipple-areolar complex on the breast mound; fourth, skin incision, de-epithelialization and undermining; and finally, closure combining the the Purse-String maneuver with the vertical incision.
Subcutaneous Basal Cell Carcinoma: A Case Report
Authors: Voris Tenley , Quinn Robert , Elahi Mohammed , Alani Hashim
Published: February 2017

An unusual case of a patient who presented with a subcutaneous soft tissue lesion of the back is described. The patient had no preceding history of cutaneous malignancy or local trauma. Excision of the lesion revealed a diagnosis consistent with basal cell carcinoma with deep infiltration. The site was re-excised with a generous margin to ensure complete removal. There has been no recurrence for 18 months. This case is presented to underscore the rarity and importance of its existence.
Eccrine Porocarcinoma: A Case Report and Review of the Literature
Authors: Lloyd Mark Sheldon , El-Muttardi Naguib , Robson A
Published: February 2017

Eccrine porocarcinoma is a rare form of skin cancer that is often con-fused with other types of skin malignancy The present paper high-lights a typical case to remind plastic surgeons of the natural history, pathological findings and current literature on the management of this cancer.
Ischemia of the Hand Secondary to Radial Artery Thrombosis: A Report of Three Cases
Authors: Chitte Sachin A , Veltri Karen , Thoma Achilleas
Published: February 2017

Upper extremity arterial thrombosis, though rare, is more prevalent on the ulnar side of the circulation, with the most common etiology being repetitive blunt trauma to the hypothenar eminence. Radial artery thrombosis is even more rare and when it does occur, is associated most often with iatrogenic cannulation, producing subsequent thrombi and emboli.

Three cases of spontaneous thrombosis of the radial artery extending to the superficial palmar arch and the princeps pollicis artery are presented here. Two patients underwent thrombectomies and one underwent excision of the thrombosed segment and reconstruction with a reversed saphenous vein graft. The etiology of the thrombus was consistent with cancer in two cases and trauma in one.
Post-traumatic stenosing flexor tenosynovitis
Authors: Best Timothy J
Published: February 2017

Two cases of post-traumatic stenosing flexor tenosynovitis (flexor tendon entrapment or trigger digit) are presented. The medical literature contains few reports of this uncommon etiology for a problem that afflicts at least 2% of the adult population.
Transconjunctival approach in lower eyelid blepharoplasty
Authors: Korchia D , Braccini F , Paris J , Thomassin Jm
Published: February 2017

Aim

To specify interest and indications of the transconjunctival approach in lower-eyelid plastic surgery.

Materials and Methods

Twenty-three cases of inferior blepharoplasty performed through a transconjunctival approach are reported. The authors describe the surgical technique, its indications and results.

Results

The transconjunctival approach provides excellent access to the inferior fatty chambers and is cutaneous scar free. It has a lower complication rate than the classic transcutaneous approach, and no case of cyclid retraction has been reported.

Conclusion

In our ‘cosmetic society’, the inferior blepharoplasty through a transconjunctival approach has taken a significant place in the armamentarium of the esthetic surgeon. Juvenile palpebral lipoptosis without skin excess constitutes the best indication for this technique. It is also indicated in secondary blepharoplasty and in patients presenting with a cicatricial risk or with orbital septum distention.
Anthrax of the lower eyelid
Authors: Koçer Ugur , Aksoy Hasan Mete , Tiftikcioglu Yigit Özer , Aksoy Berna
Published: February 2017

Because cutaneous anthrax, caused by Bacillus anthracis, is rare in developed countries, sporadic cases of anthrax may easily be over-looked because the diagnosis is often difficult to make. Lower eyelid involvement of anthrax is rare in clinical practice.

A 40-year-old woman with a history of contact with animals was evaluated and treated for a left lower eyelid lesion with a black eschar on it. A diagnosis of cutaneous anthrax had been made and intra-venous penicillin had been given by the department of infectious diseases before plastic surgery consultation. Any kind of surgical intervention was delayed for three months. The lesion healed secondarily and the resulting scar did not result in ectropion of the lower eyelid.

