bluuebunny/crossref_metadata_2025 huggingface dataset:
Donor-site morbidity of the inferior gluteal artery perforator flap for breast reconstruction in teenagers
Authors: Godbout Emilie , Farmer Lucie , Bortoluzzi Patricia , Laberge Louise Caouette
Published: February 2017

Background/Objective

Few options, apart from the buttock area, are available for autologous breast reconstruction in thin teenagers. The aim of the present study was to objectively evaluate and compare donor-site morbidity of the inferior gluteal artery perforator (IGAP) flap with that of the previously described inferior gluteal musculocutaneous flap.

Method

A retrospective review of all IGAP flaps for breast reconstruction performed in teenagers between June 2006 and April 2011 at the Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, was performed. Patients were invited to undergo a specific physical evaluation and complete a questionnaire on aesthetic and functional outcomes.

Results

Thirteen records and 11 photographic charts were reviewed. Lateral buttock flattening was noticeable in nine of 11 cases. Three patients experienced some degree of inferior displacement of the gluteal crease. All six patients available for the appointment presented with a zone of dysesthesia or hypoesthesia in the territory of the operated buttock and/or posterior thigh. No motor impairment was found. The questionnaire, completed by eight patients, revealed that six were satisfied or very satisfied with the surgery. Appearance of the operated buttock was rated 3.4 on a scale from 1 to 5 (5 = normal) compared with the normal side.

Conclusions

The IGAP flap remains a suitable option for breast reconstruction in slim teenagers. Similar to the myocutaneous flap, the major donor-site morbidity of the IGAP flap remains sensory impairment involving the posterior femoral cutaneous nerve. There is, however, less visible lateral depression when it is harvested as a perforator flap.
Factors influencing prioritization for carpal tunnel syndrome consultation
Authors: Chung Bryan , Morris Steven F
Published: February 2017

Background

In a socialized medicine model, prioritization of referrals for specialist consultation is highly important in the distribution of heath care. For high-burden diseases, such as carpal tunnel syndrome (CTS), the factors that influence prioritization are not well understood.

Objective

To determine the factors that influence the prioritization of referrals for CTS consultation by plastic surgeons in Canada.

Methods

All members of the Canadian Society of Plastic Surgery with e-mail addresses were invited to participate in an online survey regarding the method by which they prioritize referrals for CTS.

Results

Forty per cent of invited members completed the survey (150 surgeons). Of these, 118 (79%) stated that they performed CTS surgery. The majority of respondents who performed CTS surgery prioritized their consultation list chronologically (77%). Factors that would alter the chronological order or prioritization included subsequent contact by the referring physician (24%); personal relationship with the patient (16%); and specific information in the referral letter (15%), which usually involved symptom severity or electromyography findings. Sixty-six per cent of plastic surgeons stated that there was no conscious decision on how they came to choose the method of prioritization they used for referrals regarding CTS.

Discussion

The majority of plastic surgeons in Canada prioritize referrals for consultation on CTS chronologically. A minority of respondents reported reassigning priority based on clinical severity. The rationale for the methods by which Canadian Society of Plastic Surgery members prioritize these referrals is poorly understood. Further study on developing evidence-based prioritization methods may be useful in assisting surgeons and their patients in outcome-based decisions.
The angel flap for nipple reconstruction
Authors: Wong Wendy W , Hiersche Matthew A , Martin Mark C
Published: February 2017

Creation of an aesthetically pleasing nipple plays a significant role in breast reconstruction as a determining factor in patient satisfaction. The goals for nipple reconstruction include minimal donor site morbidity and appropriate, long-lasting projection. Currently, the most popular techniques used are associated with a significant loss of projection postoperatively. Accordingly, the authors introduce the angel flap, which is designed to achieve nipple projection with lasting results. The lateral edges of the flap and the area surrounding the top of the nipple are de-epithelialized and the flaps are wrapped to create a nipple mound composed primarily of dermis. Decreasing the amount of fat within core of the nipple and enhancing dermal content promotes long-lasting projection. Furthermore, the incision pattern fits within a desired areolar size, preventing unnecessary superfluous extension of the incisions. Thus, the technique described herein achieves the goals of nipple reconstruction, including adequate and long-lasting projection, without extension of the lateral limb scars.
Catheter use and infection reduction in plastic surgery
Authors: Barnes Zach J , Mahabir Raman C
Published: February 2017

Background

Catheter-associated urinary tract infections (CAUTI) are the most common hospital-associated infection and can result in increased health care costs, morbidity and even mortality. In 2009, The Scott & White Memorial Hospital/Texas A&M Health Science Center (Texas, USA) system's CAUTI rate placed it in the upper quartile (ie, highest rate) for the country, necessitating a system-wide change.

Objective

To design and implement a guideline to reduce the incidence of CAUTI.

Methods

A multidisciplinary team was formed and completed both a root cause analysis and a review of the available literature. Consolidating the best evidence, the team formulated a best practice guideline detailing the proper indications for insertion of, improper use of and techniques to minimize infection with catheters. Included as part of this protocol was nursing and patient education, changes in identifying patients with a catheter and automatic termination orders. Three-, six- and 12-month reviews identifying additional opportunities for improvement at the end of 2010 were completed.

