bluuebunny/crossref_metadata_2025 huggingface dataset:
Pedicle Viability As the Determinant Factor for Conversion to Free Nipple Graft
Authors: Cabs Al-Shaham Aa
Published: February 2017

INTRODUCTION

Women with extremely large breasts have many complaints. Reduction mammaplasty improves shape and relieves physical symptoms and alleviates psychological complaints. Mammaplasty is a an evolving technique; no single method is ideal or suitable for all breasts. Many techniques are advocated for reduction mammaplasty, including the superior, vertical, horizontal, lateral and inferior (the most popular) pedicle techniques. Even after 60 years of development in breast reduction techniques, there are still reported incidences of nipple-areola complex (NAC) necrosis.

Objective

To assess the perioperative conversion to free nipple graft to prevent the complication of nipple necrosis when pedicle viability is grossly compromised.

Methods

Between January 2002 and March 2006, 66 patients (132 breasts) underwent reduction mammaplasty using the inferior pedicle technique. The patients presented with breast gigantism and required excision of more than 1000 g of breast tissue per side. The mean patient age was 34.81 years. Patients had neck, shoulder and back pain as well as psychological complaints. Data regarding sternal notch-to-nipple distances and inframammary fold-to-nipple distances were recorded preoperatively and postoperatively. The weights of the excised breast tissue from either side were recorded. Viability of the pedicle flap was carefully monitored through perioperative clinical observation of skin colour, temperature, capillary refill and bleeding characteristics, and reassessed after pedicle folding and placement inside the newly tailored skin envelope. Nonvital NAC, as evaluated by the surgeon during surgery, necessitated conversion to the free nipple graft technique.

Results

During the course of the study, two patients (four breasts; 3.03%) exhibited impending gangrene to the NAC, and perioperative conversion to the free nipple graft was performed. In these two patients, the pedicle length ranged from 23 cm to 25 cm, and breast mass reduction ranged from 1950 g to 2250 g.

Conclusion

Perioperative conversion to a free nipple-areola graft is always a good and safe option when impending gangrene to the NAC is evident during mammaplasty by inferior pedicle technique.
Peripheral Nerve Gap Repair Facilitated By a Dynamic Tension Device
Authors: S Mcdonald David , Sg Bell Michael
Published: February 2017

End-to-end neurorrhaphy remains the gold standard for transected nerve repair. However, the current dogma is that to be successful, nerve repairs must be tension free. Therefore, nerve gaps are most commonly repaired with grafts. While there is evidence that nerves can regenerate successfully after initial approximation under a tensile force, the amount of tension that deters regeneration of human nerves remains unclear. The present paper describes a case in which a favourable functional outcome was obtained following repair of a median nerve gap that was reduced by a dynamic tension device. The case provides some evidence that modest separations between stumps can be overcome by dynamic tension, enabling primary end-to-end repair of nerve gaps.
Superficialization of Deep Arteriovenous Access Procedures in Obese Patients Using Suction-Assisted Lipectomy: A Novel Approach
Authors: J Krochmal Daniel , M Rebecca Alanna , A Kalkbrenner Pa-C Kristen , J Casey William , J Fowl Richard , M Stone William , B Chapital Alyssa , A Smith Anthony
Published: February 2017

Successful dialysis access necessitates superficial arteriovenous fistula (AVF) placement to facilitate identification of anatomical landmarks for safe cannulation. Suction-assisted lipectomy (SAL) may be an alternative to traditional surgical AVF revision procedures for placing fistulas more superficially. Three patients with an average body mass index of 45.2 kg/m2, with inaccessible AVFs due to obesity, underwent ultrasound-guided SAL of their upper extremities. Successful cannulation was achieved within two weeks. A clinically insignificant hematoma and arm swelling occurred in one patient. SAL provides a safe and effective alternative for salvaging deep AVFs for dialysis access in the upper extremities of obese patients.
Total Scalp Avulsion with Microvascular Reanastomosis: A Case Report and Literature Review
Authors: A Plant Mathew , Fialkov Jeffrey
Published: February 2017

Total scalp avulsion is a rare but potentially devastating injury that when treated (following a few basic principles) can have very good reconstructive results. The present article reviews the current literature and describes the steps involved in the successful replantation of a complete avulsed scalp of a 33-year-old woman. To the authors’ knowledge, the present case regarding replantation of a complete avulsed scalp using only a single artery is the first to be described in the Canadian literature.
‘Universal Retraction Suture’ for the Overprojecting Nasal Tip
Authors: Fanous Nabil , Fanous Amanda , Al-Sebeih K , Côté Valérie
Published: February 2017

Achieving a proper nasal tip projection is a crucial element of a successful rhinoplasty. A large number of correction methods and manoeuvres have been proposed in the medical literature as solutions for the prominent nasal tip, thus complicating the surgeon's strife to choose the ideal plan of action. In the present article, a single straight-forward technique, christened the ‘universal retraction suture’, is suggested to tackle the overprojecting tip in a simplified, controlled and efficient fashion.
Incorrect Radiographic Evaluation After Vascularized Bone Grafting for Scaphoid Fracture Or Nonunion
Authors: Morin Paul , Reindl Rudy , K Berry Gregory , J Harvey Edward
Published: February 2017

PURPOSE

The present study is a review of patients with scaphoid nonunions treated with a dorsal vascularized bone graft. The study highlights a subset of patients incorrectly diagnosed as graft failures.