Delaying surgery is preferred because it is a safer approach when dealing with anthrax involving the lower eyelid, and secondary healing does not always result in deformity compromising function.
Conjoint muscle free flap for obliteration of an upper thoracic empyema cavity
Authors: Hallock Geoffrey G
Published: February 2017

Successful obliteration of an empyema cavity with vascularized flaps can, on occasion, best be accomplished using a free tissue transfer. A conjoint free muscle flap captures the immunological attributes of muscle necessary in the infectious milieu of these defects, augments the potential flap volume required to fill these often large defects, yet relies on only a single recipient site for the requisite microanastomoses. These advantages are demonstrated by a case using a combined latissimus dorsi/serratus anterior conjoint muscle free flap to obliterate a chronic upper thoracic empyema cavity. The internal mammary vessels were the most readily accessible recipient site, and should be considered an important alternative when managing these challenging wounds of the upper chest.
How Long does it Take Phentolamine to Reverse Adrenaline-Induced Vasoconstriction in the Finger and Hand? A Prospective, Randomized, Blinded Study: The Dalhousie Project Experimental Phase
Authors: Nodwell Trefor , Lalonde Don
Published: February 2017

At the Dalhousie Plastic Surgery Alumni Reunion at the Atlantic Plastic Surgery meeting in Halifax, Nova Scotia, in September 2001, 22 subjects, including 18 certified hand surgeons, were injected with 1.8 mL of 2% lidocaine with 1:100,000 adrenaline in three places in one finger of each hand. One hour later, the same sites of one hand were injected with phentolamine (1 mg in 1 mL), and the other hand was injected with saline. Subjects were blinded as to which hand received the phentolamine. It took an average of 85 min for the adrenaline-injected fingers to return to normal colour after phentolamine injection. It took an average of 320 min for the adrenaline-injected fingers to return to normal colour after saline injection (no phentolamine). We also observed that lidocaine with adrenaline provided an average of 549 min of anesthesia in nonphentolamine-injected fingers. Phentolamine consistently and reliably reversed adrenaline-induced vasoconstriction in the finger.
Custom Prefabrication of Silicone Tubes From Urinary Catheters for Experimental Peripheral Nerve Surgery
Authors: Saray Aydin
Published: February 2017

The entubulation principle represents a neurobiological approach to nerve surgery in which the role of the surgeon is limited and intrinsic healing capabilities of the nerve play the primary role. Herein, a technique for fabricating custom-made silicone tubes from a silicone urinary catheter is described. Silicone tubes with varying size and dimensions can be tailored depending on the diameter of the silicone urinary catheter (14 F to 18 F). Tubes crafted from silicone urinary catheters were used either as a nerve conduit to facilitate regeneration or as compressive nerve banding to simulate compressive neuropathy in the rat sciatic nerve. Custom-made silicone tubes have similar pros and cons to the commercially available silicone tubes regarding the capsule and foreign body reaction. It can be concluded that these cost effective tubes can be easily cut and used in experimental peripheral nerve surgery in developing countries where the cost of such materials becomes an important issue for the researchers.
The Indications and Reliability of Vein Graft Use in Free Flap Transfer
Authors: Classen Dale A
Published: February 2017

Background:

Adequate recipient vessels are critical for free flap success. There are, however, situations in which the local recipient vessels are inadequate. In these situations, vein grafts are required to allow pedicle extension to recipient vessels.

Objectives:

To determine the indications, technique, reliability and outcome of vein graft use in free flap transfer.

Methods:

A retrospective review of 198 consecutive free flaps by a single surgeon.

Results:

Vein grafts were required in 9.6% of free flaps. The most common indication was vein graft use in a planned preoperative fashion. The vein graft was most commony placed as an arteriovenous fistula loop. There was no statistically significant difference in survival between flaps with or without vein grafts.

Conclusion:

Vein graft use in free flap transfer is reliable, effective and often necessary for free flap survival.
The Use of Polymethyl-Methacrylate (Artecoll) As An Adjunct to Facial Reconstruction
Authors: Mok David , Schwarz Jorge
Published: February 2017

Background:

Injectable polymethyl-methacrylate (PMMA) microspheres, or Artecoll, has been used for the last few years in aesthetic surgery as long-term tissue filler for the correction of wrinkles and for lip augmentation. This paper presents three cases of the use of PMMA microsphere injection for reconstructive patients with defects of varying etiologies. These cases provide examples of a novel adjunct to the repertoire of the reconstructive surgeon.

