bluuebunny/crossref_metadata_2025 huggingface dataset:
Contribution of Breast Density to the Volume of the Augmented Breast: A Preliminary Study
Authors: M Hill Sean , Huettner Franziska , Murray John , Elwood Eric , Pa Rebecca Barrick , Jones Glyn
Published: February 2017

BACKGROUND

Prediction of soft tissue contribution to the shape, volume and texture of the augmented breast proves to be an ever-challenging, uncontrollable variable. Similarly, the understanding of the contribution of breast density in breast augmentation has been elusive and, generally, not well studied.

OBJECTIVE

With the aid of three-dimensional photographic analysis, the present preliminary study examined the contribution of differing breast densities to the overall volume of the augmented breast.

METHODS

All patients undergoing primary augmentation over a six-month period were included in the study. To standardize technique and implant type, all patients received saline-filled moderate-profile implants, which were placed partially underneath the pectoralis muscle through a lower pole approach. Photographic analysis of the breast volume was completed preoperatively and, subsequently, at a minimum of six months postoperatively. Preoperatively, each breast was also assigned to one of four classes of increasing mammographic density, as judged by the mammographic radiologist (fatty, moderately dense, heterogeneously dense and extremely dense). Postoperative breast volumes were, subsequently, correlated to mammographic densities.

RESULTS

Thirty-eight augmented breasts in 21 patients were examined. The average volume gain based on the implant size used was 92.7%. Heterogeneously dense breasts comprised 68% of the total breasts and showed an average volume gain of 100.67%, extremely dense breasts comprised 26% of the total breasts and showed an average volume gain of 97.3%, and moderately dense breasts comprised 5% of the total breasts with an average gain of 100.04%. There was no significant difference between the augmented breast volumes and the respective expected volumes (combined preaugmented breast volumes and implant volumes; P=0.3483). Additionally, no statistical difference was found between the density classes and the expected augmented volumes.

CONCLUSION

No statistical difference was found between expected and actual augmented breast volumes among or between four different breast density classes. Thus, one would expect that the soft tissue compression or the response of the impression of the implant on the parenchyma, would not be statistically different among classes. Additionally, compressive atrophy, as seen with atrophy of the breasts over time, would be expected to be multifactorial and not uniquely independent to breast density. However, longitudinal analysis is needed to study the durability of breast shape relative to breast density.
Nasal Trauma: Primary Reconstruction with Open Rhinoplasty
Authors: Konstantinidis I , Malliari H , Metaxas S
Published: February 2017

Due to the prominent location of the nose, the most common facial traumas are nasal injuries. Although nasal traumas usually require staged intervention at a later period of time, in selected cases, primary reconstruction can be effective. A 20-year-old man who was referred from the emergency department with nasal trauma is presented. He reported a fall after feeling unsteady, which caused a direct nasal injury. Clinical examination revealed septal fracture with obstruction of the left nasal cavity and deformity of the nasal pyramid (inverted V deformity). The patient also had a complete dissection of the columella skin. Epistaxis was self-limited, and an open rhinoplasty procedure was decided because the trauma occurred 1 h before admission and there was no significant edema. Surgical intervention included septal reconstruction combined with restoration of the nasal pyramid and columella. One month later, the patient had patent nasal airways, and he was satisfied with the aesthetic result.
A systematic review of anterolateral thigh flap donor site morbidity
Authors: Collins Jessica , Ayeni Olubimpe , Thoma Achilleas
Published: February 2017

Purpose

The anterolateral thigh (ALT) flap is widely used in reconstruction. Its advantage over other flaps is its purported minimal donor site morbidity. The present systematic review summarizes the types of complications and their incidence with this flap. A secondary objective is to delineate factors that influence these complications and make recommendations to avoid them.

Method

Two independent assessors undertook a systematic review of the literature using multiple databases. All patients with ALT flap reconstruction for any defect were included. Donor site complications including lateral thigh paresthesia, musculoskeletal dysfunction, hypertrophic scarring, wound breakdown, infection, donor site pain, seroma, hematoma, compartment syndrome and muscle necrosis were extracted from identified articles and tabulated. Based on the number of pooled events and the number of cases performed, an incidence rate was calculated.

Results

Forty-two relevant articles were identified that included 2324 flaps. Of the 2324 flaps, the majority were fasciocutaneous (n=737), and 1303 of the flaps were used in head and neck reconstruction. The incidence of complications were: lateral thigh paresthesia (24.0%); musculoskeletal dysfunction (4.8%); hypertrophic scarring or wound dehiscence (4.8%); donor site pain (3.3%); seroma (2.4%); infection (2.2%); hematoma (0.7%); compartment syndrome (0.09%); and partial muscle necrosis (0.09%).