METHODS

A retrospective review of patients who received vascularized grafts for scaphoid nonunions was performed over a four-year period. The vascularized graft of choice for this group was the dorsal radial extensor compartment artery.

RESULTS

Five patients from a scaphoid fracture group who were treated with vascularized grafts were diagnosed as being failures (average of five months). None of these patients had tenderness on palpation of the scaphoid, and they were scheduled for revised vascularized grafts. All patients at the time of surgery were found to have healed. These patients were treated with arthrolysis, resulting in healing and full range of motion.

CONCLUSIONS

Scaphoid vascularized grafts may have a markedly delayed radiographic healing time. Reoperation to perform secondary vascularized procedures may result in unnecessary surgery. Early imaging following a scaphoid vascularized graft may be inaccurate and may demonstrate a continued nonunion.
Liposuction Infiltration: The Quito Formula – a New Approach Based On An Old Concept
Authors: Cueva Galárraga Iván Marcelo
Published: February 2017

INTRODUCTION

Liposuction is a highly sought after surgical procedure. Despite its popularity, not all of the factors associated with its execution are well understood. No well-established guidelines exist for plastic surgeons regarding the subcutaneous infiltration of fluid and, thus, the procedure is often performed subjectively.

OBJECTIVE

To establish the usefulness of the Quito formula (infiltrate volume = weight [kg] × percentage of body surface to be liposuctioned × 2.4 [mL]) for calculating the volume of fluid to be infiltrated subcutaneously during small-volume liposuction performed under epidural anesthesia.

METHODS

A prospective study was conducted on a group of 50 patients who were candidates for liposuction on multiple body parts between November 2004 and February 2010.

RESULTS

The maximum volume of infiltrate was 5000 mL and the maximum volume of aspirate was 4500 mL, with a 30% total aspirated area. No patient required blood transfusion, and there were no major complications. However, one patient presented with a small local infection, another with a sacral seroma and two patients had postdural puncture headaches. No patient showed clinical signs consistent with overhydration, dehydration, pulmonary embolism, fat embolism or lidocaine intoxication.

CONCLUSIONS

When performing small-volume liposuction, subcutaneous infiltration using the Quito formula to calculate the volume of infiltrate proved to be useful, safe and objective.
The New Genetico-Racial Skin Classification: How to Maximize the Safety of Any Peel Or Laser Treatment On Any Asian, Caucasian Or Black Patient
Authors: Fanous Nabil , Côté Valérie , Fanous Amanda
Published: February 2017

The popular skin classifications, notably the ‘Fitzpatrick’ and ‘Obaji’ classifications, are primarily based on skin colour. Other criteria are occasionally considered, such as the degree of skin oiliness, thickness, sensibility, etc. Although these classifications are easy to understand and apply, their simplicity limits their precision, sophistication and applicability.

The new genetico-racial skin classification proposed herein suggests that skin response to any peel or laser treatment is genetically programmed and is, therefore, linked to the genetic and racial origin of the patient. In other words, in addition to skin colour, the patient's facial features and ancestry should be taken into account when classifying any skin.

The new genetico-racial skin classification enables the physician to determine with great precision, and before any peel or laser treatment, the level of the patient's suitability and the expected postoperative outcomes; therefore, reducing the likelihood of complications.
A Rare Presentation of Flexor Digitorum Profundus Type V Avulsion Injury with Associated Intra-Articular Fracture: A Case Report
Authors: Rizis D , Mahoney Jl
Published: February 2017

Traumatic avulsions of the flexor digitorum profundus tendon are associated with young adults engaged in athletic activities such as football and rugby. The current report presents a case involving a 30-year-old man with traumatic avulsion of his flexor digitorum profundus and associated intraarticular distal phalangeal fracture secondary to injury during martial arts – an unusual cause of this injury. Increased attention to injuries acquired during this form of sporting activity is suggested.
Primary Cutaneous B-Cell Lymphoma: Role of Surgery
Authors: Parbhakar Sam , Dal Cin Arianna
Published: February 2017

PURPOSE

To evaluate the role of surgery in patients diagnosed with primary cutaneous B-cell lymphoma (PCBCL) – a rare disease entity. The authors offer a rationale for the use of primary surgical excision in the treatment of isolated cutaneous lymphomas.

METHODS

A literature review examining the use of primary surgical excision in the treatment of PCBCL was conducted. The lymphoma database at the Juravinski Cancer Centre (Hamilton, Ontario) was searched from January 1995 to July 2008, generating a list of 4924 patients. A simulated computer program was subsequently designed to search for all possible PCBCLs. A retrospective chart review was then conducted on the new list of 1325 patients, identifying 25 patients diagnosed with PCBCL.

RESULTS

The mean age of the 25 patients with PCBCL was 59.9 years; nine (36%) were treated with surgery, and sixteen (64%) with radiation. The average follow-up period for patients was 3.6 years. Twenty-four of the 25 patients were completely cured, with only one patient recurring in the radiation subgroup. There were no complications in the surgery subgroup. There were two local complications in the radiation subgroup consisting of chronic ulcerations.

