bluuebunny/crossref_metadata_2025 huggingface dataset:
Revision Buttock Implantation: Indications, Procedures, and Recommendations
Authors: Senderoff Douglas M.
Published: February 2017

Background:

Buttock implant studies have focused largely on safety, efficacy, and complication rates of primary surgery. The revision buttock implant surgical experience has to date not been published.

Methods:

A retrospective chart review was conducted to collect data from patients who underwent revision buttock implantation surgery performed by the author over a 12-year period from June of 2003 through December of 2015. Inclusion criteria consisted of any patient for whom an implant was either removed and replaced, exchanged, or repositioned after prior buttock implant surgery. The indications, types of procedures, and results of revision buttock implantation surgery based on the author’s experience are described.

Results:

Forty-three patients (32 women and 11 men) underwent revision buttock implantation surgery. Indications included replacement after removal (n = 18), asymmetry (n = 16), and size change (n = 9). Revision buttock implantation procedures included implant removal (n = 24), implant replacement (n = 19), implant exchange (n = 18), capsulotomy (n = 6), site change (n = 5), and capsulorrhaphy (n = 1). The overall complication rate was 17.8 percent. Complications were highest after unilateral implant replacement (n = 5).

Conclusions:

Revision buttock implantation is often necessary to correct or improve the results of primary buttock augmentation. Implants should be removed as soon as diagnosed in case of infection to reduce additional complications and permit successful reimplantation. Surgeons performing buttock implant surgery should be aware of the common indications, surgical procedures, and complications associated with revision buttock implantation surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Treatment of Anterior Neck Aging without a Submental Approach: Lateral Skin-Platysma Displacement, a New and Proven Technique for Platysma Bands and Skin Laxity
Authors: Pelle-Ceravolo Mario , Angelini Matteo , Silvi Erminia
Published: February 2017

Background:

A high rate of recurrence of anterior platysma bands and anterior skin laxity was reported at the 1-year follow-up of 150 patients who underwent complete neck undermining and full-width platysma transection for neck rejuvenation. The authors propose a new technique—lateral skin-platysma displacement—to treat these two aesthetic problems using only a lateral approach to avoid “opening” the anterior neck. The authors’ objective was to compare outcomes following full-width platysma transection technique and lateral skin-platysma displacement technique in terms of patient satisfaction, complications, and long-term effectiveness in the treatment of bands and anterior skin laxity.

Methods:

A prospective study was carried out on 100 patients. All patients were operated on by the senior surgeon (M.P.C.). Patient questionnaires were used to assess their levels of satisfaction.

Results:

Patient satisfaction was extremely high following both techniques. Successful correction of bands at 1 year was observed in 83.5 percent of the lateral skin-platysma displacement patients and 56 percent of the full platysma section patients. Regarding recurrent skin laxity, 68 percent of those who underwent lateral skin-platysma displacement did not show any obvious recurrence of excess skin at 1 year compared with 52 percent of the full platysma section group. Prolonged edema was the main complication and was considerably more frequent in the patients undergoing complete neck undermining.

Conclusions:

The 1-year patient satisfaction ratings were higher for those treated with the lateral skin-platysma displacement technique. The lateral skin-platysma displacement technique has proved to have a much shorter recovery and better outcomes in the correction of platysma bands and of the anterior neck skin laxity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Evidence-Based Recipes for Venous Thromboembolism Prophylaxis: A Practical Safety Guide
Authors: Pannucci Christopher J.
Published: February 2017

Learning Objectives:

After studying this article and viewing the videos, the participant should be able to: 1. Demonstrate an understanding of risk stratification for venous thromboembolism in surgical patients. 2. Calculate and interpret a 2005 Caprini score. 3. Give examples of modifiable risk factors for perioperative venous thromboembolism. 4. Propose a venous thromboembolism risk reduction strategy using mechanical and/or chemoprophylaxis and justify the risks and benefits of the proposed strategy.

This CME article provides an evidence-based summary of venous thromboembolism in plastic and reconstructive surgery patients, with a focus on current knowledge surrounding risk stratification, risk modification, and risk reduction.
Traditional Methods versus Quantitative Sensory Testing of the Feet at Risk: Results from the Rotterdam Diabetic Foot Study
Authors: Rinkel Willem D. , Castro Cabezas Manuel , Setyo Jonathan H. , Van Neck Johan W. , Coert J. Henk
Published: February 2017

Background:

Diabetic sensorimotor polyneuropathy is one of the greatest risk factors for foot ulceration. The current study investigated the measurement properties of the Pressure-Specified Sensory Device in comparison with traditional threshold screening instruments, in several categories of sensory loss. Knowledge of these values may help to identify diabetics at risk for ulceration more reliably.

