bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteochondral Allograft Transplantation of the Knee: Analysis of Failures at 5 Years
Authors: Frank Rachel M. , Lee Simon , Levy David , Poland Sarah , Smith Maggie , Scalise Nina , Cvetanovich Gregory L. , Cole Brian J.
Published: January 2017

Background:

Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, and the need for reoperations is not uncommon.

Purpose:

To quantify survival for OAT and report findings at reoperations.

Study Design:

Case series; Level of evidence, 4.

Methods:

A review of prospectively collected data of 224 consecutive patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years was conducted. The reoperation rate, timing of reoperation, procedure performed, and findings at surgery were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at second-look arthroscopic surgery.

Results:

A total of 180 patients (mean [±SD] age, 32.7 ± 10.4 years; 52% male) who underwent OAT with a mean follow-up of 5.0 ± 2.7 years met the inclusion criteria (80% follow-up). Of these, 172 patients (96%) underwent a mean of 2.5 ± 1.7 prior surgical procedures on the ipsilateral knee before OAT. Forty-eight percent of OAT procedures were isolated, while 52% were performed with concomitant procedures including meniscus allograft transplantation (MAT) in 65 (36%). Sixty-six patients (37%) underwent a reoperation at a mean of 2.5 ± 2.5 years, with 32% (21/66) undergoing additional reoperations (range, 1-3). Arthroscopic debridement was performed in 91% of patients with initial reoperations, with 83% showing evidence of an intact graft; of these, 9 ultimately progressed to failure at a mean of 4.1 ± 1.9 years. A total of 24 patients (13%) were considered failures at a mean of 3.6 ± 2.6 years after the index OAT procedure because of revision OAT (n = 7), conversion to arthroplasty (n= 12), or appearance of a poorly incorporated allograft at arthroscopic surgery (n = 5). The number of previous surgical procedures was independently predictive of reoperations and failure; body mass index was independently predictive of failure. Excluding the failed patients, statistically and clinically significant improvements were found in the Lysholm score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Short Form–12 physical component summary at final follow-up ( P < .001 for all), with inferior outcomes (albeit overall improved) in patients who underwent a reoperation.

Conclusion:

In this series, there was a 37% reoperation rate and an 87% allograft survival rate at a mean of 5 years after OAT. The number of previous ipsilateral knee surgical procedures was predictive of reoperations and failure. Of the patients who underwent arthroscopic debridement with an intact graft at the time of arthroscopic surgery, 82% experienced significantly improved outcomes, while 18% ultimately progressed to failure. This information can be used to counsel patients on the implications of a reoperation after OAT.
Is an Anterolateral Ligament Reconstruction Required in ACL-Reconstructed Knees With Associated Injury to the Anterolateral Structures? A Robotic Analysis of Rotational Knee Stability
Authors: Noyes Frank R. , Huser Lauren E. , Jurgensmeier Darin , Walsh James , Levy Martin S.
Published: January 2017

Background:

The effect of an anterolateral ligament (ALL) reconstruction on rotational knee stability and corresponding anterior cruciate ligament (ACL) graft forces using multiple knee loading conditions including the pivot-shift phenomenon has not been determined.

Purpose:

First, to determine the rotational stability and ACL graft forces provided by an anatomic bone–patellar tendon–bone ACL reconstruction in the ACL-deficient knee alone and with an associated ALL/iliotibial band (ITB) injury. Second, to determine the added rotational stabilizing effect and reduction in ACL graft forces provided by an ALL reconstruction.

Study Design:

Controlled laboratory study.

Methods:

A 6 degrees of freedom robotic simulator was used to test 7 fresh-frozen cadaveric specimens during 5 testing conditions: intact, ACL-sectioned, ACL-reconstructed, ALL/ITB-sectioned, and ALL-reconstructed. Lateral and medial tibiofemoral compartment translations and internal tibial rotations were measured under Lachman test conditions, 5-N·m internal rotation, and 2 pivot-shift simulations. Statistical equivalence within 2 mm and 2° was defined as P < .05.

Results:

Single-graft ACL reconstruction restored central tibial translation under Lachman testing and internal rotation under 5-N·m internal rotation torque ( P < .05). A modest increase in internal rotation under 5-N·m internal rotation torque occurred after ALL/ITB sectioning of 5.1° (95% CI, 3.6° to 6.7°) and 6.7° (95% CI, 4.3° to 9.1°) at 60° and 90° of flexion, respectively ( P = .99). Lateral compartment translation increases in the pivot-shift tests were <2 mm. ALL reconstruction restored internal rotation within 0.5° (95% CI, –1.9° to 2.9°) and 0.7° (95% CI, –2.0° to 3.4°) of the ACL-reconstructed state at 60° and 90° of flexion, respectively ( P < .05). The ALL procedure reduced ACL graft forces, at most, 75 N in the pivot-shift tests and 81 N in the internal rotation tests.

Conclusion:

Although the ALL reconstruction corrected the small abnormal changes in the internal rotation limit at high flexion angles, the procedure had no effect in limiting tibiofemoral compartment translations in the pivot-shift test and produced only modest decreases in ACL graft forces. Accordingly, the recommendation to perform an ALL reconstruction to correct pivot-shift abnormalities is questioned.