CONCLUSIONS

Primary surgical excision is an effective management option in the treatment of PCBCL, particularly the marginal zone and follicle centre subtypes.
Delayed Two-Stage Breast Reconstruction with Implants: The Authors’ Recent Experience
Authors: Rykała Jan , Szychta Paweł , Kruk-Jeromin Julia
Published: February 2017

BACKGROUND

Presently, breast cancer detection is delayed in Poland and, thus, the only other option for patients is amputation and breast reconstruction (immediate or delayed). Reconstructive methods are based on using the patient's own tissue (pedicled or free myocutaneous flaps) or implants (a tissue expander, which is later exchanged for a prosthesis or an expandable implant).

OBJECTIVE

To evaluate the aesthetic results of a delayed two-stage breast reconstruction with the use of implants (expander and prosthesis) in patients who have previously undergone cancer-related mastectomy.

METHODS

From 2006 to 2009, 54 patients (34 to 65 years of age) underwent reconstruction at least one year after their mastectomy and adjuvant chemotherapy; three women also received x-ray therapy. All women underwent a two-stage treatment with a tissue expander, which was later exchanged for a prosthesis.

RESULTS

Outcomes of the surgery (evaluated by the physician and the patient at least six months after all stages of reconstruction) were found to be very good in 42 patients and good in 12 patients. After amputation and x-ray therapy in two cases, a fistula developed, which necessitated implant removal.

CONCLUSIONS

After amputation, breast reconstruction with implants (expander and prosthesis) provides good aesthetic results. The method is mildly burdening to the patient and does not cause severe scarring. Symmetrization of the second breast is often recommended; however, the cost is not covered by the national health system. In principle, earlier x-ray therapy disqualifies the application of implants. Dividing reconstruction into two stages (expander and prosthesis) allows for possible correction of prosthesis placement.
Optimizing Injectable Poly-L-Lactic Acid Administration for Soft Tissue Augmentation: The Rationale for Three Treatment Sessions
Authors: Bauer Ute , H Graivier Miles
Published: February 2017

BACKGROUND

The availability and variety of different injectable modalities has led to a dramatic increase in soft tissue augmentation procedures in recent years. Injectable poly-L-lactic acid (PLLA) is a synthetic, biodegradable polymer device approved in the United States for use in immunocompetent patients as a single regimen of up to four treatment sessions for correction of shallow to deep nasolabial fold contour deficiencies and other facial wrinkles. Injectable PLLA is also approved for restoration and/or correction of signs of facial fat loss (lipoatrophy) in individuals with HIV.

METHODS

The present article provides an overview of previous studies with injectable PLLA, and specifically focuses on the number of recommended treatment sessions and intervals between treatment sessions. The authors also provide two case studies to support their recommendations for an average of three treatment sessions.

RESULTS

Although the specific mechanisms remain hypothetical, injections of PLLA are believed to cause a cascade of cellular events that lead to collagen repair and subsequent restoration of facial volume. Because the development of a response to injectable PLLA is gradual and its duration of effect is long lasting, sufficient time between treatment sessions should be allocated to avoid overcorrection.

CONCLUSION

Studies of injectable PLLA support the hypothesized mode of operation, and the experience and clinical recommendations of the authors that suggest that three treatment sessions are an optimal regimen for use of injectable PLLA in the majority of patients.
Digital Artery Pseudoaneurysm in a Patient with Previous Radial Artery Harvest
Authors: A Plant Mathew , Panchapakesan Vivek
Published: February 2017

A post-traumatic pseudoaneurysm in the ulnar digital artery of the thumb in a patient with compromised vascularity due to a previous harvest of the ipsilateral radial artery is reported. To the authors’ knowledge, the present case is the first such description of a pseudoaneurysm in the digital artery of a patient with compromised collateral blood flow.
Breast reconstruction and radiation therapy: A Canadian perspective
Authors: Afolabi Oluwatola O , Lalonde Donald H , Williams Jason G
Published: February 2017

Background

When and how best to perform breast reconstruction in the setting of radiation therapy is a much debated topic.

Objective

To investigate the approaches that Canadian plastic surgeons are taking to breast reconstruction in patients who require or may require radiation therapy.

Methods

In April 2009, a survey invitation was sent to Canadian plastic surgeons via e-mail. Survey responses were collected over a two-month period.

Results

Of the 307 invitees, 90 surgeons responded, of whom 76 met the inclusion criteria. Most surgeons (66%) do not perform immediate reconstruction in patients who require postmastectomy radiation. Most respondents (64%) perform immediate reconstructions for patients whose need for radiation is uncertain at the time of mastectomy. Expander and implants is their preferred option, followed by free transverse rectus abdominis myocutaneous (TRAM) flap. Thirty-five per cent use the delayed immediate technique in these cases. Twenty-one per cent are unfamiliar with the delayed-immediate technique. For delayed reconstruction of the irradiated patient, the pedicled TRAM is the most common choice.