Conclusion

Lateral thigh paresthesia is the most common complication. Severe complications such as compartment syndrome and muscle necrosis can occur, but are rare. Preservation of the lateral cutaneous nerve of the thigh, femoral motor nerve branches and deep fascia decreases the risk of complications. The degree of vastus lateralis disruption did not show a significant impact on musculoskeletal dysfunction.
Axon counts of potential nerve transfer donors for peroneal nerve reconstruction
Authors: White Colin P , Cooper Michael J , Bain James R , Levis Carolyn M
Published: February 2017

Background

The common peroneal nerve is the most commonly injured nerve in the lower limb. Nerve transfer using expendable donor nerves is emerging in the literature as an alternative surgical procedure to traditional treatments.

Objective

To identify potential donors of motor axons from the tibial nerve that can be transferred to the common peroneal nerve branches.

Methods

Using 10 human cadaveric lower extremities, all motor nerve branches of the tibial nerve were identified and biopsied. These were compared with the motor branches to tibialis anterior and extensor hallucis longus (branches of the deep peroneal nerve).

Results

The most suitable donor nerves with respect to cross-sectional area to tibialis anterior (cross sectional area [mean ± SD] 0.255±0.111 mm) was the motor branch to lateral gastrocnemius (0.256±0.105 mm). When comparing the total number of axons, the branch to the tibialis anterior had a mean of 3363±1997 axons. The branch to the popliteus was most similar, with 3317±1467 axons. The most suitable donor nerves for the motor branch to extensor hallucis longus (cross sectional area 0.197±0.302 mm) with respect to cross-sectional area was the motor branch to flexor hallucis longus (0.234±0.147 mm). When comparing the total number of axons, the branch to the extensor hallucis longus had an average of 2062±2314 axons. The branch to the lateral gastrocnemius was most similar with 2352±1249 axons and was a suitable donor.

Conclusion

Nerve transfers should be included in the armamentarium for lower extremity reinnervation, as it is in the upper limb.
Bilateral reduction mammoplasty following breast cancer: A case-control study
Authors: Cin Arianna Dal , Knight Casey , Whelan Kaitlyn F , Farrokhyar Forough
Published: February 2017

Purpose

Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed.

Methods

A matched case-control study with patients serving as their own control (treated breast cancer breasts were ‘cases’, healthy breasts were ‘controls’) was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri- and postoperative complications were collected. Measured outcomes included hematoma or seroma, delayed wound healing, infection, nipple-areolar complex problems, scarring, asymmetry and the need for further surgery. Continuous variables are reported as mean ± SD, and categorical variables are reported as proportions.

Results

Of the nine patients included in the study, delayed wound healing occurred in 22% of cases. Wound infections occurred in 66.7% of cases, with 22.2% experiencing a second wound infection. One patient experienced partial nipple-areolar complex loss on the radiated breast. There was abnormal scarring in 33.3% of radiated breasts. Postoperative asymmetry occurred in 77.8% of patients. Additional surgery was performed on three patients (33.3%).

Conclusions

Results of the present study suggest that women with a history of breast cancer treated by lumpectomy and radiation experience higher occurrence of postoperative complications on the radiated breast following bilateral breast reduction. Patients must be informed of these potential risks and require careful postoperative follow-up. An appropriately powered, prospective, multicentred study is required to draw definitive conclusions.
Reporting the level of evidence in the Canadian Journal of Plastic Surgery: Why is it important?
Authors: Thoma Achilleas , Ignacy Teegan A , Li Yu Kit , Coroneos Christopher J
Published: February 2017

The levels of evidence (LOE) table has been increasingly used by many surgical journals and societies to emphasize the importance of proper study design. Since their origin, LOE have evolved to consider multiple study designs and also the rigour of not only the study type but multiple aspects of its design. The use of LOE aids readers in appraising the literature while encouraging clinical researchers to produce high-quality evidence. The current article discusses the benefits and limitations of the LOE, as well as the LOE of articles published in the Canadian Journal of Plastic Surgery (CJPS). Along with an assessment of the LOE in the CJPS, the authors have provided recommendations to improve the quality and readability of articles published in the CJPS.
Reconstruction with distally based dorsalis pedis fasciocutaneous flap for the coverage of distal toe-plantar defects
Authors: Emsen Ilteris Murat
Published: February 2017