Results

In 2009, the hospital's CAUTI rate was 1.46 per 1000 catheter days. In 2011 – the first complete year of the finalized guideline – the hospital's CAUTI rate was 0.52 per 1000 catheter days, ranking the institution in the bottom quartile (ie, lowest rate) for the country. The surgery and plastic surgery subgroup analyses also demonstrated statistically significant reduction in both catheter use and CAUTI.

Conclusion

The incidence of CAUTI was successfully reduced at The Texas A&M Healthcare Center. The guideline, its development and how it applies to plastic surgery patients are discussed.
Recurrent ulnar nerve entrapment at the elbow: Correlation of surgical findings and 3-Tesla magnetic resonance neurography
Authors: Chhabra Avneesh , Wadhwa Vibhor , Thakkar Rashmi S , Carrino John A , Dellon A Lee
Published: February 2017

The authors describe the correlation between 3-Tesla magnetic resonance neurography (MRN) and surgical findings in two patients who underwent multiple previous failed ulnar nerve surgeries. MRN correctly localized the site of the abnormality. Prospectively observed MRN findings of perineural fibrosis, ulnar nerve re-entrapment abnormalities, medial antebrachial cutaneous neuroma and additional median nerve entrapment were confirmed surgically.
Observations and Conclusions From 20 Years’ Experience with the Single-Lumen Inflatable Breast Implant with 3500 Patients
Authors: Whidden Peter G
Published: February 2017

PG Whidden. Observations and conclusions from 20 years’ experience with the single-lumen inflatable breast implant with 3500 patients. Can J Plast Surg 1993;1(1):39-43. Thirty-five hundred patients underwent breast augmentation between April 1972 and April 1992; 68% were followed for a minimum of one year. The capsular contracture rate (Baker II or greater) was 8% and the product failure rate was 1%, using the Mentor/Heyer-Schulte RTV diaphragm-valve, centre-fill device. The replacement of an occasional deflated implant appears far preferable to the correction of the higher than 8% incidence of capsular contracture widely reported with the use of silicone gel-filled implants.
The Abductor Pollicis Longus: A Key to Basal Joint Surgery
Authors: Robertson G Andrew , Hong Collin , Zimmerman Carol D
Published: February 2017

GA Robertson, C Hong, CD Zimmerman. The abductor pollicis longus: A key to basal joint surgery. Can J Plast Surg 1993;1(1):30-35. Anatomical studies show that the abductor pollicis longus acts primarily as a radial deviator of the wrist and as the main stabilizer of the basal joint of the thumb. An advancement and reinforcement technique of this muscle is used in conjunction with a standard silastic replacement arthroplasty for osteoarthritis of the trapezio-metacarpal joint. Excellent postoperative stability is achieved together with good pain relief and improvement in strength.
A Case of Destructive Gout in the Hand
Authors: Backstein Robert , Freiberg Arnis , Haswell Tim
Published: February 2017

R Backstein, a Freiberg, T Haswell. A case of destructive gout in the hand. Can J Plast Surg 1993;1(2):91-94. A 49-year-old male presented with bilateral finger masses of one year duration. Radiologic findings were consistent with chronic tophaceous gout and this diagnosis was confirmed by microscopic evaluation of pathologic specimens. The patient had no prior history of acute gouty arthritis. Surgical exploration revealed tophaceous masses involving the metacarpophalangeal joint and the contents of the flexor tendon sheath of the left long finger with complete destruction of the flexor digitorum profundus tendon distal to the sublimus insertion. Gout presenting as tophaceous deposits of the finger with flexor tendon destruction has not previously been described in the literature.
Face and Neck Lifts: Smas Vectors for Support and Smile Crease Correction
Authors: Connell Bruce F
Published: February 2017

BF Connell. Face and neck lifts: SMAS vectors for support and smile crease correction. Can J Plast Surg 1993;l(2):75-82. The plastic surgeon undertaking face and neck lifts needs a precise vision of the end result, a specific anatomical diagnosis and a precise plan of repair. Using concepts which have evolved over the years, techniques can be applied to treat patients of all ages for rejuvenation and re-entry into the job market.
Volar Metacarpophalangeal Joint Dislocation of the Little Finger
Authors: Hughes Lowell A , Freiberg Arnis
Published: February 2017

LA Hughes, a Freiberg. Volar metacarpophalangeal joint dislocation of the little finger. Can J Plast Surg 1993;1(3): 145-147. A case of volar dislocation of the metacarpophalangeal joint of the little finger was managed by open reduction, initially volar and subsequently dorsal before reduction could be maintained. This unusual injury represents a difficult management problem which can lead to a less than optimal outcome.
Patient Preference for the Management of Trigger Digit
Authors: Joughin Karen , McCabe Steven J
Published: February 2017