Conclusions

The reconstructive options are increasing for patients who may need postmastectomy radiation. The use of the delayed immediate technique could increase as physicians gain more knowledge of the technique.
Giant lipomas of the upper extremity: Case reports and a literature review
Authors: Balakrishnan Chenicheri , Nanavati Dhiren , Balakrishnan Anila , Pane Thomas
Published: February 2017

Giant fibrolipomas involving the upper extremities are rare tumours. These large masses grow slowly and produce symptoms due to their size, location and compression of adjacent structures. Surgical excision usually leads to complete recovery from symptoms.
Intraneural lipoma of the ulnar nerve at the elbow: A case report and literature review
Authors: Balakrishnan Anila , Chang Yeon Jen , Elliott David A , Balakrishnan Chenicheri
Published: February 2017

Intraneural lipomas of the ulnar nerve or its branches are rare benign tumours. Although most intraneural lipomas present as asymptomatic tumours, some may present as compression neuropathies due to their location. In the majority of cases these tumours can be enucleated without damage to the nerve fibres.
Islandized mucoperiosteal flaps: A versatile technique for closure of a wide palatal cleft
Authors: Aboul-Wafa Ahmed Mabrouk
Published: February 2017

Background

A variety of surgical methods have been described to repair wide cleft palate; they are all challenging to perform and yield consistently good results. The islandized mucoperiosteal flap, the technique described in the present article, is very versatile because it can close palatal defects of any size without undue tension. Moreover, it provides adequate length and mobility of the soft palate with improved speech and feeding functions without fistula formation.

Methods

Between 2005 and 2011, 36 patients with wide cleft palate were operated on using islandized mucoperiosteal flaps. This technique involves dissection of the neurovascular bundle from the mucoperiosteal flaps for approximately 1 cm and dissecting the muscle from the posterior edge of the hard palate with intravelar veloplasty. The flaps subsequently become freely mobile in all directions. It can move medially to close palatal defects of any size without tension. In addition, posterior or backward mobilization lengthens the soft palate and renders it freely mobile.

Results

All repairs were successful, with no complications and no patients requiring secondary procedures. All patients regained normal feeding function three weeks postoperatively. All patients showed normal nasal resonance of speech except for two (three and five years of age) who experienced abnormal resonance in the form of open nasality that required regular speech therapy for six months. There was significant improvement and no secondary procedures were required for either.

Conclusions

A technical modification for closure of wide palatal clefts is introduced. The islandized mucoperiosteal flap, which is a very versatile technique, can close cleft palates of any width without tension, lengthens the soft palate and renders it freely mobile for proper speech functions. Using this technique, good speech and feeding function with no complications were achieved.
Jejunal perforation after abdominal liposuction, bilateral breast augmentation and facial fat grafting
Authors: Coronado-Malagón Martin , Tauffer-Carrion Luis Tomas
Published: February 2017

A 54-year-old woman presented to the emergency department 24 h after undergoing abdominal liposuction, bilateral breast augmentation and facial fat grafting at a private plastic surgery clinic. She presented with the classic evolution of a bowel perforation secondary to abdominal liposuction. A computed tomography (CT) scan found free air in her abdominal cavity. Based on the CT scan and the persistent pain experienced by the patient, an abdominal laparatomy was urgently performed. A jejunum perforation was found and was treated with a resection of the affected segment followed by intestinal anastomosis. The patient had a successful recovery and was discharged seven days later. The present article also reviews the classical presentation of a bowel perforation following abdominal liposuction.
Extensor indicis proprius opponensplasty for isolated traumatic low median nerve palsy: A case series
Authors: Al-Qattan Mohammad M
Published: February 2017

Introduction

The standard opponensplasty for isolated low median nerve palsy in nonleprosy patients uses the flexor digitorum superficialis of the ring finger.

Objective

To report the results of extensor indicis proprius (EIP) opponensplasty in 15 consecutive nonleprosy patients with isolated traumatic low median nerve palsy.

Methods

A retrospective study of the author's cases of EIP opponensplasty for isolated traumatic median nerve palsy over the past 15 years was conducted. The author used the EIP to restore thumb opposition in all cases of isolated median nerve palsies when the following conditions were present: protective sensibility in the median nerve distribution; normal power of EIP; supple hands; and full passive range of opposition with no contracture of the first web space. There were a total of 15 patients with a mean age of 30 years (range 20 to 45 years). They all had traumatic isolated low median nerve palsy with recovery of at least protective sensation and no recovery of opposition. The tendon was harvested just proximal to the extensor expansion, the flexor carpi ulnaris was used as a pulley and the insertion was to the tendon of abductor pollicis brevis.

Results

There were no postoperative complications or extension lag of the donor finger. Using previously published criteria, 12 patients experienced excellent results while the remaining three had a good result.

Conclusions

In nonleprosy patients with isolated traumatic low median nerve palsy, the results of this transfer are consistent and there is no need to harvest the EIP tendon distal to the extensor expansion because a single insertion to the abductor pollicis brevis is sufficient.
Effects of dextran-40 on flap viability after modified radical mastectomy
Authors: Yildiz Baris Dogu , Sulu Barlas
Published: February 2017

Background

Postoperative management of patients after modified radical mastectomy has evolved over the past decades. In the early postoperative period, wound complication rates were reported to be as high as 60%. Flap necrosis after modified radical mastectomy is a common problem encountered by surgeons. Various treatment strategies have been proposed in the literature but none have addressed the use of dextran-40.