Reconstruction of small defects in the distal portion of the foot has always been a difficult problem. A case involving a young man with a deep electric burn of the distal lateral side of the big toe, successfully treated with a distally based dorsalis pedis fasciocutaneous flap, is presented. The donor site area of the dorsum of the foot was grafted, and deambulation was reassumed three weeks later. Advantages, limits and anatomical consideration regarding the viability of the flap are also discussed.
The epidemiological profile of the Vascular Birthmark Clinic at the Alberta Children's Hospital
Authors: Fraulin Frankie OG , Flannigan Ryan K , Sharma Vishal K , Mcphalen Donald F , Harrop Robertson A
Published: February 2017

Background

The Vascular Birthmark (VBM) Clinic at the Alberta Children's Hospital (Calgary, Alberta) is a multidisciplinary clinic dedicated to the evaluation of children with vascular anomalies.

Objective

To review the characteristics of patients seen at the VBM Clinic.

Method

A retrospective data analysis of all pediatric patients presenting to the VBM Clinic between 1998 and 2009 was performed. Data including demographic, referring, diagnostic and treatment information were obtained from the clinic's database.

Results

Of 932 patients, 621 with hemangiomas and 311 patients with vascular malformations were found in the database. Hemangiomas were more commonly found in girls (68.5%), and most commonly located on the head and neck (54%), with most patients (72.6%) having only one lesion. Of the patients with hemangiomas, 14.7% underwent diagnostic imaging investigation and 23.7% received treatment including medications, surgery, pulsed-dye laser or dressings. The sex distribution among the 311 patients with vascular malformations was almost equal. Venous malformations accounted for 38.9% of patients, isolated capillary malformations for 31.5%, lymphatic malformations for 11.6%, mixed low-flow malformations for 14.8% and arteriovenous malformations for 2.9%. Overall, 37.9% of patients underwent diagnostic imaging investigation and 42.4% received treatment – either pulsed-dye laser, surgical excision, sclerotherapy or other treatment.

Conclusions

Hemangiomas and vascular malformations can occur at any anatomical site. There is a large variation in clinical presentation necessitating expertise in a variety of diagnostic approaches and treatment modalities. Vascular anomalies are best managed in a multidisciplinary setting.
Blunt carotid artery injury after minor facial trauma
Authors: Murabit Amera , Tredget Edward E
Published: February 2017

A healthy young man presented three days after suffering a punch to the face resulting in minimally displaced mandibular fractures. History revealed an episode of anterograde amnesia and a delayed episode of dysphonia. Apart from the fractured mandible, the physical examination was otherwise noncontributory. Imaging revealed severe luminal narrowing of the left cervical internal carotid artery distal to the carotid bifurcation, consistent with carotid dissection; and two focal hypodensities in the left frontal and parietal cortices, highly suggestive of acute secondary embolic infarcts. The patient was treated with systemic anticoagulation for three months and experienced no further neurological symptoms. His mandibular fractures, treated conservatively, healed without any complications.

Blunt carotid artery injuries are uncommon and diverse. Neurological symptoms may develop in a delayed fashion, thus, a high index of suspicion based on knowledge of the injury mechanisms and patterns of associated injuries may enable earlier diagnosis and treatment. Angiographic imaging is essential for the diagnosis and classification of injury characteristics (eg, type, location, etc). Treatment must be considered on an individual patient basis depending on the presentation, grade and morphology of the lesion. Although no level I clinical trials exist on the topic, anticoagulation seems to be the treatment of choice in most cases and surgical intervention is not commonly indicated. Carotid artery dissection without complete thrombosis may be effectively treated with systemic anticoagulation or antiplatelet therapy in the majority of cases.
Noninfectious inflammatory reaction to a gold weight eyelid implant: A case report and literature review
Authors: Iordanous Yiannis , Evans Brian
Published: February 2017

Upper eyelid loading with a gold weight is a generally well-tolerated procedure that helps reduce corneal exposure in patients with lagophthalmos. Complications of this procedure are infrequent. The authors present a rare case of a noninfectious inflammatory response to an eyelid gold weight implant in a 48-year-old woman and summarize all previously published cases. This particular patient presented with incomplete left eyelid closure secondary to a trauma. After having a gold weight inserted into her eyelid to improve closure, she returned with edema and erythema of the eyelid. The inflammation did not respond to oral antibiotics; however, oral steroid therapy resulted in prompt resolution of her symptoms. Her symptoms recurred after discontinuing steroid use and she subsequently required removal of her gold weight implant for permanent resolution of her eyelid inflammation. Although rare, this reaction poses a serious management issue, because it does not respond to antibiotics or short-term steroid use and, in most cases, requires removal of the gold implant.
Reporting disclosures to the reader in plastic surgery journal publications
Authors: Sinno Hani , Lutfy Justyn , Tahiri Youssef , Neel Omar Fouda , Gilardino Mirko
Published: February 2017

Background

With the associations between investigators and funding sources becoming increasingly complicated, conflicts of interest may arise that could potentially cause biases in the reporting of results.