Clinical Relevance:

The small changes in rotational stability after ALL/ITB sectioning would not seem to warrant the routine addition of an ALL reconstruction in primary ACL injuries. Clinical exceptions may exist, as in grossly unstable grade 3 pivot-shift knees and revision knees. However, the concern exists of overconstraining normal tibial rotations.
On the Primordial Origins of Group Analysis and their Relation to the Creative Nature of Humanity
Authors: Power Kevin
Published: January 2017

Of Foulkes’ Four Levels of interaction (Therapeutic Group Analysis, 1964: 114) the primordial has received the least notice, despite it being the foundation for the others. This article explores where this category may have originated and then presents a digest of anthropological research into human social group origins, and their relation to group-analysis and current human concerns.
A review of fibrous reinforcements of concrete
Authors: Anandamurthy Anarghya , Guna Vijaykumar , Ilangovan Manikandan , Reddy Narendra
Published: January 2017

Fibrous reinforcements, specifically those derived from agricultural sources, instead of steel make concrete more sustainable and provide unique properties to structures. Organic, inorganic and metallic fibers have been extensively studied as reinforcement and as aggregates for concrete. Steel, glass and carbon in fibrous forms have been used as reinforcement along with concrete or as a separate structure to improve performance or buttress dilapidated structures. Although these traditional materials provide good improvement in properties, they are derived from non-renewable and unsustainable sources. Recent focus has been to use renewable and sustainable materials in concrete instead of the traditional materials such as glass, carbon and steel. A plethora of fibers and fibrous materials, especially those derived from agricultural residues, have the potential to be used in concrete and make concrete structure more sustainable and environmentally friendly. In addition to the different types of fibers, various forms of the same fibers have also been used as reinforcement. Fibers, fabrics, tubes, rods and other structures have been used as reinforcement. In this review, we summarize the various types of fibers used in concrete and discuss the potential of using biofibers derived from agricultural residues as reinforcement and aggregates in concrete. We have broadly grouped the fibers into eight categories and further divided into sub-groups depending on the form of the reinforcement. Major focus has been to cover literature on natural fibers and agricultural residue-based reinforcements. Advantages of using fibrous materials including increase in performance properties have been reviewed. Limitations of the reinforcements and approaches to overcome the limitations have also been discussed.
Participative Decision Making and Union-Management Cooperative Efforts: Attitudes of Managers, Union Officials, and Employees
Authors: Schwarz Roger M.
Published: January 2017

Based on a surrey of 550 people at four sites, this study examines whether managers, union officials and employees in union-management cooperative efforts consider their programs more effective than do their counterparts in similar programs designed by management alone. Planned comparisons between types of programs showed that managers, union officials, and employees rated cooperative efforts differently with respect to both degree of effectiveness and areas of effectiveness. Managers and employees were more favorable about cooperative efforts than were union officials. Planned comparisons within similar types of programs showed that the three groups within cooperative efforts did not have more similar attitudes toward their programs than did the three groups in management designed programs.
Multiple Constituencies Activities and Standards: A Framework for Evaluating the Effectiveness of Public Personnel Departments
Authors: Straus Stephen K.
Published: January 2017

Previous research has failed to produce an appropriate framework for evaluating the effectiveness of public personnel departments. The lack of such a framework impedes the quality of decision making by personnel practitioners and of research by academicians.

An appropriate framework should take into account the competing demands of the groups served by and able to influence public personnel departments. This article presents the Multiple Constituencies Activities and Standards Framework (MCAS), which has been applied in North Carolina counties. MCAS provides evaluations by various groups (constituents) of the activities of their personnel departments, and compares those evaluations to ratings achieved by other personnel departments over time.
The State of Public Personnel Research
Authors: Houston David J. , Delevan Sybil M.
Published: January 2017

This article examines the nature of empirical research in two public personnel journals by focusing on the purpose of published research, as well as the research designs and statistical techniques that are employed. The analysis indicates that public personnel scholars are actively engaged in the testing of empirical theory and the development of a cumulative knowledge base, although the methodological rigor of this research is at time lacking. Thus the current state of public personnel research deviates from the atheoretical and noncumulative nature characteristics of public administration research generally.
Impact of a New Teaching and Learning Approach in an Introductory Programming Course
Authors: Iqbal Malik Sohail , Coldwell-Neilson Jo
Published: January 2017

High failure and dropout rates are reported in introductory programming (IP) courses in different studies despite extensive research attempting to address the issue. In this study, we introduced an ADRI (Approach, Deployment, Result, Improvement) approach in the teaching and learning process of an IP course to improve learning and success rates. All three entities of the didactic triangle (student, instructor, and content) were involved in the research to better understand and execute the proposed approach. The IP course materials were redesigned based on the ADRI approach, and an editor was developed to promote the new approach and encourage students to complete the various stages required in the approach. Two surveys were conducted, and final exam grades over four semesters were compared with determine the impact of including the ADRI approach in the course. We concluded that the ADRI approach provides a positive impact on outcomes that the students achieved during the course. It engages students in practicing their programming skills and provides a new presentation style for examples and exercises which discourages students from taking programming shortcuts. It not only helps to reduce the failure and, significantly, the dropout rates from the IP course but also impacts positively on all students who passed the IP course.
Improvement in Favre-Racouchot Disease Treated with a Combination Medium-Depth Chemical Peel Containing Jessner's Solution/35% Trichloroacetic Acid
Authors: Foster K. W. , Fincher E. F. , Moy R. Kissel; R. L.
Published: January 2017