Objective

To determine whether dextran-40 infusion improves skin flap viability after modified radical mastectomy.

Methods

Twenty-eight patients who underwent modified radical mastectomy were randomly assigned to receive dextran-40 or no dextran-40 intraoperatively after flap dissection. Patients were followed prospectively over a five-year period in a community hospital. The incidence of postmastectomy skin flap necrosis and prognosis of the necrotic area after dextran-40 infusion was observed.

Results

Flap necrosis was observed in five (17.8%) patients. Hypertension and diabetes mellitus were found to be risk factors for the development of flap necrosis (P<0.05). Flap thickness and tension on the flaps were found to be related to flap necrosis. Six of seven patients with flap perfusion problems (ecchymosis or necrosis) underwent dextran-40 treatment and healed without graft replacement.

Conclusions

Dextran-40 treatment did not affect development of flap necrosis. However, if necrosis had already developed, the necrotic area of the skin flaps improved with dextran-40 treatment.
Eradication of keloids: Surgical excision followed by a single injection of intralesional 5-fluorouracil and botulinum toxin
Authors: Wilson Adel Michel
Published: February 2017

Background

Keloids may complicate wound healing secondary to trauma, inflammation or surgical incision. Although various treatment modalities have been used with variable degrees of success, overall recurrence rates have remained unacceptably high.

Methods

The present study involved 80 patients with keloids of at least one-years' duration. Following total surgical excision of the keloid, a single dose of 5-fluorouracil was injected into the edges of the healing wound on postoperative day 9 together with botulinum toxin. The concentration of 5-fluorouracil used was 50 mg/mL and approximately 0.4 mL was infiltrated per cm of wound tissue, with the total dose <500 mg. The concentration of botulinum toxin was 50 IU/mL with the total dose <140 IU.

Results

Patients were followed-up for 17 to 24 months and a recurrence rate of 3.75% was found, which was significantly lower than in previously reported studies using other therapeutic modalities.

Conclusion

The author recommends that this treatment be routinely applied to all keloids because it is significantly more effective than those described by other authors.
Rethinking the superficial inferior epigastric artery flap in breast reconstruction: Video demonstration of a rapid, reliable harvest technique
Authors: Buchel Edward W , Dalke Kimberly R , Hayakawa Thomas Ej
Published: February 2017

Abdominal-based autologous free tissue breast reconstruction has undergone significant changes over the past decade. The evolution has focused on limiting morbidity of the donor site. The transition from the transverse rectus abdominus muscle free flap to the muscle-sparing transverse rectus abdominus muscle free flap to the deep inferior epigastric artery perforator free flap has markedly improved abdominal-based autologous breast reconstruction. However, all of these flaps involve an incision through the anterior rectus fascia and potential damage of intercostal motor and sensory nerves. The superficial inferior epigastric artery flap (SIEA) reliably perfuses the ipsilateral hemiabdomen, yet does not violate the fascia or any motor nerves. As a result, the incidence of hernia, abdominal wall weakness and bulging is essentially eliminated. Nevertheless, use of the SIEA flap remains marginal. Vessel size, dissection difficulties and lack of understanding of the relevant anatomy have limited its acceptance. The present article describes a rapid, reliable and safe dissection technique with an algorithm for harvesting the SIEA flap in autologous breast reconstruction.
The horizontal breast reduction: Surgical tips for maintaining projection
Authors: White Colin P , Hynes Nicolas M
Published: February 2017

Reduction mammoplasty is one of the most common procedures performed by plastic surgeons in Canada. The Wise and vertical scar techniques are two of the most commonly published and performed. Although the horizontal breast reduction is a less commonly used technique, it offers added benefits over other procedures. These include elimination of the vertical scar and a consistently round nipple. However, one of the criticisms of the horizontal technique is the loss of projection of the breast mound. The present article outlines several important points that can aid in achieving an optimal aesthetic result when performing a horizontal breast reduction.
The Canadian Journal of Plastic Surgery
Authors: Wyshynski Peter E
Published: February 2017

“Tough, dedicated, demanding. Creative, energetic, hard working. Thus can be described the pioneers of plastic surgery in Canada, men who devised new techniques and established for themselves and their medical descendants what was to become the modern specialty of plastic and reconstructive surgery … They recognized the need for a common bond and a forum in which to discuss new ideas and new problems.”
Distal Rupture of the Biceps Tendon with Median Nerve Neurological Symptoms
Authors: Qattan Mm Al- , Bowen Cva
Published: February 2017

MM Al-Qattan, CVA Bowen. Distal rupture of the biceps tendon with median nerve neurological symptoms. Can J Plast Surg 1994;1(4):191. A rare case of acute onset of median nerve neurological symptoms associated with distal biceps tendon rupture is reported. The patient had a pre-existing asymptomatic carpal tunnel syndrome and the pathophysiology was thought to be the double crush syndrome.
African Spitting Cobra (Naja Nigricollis) Bite of the Hand
Authors: Kuzon William M , Marcus Jeffrey R , Kerluke Leslie D , Phillips John H
Published: February 2017