Objective

To determine the number of published plastic surgery articles that lack reporting of disclosures.

Methods

An online review of four major North American plastic surgery journal publications from January 1, 2007 to December 31, 2007, was performed. For identification and to provide anonymity, journals were assigned a letter from A to D.

Results

Of the 1759 articles reviewed, 726 (41%) were included. Disclosure was not reported in 368 (51%) articles: Journal A (n=10, 3%), Journal B (n=153, 85%), Journal C (n=193, 93%) and Journal D (n=12, 32%). Journals differed significantly in their reporting of disclosure (P<0.01).

Conclusion

In the plastic surgery journals reviewed, the lack of documentation of disclosures was frequent. To ensure identification of bias in plastic surgery publications, a section dedicated to disclosure statements is recommended for each published article.
Teaching medical students and residents how to inject local anesthesia almost painlessly
Authors: Farhangkhoee Hana , Lalonde Jan , Lalonde Donald H
Published: February 2017

The objective of the present study was to determine whether it is possible to consistently and reliably teach medical students and resident learners how to administer local anesthetics in an almost painless manner. Using the published technique, 25 consecutive medical students and residents were taught how to inject local anesthetics for carpal tunnel release by watching the senior author perform the technique once. The learner then independently administered the anesthesia to the next patient who then scored the learner's ability to inject the local anesthetic from a pain perspective. The teaching technique is demonstrated in an accompanying online video. The learners were consistently capable of administering local anesthetics with minimal pain. During the injection process, the patients only felt pain once (‘hole-in-one’) 76% of the time. This pain was attributed to the first 27-gauge needle poke. The other 24% of the time, patients felt pain twice (eagle) during the 5 min injection process. All 25 patients rated the entire pain experience to be less than 2/10. Eighty-four per cent of the patients indicated that the experience was better than local anesthetic given at the dentist's office. Medical students and residents can quickly and reliably learn how to administer local anesthesia for carpal tunnel release with minimal pain to the patient.
In utero arterial thrombosis treated with recombinant tissue plasminogen activator in an infant of a diabetic mother: A case report and literature review
Authors: Wong Nathan , Bush Kevin
Published: February 2017

A 36+5 days' gestation infant of a diabetic mother suffered arterial thrombosis with severe vascular occlusions in multiple limbs, especially of the left upper extremity. Although the mechanism remains elusive, the association between venous and arterial thrombi in infants and diabetic mothers has previously been established. Cases typically result in the amputation of the dysvascular limbs. In the present case, the use of selective angiography to administer recombinant tissue plasminogen activator allowed the left upper extremity to be salvaged with amputation of only the left thumb.
Postoperative management of Dupuytren's disease with topical nitroglycerin
Authors: Emelife Patrick I , Kling Russell E , Wollstein Ronit
Published: February 2017

Dupuytren's contracture remains a significant clinical challenge due to associated complications and a recurrence rate of up to 60%. Commonly, the operated skin tends to rebuild scar in the area of surgery. Assuming local ischemia as an etiological factor, two cases in which topical nitroglycerin was used following surgical treatment of Dupuytren's disease are presented. In these patients, no raised scar formation developed during healing. At least six months after surgery, disease recurrence was not noted and the patients and surgeon reported improved skin quality. In the present study, the use of topical nitroglycerin, a local vasodilator, appeared to prevent recurrent scar formation, possibly through prevention of local ischemia. Further study and follow-up is necessary.
The effects of transcutaneous electrical nerve stimulation on tissue repair: A literature review
Authors: Perez Machado Aline Fernanda , Santana Eduardo Ferreira , Tacani Pascale Mutti , Liebano Richard Eloin
Published: February 2017

Background

Transcutaneous electrical nerve stimulation (TENS) consists of a generic application of low-frequency, pulsed electrical currents transmitted by electrodes through the skin surface. It is a therapeutic modality that is nonpharmacological, noninvasive, inexpensive, easy to use and widely applied in clinical practice.

Objective

To narratively review the scientific evidence of the effects of TENS on tissue repair with respect to wound healing, skin flap viability and tendinous repair.