K Joughin, SJ McCabe. Patient preference for the management of trigger digit. Can J Plast Surg 1993;1(3):141-142. Steroid injection and surgery are both accepted treatment options for trigger digit. The objective of this study was to determine which modality patients would prefer when given a choice of treatments, the strength of their preference and factors that may influence their preference. A probability trade-off technique was used in 151 subjects. On average, subjects selected injection over surgery and would do so with a probability of success by injection as low as 57%. If the probability of cure by injection was less than 57%, surgery would be the preferred method of treatment, on average. A bimodal distribution of patient preference showed that some patients may strongly prefer either surgery or injection, with many patients preferring surgery even with a high expected cure rate of the first injection. Age, gender and previous experience with injections or surgery did not correlate with preference. Patients with trigger digits should be presented with unbiased information about treatment and be allowed to take part in the selection of the type of treatment they receive.
Subcutaneous Forehead Lift: A Technical Alternative for Upper Facial Rejuvenation
Authors: Wojtanowski Michael H
Published: February 2017

MH Wojtanowski. The subcutaneous forehead lift: A technical alternative for upper facial rejuvenation. Can J Plast Surg 1993;1(3):116-122. The subcutaneous forehead lift, using either the anterior or modified anterior approach, is reviewed. The advantages of this technique far outweigh the disadvantages. In selected cases, the subcutaneous approach should be considered as an alternative approach to brow ptosis in patients with a significant history of medical alopecia, those with thin, brittle hair, extensive forehead rhytides, brow asymmetry, and those with a long forehead and a high anterior hairline. Incorporation of this technique into the surgical armamentarium will allow for a more individualized approach to periorbital rejuvenation. Although the subgaleal coronal approach is acceptable in the majority of patients, there are limitations in selected patients.
Canthopexy and Transconjunctival Blepharoplasty Are Preferable to Lower Blepharoplasty
Authors: Camirand André
Published: February 2017

A Camirand. Canthopexy and transconjunctival blepharoplasty are preferable to lower blepharoplasty in the aged. Can J Plast Surg 1994;1(4):184-187. The lateral canthus stretches with age, lowering the lateral corner of the eye from 2 to 3 mm above the medial canthus in youth to the level of or below the medial corner in old age. The lower lid drops from 2 mm above the lower limbus to below it. This creates pseudodermachalasis or tired, sad and aged eyes, which cannot be improved by lower blepharoplasty. Fat pads should be removed via a transconjunctival approach to avoid the risk of scleral show in the elderly.
Current status of silicone gel breast implants
Authors: Peters Walter
Published: February 2017

There are currently three main areas of concern regarding the safety of silicone gel implants: implant failure; a potential link to autoimmune connective tissue disease; and a possible link to breast cancer. All silicone gel implants ‘bleed’ small levels of silicone. In addition, silicone gel implants appear to fail (leak or rupture) with time. Most implants in place for less than seven years appear to be intact. It appears that many silicone gel implants implanted for over seven years are probably ruptured or leaking. Implant failure may occur simply from deterioration. Implants can also rupture following closed capsulotomy. Mammography and ultrasound studies are generally not helpful in predicting implant failure. Magnetic resonance imaging (MRI) studies appear to be useful, but the ‘breast coil’ necessary to perform these studies is not currently available in most MRI units in Canada. The significance of implant failure is not known. There is a growing (but unproven) concern that immunological sensitization to silicone could develop in women with silicone gel implants. An extensive review of all clinical and immunological studies in the current literature has failed to demonstrate any conclusive link between silicone gel implants (whether intact or nonintact) and the development of autoimmune connective tissue disease or other disease process. However, large scale epidemiological studies remain to be done. Several large studies have proven that there is no relationship between silicone gel implants and the development of breast cancer.
Lymphedema following skin avulsion injury of the male genitalia
Authors: Al-Qattan Mm , Ziesmann M
Published: February 2017

A case of skin avulsion injury of the penis and scrotum complicated by lymphedema of the foreskin is described. The general principles are discussed, especially regarding debridement, choice of reconstruction, foreskin preservation and dressing.
Aggressive Soft Tissue Tumours of Infancy
Authors: Masri Bassam A , Son-Hing Quintin R , Beauchamp Richard D
Published: February 2017

BA Masri, QR Son-Hing, R Beauchamp. Aggressive soft tissue tumours of infancy. Can J Plast Surg 1994;2(2):81-84. Three cases of aggressive congenital soft tissue musculoskeletal neoplasms are presented. Two of these cases are congenital alveolar rhabdomyosarcoma of the foot. The third case is an infantile hemangiopericytoma of the thigh. These are rare conditions that should always be kept in mind when faced with a young infant with a mass in his or her limbs. Appropriate diagnosis and treatment are of paramount importance in these rare tumours. The management of these tumours is outlined and the pertinent literature reviewed.
Gore-Tex Implants in Facial Surgery.
Authors: Mole Bernard
Published: February 2017

In the last nine years, we have inserted 357 Gore-Tex implants in 154 patients for purely aesthetic reasons in order to attenuate depressions or enhance poorly developed or atrophied structures as a result of age. Results are different from one area to another, but are very worthwhile for improving crows’ feet, in manolabial-depression, in molar filling, and in lip augmentation. As a synthetic, open mesh fabric in which fibrous tissue can grow, Gore-Tex is available in 1 and 2 mm sheets which may be cut as desired. Complications requiring removal are exceptions, more often being due to implant malposition rather than the result of infection which is a complication inherent to all foreign bodies, whatever their origin. Whether done as an open or closed technique, it has the advantage of being completely reversible if needed.
Liposuction with ‘Sonic Sculpture’: Four Years’ Experience in Over 250 Patient Procedures
Authors: Kloehn Ralph A
Published: February 2017