Objectives:

To evaluate the effectiveness (short- and long-term) of PMMA injection for the correction of small soft tissue defects of the face.

Methods:

Three case histories are presented. They include the origin of the defect; previous reconstructions of the defect; and area, volume, timing and technical particularities of PMMA administration.

Results:

All three cases showed improvement of the defect with the PMMA injection with respect to both objective evidence and patient satisfaction. The improvements can still be seen after several years.

Conclusions:

PMMA microsphere injection can be effectively used to correct selected small facial defects in reconstructive cases and the results are long lasting.
Treatment of Electrical Burns By Single Debridement Followed By Free-Flap Coverage: How Important Is Timing?
Authors: Thomson Christopher J , Miles Duncan Ag , Beveridge John , Chang Peter S
Published: February 2017

Background:

High-voltage electrical burns involving the extremities may cause marked loss of skin and subcutaneous tissue exposing underlying bone and tendon. Treatment of electrical burns has historically involved serial debridement with late wound closure. Success has been reported with the use of microvascular free-flap transfer within three days of injury.

Objective:

Seven patients with severe high-voltage electrical burns are presented. The application and timing of microvascular free-flap coverage is discussed.

Results:

Six of the seven patients achieved successful healing with the free flaps.

Conclusion:

Delay of microvascular free-flap coverage beyond the previously published three-day protocol may not dramatically affect treatment success.
Vitamin C and Oxidative Stress On Cultured Human Keratinocytes
Authors: Ramos Santos Laélcio Lins , Gragnani Alfredo , Ferreira Lydia Masako , Silva Duarte Ivone Da , Silva Ronaldo Gonçalves
Published: February 2017

The aim of this research was to study the hypoxia-induced oxidative stress on cultured human keratinocytes. Control and cultured human keratinocytes were treated with vitamin C, and were then assessed by determining the concentration of malonyl dialdehyde (a final product of lipid peroxidation) existing in the cultured environment. Forty-eight flasks with culture of keratinocytes in confluent layer were divided into four groups: one control and one experimental group treated with vitamin C, and one control and one experimental group without vitamin C. All the cultures were sampled for malonyl dialdehyde assessment immediately after the end of a 30 min period of hypoxia. The statistical analysis of the results showed that vitamin C was not an effective protective agent against oxidative stress caused by hypoxia.
Gorlin'S Syndrome: An Interesting Case Study and Literature Review
Authors: Watts Robyn J , Paletz Justin
Published: February 2017

Gorlin's Syndrome, Or Basal Cell Nevus Syndrome, Is a Relatively Rare Disease. It Consists of a Classic Pentad of Features Comprised of Multiple Basal Cell Carcinomas, Jaw Cysts, Calcification of the Falx Cerebri, Pitting of the Palmar and Plantar Surfaces and Rib Anomalies. A Review of the Clinical Features, Differential Diagnosis, Clinical Work-Up and Current Treatment Is Presented.
Ketamine-Diazepam Protocol for Intravenous Sedation: The Cosmetic Surgery Hospital Experience
Authors: Quttainah Adel , Carlsen Lloyd , Voice Sandra , Taylor John
Published: February 2017

Rising hospital costs and operating room scheduling difficulties have influenced plastic surgeons to rely more often on intravenous sedation in office surgical settings. The use of ketamine as an intravenous sedation agent has enjoyed some popularity, but this has been far from universal. Its reputation for producing psychological sequelae such as nightmares, flashbacks and schizophrenic-like reactions have made many anesthesiologists and plastic surgeons reluctant to use this drug.

The authors’ experience using a ketamine/diazepam protocol with approximately 11,400 patients since 1971 at the Cosmetic Surgery Hospital in Woodbridge, Ontario is presented. The methodology consists of intravenous diazepam followed with low-dose ketamine (0.5 mg/kg to a maximum of 40 mg) 2 min later. This provides the surgeon with a period of profound amnesia to allow for infiltration of the local anesthetic. It is this local anesthetic delivered during the dissociative state that provides prolonged analgesia throughout the surgery. The patient is maintained throughout the procedure with increments of diazepam and midazolam.