Methods

The study was conducted using the MEDLINE, Lilacs and Scielo databases, without limit to the period of publication, and was completed in November 2011. Inclusion criteria were randomized or nonrandomized, controlled or noncontrolled clinical trials, and experimental trials involving rats subjected to TENS for tissue repair.

Results

Thirty articles on tissue repair were found and, among these, 14 reported on wound healing, 14 reported on skin flaps and two analyzed tedinous repair.

Discussion

It was suggested that TENS stimulates skin wound healing and tendon repair, as well as the viability of random skin flaps. Such effects may be due to the release of substance P and calcitonin gene-related peptide, which would increase blood flow and, consequently, hasten the events leading to tissue repair.

Conclusions

Based on the scientific evidence regarding the effects of TENS on tissue repair, the findings of the present literature review were inconclusive because data from the randomized controlled clinical trials were insufficient to confirm such effects.
Does the presence of an implant including expander with internal port alter radiation dose? An ex vivo model
Authors: Strang Barbara , Murphy Kyla , Seal Shane , Dal Cin Arianna
Published: February 2017

Background

There is a lack of literature examining the dosimetric implications of irradiating breast implants and expanders with internal ports inserted at the time of mastectomy.

Objective

To determine whether the presence of breast expanders with port in saline or silicone implants affect the dose uniformity across the breast when irradiated with various photon and electron energies.

Methods

One tissue-equivalent torso phantom with overlying tissue expanders in saline or silicone implants were irradiated using tangential fields with 6 MV and 18 MV photons and 9 MeV and 12 MeV electrons. All dose measurements were performed using thermoluminescent dosimeters (TLDs). The TLDs were arranged around the port and the perimeters of either the expander, or saline or silicone implant. Comparisons of measured radiation doses, and between the expected and measured doses of radiation from the TLDs on each prosthesis, were performed. Data were analyzed using two-tailed t tests.

Results

There were no differences in TLD measurements between the expander and the saline implant for all energy modalities, and for the expected versus actual measurements for the saline implant. Higher than anticipated measurements were recorded for a significant number of TLD positions around the silicone implants.

Conclusions

Radiation doses around saline implants or expanders with internal port were unaltered, whereas dose recordings for silicone implants were higher than predicted in the present laboratory/ex vivo study.
Onset and duration of intradermal mixtures of bupivacaine and lidocaine with epinephrine
Authors: Collins James B , Song Juhee , Mahabir Raman C
Published: February 2017

Background/Objective

Bupivacaine and lidocaine are often used concurrently, in theory, to combine the more rapid onset of lidocaine and the longer duration of bupivacaine. The purpose of this study was to evaluate this concept.

Methods

Twenty-five subjects were enrolled in a double-blinded, randomized block design study to evaluate the onset and duration of four different mixtures of lidocaine and bupivacaine with epinephrine. The study was designed to achieve 80% power to detect an effect size of 0.37 at 5% overall significance. The four mixtures tested were: 0.25% bupivacaine with epinephrine (1:200,000); 1% lidocaine with epinephrine (1:100,000); 0.125% bupivacaine and 0.5% lidocaine with epinephrine (1:150,000); and 0.25% bupivacaine and 1% lidocaine with epinephrine (1:150,000). Four intradermal injections were made in the volar forearms of each participant. Time to effect and duration were measured by sensation of a sharp skin prick.

Results

Mean time to onset ranged from 12 s to 29 s without statistical significance across all tested solutions (P=0.891). Mean duration of effect ranged from 6 h 38 min to 7 h 25 min with a statistically significant difference across the tested solutions (P=0.036).

Conclusions

No statistical benefit was measured when comparing lidocaine with epinephrine, bupivacaine with epinephrine, and mixtures of these local anesthetics with regard to onset of action. While a statistical difference was observed in duration of effect, the clinical benefit measured was narrow.
Reversed palmaris longus muscle: Anatomical variant – case report and literature review
Authors: Murabit Amera , Gnarra Maria , Mohamed Adel
Published: February 2017

The palmaris longus, a slender fusiform muscle, is especially prone to exhibiting anatomical variance relative to other muscles in the upper extremity. The most frequent anatomical variation is the completely absent palmaris longus, followed by the reversed, duplicated, bifid or hypertrophied palmaris longus muscles. The reversed palmaris longus muscle represents a structure that is tendinous proximally and muscular distally (opposite of the normal palmaris longus). The present report describes a case of reversed palmaris longus muscle, followed by a literature review to illustrate the wide spectrum of anatomical variations in the palmaris longus muscle and their clinical and surgical relevance.
Acral myxoinflammatory fibroblastic sarcoma: A case report and literature review
Authors: Silver Andrew G , Baynosa Richard C , Mahabir Raman C , Wang Wei Z , Zamboni William A , Khiabani Kayvan T
Published: February 2017