RA Kloehn. Liposuction with ‘sonic sculpture’: Four years’ experience in over 250 patient procedures. Can J Plast Surg 1994;2(2):85-89. The author has now used ultrasonic liposculpture for over four years on a large series of patients, employing first the Ultravac Series 3 and currently the Surgitron Series 2000 prototypes for this application. Use of ultrasonic energy for liquefaction of body fat has evolved from the earlier use of such energy in phacoemulsification for cataract removal. This adaptation has proven advantageous to both patient and surgeon alike, when comparing previous methods of closed liposuction with those of ultrasonic-assisted lipoaspiration. Specific patient advantages include greater comfort postoperatively due to decreased tissue trauma, more refinement possible in body sculpting, diminished blood loss during surgery, and an opportunity for the larger patient to benefit from technology heretofore reserved for only the smaller individuals. The benefits to the surgeon include greater speed of execution in liposuction surgery and reduced physical effort. Electrical energy is transformed to high frequency energy by the ultrasonic generator, which is transmitted to a piezoelectric transducer or handpiece. The handpiece changes the energy into ultrasonic mechanical vibrations which are conveyed and amplified by the hollow titanium cannula to the fatty tissues. These ultrasonic mechanical vibrations, capable of creating microcavities within fluid and fat, do not affect the more dense structures in the area such as vessels, nerves, muscle or bone, at the specific energy levels employed. Following the initial creation of microcavities within fatty tissue, these cavities implode with continued energy application. This leads to cavitation, with explosion of fat cells and fatty liquefaction within adipocytes. Triglycerides are released into extracellular tissues and aspirated along with damaged fat cells, connective tissue and infused fluid. Heat generated in the process is not damaging if the tumescent technique is used.
Cutaneous Blue Nevi: Classification and Malignant Degeneration
Authors: Al-Qattan MM , Stranc MF , Anderson BJ
Published: February 2017

MM Al-Qattan, MF Stranc, BJ Anderson. Cutaneous blue nevi: classification and malignant degeneration. Can J Plast Surg 1994;2(3):130-132. A case of malignant melanoma arising in a congenital giant blue nevus on the arm of a 72-year-old male is reported. The literature is reviewed and a classification of cutaneous blue nevi presented. Malignant degeneration of different types of blue nevi is also discussed.
Blistering Distal Dactylitis: A Distinct Clinical Entity
Authors: Weinberg MJ , Al-Qattan MM , Mahoney J
Published: February 2017

MJ Weinberg, MM Al-Qattan, J Mahoney. Blistering distal dactylitis: A distinct clinical entity. Can J Plast Surg 1994;2(4):181-182. A rare case of blistering distal dactylitis in an adult is described. The differential diagnosis of this distinct clinical entity is also discussed.
Patients Refusing to Undergo Carpal Tunnel Release Despite Persistent Symptoms After Conservative Therapy
Authors: Al-Qattan Mm , Bowen V
Published: February 2017

MM Al-Qattan, V Bowen. Patients refusing to undergo carpal tunnel release despite persistent symptoms after conservative therapy. Can J Plast Surg 1994;2(4): 171-172. Seven patients who presented to one surgeon with persistent carpal tunnel symptoms after conservative therapy and who refused to undergo surgery were studied. All patients were interviewed four to six years later by another surgeon to assess the severity of any persistent symptoms and to find out if any had surgical decompression at another institution. The possible reasons for refusing to undergo carpal tunnel release despite persistent symptoms after conservative therapy are also discussed.
Tenosynovitis Associated with ‘Fowl Play’ – An Unusual Case Report
Authors: Sproat Janet E
Published: February 2017

JE Sproat. Tenosynovitis associated with ‘fowl play’ - An unusual case report. Can J Plast Surg 1994;2(4):175-176. An unusual combination of high-pressure oil injection injury and flexor tenosynovitis following accidental auto-inoculation with a killed chicken vaccine in the index finger of a farmer is presented, with recommendations for treatment.
Giant Congenital Pigmented Nevi of the Face: Operative Management and Risk of Malignancy
Authors: Zuker Ronald M , Iconomou Thomais G , Michelow Bryan
Published: February 2017

Giant congenital pigmented nevi of the face are rare but of major consequence. Complete early excision of these lesions is recommended not only because of the cosmetic deformity they impose but also because of their life threatening potential for malignant transformation. At the Hospital for Sick Children in Toronto 19 patients with giant congenital nevi of the face were reviewed. The anatomical location of the lesions, their morphological and histological characteristics, and the authors’ experience with surgical management of these lesions were evaluated. The risk of malignancy arising from these lesions was also evaluated. In this study, one patient died of leptomeningeal melanocytosis associated with her giant congenital nevus of the face. Although an accurate incidence of malignant transformation has not been determined, the risk of malignancy in congenital giant facial nevi must be considered.
Irreducible Volar Dislocation of the Proximal Interphalangeal (Pip) Joint: A Case Report
Authors: Cartotto R
Published: February 2017