Introduction:

Favre-Racouchot disease is a condition typified by grouped comedones occurring on sun-damaged skin. This disorder affects mainly white men who have had extensive exposure to sun and harsh weather and has been estimated to occur in 6% of persons older than 50 years. Although topical retinoids have been the mainstay of therapy for this condition, many patients have an incomplete response to this therapeutic modality, and other treatments such as manual extraction, oral isotretinoin, staged excision, dermabrasion, and combination approaches have been attempted.

Materials and Methods:

A combination medium-depth chemical peel containing Jessner's solution/35% trichloroacetic acid was used to treat a 53 year-old white woman with Favre-Racouchot disease. The patient showed no response to topical retinoids applied twice daily for greater than 16 weeks and a more superficial combination peel consisting of Jessner's solution/20% trichloroacetic acid. Complicating factors included preexisting rosacea and early rhinophyma.

Results:

After treatment with a medium-depth chemical peel containing Jessner's solution/35% trichloroacetic acid, marked improvement was noted with concomitant resolution of >90% of comedones. No postoperative complications, such as prolonged erythema, scarring, viral reactivation, or bacterial infection, were observed. The patient was pleased with the overall result.

Discussion:

These results demonstrate the utility of combination medium-depth chemical peels containing Jessner's solution/35% trichloroacetic acid in the management of Favre-Racouchot disease that is resistant to more conservative therapies. We recommend the judicious use of this procedure in patients who do not respond to more conservative measures.
Single-Stage Male Body Contouring after Massive Weight Loss—A Case Report
Authors: Thomas Mohan , D'Silva James Allen , Verma Harikumar Menon; Sachin
Published: January 2017

Introduction:

Body contouring surgeries after massive weight loss are done with the goal to improve the patient's aesthetic appearance and quality of life. Usually this is performed as a staged procedure, but we are presenting a single-stage procedure, emphasizing the fact that single-stage procedures improve the patient's degree of satisfaction and do not jeopardize the patient's health status.

Methods:

Body contouring was done as a single-stage procedure in a 25-year-old man after he had lost 30 kg. The loose skin on the abdomen, anterior and lateral chest, and back, along with residual fat deposits, were addressed by liposuction, abdominoplasty, and chest-contouring surgery using boomerang flaps.

Results:

Aesthetically acceptable results could be obtained by combining these procedures. Total operative time was 6 hours. There were no perioperative complications. All incisions healed in primary intention.

Discussion:

Although body contouring after massive weight loss in men is usually treated as a staged procedure, in well-selected cases, it can be done as a single-stage procedure without compromising results or safety. Although a larger series of such cases would prove this more emphatically, this case report certainly demonstrates the feasibility of single-stage contouring in men. Young patients without comorbid conditions are ideal candidates.
Breast Augmentation: Minimizing Postoperative Nausea and Vomiting (PONV), Maximizing Patient Satisfaction
Authors: Eisenberg Ted S.
Published: January 2017

Introduction:

This study evaluates postoperative nausea and vomiting (PONV) after bilateral submuscular saline breast augmentation surgery. The efficacy of a particular protocol of medications and anesthetics, used during the preoperative, intraoperative, and postoperative phases of care, is evaluated.

Materials and Methods:

Preoperatively, all but 2 patients (who were allergic to sulfa) received 200 mg of Celebrex capsule, a cyclooxygenase (COX)-2 inhibitor, along with Alka Seltzer Gold or Bicitra, and had the option of taking 5 mg of Valium. Six patients with a prior history of nausea and vomiting were given Emend 40 mg PO within 3 hours of surgery, and Benadryl was withheld from these 6 patients to evaluate the effects of Emend. All patients received intravenous propofol, Versed, and fentanyl for induction. Intraoperatively, they were given intravenous Zofran 4 mg, Benadryl 25 mg, and Decadron 8 mg. Sevofluorane gas was used, and no nitrous gas was used. Postoperatively, patients were advised to take Celebrex. They were given supplemental prescriptions for Zofran ODT 4 mg and Valium 5 mg. Patients were advised that they could use antacids like Rolaids or Turns for postoperative nausea if needed. The questionnaire evaluated PONV on the day of surgery and on the following 2 days; patient satisfaction with the overall surgical experience was evaluated, and results of their operation were reported on a scale from 0 to 10.

Results:

In all, 72.6% of the 241 patients reported no nausea and vomiting on the day of surgery. The numbers of patients who reported no nausea and vomiting on the first and second days after surgery were similar, at 73% and 75.5%, respectively. On average, the remaining 27.4% had some PONV (“3” on the 0 to 10 scale) on all 3 days. A total of 94% of patients reported a “10” to rate their overall experience, and 90% gave a “10” rating for the results of their operation.