Acral myxoinflammatory fibroplastic sarcoma is an extremely rare soft-tissue sarcoma. It typically presents as an inflammatory mass in the distal extremities of adult patients. The authors present a review of the available literature as well as a discussion on the surgical management of a patient with acral myxoinflammatory fibroplastic sarcoma who originally requested conservative management but ultimately required a two-digit ray amputation after local recurrence.
Article Commentary: Albert Ross Tilley: The legacy of a Canadian plastic surgeon
Authors: Mowbrey Kevin
Published: February 2017

The present article chronicles the career of Dr Albert Ross Tilley, one of the most important Canadian plastic surgeons of the 20th century. Tilley is most well known for his innovations of burn management during World War II and his treatment of a group of burn patients known affectionately as the ‘Guinea Pig Club’. In addition to the superb surgical skills he applied to the physical wounds of his patients, Tilley was also a pioneer of caring for the emotional and psychological afflictions suffered by many airmen of World War II. As one of the founding fathers of the Canadian Society of Plastic Surgeons, Tilley's work was instrumental in establishing the specialty and ensured its prosperity for years to come. Serving in the capacity of leader, educator and innovator, Tilley remains one of Canada's most decorated physicians, and his body of work encompasses contributions to the medical field that remain significant and beneficial to patient care to this day.
Characterizing the lateral slope of the aging female eyebrow
Authors: Delyzer Tanya L , Yazdani Arjang
Published: February 2017

Background

Ideal eyebrow aesthetics give a framework for brow rejuvenation and surgical procedures do not always provide satisfying results. Previous studies have shown elevation of the medial brow with aging; however, they failed to characterize overall shape changes.

Objective

To characterize changes in eyebrow slope with increasing age to better direct brow rejuvenation.

Methods

From standardized anteroposterior facial photographs of 100 women 20 to 80 years of age, eyebrow height was measured at the medial limbus and arch apex from a mid-pupillary horizontal. The slope of the eyebrow was calculated. Using group analysis, mean height and slope were compared using the Mann-Whitney U test. Regression analysis was used to determine the relationship between slope and age.

Results

Mean slope significantly decreased from 20 to 29 years of age to 40 to 49 years of age (0.22 versus 0.12; P=0.03), and then increased between 40 and 49 years of age and ≥60 years of age (0.12 versus 0.21; P=0.05). Medial height did not change significantly, and arch apex significantly decreased between 20 and 29 years of age and 40 and 49 years of age. Regression analysis showed a quadratic relationship between age and slope, with the decrease in slope until the fifth decade of life being directly related to increasing age. After this, age was not a significant contributor to slope changes.

Conclusions

With increasing age, the slope of the eyebrow decreases until the fifth decade dependent on age. After the fifth decade, age no longer plays a significant role. Therefore, choice of brow lift technique should be carefully selected.
Carpal Tunnel Syndrome and Hand Function
Authors: Taylor G Allan
Published: February 2017

GA Taylor. Carpal tunnel syndrome and hand function. Can J Plast Surg 1993; 1 (1):44-46. A prospective review of 78 hands in 58 patients with carpal tunnel syndrome is presented. The author's technique for carpal tunnel release under local anesthesia is described. Comparison of the patients in the series with age- and sex-matched controls revealed a high incidence of preoperative weakness of grip and pinch strength. Postoperatively, many patients experienced further loss of strength persisting six months or more. Some had not regained preoperative strength by six months. Explanations for diminished hand strength in patients with carpal tunnel syndrome both pre- and postoperatively are advanced and recommendations made for improved informed consent for patients undergoing carpal tunnel release.
Early Experience with Hand Continuous Passive Motion
Authors: Morris Steve , Freiberg Amis , Harris Leonard
Published: February 2017