This protocol is found to be effective, reliable and reproducible, and the experience of the patient and plastic surgeon has been overwhelmingly favourable.
Skin Wound Healing, Ischemia-Reperfusion Injury and Nerve Regeneration: Similarities in the Sequential Events and Molecular Basis
Authors: Al-Qattan Mm , Al-Kattan Wm
Published: February 2017

Skin wound healing, ischemia-reperfusion injury and nerve regeneration are three important topics for the hand surgeon. The events and molecular basis for each of these three topics are very complex, and previous review articles have discussed each topic separately the present review demonstrates and comments on the similarities in the sequential events and molecular basis among skin wound healing, ischemia-reperfusion injury and nerve regeneration.
A Case of Epiphora and Recurrent Basal Cell Carcinoma of the Nasal Tip and Review of Acquired Nasolacrimal System Obstruction
Authors: Parker Wendy Lynne , Lessard Marie-Lucie
Published: February 2017

A case of a 67-year-old man with recurrent basal cell carcinoma of the nasal tip and an incidental symptom of epiphora (volunteered by the patient) is presented. Epiphora is an abnormal overflow of tears that fail to drain into the inferior nasal meatus via the nasolacrimal system. Within the differential diagnosis of epiphora and nasolacrimal obstruction is neoplasm – primary, secondary or metastatic. On further investigation, including computed tomography imaging, he was subsequently found to have invasive disease extending along the left embryological cleavage plane superiorly to the medial canthal tendon. An excision attempt using Mohs technique by the dermatological surgeon was unsuccessful in adequately clearing the margins, and revealed a diagnosis of morphea-like basal cell cancer. This failure, taken together with the extent of disease identified by computed tomography scan, resulted in significant alteration of the operative approach. The patient underwent extensive tumour extirpation and nasal reconstruction using a forehead flap.

The present case alerts surgeons involved in the management of skin cancers to the importance of the anatomical relationship of the nasolacrimal apparatus to embryological soft tissue cleavage planes when dealing with recurrent and aggressive lesions. In addition, it serves as a reminder to inquire about the signs and symptoms associated with nasolacrimal obstruction. Moreover, when preparing for surgical excision of recurrent aggressive basal cell carcinoma, high-quality imaging is essential to tailor the operative plan.
A Methodological Guide to Performing a Cost-Utility Study Comparing Surgical Techniques
Authors: Thoma Achilleas , Haines Ted , Veltri Karen , Goldsmith Charlie H , O'brien Bernie J , Quartly Caroline
Published: February 2017

Background:

When recommending the adoption of a new surgical intervention as opposed to maintaining an old one, surgeons need to consider the opportunity cost, which is the value of the forgone benefits. To inform these decisions, surgeons can use economic analyses of surgical practices. Unfortunately, economic analyses conducted alongside randomized controlled trials in surgery are rare.

Objectives:

The objective of the present study was to use data from a small randomized controlled trial to illustrate the methodology for a cost-utility analysis comparing two techniques of carpal tunnel release: open release without (‘usual’ technique) and with (‘novel’ technique) ligament reconstruction.

Methods:

Eighteen eligible patients were entered into this prospective study. Fifteen were followed to six weeks postoperatively. One day preoperatively, and five days, three weeks and six weeks postoperatively, patients completed a self-administered Health Utilities Index Mark 2-3 questionnaire (utilities) and a case report form from which resource utilization (cost) was collected. Utilities were expressed as quality-adjusted life weeks, a fraction of quality-adjusted life years.

Results:

The mean total cost of the usual technique was lower than the novel technique, and the mean quality-adjusted life week was higher, favouring the usual technique. Indirect costs were four to nine times higher than direct costs in both techniques.