Conclusions:

My approach, which evolved over 10 years with 3000 patients, has improved my results from several days of extreme postoperative nausea and vomiting to almost zero. I attribute much of this success to the use of Decadron, Zofran, Benadryl, and Emend, all of which may affect multiple pathways and nausea receptor sites. During surgery, I use a laryngeal mask airway (LMA) and eliminate nitrous; I believe this may help decrease postoperative nausea and vomiting. I also use Celebrex, which may possibly lower the amount of narcotic needed during and after surgery. Finally, I believe that the outstanding level of patient satisfaction reported in the study is directly related to the fact that patients had minimal or no nausea and vomiting after surgery.
Treatment of Surgical Scars: A Pilot Study Comparing Fractional Photothermolysis with Pulsed Dye Laser
Authors: Tierney Emily , Mahmoud Bassel , Srivastava Divya , Ozog David , Kouba David
Published: January 2017

Introduction:

Fractionated resurfacing has been demonstrated in case reports to notably improve the cosmetic outcome of surgical scars. The aim of this study was to compare fractionated resurfacing (fractional photothermolysis [FP]) with the pulsed dye laser (PDL). If novel minimally invasive therapies such as FP are proven to be safe and effective for the treatment of surgical scars, patients receiving cutaneous surgery will be significantly allayed in their concern about the cosmetic outcomes of their surgical scars.

Materials and Methods:

Randomized, double-blinded split scar study in 15 scars in a total of 12 patients after Mohs surgery for nonmelanoma skin cancer on the face, neck, chest, or back. Patients were treated on one-half of the scar with 1550-nm erbium doped fiber laser and on the contralateral half with the 595 nm V-Beam PDL. Patients were treated with each laser device on half of the scar for a total of 2 treatment sessions at 2-week intervals.

Results:

After a series of 2 treatments, greater improvements were noted in the portion of surgical scars treated with FP than with PDL in overall cosmetic outcome (FP, mean improvement = 59.7%, range = 40–80% vs PDL, mean improvement = 47.9%, range = 20–60%; P= .05). In pigmentary variation (FP, mean improvement = 47.2%, range = 20–80% vs PDL, mean improvement = 28.5%, range = 0–40%; P<.05); scar thickness (FP, mean improvement = 71.4%, range = 40–80% vs PDL, mean improvement = 35.4%, range = 0–60%; P<.05); and scar texture (FP, mean improvement = 64.3%, range = 40–80% vs PDL, mean improvement = 43.4%, range = 20–60%; P< .05). A total of 4 scars with significant hypopigmentation had improvements in pigmentation after treatment with FP (mean improvement = 45.0%, range = 20–80%) with no improvement after treatment with PDL (0%) (P < .05). There was no incidence of dyspigmentation, ulceration, or scarring with either device.

Conclusions:

To the authors' knowledge, this is the first study to compare the outcome of treatment with PDL with FP in terms of pigmentary variation, textural change, and overall cosmetic improvement. The data presented herein suggest that FP results in significantly greater improvements in surface pigmentation, textural variation, and scar thickness relative to PDL. Similar to previous case reports, FP was uniquely successful in improving hypopigmented scars. The greater depth of penetration and significant skin remodeling induced with FP likely account for its greater improvement in textural change and thickness of surgical scars. Both FP and PDL appear to be highly safe modalities for the treatment of surgical scars with minimal discomfort and no adverse effects.
Unexplained Massive Galactorrhea following Bilateral Subpectoral Breast Augmentation: Report of a Case
Authors: Guanciale Jerry , Forouzanpour Fardad
Published: January 2017

Galactorrhea, although a fairly common condition in a gravid or recently postpartum female, is rarely seen as a complication of breast augmentation or reduction. Although sporadic cases have been documented in the literature after cosmetic and reconstructive breast surgery, documented evidence of the cause of the abnormal lactation, save the identification of a pituitary prolactinoma, remains speculative at best. This case report involves a 32 y.o. Hispanic female who underwent elective bilateral subpectoral saline breast augmentation and developed massive galactorrhea in the immediate postoperative period.
Use of the Breast Bolster to Address Intraoperative Asymmetries in Breast Augmentation Surgery
Authors: Blyer Scott M. , Sherry Steven , Watson Stephen W.
Published: January 2017

Introduction:

Breast asymmetry is a common complication following breast augmentation surgery. It is a frequent cause for reoperation and many times can be prevented with good preoperative examination and planning. Iatrogenic asymmetric breast pocket development is among the unforeseeable causes of breast asymmetry. We submit a simple technique to prevent breast asymmetry intraoperatively if asymmetric pocket development has been identified.

Materials and Methods:

A 46-year-old female patient with no preoperative asymmetries was planned for submuscular breast augmentation. Upon creation of the submuscular pocket, an asymmetry was noted in a more inferiorly positioned right breast. Using the breast bolster technique, this problem was addressed and corrected intraoperatively. The details of the procedure are presented.