S Morris, a Freiberg, L Harris. Early experience with hand continuous passive motion. Can J Plast Surg 1993; 1 (1): 19-23. Clinical experience with continuous passive motion (CPM) has increased in recent years. However, little information is available in the literature of objective evaluation of the results obtained using this treatment modality. The purpose of this study was to review both the indications for hand CPM at the Toronto Western Hospital. Toronto. Ontario, and the course and the outcome of the patients treated. Between 1984 and 1989 the Mobilimb H1 CPM was used on 43 patients for a mean period of 39±6 days (mean total hours of CPM 741+84 h). Indications for hand CPM included hand trauma, capsulectomy and tenolysis and other hand conditions. Mean follow-up was 32+3 months. Overall, hand CPM was well tolerated and highly effective in relieving hand pain and increasing active and passive range of motion. Compliance was excellent.
Opponensplasty Hypothenar Muscles Transfer
Authors: Hashem Fuad , Stranc Miroslaw
Published: February 2017

F Hashem, M Stranc. Opponensplasty hypothenar muscles transfer. Can J Plast Surg 1993;1(1):36-38. Opponensplasty using hypothenar muscles (abductor and flexor digiti minimi) is presented. This technique was used with gratifying results in two patients; the first having sustained congenital absence of the thenar eminence and the second presenting with a traumatic loss of the thenar muscles. Function 10 years after treatment is described for the later and one year follow-up for the former.
Sublimis Loop Reconstruction of the Transverse Metacarpal Ligament Following Central Ray Amputation
Authors: Robertson G Andrew , Al-Qattan Mohammad M
Published: February 2017

GA Robertson, MM Al-Qattan. Sublimis loop reconstruction of the transverse metacarpal ligament following central ray amputation. Can J Plast Surg 1993;1(3):128-130. A new procedure to restore the integrity of the deep transverse metacarpal ligament after central ray amputation using a flexor sublimis loop is described. This technique can be used both for primary or secondary reconstruction where the remaining ligamentous tissues are insufficient for direct repair.
Sculpturing the broad face to ‘golden proportions’
Authors: Schultz Richard Carlton
Published: February 2017

The oval shaped face is generally accepted as having the most beautiful configuration and the ‘golden proportion’ (1:1.618) ideal. Such a configuration can be altered to a square or rectangular shape by an increase in width of the lower face. This broadened morphology can be caused by three anatomical elements: hypertrophy of the masseter muscles, hypertrophy and flaring of the mandibular angles, and hypertrophy or herniation of the buccal fat pads of Bichat. The first two anatomical structures can occasionally become enlarged through work hypertrophy related to malocclusion or dental disease, and the latter displaced through traumatic herniation. Each of these contributing anatomical anomalies can be reduced in size by a single intraoral operative procedure with minimal risk to achieve an aesthetically pleasing oval shaped configuration to the face. There are very few hazards to this procedure and the results are routinely satisfying to both the patient and the surgeon.
Unusual index fingertip avulsion injury
Authors: Jason Li , Morris Steven , Freiberg Arnis
Published: February 2017

An unusual index fingertip avulsion including the digitorum profundus tendon-muscle unit is described in a 57-year-old workman. Although ring avulsion injuries are common, this type of injury has not been reported in the literature.
Improving Pseudoptosis in Robbins Reduction Mammaplasty
Authors: Freiberg Arnis , Carr Michele M
Published: February 2017

A Freiberg, MM Carr. Improving pseudoptosis in Robbins reduction mammaplasty. Can J Plast Surg 1994;2(2):71–74. The problem of the high nipple is frequently observed after reduction mammaplasty. Our hypothesis was that this deformity could be avoided with proper nipple-areolar complex (nac) placement. The original Robbins inferior pedicle reduction mammaplasty was modified by the placement of the nac intraoperatively at the completion of the breast mound construction. One hundred and fifty-three consecutive patients were followed after reduction mammaplasty. Pseudoptosis, defined as a nac above the inframammary fold while the breast tissue appeared to have descended, was graded as mild, moderate or severe. Individuals were classified by two independent observers. Frequency and degree of pseudoptosis in the original technique was significantly greater than in the modified group. In both groups there was no relationship between number of years postoperative or amount of breast excised and pseudoptosis. Incidence of pseudoptosis was related to breast type and possibly pregnancy in both groups. We conclude that pseudoptosis is likely a result of an initial improper nac placement as opposed to an expected result of reduction mammaplasty.
Keratoacanthoma in the Immunocompromised Patient - Surgical Concerns
Authors: Singleton Kathleen M , Morris Steven F , Freiberg Arnis
Published: February 2017