Volar dislocation of the proximal interphalangeal (pip) joint is an uncommon injury. Typically, one condylar head of the proximal phalanx perforates the extensor mechanism, thus becoming entrapped in a ‘buttonhole’. Closed reduction is frequently unsuccessful due to the presence of extensor mechanism trapped within the joint, necessitating surgical reduction. This case report describes an irreducible volar pip joint dislocation, which required open reduction. At operation, the classic pathologic disruption was identified and repaired.
Bacillary Angiomatosis: A Unique Cutaneous Complication of Hiv Infection
Authors: Lipa Joan , Peters Walter , Fornasier Victor , Fisher Benjamin
Published: February 2017

As the prevalence of human immunodeficiency virus (HIV) infection increases, so does the recognition of unusual manifestations of this syndrome. This study describes two patients who presented with a unique, rare, cutaneous manifestion of HIV infection. One patient developed an aggressive atypical cellulitis and ascending lymphangitis of the hand, which failed to improve following multiple courses of several different antibiotics. The other patient presented with multiple, vascular, nodular lesions, clinically resembling Kaposi's sarcoma. Routine biopsies and wound cultures were not helpful for diagnosis. A definitive diagnosis of bacillary angiomatosis (BA) was made using a special silver-staining (Warthin-Starry) histological technique and electron microscopy. Both patients responded completely to oral erythromycin therapy. BA is a newly recognized bacterial infection caused by bacteria of the genus Bartonella. It is seen primarily in patients with acquired immunodeficiency syndrome (AIDS), and less commonly in patients with other immunosuppressed conditions. The term BA describes the lesion's pathogenesis (infective-bacillary) and clinico-histology (angiomatosis). The causal organism cannot be cultured reliably and is resistant to most antibiotics. This study reviews these two patients, the differential diagnosis of BA, specific confirmatory tests used in diagnosis, and the treatment outcome of this condition. It is important for the plastic surgeon to understand BA, because it can resemble other common presentations, but it can also be associated with internal involvement leading to mortality. However, when recognized, it can usually be cured by oral erythromycin therapy (500 mg qid) for several weeks.
Pelvic Fracture: A Complication of Iliac Crest Bone Grafting
Authors: Lammens Peter N , Richards Robert S , Roth James H
Published: February 2017

The iliac crest is a common site for harvesting bone grafts. This paper describes an iliac wing fracture after bone graft was harvested from the iliac crest. The patient was treated nonoperatively with a good result. with minimization of the depth of the osteotomy cuts this complication may be avoided.
Sagittal Fractures of the Palate: A New Method of Treatment
Authors: Wells Mark D , Oishi Scott , Sengezer Mustafa
Published: February 2017

A new technique is described for stabilizing complex vertical fractures of the maxilla. Advantageous use of the comminuted fracture pattern of the maxillary buttresses allows the maxilla to be divided into two parts at the Le Fort I level. with intermaxillary fixation applied, stabilization is achieved by applying miniplate fixation to the nasal side of the hard palate. The maxilla is reduced to the previously stabilized anterior midfacial buttresses with plates and screws. Comminuted segments of defects in the anterior buttresses are replaced with contoured calvarial grafts. This method has the advantage of maintaining transverse palatal width in a rigid fashion without the need for further osteotomies. It has satisfactorily restored preinjury occlusal relationships in six patients, without the need for dental splints. In no instance has hardware extrusion occurred after fixation.
Subpectoral Breast Augmentation Under Local Anaesthesia
Authors: Camirand André , Doucet Jocelyne
Published: February 2017

The procedure for performing subpectoral breast augmentation under local anaesthesia is described, and the results of over 300 operations presented.
Circumferential little finger nailplate
Authors: Thoma Achilleas , Alexopoulou Iakovina
Published: February 2017

This is a case report of a seven-year-old female who presented with a congenital anomaly of the little finger in which the nailplate was circumferentially covering the tip of the distal phalanx. There was a well-developed eponychial fold on the palmar aspect of the digit. This rare congenital ‘clam nail deformity’ may be the result of an insult to the zone of polarizing activity occurring late in the embryological development.
Reducing periorbital edema and ecchymosis to a minimum when performing rhinoplasty without splints or packing
Authors: Camirand André , Doucet Jocelyne
Published: February 2017

In view of the discomfort and medical risks associated with conventional rhinoplasties, an innovative approach to aesthetic modification of the nose, which does not require splints or packing and helps to minimize risks and complications, has been developed. The steps in this procedure are presented, together with the results from nearly 200 rhinoplasties.
Treatment of cellulite deformities of the thighs with topical aminophylline gel
Authors: Artz J Sheldon , Dinner Melvyn I
Published: February 2017

Cellulite deformities of the lateral thighs and buttocks are a poorly understood phenomenon, an embarrassment for even the fittest of women, and a frustration for the cosmetic surgeon. Multiple treatments have been attempted for this particular malady, and none have been universally successful. Early reports of the use of topical aminophylline/theophylline gel have shown pleasing improvements in the texture of the skin as early as three weeks after application.
Evaluation of multiple level nerve compression
Authors: Omurtag Meral , Novak Christine B , Mackinnon Susan E
Published: February 2017