Results:

Evaluation on 4-week and 3-month follow-up appointments revealed an excellent result with high patient satisfaction.

Discussion:

The application of the breast bolster is a quick procedure with little to no morbidity and could potentially prevent a need for further corrective surgery. Its application may be used to prevent such problems as symmastia when identified intraoperatively.
Helmet Design Excision for Management of Skin Excess in Patients with Grade 2b/3 Gynecomastia Treated with Liposuction
Authors: Thomas Mohan , Silva James D. , Menon Hari , Satish Chetan
Published: January 2017

Introduction:

With the advent of liposuction, key-hole surgery for gynecomastia is on the rise. However, the skin excess in Grade 2b/3 gynecomastia that exists in vertical and horizontal axes in most cases has to be excised after completion of the liposuction. For the management of patients with Grade 2b/3 gynecomastia, we propose the helmet design for removing skin excess effectively and for relocating the nipple-areola complex in proper position concomitantly with suction-assisted liposuction.

Method:

The helmet design technique is described here. This technique was performed on 5 consecutive patients with Grade 2b/3 gynecomastia treated at our institute over a period of 2 years from November 2006 to November 2008 with a minimum follow-up period of 3 months. The aesthetic outcome was evaluated by patients on a grading scale from Grade 1 to Grade 3 (Grade J = poor, Grade 2 = satisfactory, Grade 3 = good). All patients were treated on a day care basis.

Results:

The helmet design technique takes care of the excess skin that remains after liposuction and avoids the skin pleating and puckering that result from use of the circumareolar method of skin excision. We did not encounter any complications when using this technique. Two patients had decreased nipple sensation that recovered later. The aesthetic outcome was rated as Grade 2 by 1 patient and Grade 3 by 4 patients.

Conclusion:

The helmet design excision used in patients with Grade 2b/3 gynecomastia treated with suction-assisted liposuction helps in relocating the nipple-areola complex to proper position and in achieving complete removal of excess skin. This is an effective single-stage treatment for patients with Grade 2b/3 gynecomastia.
Vacuum Pressures during Autologous Fat Transfer (AFT): A Study of the Closed Syringe Type and other Aspirator Pressures
Authors: Shippert Ron D.
Published: January 2017

Objective:

Vacuum pressures have long been thought to damage the lipocytes during harvest. Several studies have described this as well as the need to reduce the pressure during harvest. The goals of this article are to increase awareness of the pressures associated with the closed syringe technique and other methods of harvesting for autologous fat transfer (AFT).

Methods:

The closed syringe pressures are presented for 60-, 30-, and 10-mL syringes. Note that the vacuum force for any manual syringe is the plunger and the position of the plunger will dictate the pressure that will be applied to the fat.

Results:

The closed syringe tests on 60-, 30-, and 10-mL syringes (three brands) show that a 60-mL syringe will produce an 18.5-in mercury vacuum pressure, but only when the plunger is withdrawn to maximum. The tests also showed that when the plunger is at 30 mL, the response is 16 in of mercury; at 10 mL the response is 6 in of mercury. Thus, the smaller the syringe capacity, the lower the vacuum pressure. This lessening of the vacuum pressure is not due to the plunger losing pressure around its gasket, but it is directly related to the empty space (volume) left in the syringe. Thus, a 60-mL syringe that is half full of fat renders an identical pressure to an empty 30-mL syringe, that being 16 in of mercury.

Discussion:

Electrically powered vacuum sources do not respond in this manner because the motor will maintain a relatively constant pressure throughout the procedure. The economic advantages of the closed syringe technique are discussed with emphasis on the availability of generic materials and thus lessened cost. The disadvantages include the varying downward pressures during harvest, the added time to decant or centrifuge the harvested material, and the need for added transfers. Also presented are the 2 filter-type harvest units on the market today (Lipivage and TissuTrans) that will save considerable time by separating out the unwanted material during the harvest and without additional transfers.

Conclusion:

Knowing the pressures administered (to fat) by the syringes or reservoirs used in all types of fat harvesting equipment is important and part of the standardization process.
Per-Sternomastoid Neck Suspension in Rhytidectomy: A Technical Note
Authors: Mommaerts Maurice Y. , Moreno David J. Durán
Published: January 2017

Introduction:

Compound skin platysma suspension to the tympanoparotid fascia according to Labbé is an efficient technique in neck lift with minimal dissection and morbidity. One disadvantage remains in the fatty neck; the lifted tissue block is pulled over one of the most prominent features of a young neck: the retromandibular fovea situated between the ascending mandibular ramus and the insertion of the sternomastoid muscle (SCM). The authors propose to pull the compound flap medially by suspending it deep through the SCM to the mastoid fascia. This also helps to support a ptotic submandibular gland.

Materials and Methods:

Computed tomography (CT) scans and magnetic resonance imaging (MRI) of 40 patients (20 female, 20 male) with oropharyngeal malignancy were analyzed for the thickness of the SCM and the safety distance to the internal jugular vein.

Results:

The total average thickness of the SCM was 10.5 mm (SD 1.4) for females and 11.7 mm (SD 1.9) for males. A security distance of 6 mm from the medial SCM surface to the jugular vein was noted in females, and 7–8 mm in males.