Conclusion:

The novel technique was more costly and less effective, and fell in the ‘lose-lose’ quadrant of the cost-effectiveness plane; it was rejected in favour of the usual technique. This methodology should be applied when deciding whether to adopt novel surgical techniques in plastic surgery to optimize scarce health care resources.
Juvenile Xanthogranuloma of the Nose
Authors: Aburezq Hisham , Jaeger Marcos , Iyengar Pratibha , Zuker Ronald
Published: February 2017

Juvenile xanthogranuloma is a type of non-Langerhans cell histiocytosis that occurs most frequently in infants and children. It is usually asymptomatic and can present as either a cutaneous or extracutaneous lesion. The present case is believed to be the first reported in the English literature of juvenile xanthogranuloma presenting as an ulcerated bleeding lesion on the dorsum of the nose.
A Survey of Volunteer Reconstructive Surgery Performed Outside of Canada By Canadian Plastic Surgeons
Authors: Fitzcharles-Bowe Colleen M , Lalonde Donald H
Published: February 2017

Background:

Members of the Canadian Society of Plastic Surgeons have been offering humanitarian services to countries outside of Canada since the 1960s.

Objective:

To document the extent of voluntary reconstructive services performed by members of the Canadian Society of Plastic Surgeons.

Method:

A survey was sent to all members of the Canadian Society of Plastic Surgeons asking them to list the extent of their voluntary services.

Results:

Over 80 Canadian Society of Plastic Surgeons members have performed voluntary reconstructive services with more than 40 organizations in over 60 countries.

Conclusion:

These voluntary services provide a significant benefit to patients around the world and are rewarding for the surgeons who perform them.
Case of Hibernoma in the Right Supraclavicular Fossa
Authors: Neufeld Marilyn , Medlicott Shaun , Nickerson Duncan
Published: February 2017

A patient with a supraclavicular mass originally diagnosed as a lipoma who was referred to a plastic surgeon for definitive treatment is presented. Gross intraoperative findings were inconsistent with lipoma, and subsequent pathological evaluation revealed the mass to be a hibernoma (a benign, brown adipose tumour). The incidence, etiology, presentation, pathology and imaging characteristics of this somewhat rare soft tissue tumour are reviewed.
Closure of a Pharyngocutaneous Fistula Using a Sternomastoid Muscle Flap
Authors: Raman Rajagopalan , Arumainathan Usha Devi
Published: February 2017

Presented here is a case of a pharyngocutaneous fistula which was closed primarily using a sternomastoid muscle flap, without skin coverage, thus obviating the need for a three-layered closure. Providing an intermediate cover was sufficient for the closure because the mucosal lining on the inside and the cutaneous covering on the outside grew using the muscle for support.
The Suction-Assisted Curettage Procedure
Authors: Bell Michael Sg , Doumit Gaby
Published: February 2017

Surgical soft tissue debridement of an inflamed or necrotic wound can be a challenging, time-consuming exercise, often with disproportionate blood loss. Suction-assisted curettage is a safe, simple and effective technique for these common, frustrating problems.
Patterns of Reinnervation and Blood Flow in Split-Skin Grafts
Authors: Juma A , Oudit D , Ellabban M
Published: February 2017

One of the most important functions of skin is thermoregulation. The alterations in the patterns of blood flow in skin is one of the main physiological processes responsible for thermoregulatory control. The mechanisms governing the thermoregulatory control of cutaneous blood flow are mainly neural and chemical in nature. At present, there is a lack of studies in the literature looking at the relationship between reinnervation and the blood flow pattern of skin grafts.

The present study uses Laser Doppler flowmetry and the immunohistochemical stains protein gene product 9.5, calcitonin gene-related peptide and substance P to identify nerve fibres, and antibodies to CD31 and von Willebrand factor to identify endothelial tissues. The aim of the present study was to investigate the patterns of blood flow and nerve tissue regeneration in split-skin grafts up to 15 years following the original procedure. Thirty-two split-skin grafts were studied and these were placed into two groups based on the nature of the bed of excision: group I consisted of patients who underwent tangential excision and split-skin grafting (n=17), and group II consisted of patients with split-skin grafts placed onto fascial beds (n=15). Each subpopulation of patients was further divided into three groups based on the length of time following grafting: one to three years, four to six years and seven to 15 years. These divisions were arbitrarily chosen and called A1, A2 and A3, respectively. In the Laser Doppler flowmetry arm of the study, the grafts were assessed at various stages after heating, cooling and further reheating.

The Laser Doppler flowmetry studies showed that, on subjecting the skin grafts in both groups I and II to heating and cooling followed by reheating, the overall response of the blood flow to changes in the temperature was slower.