Methods:

A partially cross-sectional cohort study was carried out in patients with diabetes. Traditional instruments classified each patient into groups representing severity of diabetic sensorimotor polyneuropathy. Demographic characteristics, laboratory measures, and Pressure-Specified Sensory Device measurements were compared between groups. The Bland-Altman method was used to characterize reliability of the Pressure-Specified Sensory Device, and construct validity was determined by comparison with Semmes-Weinstein monofilaments.

Results:

One hundred fifty-five diabetic patients were measured. Fifteen patients had a diabetic ulcer in their medical history, seven patients were insensate to the 10-g monofilament and had diminished vibration sense (group 1), 34 patients had diminished vibration sense but no elevated cutaneous threshold (group 2), and 99 patients acted as controls (no elevated cutaneous threshold or diminished vibration sense, group 3). The Pressure-Specified Sensory Device distinguished these groups with one-point static cutaneous thresholds alone. Semmes-Weinstein monofilament and Pressure-Specified Sensory Device measurements were not interchangeable. Spatial discrimination (two-point static and two-point moving discrimination) by the Pressure-Specified Sensory Device was more reliable compared with one-point static discrimination. Semmes-Weinstein monofilament (force in grams and pressure in grams per square millimeter) correlations with Pressure-Specified Sensory Device measurements differed between groups.

Conclusions:

The Pressure-Specified Sensory Device is able to distinguish between categories of sensory loss. The Pressure-Specified Sensory Device is valid in measuring cutaneous thresholds and can reliably measure spatial discrimination at the feet.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, II.
Predicting Complications in Immediate Alloplastic Breast Reconstruction: How Useful Is the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator?
Authors: O’Neill Anne C. , Murphy Blake , Bagher Shaghayegh , Al Qahtani Saad , Hofer Stefan O. P. , Zhong Toni
Published: February 2017

Background:

Complications following immediate breast reconstruction can have significant consequences for the delivery of postoperative chemotherapy and radiation therapy. Identifying patients at higher risk of complications would ensure that immediate breast reconstruction does not compromise oncologic treatment. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator is an online tool in the public domain that offers individualized preoperative risk prediction for a wide range of surgical procedures, including alloplastic breast reconstruction. This study evaluates the usefulness of this tool in patients undergoing immediate breast reconstruction with tissue expanders at a single institution.

Methods:

Details of 278 patients who underwent immediate breast reconstruction with tissue expander placement were entered into the calculator to determine the predicted complication rate. This was compared to the rate of observed complications on chart review. The predictive model was evaluated for calibration and discrimination using the statistical measures used in the original development of the calculator.

Results:

The predicted rate of complications (5.2 percent) was significantly lower that the observed rate (16.2 percent; p < 0.01). The Hosmer-Lemeshow test confirmed lack of fit of the model. The C statistic was 0.62 and the Brier score was 0.173, indicating that the model had poor predictive power and could not discriminate between those who were at risk for complications and those who were not.

Conclusions:

The American College of Surgeons National Surgical Quality Improvement Program universal Surgical Risk Calculator underestimated the proportion of patients that would develop complications in this cohort. In addition, it was unable to effectively identify individual patients at increased risk, suggesting that this tool would not make a useful contribution to preoperative decision-making in this patient group.
Multivariate Preoperative and Intraoperative Predictors of Postmastectomy Radiation Therapy in Patients for Whom Immediate Breast Reconstruction Is Planned
Authors: Chao Albert H. , Martinez Juan Carlos , Wobb Jessica , Povoski Stephen P.
Published: February 2017

Background:

Postmastectomy radiation therapy often impacts decision-making and outcomes of breast reconstruction. However, plastic surgeons typically have limited information regarding the likelihood of radiation therapy when decisions about immediate breast reconstruction are made. The study objective was to examine whether commonly available information can be used to predict the probability of radiation therapy.

Methods:

A retrospective review was performed of patients undergoing mastectomy and sentinel lymph node biopsy. Multivariate logistic regression analysis of variables available in greater than 95 percent of patients was performed in relation to predicting radiation therapy.

Results:

A total of 322 patients were reviewed, of whom 55 (17.1 percent) received radiation therapy, which was indicated for patients having four or more positive axillary lymph nodes in all cases. Multivariate logistic regression identified the intraoperative sentinel lymph node frozen section results (OR, 27.3), tumor size (OR, 1.7), and age (OR, 0.96) as significant predictors. The sentinel lymph node frozen section exhibited negative and positive predictive values for radiation therapy of 95.4 percent and 54.3 percent, respectively. When sentinel lymph node frozen section was combined with tumor size greater than or equal to 2.0 cm, the positive predictive value increased to 80.5 percent.