Conclusion:

Deep per-sternomastoid suspension of the platysma to the mastoid fascia, performed with an Obwegeser mandibular awl coming from the superoposterior direction, is a safe and useful modification of the Labbé platysma suspension.
A New Surgical Approach for the Treatment of Extensive Baldness
Authors: Brandy Dominic A.
Published: January 2017

Utilizing the bilateral occipitoparietal flap, the Brandy bitemporal flap, and non-part-side frontoparietal advancement flaps, a patient with extensive male pattern baldness can now be treated aesthetically in just three or four steps.
Kirschner Pin Migration Associated with the Sliding Genioplasty
Authors: Gingrass David J.
Published: January 2017

The sliding genioplasty for cosmetic augmentation of microgenia is a common procedure performed by maxillofacial and cosmetic surgeons. There are multiple designs for this osteotomy, and multiple fixation techniques proposed, among which include wires, screws, bone plates, and pins. Likewise, there are many advantages and disadvantages to each of the designs and the fixation techniques that will be utilized according to the surgical indications and the surgeon's preference.

A techique used at the Medical College of Wisconsin in Milwaukee involves fixation of the osteotomy segments with Kirschner pins placed at multiple divergent angles. This technique allows for placement of the free segments in virtually any location, and provides for a type of rigid stabilization, particularly in large anterior and vertical movements. One criticism that has been suggested with the use of Kirschner pins is the possibility of migration. This retrospective study evaluates 13 patients who underwent augmentation genioplasty, rigidly fixated with Kirschner pins. Twenty-eight total Kirschner pins were placed, with one being removed. The mean postoperative follow-up was 32 months, and the average number of pins placed was 2.15 per patient. It would appear then, from this study, that migration of Kirschner pins when used with the sliding genioplasty, is not a significant postoperative concern.
Postrhytidectomy Hematoma, Anesthesia, and Blood Pressure: A Retrospective Analysist
Authors: Morehead John M. , Tobin Howard A.
Published: January 2017

Hematoma is the most common complication of cervicofacial rhytidectomy (facelift). A group of consecutive facelifts from a busy cosmetic surgery practice is reviewed with respect to multiple variables, most importantly, anesthetic technique and perioperative blood pressure. No common characteristics or cause was identified among the patients with hematoma, but close examination of the behavior of the perioperative blood pressure suggests that a rise in blood pressure from intraoperative to postoperative levels may be an important factor.
Augmentation Mentoplasty: An Approach for Increased Sophistication and Better Accuracy
Authors: Glasgold Mark , Glasgold Alvin I.
Published: January 2017

Augmentation mentoplasty is a standard operation for facial contouring. A review of the currently available preformed chin implants demonstrates a lack of standardization and poor manufacturer dimensioning. This paper provides a system for standardizing the choice of implant and introduces a measuring device that can simplify the procedure. Silicone rubber extension wafers are introduced for modifying and customizing available implants. A technique for secure implant fixation, which reduces postoperative implant movement, is presented.
The Silicone Gel Breast Implant Controversy—A Chronology of Recent Regulations and Decisions
Authors: Tobin Howard A.
Published: January 2017

This article summarizes the regulatory actions of the Food & Drug Administration as related to gel-filled silicone breast implants. It also relates the actions to the influences of outside forces such as press coverage, congressional investigations, and consumer activism.
Silicone Chemistry
Authors: Shiffman Melvin A.
Published: January 2017

Understanding the chemistry of silicone is essential for the surgeon in order to evaluate the controversies concerning silicone and the possible production of autoimmune/connective tissue diseases and other disorders. The production and testing of silicone gel is discussed.
Use of Vicryl Mesh in Prevention of Postrhinoplasty Dorsal Irregularities
Authors: Gilmore Jim
Published: January 2017

Small, palpable, and visible dorsal irregularities may occur in as many as 5–10% of rhinoplasties. They can be unacceptable to both the surgeon and patient and can lead to unwanted secondary surgery. In 88 patients treated over an 18-month period, VICRYL mesh implants consisting of one to three layers of VICRYL were placed under direct vision over the dorsal cartilage; care was taken to avoid disturbing any cartilage implants. Early results were impressive; there was an absence of palpable dorsal irregularities. This report describes the surgical technique and impressions during the 18-month period.
Correction of the Overprojected Nasal Tip
Authors: Ordon Andrew P.
Published: January 2017

Our approach to decrease tip projection is presented. These techniques may be applied to the three degrees of overprojection, namely the relative, moderate, and ultraprojecting tip. We feel that our techniques will apply to all clinical situations where decrease in projection is desirable. Our concepts have emerged from review of previous techniques and have evolved over our past 1000 rhinoplasties.

Excess nasal septum including the nasal spine area, redundancy in the feet of the medial crura, and soft tissue excess may all contribute to the overprojecting tip. However it is excess in the lower lateral cartilage complex, specifically in the medial crus, that requires the most surgical attention and alteration. Our technique in reducing the medial crus to decrease projection is patterned after the Universal Tip Technique described by Parkes and Kanodia. This endonasal technique utilizes a laterally based unipedicled lower lateral cartilage flap, which is freely rotational, but does not violate the continuity of the vestibular skin.