The immunohistochemical analysis showed that in all graft types and graft ages, protein gene product 9.5, calcitonin gene-related peptide and substance P stains demonstrated a relative lack of the presence of nerve fibres in the split-skin grafts compared with the control (‘normal’ skin). However, von Willebrand factor and CD31 immunological staining demonstrated that vessels were present in the split-skin grafts, with no significant difference in size or quantity from the control samples.

It was found that the blood flow in the split-skin graft in response to thermal challenge, although present, was slower than that of normal skin, a finding which was independent of the age of the skin graft. It is thought that this was related to a lack of regeneration of nerve fibres and, hence, a deficiency in the neurally mediated reflexes of the blood vessels within the split-skin grafts.
A Double-Blind Randomized Controlled Trial Showing the Analgesic and Anesthetic Properties of Lidocaine E to Be Equivalent to Those of Ropivicaine and Bupivacaine in Carpal Tunnel Release Surgery
Authors: Pressman A , Doumit G , Rosaeg O , Bell M
Published: February 2017

In a three-phase trial, the anesthetic properties of lidocaine, bupivacaine and ropivicaine were compared in carpal tunnel release surgery. In phase I, two groups of 25 sequential patients were injected with either lidocaine plain 2% or lidocaine 2% with adrenaline 1:100,000 (E), as the local anesthetic for outpatient carpal tunnel release surgery. Subjective injection pain, postoperative pain at 2 h increments and the number of analgesic pills taken were recorded. During the first postoperative hours, outcome measures were superior in the lidocaine E group.

In phase II, a double-blind randomized design compared 42 patients injected with either lidocaine E or a combination of lidocaine E and bupivacaine. Postoperative pain scores and analgesic pills taken were compared using nonparametric statistical tests. During the first 4 h there was a slight benefit in the duration of the anesthetic and fewer pain pills were used in the bupivacaine group.

Phase III was a randomized double-blind comparison of ropivicaine and lidocaine E 2% in 72 patients. There was a slight decrease in pain scores and fewer analgesic pills required during the first 6 h in the ropivicaine group.

Lidocaine plain 2% provided significantly inferior analgesic and anesthetic properties compared with lidocaine E 2%, bupivacaine or ropivicaine. Sequential randomized comparisons between lidocaine E and bupivacaine and ropivicaine showed clinical equivalence. The present study showed lidocaine E 2% to be a satisfactory and comparatively cost-effective anesthetic for outpatient carpal tunnel surgery.
A Midface Swelling in a Child – a Possible Diagnostic Dilemma
Authors: Patel Kuntal , Oudit Deemesh , Ross G , Nicolson Caroline , Howcroft AJ
Published: February 2017

A lump on the midface of a child can pose as a diagnostic dilemma. There is a wide variety of possible differential diagnoses, ranging from simple benign conditions such as a sebaceous cyst, dermoid cyst, lipoma, neuroma and neurofibroma, to potentially devastating conditions such as odontogenic myxoma.

A case of a child in which the formulation of a definite diagnosis was clinically and histologically challenging is presented.
Compression Neuropathy of the Median Nerve During Tissue Expansion of the Forearm
Authors: Balakrishnan Chenicheri , Mussman Jason L , Vandemark Shawn , Erella Venkata S
Published: February 2017

Acute median nerve compression usually occurs from increased pressure within the compartments. During tissue expansion of the forearm, the interstitial pressure increases, which usually decreases following the relaxation of tissue. Clinical diagnosis of acute neuropathy is usually made from the history and clinical signs and symptoms. The cases of two patients who developed acute symptoms of neuropathy during tissue expansion of the forearm are presented.
Digital Merkel Cell Carcinoma
Authors: Rebecca Alanna M , Craft Randall O , Smith Anthony A
Published: February 2017

Merkel cell carcinoma (MCC) is a rare and biologically aggressive neuroendocrine tumour of the skin. Recent analysis of a surveillance, epidemiology and end results program has shown a statistically significant increase of 8% per year in the age-adjusted rates for MCC of the skin over the past 15 years. MCC commonly presents as a painless, rapidly growing, single red or purple cutaneous nodule. Diagnosis is often delayed until histopathological examination due to the relative rarity of the disease. MCC-specific immunohistochemical markers are available for definitive diagnosis, including anticytokeratin-20-positive stain and thyroid transcription factor-1-negative stains. Because there are no phase III trials to guide management, treatment is often tailored to the individual patient by integrating surgery, radiation and chemotherapy.
Fasciocutaneous Cubital Flap in Soft Tissue Loss of the Wrist
Authors: Elena-Sorando E , Arranz-López JL , García-Martínez ML , Núñez-Serrano AA , Juan-Huelves A De , Benito-Duque P
Published: February 2017