Conclusion:

Immediate breast reconstruction patients who have negative intraoperative sentinel lymph node frozen section results have a less than 5 percent chance of radiation therapy, whereas patients with positive intraoperative sentinel lymph node frozen section results and tumor size greater than or equal to 2.0 cm have a greater than 80 percent chance of radiation therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Versatility of the Profunda Artery Perforator Flap: Creative Uses in Breast Reconstruction
Authors: Haddock Nicholas , Nagarkar Purushottam , Teotia Sumeet S.
Published: February 2017

Background:

Flaps based on the profunda artery perforators were first used for reconstruction of pressure sores, burn contractures, and extremity wounds. Recently, a revised profunda artery perforator flap was introduced for breast reconstruction. However, the flap is rarely used despite interesting reports on its use. The authors present their experience with the profunda artery perforator flap, describing its versatile applications in breast reconstruction.

Methods:

The authors conducted a retrospective review of all patients of the lead author who underwent breast reconstruction with profunda artery perforator flaps before January of 2015. Patient demographics, perioperative data, and postoperative complications were recorded and analyzed.

Results:

Seventy-three consecutive profunda artery perforator flaps were used to reconstruct 71 breasts. In 21 breasts, a profunda artery perforator flap was used in conjunction with another flap—with a deep inferior epigastric perforator flap (n = 18), a superior gluteal artery perforator flap (n = 1), or as stacked profunda artery perforator flaps (n = 2). The flap failure rate was 2.7 percent. There was one case of clinically apparent fat necrosis. There were no other major flap complications. Donor-site complications included cellulitis in two thighs (2.7 percent) and minor wound dehiscence in six thighs (8.2 percent). All donor-site complications healed satisfactorily by secondary intention without any additional procedures.

Conclusions:

The profunda artery perforator flap is a safe and versatile option for breast reconstruction. It can be combined with other flaps when additional volume or skin requirements are present. Flap and donor-site complications are comparable to other free tissue breast reconstruction options.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Improved Recovery Experience Achieved for Women Undergoing Implant-Based Breast Reconstruction Using an Enhanced Recovery after Surgery Model
Authors: Dumestre Danielle O. , Webb Carmen E. , Temple-Oberle Claire
Published: February 2017

Background:

Enhanced recovery after surgery was compared with traditional recovery after surgery for postmastectomy alloplastic breast reconstruction.

Methods:

Length of stay, emergency room visits, and complications within 30 days of surgery were compared among three groups: traditional recovery after surgery, transition (some elements of enhanced recovery protocol, not transitioned to outpatient care), and enhanced recovery after surgery (day surgery, provided with standardized perioperative education and multimodal analgesia). Prospective data collection allowed quality-of-recovery assessment using a validated questionnaire for enhanced recovery/transition groups. Results were statistically analyzed (analysis of variance/chi-square).

Results:

The traditional recovery, transition, and enhanced recovery cohorts comprised 29, 11, and 29 patients, respectively. No significant differences were present regarding age, smoking status, preoperative radiation, single stage direct-to-implant versus tissue expander, bilateral versus unilateral surgery, or immediate versus delayed reconstruction among groups. Average length of stay was 1.6 nights in both the traditional recovery and transition groups, compared with 0 nights in the enhanced recovery group (p < 0.001). Enhanced recovery patients had less severe pain (p = 0.02) and nausea (p = 0.01), and better enjoyed their food (p = 0.0002) and felt more rested (p = 0.02) than their transition counterparts. There were no differences in the number of emergency room visits among the three groups (p = 0.88). There was no difference in the rate of hematoma (p = 0.36), infection requiring intravenous antibiotics (p = 0.36), or infection requiring explantation (p = 0.36) among the three groups.

Conclusion:

An enhanced recovery protocol for alloplastic breast reconstruction treated patients safely, with improved patient satisfaction and same-day discharge and with no increase in complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
The Anterior Intercostal Artery Flap: Anatomical and Radiologic Study
Authors: Carrasco-López Cristian , Julian Ibañez Juan Francisco , Vilà Jordi , Rodriguez-Baeza Alfonso , Carrera-Burgaya Anna , Reina-de-la-Torre Francisco , Damaso-Margelí-Cervera Victor , Fernandez-Llamazares-Rodriguez Jaime , Higueras-Suñe Carmen
Published: February 2017

Background:

Reconstruction of the anterior thorax is complex because of the presence of aesthetically important areas such as the breast, sternum, and upper abdomen. For this reason, a wide variety of pedicled perforator flaps have been described. The anterior intercostal perforator flap is one of these perforators flaps and is valuable for use in breast reconstruction surgery.