In this retrospective study, the charts of 100 patients (81 females and 19 males, mean age 41 years) with a diagnosis of multiple level nerve compression were reviewed. Forty-five patients were involved with Workers' Compensation. The most common referral diagnosis was carpal tunnel syndrome (43%); only one patient was referred with the diagnosis of ‘multiple crush’. Of the 43 patients referred with a diagnosis of carpal tunnel syndrome, 35% had two levels of nerve compression (carpal and cubital tunnel or carpal tunnel and thoracic outlet) and 65% had three levels of nerve compression (carpal tunnel, cubital tunnel and thoracic outlet). This study suggests that multiple level nerve compression is frequently unrecognized and recommends full upper extremity evaluation, especially in patients referred with a diagnosis of carpal tunnel syndrome, to identify all levels of nerve compression.
The Hybrid Palatoplasty: A Preliminary Report
Authors: Gillett David A , Clarke Howard M
Published: February 2017

A composite technique was developed for repair of the complete unilateral cleft palate. Using a Veau type pushback on the cleft side simplified anterior closure, and the cleft hemipalate was lengthened. A von Langenbeck procedure on the noncleft side minimized anterior raw area and provided a stable point for fixation. Fourteen consecutive patients with unilateral complete cleft palate underwent hybrid palatoplasties. There were no significant intra- or postoperative complications. No differences in speech development have been noted. The procedure was no more difficult than either of the standard procedures and offers technical and theoretical benefits.
Warfarin-Related Skin Necrosis
Authors: Chalain Tristan Mb De , Jones Glyn E
Published: February 2017

Skin and soft tissue necrosis may be an unexpected and unpredictable consequence of warfarin therapy, occurring in 0.01% to 0.1% of patients receiving the drug. Classically, the archetypal patient is female, middle-aged or older, and the area of necrosis occurs in areas of abundant fat, such as breast, thigh or abdomen. The onset begins three to 10 days after commencing therapy. Two cases of warfarin-related skin necrosis are presented. One is a classical abdominal presentation. The other is a much rarer presentation of warfarin necrosis affecting the hand. The implications of the variable presentations in terms of pathophysiology and treatment strategies are discussed.
Anatomical Findings and Preservation of Transverse Sensory Branches of the Palmar Cutaneous Nerve during Carpal Tunnel Decompression
Authors: Lawrence Watters Conrad William , Jadick Carmen , Fleuriau-Chateau Phillipe
Published: February 2017

Of the possible complications following carpal tunnel release, one of the most distressing to the patient is a painful surgical scar. In this clinical study, 89 hands were examined at the time of surgery in order to identify the precise location, number and size of transverse sensory branches of the median palmar cutaneous nerve (PCN) and to preserve these during the procedure. Without the aid of operating microscope or loupes, a longitudinal interthenar incision was made, followed by careful splitting dissection of the subcutaneous fat. Transverse branches of the PCN, arising from the median nerve, were found in 85.4% of hands. Both median and ulnar nerve branches were found in 3.4% of hands, only ulnar nerve branches were found in 1.12% of hands and no branches were identified in 13.5% of hands. Multiple branches were found in 32.6% of cases. On average, these branches crossed the palm 1.5 cm from the distal wrist crease and were preserved 95% of the time without the use of operating microscope or loupes. Preservation of these small sensory nerves may prevent neuroma formation and, thereby, reduce the incidence of painful scars following carpal tunnel release.
Missed Breast Cancer in Two Patients with Prepectoral Silicone Gel Breast Implants following Implant Displacement Mammography
Authors: Peters Walter , Fornasier Victor
Published: February 2017

Two patients with prepectoral silicone gel breast implants and class IV capsular contractures presented at explantation with incidental breast carcinomas, which had been missed following implant displacement mammography. In both patients, the radiologists had commented that imaging was difficult because of the presence of the implants and their associated capsular contractures. Both patients had metastases – one had involvement of multiple axillary lymph nodes and the other had widespread metastases to the liver and to multiple skeletal sites. The cases reinforce the findings that breast implants can mask the early detection of breast carcinoma.
Pectoralis Major Rupture: Presentation of Two Cases and Review of 74 Cases
Authors: Chao Hubert YM , Manktelow Ralph T
Published: February 2017

Pectoralis major rupture is uncommon. Injury usually occurs from sporting activities. The incidence and management of pectoralis major rupture is not well known, despite 74 case reports in the English language literature over the past 34 years. Two cases of chronic pectoralis ruptures and their successful surgical management are described. A review of the literature shows that most injuries occur at the humeral insertion, and most are complete ruptures. Distinguishing between complete and partial ruptures is important. Complete ruptures are best treated surgically in the acute situation. When chronic complete ruptures present, surgical repair yields fair to good results. Acute partial ruptures can be effectively managed conservatively or with surgery. Chronic partial ruptures can be managed surgically with good results, following unsatisfactory conservative management in the acute situation.
Aerosol vehicle for Delivery of Epidermal Cells – An in Vitro Study
Authors: Bahoric Andre , Harrop A Robertson , Clarke Howard M , Zuker Ronald M
Published: February 2017