Surgical managment of soft tissue loss in the wrist consists of suitable coverage for the protection of vascular, nervous and tendinous structures. The fasciocutaneous cubital flap covers wrist defects, providing safe support over the nerves, tendons and vessels. Reported here is five cases of wrist defects by different etiology (extravasations, autolysis, trauma and neuritis). A fasciocutaneous cubital flap successfully covered the soft tissue loss in all cases. This flap is applied in an easy, one-stage procedure and it maintains the major arteries of the forearm.
Evacuation of Hematomas Using Liposuction Technology: Technique and Literature Review
Authors: Bell Michael Sg , Doumit Gaby
Published: February 2017

Established nonexpanding hematomas can be successfully treated with minimal morbidity using standard liposucstion techniques at the bedside or in an outpatient setting under local anesthesia. The authors presents a series of eight patients and discuss current concepts of dealing with this common and distressing surgical complication.
Intraneural Lipoma of the Ulnar Nerve: A Case Report and Review of Literature
Authors: Balakrishnan Chenicheri , Saini Manmit S , Demercurio Jeffrey
Published: February 2017

Intraneural lipomas of the peripheral nerve or its cutaneous branches are rare benign tumours. These slow-growing tumours present as asymptomatic swelling, and diagnosis is usually made at the time of exploration. In most cases, these tumours can be enucleated without damage to the nerve fibres.
Isolated Primary Osteoma Cutis of the Head:
Authors: Montecinos Ayaviri Natalia Alinda , Nahas Fábio Xerfan , Jardini Barbosa Marcus Vinícius , Farah Andréia Bufoni , Arimatéia Mendes José De , Ferreira Lydia Masako
Published: February 2017

Osteoma cutis is a rare disease in which there is formation of bony tissue in the skin that causes deformities. The etiology remains unknown and its treatment is controversial. A rare case of primary osteoma cutis in the face and scalp, which was not associated with any syndrome, is described. The patient was treated with surgery and topical retinoic acid. The retinoic acid treatment resulted in an improvement of the frontal area, and stabilized the disease over a two-year follow-up period. Surgical resection was a simple treatment with a quick recovery, minimal scarring and no local recurrence. The patient was followed for two years and presented a satisfactory result. The treatment of osteoma cutis is quite variable, and surgery is the most frequently reported treatment. However, a combination of clinical and surgical treatments seems to be an efficient way to manage these patients.
The Effectiveness of Sodium Tetradecyl Sulfate in the Treatment of Wrist Ganglia
Authors: Ajekigbe Lawrence , Stothard John
Published: February 2017

Background

Ganglia are the most common benign soft tissue tumours of the hand. Although benign, a significant number of patients with wrist ganglia consult with their general practitioners, and ultimately the hand surgeon, complaining of pain. A great number of patients are concerned about the cosmetic appearance, and an equally significant number genuinely believe that the ganglion is a cancer. There are several management options resulting in varying degrees of success. These include observation only, surgical excision, aspiration only, aspiration with injection of methylprednisolone, and aspiration with injection of methylprednisolone and hyaluronidase.

Objective

The main objective was to investigate the effectiveness and safety of sodium tetradecyl sulfate as a sclerosing agent after aspiration of wrist ganglia.

Methods

Initial data were collected prospectively during a period of 48 months. Following this, patients were sent a postal survey at least two years after they had received treatment to access the levels of recurrence and persistent complications.

Results

In the short term, 90% of the patients achieved complete resolution after one episode of aspiration and injection. However, there was only a 65% cure rate after two to five years. Complications were few and not significant.

Conclusion

Sodium tetradecyl sulfate is an effective sclerosing agent after aspiration of wrist ganglia with an excellent short-term efficacy and a long-term cure rate comparable to that of surgical excision.