Methods:

The location and characteristics of the anterior intercostal perforators were evaluated both anatomically and radiologically. The anatomical study was conducted in a set of 14 hemitrunk cadavers, and the radiologic study was performed retrospectively from a randomly selected set of images obtained from 30 female patients who underwent thoracic computed tomographic angiography for other health problems at the authors’ institution during the year 2015. The findings were then compared.

Results:

A total of 60 perforators in 14 hemitrunks were identified and mapped. Perforators were found in all hemithoraces. The lateral third donor location was the most reliable zone, containing larger and more numerous perforators compared with the other donor regions. According to the radiologic study, a total of 164 perforators in 30 computed tomographic angiographs were identified and mapped. Perforators were found in all thoraxes.

Conclusions:

The authors found that the intercostal perforator flap has a consistent vascularization. Computed tomographic angiography is less reliable than dissection in identifying the number of perforators. The authors’ findings suggest that intercostal perforator flaps are reliable and consistent flaps for reconstruction of the upper trunk.
Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System
Authors: Waltho Daniel , Hatchell Alexandra , Thoma Achilleas
Published: February 2017

Background:

Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed.

Methods:

A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making.

Results:

The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features.

Conclusions:

Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current classification systems appears to fulfill these criteria.
Topographic Analysis of the Supratrochlear Artery and the Supraorbital Artery: Implication for Improving the Safety of Forehead Augmentation
Authors: Cong Li-yao , Phothong Weeranut , Lee Sang-Hee , Wanitphakdeedecha Rungsima , Koh Iksoo , Tansatit Tanvaa , Kim Hee-Jin
Published: February 2017

Background:

The supratrochlear and supraorbital artery branches from the ophthalmic artery are the primary suppliers of blood to the forehead. Filler injection into the forehead without precise knowledge of its vascular topography poses a risk of severe complications.

Methods:

Twenty hemifaces from 11 cadavers were dissected.

Results:

Based on the presence of the deep branch of the supratrochlear artery, two main arterial distribution patterns of the forehead were observed. Type I (deep branch of the supratrochlear artery–present pattern) was classified into two subtypes: type Ia, in which the layer superficial to the frontalis was supplied medially by the superficial branch of the supratrochlear artery and laterally by the superficial branch of the supraorbital artery, and the deep branch of the supratrochlear artery and the deep branch of the supraorbital artery were distributed deep to the frontalis; and type Ib, in which the layer superficial to the frontalis was supplied by the superficial branch of the supratrochlear artery and the superficial branch of the supraorbital artery in addition to the central artery or the paracentral artery, and the layer deep to the frontalis was supplied the same with type Ia. For type II (deep branch of the supratrochlear artery–absent pattern), the layer superficial to the frontalis was supplied the same with type Ia; only the deep branch of the supraorbital artery supplied the layer deep to the frontalis.

Conclusion:

This study yielded novel arterial systems of the forehead and provided guidance for the safe forehead augmentation.
An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature
Authors: Frey Jordan D. , Poudrier Grace , Chiodo Michael V. , Hazen Alexes
Published: February 2017

Although many transgender individuals are able to realize their gender identity without surgical intervention, a significant and increasing portion of the trans population is seeking gender-confirming surgery (alternatively, gender reassignment surgery, sexual reassignment surgery, or gender-affirming surgery). This review presents a robust overview of genital reconstruction in the female-to-male transgender patient—an operation that, historically, was seldom performed and has remained less surgically feasible than its counterpart (male-to-female genital reconstruction). However, as the visibility and public awareness of the trans community continues to increase, the demand for plastic surgeons equipped to perform these reconstructions is rising. The “ideal” neophallus is aesthetic, maintains tactile and erogenous sensibility, permits sexual function and standing urination, and possesses minimal donor-site and operative morbidity. This article reviews current techniques for surgical construction, including metoidioplasty and phalloplasty, with both pedicled and free flaps. Emphasis is placed on the variety of techniques available for constructing a functional neophallus and neourethra. Preparative procedures (such as vaginectomy, hysterectomy, and oophorectomy) and adjunctive reconstructive procedures (including scrotoplasty and genital prosthesis insertion) are also discussed.
Learning How to Ask: Women and Negotiation
Authors: Fischer Lauren H. , Bajaj Anureet K.
Published: February 2017