This in vitro study investigated the possibility of delivering epidermal cells to cell culture plates using a simple and inexpensive aerosolization apparatus. Full-thickness skin biopsies were incubated in dispase to separate the epidermis from the dermis, and the epidermis was treated with trypsin to separate the epidermal cells from one another. The cells were suspended in aerosolization medium (1x106 cells/mL) and sprayed onto culture plates using a sterilized pump-action aerosol nozzle. The plates were incubated and microscopically examined on a daily basis. The aerosolization process was successful in consistently delivering a uniform distribution of suspended epidermal cells. By day 4 there was evidence of cell proliferation, and by days 7 to 9 a confluent layer of cells was achieved on the plates. The monolayer consisted primarily of keratinocytes interspersed with a few fibroblasts. The aerosol method was shown to be effective at delivering a suspension of viable epidermal cells to a culture plate.
Fibroma of Tendon Sheath as a Cause of Carpal Tunnel Syndrome
Authors: Rao Jaggi , Thoma Achilleas , Salama Sam
Published: February 2017

This report describes a 28-year-old male with a fibrovascular tumour of the left midpalm, extending into the carpal tunnel. It compressed the median nerve, producing carpal tunnel syndrome. Upon carpal tunnel decompression and local excision, the symptoms were relieved. Histopathological study of the tumour revealed characteristics suggestive of fibroma of tendon sheath, an uncommon tumour of the hand and rare cause of carpal tunnel syndrome.
Hydrofluoric Acid Burns: A Case Report
Authors: Lukinuk C , Dasgupta R , Mahoney Jl
Published: February 2017

Hydrofluoric (HF) acid has numerous uses both in industry and the home. HF burns are characterized by intense pain, progressive tissue damage and significant systemic effects. Pain may be prolonged because the fluoride ion remains active despite irrigation of the burn. Subcutaneous infiltration of calcium gluconate is the local treatment of choice. We present a case of hydrofluoric acid burn from rust remover that was effectively treated by topical calcium gluconate baths. A calcium gluconate solution can be prepared with material available in most hospitals and may be readily administered in this fashion. Early recognition and appropriate treatment of hydrofluoric acid burns will provide symptomatic relief and minimize tissue damage.
Failure Properties of Leaf Valve Inflatable Saline Breast Implants
Authors: Peters Walter
Published: February 2017

From 1992 to 1996, 189 saline breast implants were inserted into patients (54 for breast augmentation and 135 for replacement of explanted silicone gel implants). Nine implants (4.8%) underwent spontaneous deflation at a mean of 2.8 months postoperation (range, 0.5 to nine months). Six deflations were partial (10% to 50% of implant volume), and three were complete. All failed implants were from the same manufacturer and had the same leaf valves. None of the failed implants demonstrated any visible defects in their walls or valve mechanisms when examined in the operating room. However, subsequent analyses indicated that all failed implants demonstrated a slow leak through the leaf valve mechanism – as slow as two to three drops per 12 h. This rate increased significantly when pressure was applied to the implant. In the three implants with delayed leakage (six to 10 months), fibrous tissue was observed in the leaf valve mechanism of the implants. It is postulated that failure of all nine implants resulted because of defects in their valves and that fibrous tissue ingrowth into the leaf catheter valve mechanism may have played a role in at least three. The tissue may have provided a ‘wick’ to stimulate fluid leakage. The use of these leaf valve implants was discontinued one year ago. Since then, no failures have been observed in any of the 68 diaphragm valve implants that have been inserted during the past year.
Treatment of Carpal and Digital Ganglions by Simple Aspiration, or Aspiration and Injection of Corticosteroid And/Or Hyaluronidase
Authors: Seki John T , Bell Michael Sg
Published: February 2017

This retrospective study examined the treatment outcome of 178 carpal and digital ganglion cysts by simple aspiration or aspiration and injection of corticosteroid (triamcinolone acetonide 40 mg/mL) and/or hyaluronidase in 174 patients between 1987 and 1995. A total of 106 ganglions were treated with aspiration and triamcinolone acetonide injection; the cumulative cure rates were 45.3%, 50.0% and 53.8% following one, two or three treatments, respectively. The cure rates were similar in 23 ganglions in the hyaluronidase group: 43.5%, 52.2% and 56.5%, respectively. Seventeen of the 23 ganglions treated with a combination of triamcinolone acetonide and hyaluronidase recurred, yielding success rates of 17.4% and 26.1% following two or three treatments, respectively. Twenty-six ganglions were treated with simple aspiration. Of these, 23 were volar digital ganglions. The success rates were 61.5% and 69.2% following one or two treatments, respectively. The overall success rate was 94 of 178 (52.8%) after a maximum of three treatments, regardless of the type of treatment and the anatomical location of the ganglions. This study provided baseline data following nonoperative management of ganglions; the data can be compared with those from a planned prospective randomized clinical trial involving the use of rolitetracycline as a sclerosing agent, which is currently under review by the Ethics Committee at the authors’ institution.
V-Y Tensor Fascia Lata for Trochanteric Pressure Sore Treatment
Authors: Alvarez Lazo Daniel álvaro , Filho Olímpio Colicchio , Chaim Ricardo Galvão , Moro Paula Zuccolotto
Published: February 2017