With development of our laterally based unipedicle lower lateral cartilage flap, the number of millimeters desired to reduce the projection is removed from the medial crus and eliminated in the final adjustment of tip projection and, in this way, decreases tip projection. In the moderate case, approximately 3 mm of medial crus is excised. In the more severe or ultraprojecting tip, ≥5 is removed from the medial crus.

In extreme overprojecting noses, excess soft tissue is addressed by excision of an ellipse of mucosa at the intercartilaginous incision at the septal angle.

In the ultraprojecting tip, in addition to resection of redundant cephalic lower lateral cartilage and a ≥5-mm segment of medial crus, it may be necessary to also resect the lateralmost extension of the lower lateral cartilage, the feet of the medial crura, and alar bases. Septal modification, including an inferior strip resection of septum including the nasal spine, may also contribute to decreasing projection. We have found this technique to be effective and predictable over the last 10 years.
Preoperative Evaluation and Surgical Techniques for African-American Rhinoplasty
Authors: Ofodile Ferdinand A.
Published: January 2017

The wide variation found in the African-American nose makes preoperative evaluation and surgical planning complicated. To bring order to these variations we have divided the African-American nose into three types: the African (type A), the Afro-Caucasian (type B), and the Afro-Indian (type C). The morphologic and anatomic properties of the groups and their surgical implications are described. In our preoperative evaluation of the African-American patient, we try to place the nose into one of the these categories. The process of classification makes us look more critically at the nasal features and the classification itself ties together the anatomic and morphologic properties of the particular nose and highlights the surgical options. In our practice we have also found it useful to divide the African-Americans who seek rhinoplasty into three groups. In group I are the newly emerging African-American professionals who want to maintain their ethnicity. In group II are the African-Americans in the modelling and entertainment industry who request caucasianization of their noses. In group III are the ambivalent patients, who want caucasianization but tell the surgeon the opposite. Those in group III are the most dissatisfied patients and must be identified preoperatively.
Modified Gasparotti Superficial Liposuction
Authors: Yvorchuk William A.
Published: January 2017

The superficial technique of liposuction as recently introduced by Marco Gasparotti and others allows for improved contouring results in patients with loss of skin elasticity and with excess skin redundancy, and may allow for improved success in patients previously thought to be poor candidates for conventional deep suction-assisted lipectomy.

The traditional Gasparotti technique can be described as the primary use of syringe liposuction, along with aspiration with beveledcannulae with endholes in a “multiple biopsy” technique, with specific contouring techniques and replacement ofautolo-gous fat for maximal contour improvement. Modifications in the superficialliposculpture technique can be afforded through greater use of the vacuum pump, through the use ofspatula cannulae, and through changes in specific contouring goals and techniques in keeping with the desires ofa North American patient profile.
Rapid Hairline Sculpting with Integrated Line Grafting and Single-Hair Grafting Techniques
Authors: Puig Carlos J.
Published: January 2017

Only in recent years has the attention of hair-replacement surgery moved from producing as much hair as possible to producing the most natural-looking results. A consistent natural result has been attained by modifying the size and shape of the hair-bearing autograft. The author describes an alternative graft morphology, and reports on the results of using this technique in 2507 patients. The results indicate that a natural-looking cosmetic result can be attained in as few as three procedures, with an overall complication rate of 1.0%.
Vermilion Border Cheiloplasty
Authors: Gilbert Scott E.
Published: January 2017

The aging process is, in part, characterized by thinning lips, This is antithetical to our culture, which idolizes youth and the plump, full lips associated with youthfulness. Because the appearance of aging lips is not desirable, and many times aging face techniques accentuate the thinning, techniques have been developed to augment aging oral labia.

Substances such as fat tissue and bovine collagen are among the choices for use in injectable augmentation. Use of these products will temporarily fill thinning, wrinkled lips, as well as other perioral structures. The use of Gore-Tex provides more permanent enhancement, but is limited as to results.

Vermilion border cheiloplasty is a permanent surgical procedure to augment labial tissue that can create lips of virtually any size or shape, as well as excise perioral rhytids. Herein we review 65 lip-lifts (cheiloplasty), with or without corner lifts, where the incision extends beyond commissure. These procedures may be performed together or independently on both the upper and lower labia. However, poor scar formation, asymmetries, and prolonged healing make this a procedure for those who fail lesser techniques.
Photoinstability of UVA Sun Protection Products
Authors: Vaughan C. , Schimmel J. , Tapman M.
Published: January 2017

Thin films of leading commercial high-sun-protection-factor sun products with UVA (ultraviolet 340- to 380-nm radiation) claims were compared to a new, high-efficiency sunscreen product that was designed to resist breakdown from exposure to UV radiation. The relationship between the thickness of the topical application of sunscreen films and the durability and efficacy of the product has significant clinical implications for physicians.
Gore-Tex® Implant to Address Glabellar Depression following Forehead Surgery
Authors: Steinsapir Kenneth D. , Morrow David M.
Published: January 2017