Women are less likely to reach top-level leadership positions, and more likely to leave academic positions, than men, and are likely to earn less money than men. Women are also less likely to initiate a negotiation—a process that is crucial for professional advancement. This reluctance to ask hinders their advancement and can have long-lasting consequences—both financial and professional. The reasons that women do not ask are multifactorial. In this article, we will explore reasons why women are less likely to negotiate, the barriers they face when they do, and strategies that women can apply to improve their negotiation skills.
The Role of Bacterial Biofilm in Adverse Soft-Tissue Filler Reactions: A Combined Laboratory and Clinical Study
Authors: Saththianathan Mayuran , Johani Khalid , Taylor Alaina , Hu Hongua , Vickery Karen , Callan Peter , Deva Anand K.
Published: February 2017

Background:

The development of chronic nodules and granulomatous inflammation after filler injections has been attributed to bacterial biofilm infection. The authors aimed to investigate the relationship between filler and bacterial biofilm using a combined in vitro and in vivo study.

Methods:

In vitro assays to investigate the ability of filler materials to support the growth of Staphylococcus epidermidis biofilm and the effect of multiple needle passes through a biofilm-contaminated surface were designed. Analysis of clinical biopsy specimens from patients presenting with chronic granulomas following filler administration using a number of laboratory tests for biofilm was performed.

Results:

All fillers (i.e., hyaluronic acid, polyacrylamide gel, and poly-l-lactic acid) supported the growth of S. epidermidis biofilm in vitro. Multiple needle passes through a biofilm-contaminated surface resulted in significantly increased contamination of filler material by a factor of 10,000 (p < 0.001). Six clinical samples from five patients all demonstrated bacterial biofilm. The mean number of bacteria was found to be 2.2 × 107 bacteria/mg tissue (range, 5.6 × 105 to 3.7 × 107 bacteria/mg tissue). Microbiome analysis detected a predominance of Pseudomonas, Staphylococcus, and Propionibacterium as present in these samples.

Conclusions:

Filler material can support the growth of bacterial biofilm in vitro. Multiple needle passes can significantly increase the risk of filler contamination. Biofilm appears to be associated with high numbers in clinical samples of patients presenting with chronic granulomatous inflammation. Strategies to reduce the risk of bacterial contamination need to be further studied and translated into clinical practice.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Comparison of the Hydroxylase Inhibitor Dimethyloxalylglycine and the Iron Chelator Deferoxamine in Diabetic and Aged Wound Healing
Authors: Duscher Dominik , Januszyk Michael , Maan Zeshaan N. , Whittam Alexander J. , Hu Michael S. , Walmsley Graham G. , Dong Yixiao , Khong Sacha M. , Longaker Michael T. , Gurtner Geoffrey C.
Published: February 2017

Background:

A hallmark of diabetes mellitus is the breakdown of almost every reparative process in the human body, leading to critical impairments of wound healing. Stabilization and activity of the transcription factor hypoxia-inducible factor (HIF)-1α is impaired in diabetes, leading to deficits in new blood vessel formation in response to injury. In this article, the authors compare the effectiveness of two promising small-molecule therapeutics, the hydroxylase inhibitor dimethyloxalylglycine and the iron chelator deferoxamine, for attenuating diabetes-associated deficits in cutaneous wound healing by enhancing HIF-1α activation.

Methods:

HIF-1α stabilization, phosphorylation, and transactivation were measured in murine fibroblasts cultured under normoxic or hypoxic and low-glucose or high-glucose conditions following treatment with deferoxamine or dimethyloxalylglycine. In addition, diabetic wound healing and neovascularization were evaluated in db/db mice treated with topical solutions of either deferoxamine or dimethyloxalylglycine, and the efficacy of these molecules was also compared in aged mice.

Results:

The authors show that deferoxamine stabilizes HIF-1α expression and improves HIF-1α transactivity in hypoxic and hyperglycemic states in vitro, whereas the effects of dimethyloxalylglycine are significantly blunted under hyperglycemic hypoxic conditions. In vivo, both dimethyloxalylglycine and deferoxamine enhance wound healing and vascularity in aged mice, but only deferoxamine universally augmented wound healing and neovascularization in the setting of both advanced age and diabetes.

Conclusion:

This first direct comparison of deferoxamine and dimethyloxalylglycine in the treatment of impaired wound healing suggests significant therapeutic potential for topical deferoxamine treatment in ischemic and diabetic disease.
Tendon Rupture and Tenosynovitis following Internal Fixation of Distal Radius Fractures: A Systematic Review
Authors: Azzi Alain J. , Aldekhayel Salah , Boehm Kaitlin S. , Zadeh Teanoosh
Published: February 2017

Background:

Tendon-related complications after plate fixation of distal radius fractures can cause significant morbidity in the patient. This retrospective systematic review aims to report and compare the current rate of tendon rupture and tenosynovitis complicating the operative management of distal radius fractures.