WM Kuzon, JR Marcus, LD Kerluke, JH Phillips. African spitting cobra (Naja nigricollis) bite of the hand. Can J Plast Surg 1994;2(2):90-92. Fifty thousand snakebites occur annually in North America. of these, about 8000 result in envenomation by poisonous species. In North America, 98% of poisonous snakebites are caused by pit vipers (Crotilidae). This report describes a Naja nigricollis (family Elapidae, the African spitting cobra) bite of the hand that occurred in Ontario. This species is common in West Africa and is popular with North American collectors. Its venom is quite different from the venoms of pit vipers and results in significant tissue necrosis. The management of a bite by N nigricollis requires aggressive medical and surgical treatment.
An Unusual Complication of Surgical Decompression of Partial Anterior Interosseous Nerve Syndrome
Authors: Al-Qattan Mm , Manklelow Rt , Murray Ka
Published: February 2017

MM Al-Qattan, RT Manktelow, KA Murray. An unusual complication of surgical decompression of partial anterior interosseous nerve syndrome. Can J Plast Surg 1994;2(2):93-94. Two cases of complete anterior interosseous nerve palsy immediately following surgical decompression of the nerve in patients with partial nerve palsy are presented. The etiology and outcome of this unusual complication are discussed.
Facial Danger Zones: Avoiding Nerve Injury in Facial Plastic Surgery
Authors: Seckel Brooke R
Published: February 2017

BR Seckel. Facial danger zones: Avoiding nerve injury in facial plastic surgery. Can J Plast Surg 1994;2(2):59-66. with today's new emphasis on more aggressive and deeper facial dissection during rhytidectomy, the peripheral nerve branches of cranial nerves V and VII in the face are more often exposed closer to the plane of dissection and more likely to be injured in the course of composite, extended sub-submuscular aponeurotic system (sub-SMAS), and subperiosteal rhytidectomy. It is important to have a keen and thorough understanding of the location of these nerves to avoid injury. I divide the face into seven facial danger zones based on known anatomic locations of the branches of the peripheral nerves of the face and the location in which they are most easily injured in the course of facial dissection. A description of the nerve and consequence of injury, the anatomic location of the zone, and the technique for safe surgical dissection for each facial danger zone is presented.
Reduction Mammaplasty: Position of the Nipple-Areolar Complex After Long-Term Follow-Up
Authors: Freiberg Aris , Carr Michele M
Published: February 2017

A Freiberg, MM Carr. Reduction mammaplasty: Position of the nipple-areolar complex after long-term follow-up. Can J Plast Surg 1994;2(3):117-120. Permanence of the location of the nipple-areolar complex after reduction mammaplasty was examined in 59 women undergoing a modified Robbins technique. Average age was 35.9 years and follow-up ranged from 8.5 months to 14.5 years. Measurements were taken bilaterally by the same observer at each follow-up visit without regard for previous measurements. These included the sternal notch to nipple distance (snn), areola to inframammary crease distance (aim), and the vertical limb of the scar length (vl). The first visit between one month and one year postoperatively was taken as the baseline to which later measurements were compared. with time, there was a trend to lengthening of the snn and shortening of the vl, but all changes were less than 1 cm and none was statistically significant (P>0.05). Groups were divided on the basis of patient age, amount of tissue excised, preoperative breast type, and pregnancies since operation, and the same measurements compared. There were no statistically significant differences (P>0.05). These results support the authors’ contention that nipple location remains stable following reduction mammaplasty.
False Aneurysm of the Superficial Temporal Artery Following Blunt Trauma
Authors: Waitzman Ariel A , Neligan Peter C , Butany Jagdish W
Published: February 2017

AA Waitzman, PC Neligan, JW Butany. False aneurysm of the superficial temporal artery following blunt trauma. Can J Plast Surg 1994;2(4):179-180. Aneurysms of the superficial temporal artery are uncommon. Motor vehicle accidents and assaults are the most frequent etiologies. There are, however, several cases reported following sports related trauma. The aneurysm is usually detected two to six weeks after injury. The diagnosis is made from clinical examination, aided in certain circumstances by radiological investigations. Treatment is primarily surgical, embolization being reserved for inaccessible aneurysms. A case is presented of a false aneurysm of the superficial temporal artery following a kickboxing injury. The diagnosis in this case was made clinically. Excision of the aneurysmal cavity after ligation of the afferent and efferent vessels was curative.
Fabrication of Silicone Tubes in Experimental Nerve Surgery
Authors: Al-Qattan MM
Published: February 2017

A technique of fabricating silicone tubes to the desired dimensions from a silicone sheet is described. The fabricated tube was used successfully as a conduit for the rat tibial nerve defect. The advantages and disadvantages of fabricated tubes are discussed.
Presentation and Detection of Breast Cancer in Seven Patients with Subglandular Augmentation Mammaplasty
Authors: Brown Mitchell H , Semple John L
Published: February 2017