There are several alternatives for pressure sore reconstruction, but it is of utmost importance that an appropriate surgical technique be adopted, because although treatment is successful, recurrence of these ulcers is frequent. The purpose of this study was to conduct a precise evaluation of the V-Y tensor fascia lata flap, pointing out its advantages compared with the classical flap and with other possibilities described in the literature. The author employed 20 V-Y tensor fascia lata flaps to correct 20 trochanteric ulcers. The use of the classical tensor fascia lata flap to cover trochanteric ulcers is unquestionable. However, primary closure for flaps wider than 10 cm is difficult, necessitating an eventual skin grafting of the donor site. The V-Y tensor fascia lata allows a covering similar to the classical flap, simplifies primary closure and essentially presents the possibility of numerous reutilizations.
Has There Been Progress in the Early Diagnosis of Malignant Melanoma?
Authors: Atlan Gérald , Verrault Jean-Marc , Franchebois Pierre
Published: February 2017

Lesion thickness is still the best predictor of prognosis of cutaneous malignant melanoma. In order to evaluate whether some benefit resulted from early diagnosis, cases of melanoma referred to St Luke Hospital, Montreal, Quebec from 1983 to 1993 were studied. The series was homogenous in that the recruitment staff, surgeon and dermatopathologist were the same for all cases. It was observed that, from 1983 to 1991 the thickness of malignant melanoma cases was about the same. In 1992 and 1993, relatively more thin cases versus very thick cases were detected. Further study is indicated.
The Once-Twice Test for Evaluation of the Completely Anesthetic Digit
Authors: Mccabe Steven J , Breidenbach Warren C , Herrand Hector A
Published: February 2017

SJ McCabe, WC Breidenbach, HA Herrand. The once-twice test for evaluation of the completely anesthetic digit. Can J Plast Surg 1998;6(1):21-22.

A test to aid in the evaluation of the completely anesthetic digit – the once-twice test – is described. This rapid, easily performed clinical test can help identify patients with anesthesia of the digits of nonphysiological origin.
A Bone Clamp
Authors: Lalonde Donald H
Published: February 2017

DH Lalonde. A bone clamp. Can J Plast Surg 1998;6(2):105-106.

A bone clamp for use in small bone fracture reduction is described. Its tips are modelled after the towel clip. It is designed to fit in the small spaces of the hand.
Effect of Dimethyl Sulphoxide On Necrosis of Skin Flaps in Rats
Authors: Da Silva Duarte Ivone , De Carvalho Gomes Heitor Francisco , Ferreira Lydia Masako
Published: February 2017

I da Silva Duarte, HF de Carvalho Gomes, LM Ferreira. Effect of dimethyl sulphoxide on necrosis of skin flaps in rats. Can J Plast Surg 1998;6(2):93-97.

The effect of dimethyl sulphoxide (DMSO) on necrosis of the distal portion of random skin flaps was studied. Twenty-eight Wistar-EPM rats each had a random skin flap created that measured 10×4 cm. A plastic barrier was interposed between the flap and the bed. Rats in group 1 received distilled water and those in group 2 received DMSO 2 mL/kg/day by intragastric lavage for seven days. The percentages of necrotic area were calculated in the two groups, and malondialdehyde (MDA) was measured in the serum, in the samples of normal skin and in the transition region from viable to necrotic skin. Statistical analysis showed that DMSO was efficient in reducing the necrotic areas and MDA values compared with results from group 1. Statistical analysis also revealed that the action of DMSO as an antioxidant can be inferred to be the mechanism responsible for the results obtained.
Arthrodesis of Small Joints of the Hand Using Cerclage and a Single K Wire
Authors: Rice Sean B , Thoma Achilleas
Published: February 2017

Arthrodesis for small joints of the hand is a well established technique for the treatment of joint instability, deformity and pain. A technique for compression arthrodesis in small joints of the hand utilizing both Kirschner wire and cerclage is reviewed. The results of a retrospective series of 44 small joint arthrodesis in 33 patients are presented. Indications for arthrodesis were trauma (28.3%), rheumatoid arthritis (30.5%), osteoarthritis (14.7%) and traumatic arthritis (26.5%). Patient age ranged from 18 to 73 years, and 38% were male. Joint fusion as determined by radiography occurred in 41 of 44 cases, representing a 93% success rate, comparable with that cited in the literature. Complications included nonunion in three cases and infection in two cases, leading to eventual amputation. The present technique represents a simple, fast and effective method for small joint arthrodesis of the hand.
Clinical Applications of Magnetic Resonance Imaging in the Hand and Wrist for Soft Tissue and Ligamentous Injuries
Authors: Turner Robert B , Richards Robert S , Roth James H
Published: February 2017

With advances in magnetic resonance imaging (MRI) technology and observer experience, MRI is an established part of the diagnostic work-up for soft tissue injuries of the hand and wrist. It potentially minimizes the need for invasive procedures such as arthrography or arthroscopy. However, there are limitations of MRI, and many patients who undergo MRI of the wrist still need wrist arthroscopy for both diagnostic and therapeutic purposes. A review of the recent literature of the role of MRI in the assessment of soft tissue injuries of the hand and wrist is presented.
Viral Infections and Wounds
Authors: Karsan Naznin , Zuker Ronald M
Published: February 2017

The effects of viral infections on normal wound healing are discussed. The case report presented suggests that viruses can have a detrimental effect on the normal wound healing process.