Methods:

A systematic literature search was performed to identify relevant articles reporting tendon complications after operative management of distal radius fractures. The search included published articles in three electronic databases—Ovid MEDLINE, EMBASE, and the Cochrane Library—starting from the establishment of each database to February of 2016.

Results:

A total of 56 studies met the inclusion criteria, including 6278 patients. Overall tendon-related adverse events were reported in 420 patients (6.8 percent). The incidence of tendon rupture was 1.5 percent with volar plates and 1.7 percent with dorsal plates. The incidence of tenosynovitis was 4.5 percent with volar plates and 7.5 percent with dorsal plates. Individual tendon complications were reported with volar and dorsal fixation, respectively: extensor pollicis longus tenosynovitis (0.3 percent and 1.1 percent), extensor pollicis longus rupture (0.8 percent and 0.3 percent), flexor pollicis longus tenosynovitis (1.3 percent and 0 percent), flexor pollicis longus rupture (0.6 percent and 0.2 percent), flexor digitorum profundus/flexor digitorum superficialis tenosynovitis (1.2 percent and 1.3 percent), flexor digitorum profundus/flexor digitorum superficialis rupture (0.1 percent and 0 percent), extensor digitorum communis tenosynovitis (1.7 percent and 5.9 percent), and extensor digitorum communis rupture (0.05 percent and 1.3 percent).

Conclusion:

This systematic review provides an update on the literature regarding tendon-related complications in the management of distal radius fractures.
Photosensitizer Effects of Artificial Red Cells on Dye Laser Irradiation in an Animal Model Assuming Port-Wine Stain Treatment
Authors: Rikihisa Naoaki , Watanabe Shoji , Satoh Kaneshige , Saito Yoshiaki , Sakai Hiromi
Published: February 2017

Background:

The complete removal of port-wine stains has remained challenging. Based on the principle of treating port-wine stains with a dye laser, intravenous injection of artificial red cells (hemoglobin vesicles) immediately before laser treatment might improve the clinical outcome of the therapy. The hemoglobin vesicle injection increases the hemoglobin concentration in microvessels. Photons of dye laser are absorbed by the mixture of red blood cells and this newly added hemoglobin, potentially producing more heat and photocoagulation and, ultimately, necrosis of the endothelial cells effectively.

Methods:

To confirm the performance of hemoglobin vesicles as a photosensitizer, the authors compared the absorbance of hemoglobin vesicles and human blood against 595-nm wavelength and the temperature increases that occur following dye laser irradiation. Furthermore, the authors investigated the microvessel transformation induced by the hemoglobin vesicle intravenous injection. Finally, the authors investigated the effect of the hemoglobin vesicle on the vascular destruction of dye laser irradiation with chicken wattle.

Results:

Results show that hemoglobin vesicles have the same absorbance as that of human blood. They produce the same level of heat as human blood after laser irradiation. The hemoglobin vesicle intravenous injection caused dilatation of microvessels in animal models. The dye laser with hemoglobin vesicle can destroy the vessel wall effectively in animal models.

Conclusions:

Hemoglobin vesicles can function as photosensitizers to destroy the vessel wall. A possible mechanism of pulsed dye laser–resistant port-wine stains is that overly small vessels do not contain sufficient red blood cells. They are therefore poor absorbers/heaters for these lasers. Hemoglobin vesicle combination therapy will improve clinical outcomes of dye laser treatment against such lesions only.
Shared Decision-Making in the Management of Congenital Vascular Malformations
Authors: Horbach Sophie E. R. , Ubbink Dirk T. , Stubenrouch Fabienne E. , Koelemay Mark J. W. , van der Vleuten Carine J. M. , Verhoeven Bas H. , Reekers Jim A. , Schultze Kool Leo J. , van der Horst Chantal M. A. M.
Published: February 2017

Background:

In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients’ personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters.

Methods:

In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making–specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire–Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making).

Results:

Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean ± SD, 31 ± 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 ± 18 and 68 ± 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores.

Conclusions:

Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most likely because of poor awareness of the shared decision-making concept among patients, parents, and physicians. To improve shared decision-making practice, targeted interventions (e.g., decision aids, staff training) are essential.
Relevant Surgical Anatomy of Pterygomaxillary Dysjunction in Le Fort III Osteotomy
Authors: Orra Susan , Tierney William S. , Capone Avery C. , Gharb Bahar Bassiri , Papay Frank A. , Doumit Gaby
Published: February 2017

Background:

Le Fort III osteotomy represents the foundation of surgical correction for midface hypoplasia. One serious complication of Le Fort III osteotomy is severing the internal maxillary artery or its branches during osteotome advancement for pterygomaxillary dysjunction. This study sought to characterize the relevant surgical anatomy of the infratemporal fossa and of the internal maxillary artery as it enters the pterygomaxillary fissure.