More than two million women in the United States have undergone augmentation mammaplasty. A woman's lifetime risk of developing breast cancer is nearing 1 in 9, which means that over 200,000 augmented women may go on to develop breast cancer. Several studies have implied that women who develop breast cancer following augmentation mammaplasty are less likely to present with occult disease. They present more often with a palpable mass and are more likely to have involved axillary nodes. This paper looks at seven patients who developed breast cancer in the presence of subglandular mammary implants. Mode of presentation, pathologic type, nodal status, relationship of the tumour to the breast capsule and surgical treatment will be discussed. Consideration should be given to recommending against augmentation mammaplasty in those women with a strong family history of breast cancer or other significant risk factors. Women who undergo breast augmentation should be informed that the detection of occult disease with mammography may be more difficult following augmentation. The prognostic significance of this has yet to be fully determined.
Semmes Weinstein Monofilaments Versus Weinstein Enhanced Monofilaments: Their Use in the Hand Clinic
Authors: Al-Qattan Mm
Published: February 2017

The frequency of testing pressure threshold, the time consumed for testing, and the slippage rate using the original Semmes Weinstein monofilaments and the enhanced monofilaments (west) in the hand clinic are studied. A modified technique of using the west device is also described. It is concluded that west has several advantages and will likely encourage hand surgeons to perform pressure threshold testing more frequently in the clinic.
Dermis fat grafts for bilateral augmentation mammaplasty
Authors: Drever John Michael
Published: February 2017

Dermis fat grafts for body contouring have been used for over a century and extensively reported and researched, but since the advent of the more reliable silicone implants they have been dropped and neglected. As a consequence of the present controversy surrounding silicone breast implants, women are inquiring about augmentation with their own tissues. Healthy patients with good vascularity are the best candidates. These grafts are removed from the lower abdomen and placed with the dermis side facing the muscle, ‘take’ and then lose about 30 to 50% of their initial volume. Thirty-six cases were performed with this technique, and a two-and-a-half year follow-up with few complications and a high level of satisfaction is reported.
Is acute calcific tendinitis in the wrist unrecognized and under-reported?
Authors: Wells Neil J , Carr Nicholas J
Published: February 2017

Acute calcific tendinitis is currently thought to be a rare entity in the wrist, with few reports in the surgical literature. We review five cases seen in our institution in an eight-month period and question whether this entity is increasing in frequency or misdiagnosed, leading to underreporting.
Skier's thumb injury – Whistler experience
Authors: Rai Kimit
Published: February 2017

Thirty-eight per cent of skiing injuries seen at the Health Care Centre in Whistler, British Columbia are related to thumb injuries. A diagnosis of skier's thumb injury is made by clinical evaluation. The confirming diagnostic procedure is a positive stress test of the thumb, supported by supplementary investigations such as radiography, which may show an avulsion chip fracture with a localized area of tenderness. The treatment plan involves surgical exploration and ligament repair for total tear of the ulnar collateral ligament. Patients do extremely well with reconstruction and are able to return to skiing after six weeks, and to work between four to six weeks post surgery. Patients who refuse surgery do not do so well and have unstable painful thumbs with a weak pinch, and are likely to require future reconstructive surgery. Partial tears with a positive stress test have better results with surgical intervention and reconstruction of the ligament, rather than splinting alone. Finally, partial tears with a negative abduction stress test do well with splinting alone for six weeks.
Antibiotic Bead Pouch Dressing
Authors: Classen Dale A
Published: February 2017

The antibiotic bead pouch is a dressing consisting of antibiotic laden polymethylmethacrylate (PMMA) beads placed in a wound, which is covered by a porous membrane (Opsite). This paper outlines the method, rationale and results of the use of this dressing technique for extensive wounds before definitive wound closure. A case series review of 15 consecutive patients with a variety of soft tissue wounds that were managed with an antibiotic bead pouch dressing is presented. The method of dressing has been a useful and successful adjunct to the management of extensive infected and contaminated wounds.
Microvascular Reconstruction of a Full Thickness Scalp and Skull Defect following Herpes Zoster Infection
Authors: Waitzman Ariel A , Neligan Peter C
Published: February 2017

Herpes zoster is a common infection caused by reactivation of the varicella zoster virus. In most patients the disease runs a painful but benign course with complete recovery. A unique case of trigeminal ophthalmic herpes zoster presented to The Toronto Hospital, Toronto, Ontario. This patient had a unilateral full thickness defect of scalp and skull with secondary osteomyelitis and opacification of the eye. After appropriate medical therapy and surgical debridement, reconstruction was undertaken using a latissimus dorsi free flap and split thickness skin grafts. This achieved a satisfactory reconstruction with obliteration of the diseased tissue. On follow-up several months later, there was erosion through the central area of the skin graft. This appears to be secondary to trauma caused by the patient frequently scratching the area, and that the original defect likely had a factitious component of the same etiology.
Not another Diabetic Foot Infection: A Case Report of Charcot's Joint
Authors: Jain Rina , Brown Mitchell , Boynton Erin L
Published: February 2017

Diabetic patients are susceptible to foot infections, including cellulitis and osteomyelitis. However, not every diabetic's foot with erythema, swelling and pain is the result of an infection. The presentation of a Charcot's joint (neuroarthropathy) may mimic that of an acute infection. In the absence of systemic signs of sepsis, a diagnosis of a Charcot's joint should be considered.
Obstetric Brachial Plexus Injury in Subsequent Deliveries
Authors: Al-Qattan Mm , El-Sayed Aaf , Al-Kharfy Tm , Al-Jurayyan Nam
Published: February 2017