GORE-TEX® surgical implant material has been available since the early 1970s and has been available as a facial implant material since the 1980s. In the face, it has been used to augment the nose, cheeks, chin, and lips and to soften rhytids. This paper describes a new use for this implant material following endoscopic forehead elevation. When the glabellar musculature is weakened, ablated, or excised to reduce muscle volume and action, a postoperative tissue deficit may result. GORE-TEX® may be implanted at the time of endoscopic forehead elevation or secondarily if a glabellar depression becomes evident following endoscopic forehead-lifting. Between January and December 1995, 18 such implantations were performed. There were no infections or implant migrations. One implant was removed because its contour was visible and a second was replaced because it was not large enough.
Exoderm—A Novel, Phenol-Based Peeling Method Resulting in Improved Safety
Authors: Fintsi Yoram
Published: January 2017

Exoderm is a newly developed chemical deep-depth peeling method that has been shown to exhibit excellent results in the treatment of a broad spectrum of aging-skin defects. The new formula is devoid of common undesired effects, such as cardiac arrhythmias, long-lasting erythema, depigmentation, and scar formation. Our experience with more than 4000 patients attests to the safety of the method. Exoderm compares favorably with other surgical and nonsurgical procedures for facial rejuvenation.
Off-Label Use of Drugs and Devices
Authors: Shiffman Melvin A.
Published: January 2017

Off-label use of drugs and devices may have legal consequences to the physician. When planning to use a drug or device in a situation that does not have specific FDA approval, it would be prudent to have medical literature to support the use, a record of all reasons for off-label use, and an accurate record of the results of the use.
Lipoplasty in the Treatment of Obesity
Authors: Ferreira Julio A.
Published: January 2017

This paper presents a comprehensive review of the factors influencing obesity and the characteristics of adipose tissue. The author describes how adipose cells form and how cellulite develops, also explaining how liposculpture removal of excess adipose tissue can improve lymphatic return and the appearance of the skin. The author presents liposculpturing as part of an integrated approach to the treatment of obesity. By decreasing fat mass, liposculpturing helps improve body image and self esteem and physical activity increases.
Why Abdominoplasty When You Have Liposuction?
Authors: Lieberman Clara , Cohen Joseph
Published: January 2017

A retrospective study of 100 patients who underwent abdominal liposuction under local anesthesia from 1991 to 1995 is presented. All patients were overweight and had redundant abdominal skin fold. With the advent of superficial liposuction plus adequate and strict garment usage in the postoperative period we believe that abdominoplasty is rarely indicated in this type of patient. There is marked abdominal skin retraction after superficial liposuction. The results are excellent as can be seen with pre- and postoperative photographs. By avoiding abdominoplasty some complications can be minimized, such as pulmonary embolism, pulmonary fat embolism, and hypovolemic shock, as well as “minor” complications like anemia, blood transfusion, long scars (stigma), wound dehiscence, hematomas, seromas, atelectasis, and nerve damage. With liposuction, general anesthesia, with long and painful recovery and time away from work, may be avoided. Patients are very grateful when they are told that their abdominal deformity can be corrected with no major risks, and with fast recovery.
Therapeutic Megalipoextraction or Megaliposculpture: Indications, Technique, Complications, and Results
Authors: Fournier Pierre F.
Published: January 2017

For a long time, surgeons hesitated to extract more than 2.5 L of adipose tissue from a patient during liposculpture. Through the years, the technique has advanced, now allowing megaliposculptures to be performed so that more than 10 L can be extracted without posing any greater risk to the patient than would a conventional aesthetic liposculpture. This article traces the progressive evolution of the technique through the years, also discussing complications and the concept of megaliposculpturing. The syringe-assisted extraction of large quantities of adipose tissue without transfusion, hypovolemic shock, or any major complication opens new horizons in the symptomatic treatment of certain types of osteoarthritis of the lower extremities and of the acquired or potential complications of obesity. Large quantities of adipose tissue may safely, quickly, and efficiently be extracted. Numerous investigations in various pathological domains can now begin after this first step (megalipotherapy). Therapeutic megalipoextraction can be done either as a preliminary indication or as a treatment of the residual adiposities that occur after bariatric operations.
Liposuction and Serum Lipids
Authors: Hildreth Bruce
Published: January 2017

The effect of liposuction on serum lipids is unknown. This study evaluated the reduction in lipid levels following suction-assisted lipectomy (SAL) in 23 patients with preoperative elevated serum lipids. Sixty-five percent (15 patients) had reduction in lipids following SAL. The mechanism of this change is unknown and further, better controlled, studies are necessary.
Anesthesia Risks in Patients Who Have Had Antiobesity Medication
Authors: Shiffman Melvin A.
Published: January 2017

The effects of antiobesity medication can include cardiac valvular disorders and pulmonary hypertension. Fenfluramine, phentermine, and dexfenfluramine are particularly prone to cause these problems. Sudden hypotension with administration of general anesthesia in patients who have taken antiobesity drugs has been reported. The cosmetic surgeon should question patients regarding intake of antiobesity medications and should consider cardiac workup prior to performing surgery.