Methods:

Bilateral midface dissections were performed on 15 fresh, normocephalic adult cadavers (30 hemifaces). Four superficial anatomical measurements were performed on the surface of the face, followed by 10 deep measurements of the internal maxillary artery and its branches relative to the infratemporal fossa and its surrounding bony landmarks.

Results:

The distance from the anterosuperior aspect of the zygomatic arch to the sphenopalatine artery entering the pterygomaxillary fissure was 38.9 ± 3.2 mm. The distance from the alveolar process of the maxillary bone to the sphenopalatine artery entry into the pterygomaxillary fissure was 30.3 ± 6.4 mm. The zygomaticofrontal suture was 43.4 ± 8.5 mm from the sphenopalatine artery entry into the pterygomaxillary fissure, 58.8 ± 8.0 mm from the pterygomaxillary junction, and 74.9 ± 6.5 mm from the maxillary alveolar process. The distance from the sphenopalatine artery to the posterior superior alveolar artery was 14.4 ± 4.1 mm. Elevation of the internal maxillary artery from the lateral pterygoid plate was 5.8 ± 2.5 mm.

Conclusion:

This study characterizes the surgical anatomy of the infratemporal fossa in the context of Le Fort III osteotomies and their associated pterygomaxillary dysjunctions.
Transverse Cervical Artery: Consistent Anatomical Landmarks and Clinical Experience with Its Use as a Recipient Artery in Complex Head and Neck Reconstruction
Authors: Tessler Oren , Gilardino Mirko S. , Bartow Matthew J. , St. Hilaire Hugo , Womac Daniel , Dionisopoulos Tassos , Lessard Lucie
Published: February 2017

Background:

Many head and neck reconstructions occur in patients with extensive history of surgery or radiation treatment. This leads to complicated free flap reconstructions, especially in choosing recipient vessels in a “frozen neck.” The transverse cervical artery is an optimal second-line recipient artery in head and neck reconstruction.

Methods:

Seventy-two neck sides in 36 cadavers were dissected, looking for the transverse cervical artery and transverse cervical vein. Anatomical location of these vessels, their diameter, and length were documented. A retrospective analysis on 19 patients who had head and neck reconstruction using the transverse cervical artery as a recipient artery was undertaken as well with regard to outcome of procedures, reason for surgery, previous operations, and use of vein grafts during surgery.

Results:

The transverse cervical artery was present in 72 of 72 of cadaveric specimens, and was infraclavicular in two of 72 specimens. Transverse cervical artery length ranged from 4.0 to 7.0 cm, and the mean diameter was 2.65 mm. The transverse cervical vein was present in 61 of 72 cadaveric specimens, the length ranged from 4.0 to 7.0 cm, and the mean diameter was 2.90 mm. The transverse cervical artery averaged 33 mm from midline, and branched off the thyrocervical trunk at an average 17 mm superior to the clavicle. Transverse cervical artery stenosis was markedly less in comparison with external carotid artery stenosis. In a 20-year clinical follow-up study, the transverse cervical artery was the recipient artery in 19 patients. A vein graft was used in one patient, and no flap loss occurred in any of the 19 patients.

Conclusion:

The transverse cervical artery is a reliable and robust option as a recipient artery in free flap head and neck reconstruction.
Annual Hospital Volume and Success of Digital Replantation
Authors: Brown Matthew , Lu Yiwen , Chung Kevin C. , Mahmoudi Elham
Published: February 2017

Background:

Digital replantation attempt and success rates have been declining in the United States. Regionalization of digit replantation has been proposed as a solution to improve both attempt and success rates of these procedures. There is limited information about which criteria could establish a hospital as a center specialized for digit replantation. The authors analyzed hospital replantation volume and patient factors associated with successful thumb/finger replantation.

Methods:

A retrospective study using data from the 2008 to 2012 State Inpatient Databases of the Health Care Cost and Utilization Project from five states (New York, California, North Carolina, Utah, and Florida) was performed. The generalized estimating equation method was used to examine the association between patient characteristics and hospital volume and success of thumb/finger replantation. A receiver operating characteristic curve and Youden’s J statistic were used to determine annual hospital replantation volume cutoff levels for success rates.