Two cases of obstetrical brachial plexus injury in subsequent deliveries in the same family are described. Medicolegal aspects, review of the literature and recommendations regarding its prevention are given.
Effect of the Extract from Salvia Miltiorrhiza Radix (SMR) on Skeletal Muscle Ischemia and Reperfusion Injury in Rabbits
Authors: Yang Daping , Frcsc Steven F
Published: February 2017

The extract of salvia miltiorrhiza radix (SMR) is a well known Chinese herbal medicine known as danshen. It has been found in several experimental studies, published mostly in China, to have antioxidant properties. The purpose of this experiment was, therefore, to compare the effects of danshen injection with those of superoxide dismutase (SOD) and mannitol on skeletal muscle ischemia and reperfusion injury in rabbits. The authors used a rabbit limb replantation model subjected to 5 h of global ischemia. Immediately before reperfusion, the animals received SOD (16,000 U/kg), mannitol (1 g/kg) or danshen injection (2 g/kg) intravenously. Both danshen and mannitol significantly increased limb survival (P<0.01). Increased limb survival was observed in the SOD-treated group compared with the saline-treated group (P<0.05) but not with the ischemic group (P>0.05). Light and transmission electron microscopy revealed that the pathologic and ultrastructural changes in skeletal muscles, which were subjected to 5 h of ischemia followed by 2 h of reperfusion, were reduced with SOD, mannitol and danshen injection. These results suggest that the hydroxyl radical seems to be the most important factor in ischemia and reperfusion injury to skeletal muscle and that danshen, like mannitol, may have a role in antioxidation as a hydroxyl radical scavenger.
Pediatric Burns: A Decade Later
Authors: Sándor George Kb , Clarke Howard M , Thomson Hugh G , Zuker Ronald M
Published: February 2017

The Hospital for Sick Children, Toronto, Ontario serves as a regional pediatric burn centre for metropolitan Toronto and the province of Ontario. The demographics and outcomes of the admissions of burn patients are reviewed periodically to help in future planning of resources and preventive strategies. This study was designed to review recent admissions and detect trends of the past decade by comparing admission and outcome data from two cohorts: one from 1986 to 1988 and one from 1977 to 1979. The number of admissions increased during the past decade. There was a lower proportion of patients with flame burns and a higher proportion with scald burns. This may be due to a combination of preventive measures and changing demographics. The overall mortality rate decreased from 2.2% in the previous decade to 0.78% in the past decade.
Anthropometric Anatomical and Morphological Nose Widths in Canadian Caucasian Adults
Authors: Farkas Leslie G , Phillips John H , Katic Marko
Published: February 2017

The ratio of morphological (bialar diameter [al-al]):anatomical (alar base width [ac-ac]) nose width defines the quality of the soft nose contours. Quantitative data on ac-ac and its relationship to al-al, and the relationship of both nose widths to face width (bizygomatic diameter) have not been available in the literature. To correct this, the anatomical and morphological widths of the nose were measured anthropometrically in an ethnically mixed group of 120 healthy, young adult, Caucasian Canadians, and the ratios of nose widths:face width (which greatly influences nasofacial harmony in the frontal view) calculated. In 80% of subjects, the morphological (classical) nose width was larger than the anatomical nose width, which has close contact with the underlying skeleton. Mean nose width was 24.9% (ac-ac) and 26.1% (al-al) of the face width. This study may help in the corrective surgery of disproportions between the two nose-width measurements in patients with cleft lip nose, and in the restoration of harmony between the nose and face widths.
Kavanel Revisited – Hand Infections At the Turn of the Century
Authors: Cohen Jack
Published: February 2017

By the use of dissections and ingenious experiments, Allen Kavanel clarified how hand infections spread along the various tissues and planes. This work enabled him to determine the best incisions to drain each type of infection and how to prevent its spread. Earlier, very little was known about how infections spread in the hand. Infections were often treated medically for long periods. Incision and drainage, when they were performed, in many cases were inadequate and focused in the wrong place. Even trivial infections often led to stiff useless digits or hands. Amputation and death were not unusual in the more serious infections. Representative cases are presented from Kavanel's classic textbook Infections of the Hand, published in 1912.
Anatomical Study of Intramuscular Arterial Patterns in Rabbits
Authors: Yang Daping , Morris Steven F
Published: February 2017

D Yang, SF Morris. Anatomical study of intramuscular arterial patterns in rabbits. Can J Plast Surg 1998;6(4):183-189.

In order to identify intramuscular arterial patterns in the rabbit and select suitable muscles for experimental models of muscle transfer, 25 animals were injected with a lead oxide, gelatin and water mixture (200 mL/kg). Twenty individual muscles from each rabbit were dissected. The length and size of the dominant vascular pedicle to each muscle were measured, and the location of the neurovascular hila was recorded. A total of 1000 muscles were radiographed and analyzed. The main patterns of the muscle arterial supply, based on the number of vascular territories, were described. Four main patterns of intramuscular vasculature were identified in these 20 muscles. This study provides detailed anatomical data of the intramuscular vasculature in the rabbit that allow an accurate anatomical delineation of rabbit muscle flap models and indicates that the rabbit muscle is an appropriate experimental model for various surgical research studies.