Results:

There were 3417 digit amputation injuries, with 631 replantation attempts (18 percent) and with an overall thumb/finger replantation success rate of 70 percent. The hospital annual replantation volume increased the odds of success (OR, 1.06; 95 percent CI, 1.02 to 1.10). The annual hospital volume of three replantations was needed to achieve a success rate of 70 percent.

Conclusions:

Practice patterns demonstrate that hospitals with higher annual volume have greater success. Identifying high-volume centers and regionalization of digit replantation should be considered a priority.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
The Lymphatic Anatomy of the Lower Eyelid and Conjunctiva and Correlation with Postoperative Chemosis and Edema
Authors: Shoukath Sajna , Taylor G. Ian , Mendelson Bryan C. , Corlett Russell J. , Shayan Ramin , Tourani Saam S. , Ashton Mark W.
Published: February 2017

Background:

There are minimal data in the literature regarding the lymphatic drainage of the conjunctiva and lower eyelid and the relationship with postoperative chemosis and edema.

Methods:

Injection, microdissection, and histologic and radiologic studies were conducted on 12 hemifacial fresh cadaver specimens. Indocyanine green lymphography was conducted in five volunteers.

Results:

Histology identified lymphatic vessels superficial and deep to the orbicularis oculi. Cadaveric dissection, injection, and radiographic studies identified interconnecting superficial and deep facial lymphatic systems and a conjunctival lymphatic network draining through the tarsal plate to the deep lymphatic system. The superficial lymphatic collectors traveled in subcutaneous fat within the lateral orbital and nasolabial fat compartments. The lateral deep lymphatic collectors traveled beneath orbicularis oculi, then through the superficial orbicularis retaining ligament, and into the sub–orbicularis oculi fat in the roof of the prezygomatic space. These vessels descended to preperiosteal fat at the level of zygomaticocutaneous ligaments to travel adjacent to the facial nerve into preauricular nodes. Indocyanine green lymphography identified correlating draining pathways laterally to the parotid nodes and medially to submandibular nodes.

Conclusions:

The authors have found that the lower eyelid and conjunctiva are drained by interconnecting superficial and deep lymphatic systems of the face. The superficial system is vulnerable to damage in incisions and dissection in the infraorbital area. The deep system is vulnerable to damage in dissection around the orbicularis retaining ligament and the zygomaticocutaneous ligaments. The authors suggest that concurrent damage to both the superficial and deep lymphatic systems, especially laterally, may be responsible for postoperative chemosis and edema.
The Influence of a Pfannenstiel Scar on Venous Anatomy of the Lower Abdominal Wall and Implications for Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction
Authors: Kim So Young , Lee Kyeong-Tae , Mun Goo-Hyun
Published: February 2017

Background:

A Pfannenstiel incision involves the obstruction of superficial venous pathways and functional diversion of flow through alternative pathways and adjacent vessels. This study investigated the effect of a prior Pfannenstiel incision on venous anatomy of the lower abdominal wall; specifically, the superficial inferior epigastric vein (SIEV), using computed tomographic angiography.

Methods:

A case-control study was performed of 50 patients with Pfannenstiel scars and 50 age-matched, body mass index–matched control patients without Pfannenstiel scars. The authors compared the number of direct/indirect and total communications between the SIEV and deep inferior epigastric artery perforator (DIEP) venae comitantes, midline crossover, and other SIEV-related anatomical changes by using computed tomographic angiography. Flap-related clinical outcomes and donor-site–related complications were also assessed.

Result:

The median number of direct and total communications between the SIEV and DIEP venae comitantes in the study group was greater than in the control group. The percentage of SIEVs having more than two branching patterns per hemiabdomen was significantly higher in the study group than in the control group. The study group also showed a significantly lower rate of fat necrosis compared with the control group (p = 0.03). The rate of donor-site seroma was significantly higher in the study group.

Conclusion:

This study suggests that the presence of a Pfannenstiel scar may promote the development of direct and total communications between the SIEV and DIEP venae comitantes and branching within the SIEV in the lower abdominal wall, which may facilitate venous drainage of adipose tissue in DIEP flap breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft: To Graft or Not to Graft?
Authors: Buncamper Marlon E. , van der Sluis Wouter B. , de Vries Max , Witte Birgit I. , Bouman Mark-Bram , Mullender Margriet G.
Published: February 2017

Background:

Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction.

Methods:

Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires.

Results:

A total of 100 patients were included (32 with and 68 without additional full-thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (−15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01).

Conclusions:

The authors can confirm neither of the suggested arguments, for or against full-thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient- and physician-reported aesthetic or functional outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.