KM Singleton, SF Morris, a Freiberg. Keratoacanthoma in the immunocompromised patient - Surgical concerns. Can J Plast Surg 1994;2(3): 108-112. It is well known that clinical and histological differentiation between keratoacanthoma and squamous cell carcinoma is often difficult. The two lesions share many common features, but have very different outcomes. Both occur with increased frequency in immunosuppressed patients. This report documents two cases of histologically confirmed keratoacanthoma in immunosuppressed patients. These lesions were excised but had frequent recurrences and in both cases underwent histologically proven malignant transformation. The purpose of this report is to demonstrate the potentially aggressive nature of keratoacanthomas in the immunocompromised patient.
Teeth in the Line of Mandibular Fractures
Authors: Nickerson Duncan , Mcphalen Donald
Published: February 2017

D Nickerson, D McPhalen. Teeth in the line of mandibular fractures. Can J Plast Surg 1994;2(3):113-116. This study considers 710 mandibular fractures occurring in 546 patients over a five-year period and notes the fate of 114 teeth involved in the line of 104 of these fractures. Analysis of retention versus removal of teeth in the fracture line and any associated infection was undertaken. Overall, 15.5% of cases that involved retained teeth became infected, as compared with 7.1% of cases in which a tooth was extracted from the fracture site. for third molars, the teeth most commonly involved in mandibular fractures, infection was associated with 20.5% of retained teeth and 10% of cases where teeth were extracted from the fracture site. These data support careful consideration of a tooth's disposition before a decision regarding retention or extraction is made. Furthermore, they suggest that even in the absence of a grossly evident risk factor for infection, such as a fractured tooth, the tooth itself may inherently predispose to infection if retained. Infection rates were higher for retained teeth regardless of whether open reduction with rigid internal fixation or closed reduction with maxillomandibular fixation was used.
The Tumescent Technique for Bloodless Breast Reduction
Authors: Beveridge Massey , Bell Michael
Published: February 2017

M Beveridge, M Bell. The tumescent technique for bloodless breast reduction. Can J Plast Surg 1994;2(3):121-124. The tumescent technique for reduction mammaplasty provides a safe, reliable and inexpensive way to reduce intraoperative blood loss in reduction mammaplasty. The results of a study involving 64 consecutive patients operated on by the same surgeon are presented. Initial subjective experience with the infiltration of large volumes of very dilute anaesthetic solution deep in the breast along the planned incision lines suggested that the technique significantly reduced blood loss. To confirm this. 23 consecutive cases were operated upon without infiltration and the next 20 cases were done with infiltration of 250 mL of 0.1 % lidocaine with 1:1,000,000 adrenaline. Preoperative hemoglobin was compared with that obtained at an office visit on the seventh postoperative day. The difference in the drop in hemoglobin observed in the two groups was significant at the P<0.02 level; however, the difference was most pronounced in the group in whom a smaller volume of tissue was removed. Accordingly in the next phase of the study the volume of solution to be injected was calculated in relation to body weight. When 10 mL/kg body weight of solution was injected there was dramatically less bloodloss compared with the control group (P<0.01). Patients experienced no ill effects attributable to the injection: there were no significant postoperative hematomas nor any adverse effect on wound healing.
High Pressure Subcutaneous Injection of Air and Nepheline Syenite Into the Lower Limb From a Sandblasting Accident
Authors: Born Trevor , Levine Ron
Published: February 2017

This is a case report of a high pressure injection injury to the lower limb that resulted from a sandblasting hose. The management of the patient's injury, as well as the current concepts of the treatment of high pressure injection injuries, are described.
Moisture-Retentive Dressings: A Review of the Current Literature
Authors: Nickerson Duncan , Freiberg Arnis
Published: February 2017

Moisture-retentive dressings allow rapid epithelialization, reduce pain, reduce fibrosis, reduce infection and yield better cosmetic results. Furthermore, occlusive dressings allow less painful debridement and stimulate granulation tissue. Despite these advantages, moisture-retentive dressings are still underused. Among the reasons for this underuse are confusion due to the variety of dressings available, fear of infection, and excessive cost. The studies reviewed here refute concerns that moisture-retentive dressings are associated with more infections or that they are too expensive to be practical. The issue of cost was addressed in several of the articles reviewed here, and while moisture-retentive dressings are certainly more expensive on a per unit basis, their overall cost-effectiveness can be more favourable than other more conventional dressings.
Latex allergy in association with tissue expansion
Authors: Zuker Ronald M , Sapijaszko Marius
Published: February 2017

This case report outlines the sequence of events in an intraoperative anaphylactic reaction as the pockets for tissue expanders were bing developed. Previous expansion had been carried out uneventfully suggesting previous sensitization. Subsequent testing revealed significant latex allergy. Latex avoidance during repeated tissue expansion is recommended.
Role of mammography to assess complications of silicone gel breast implants
Authors: Peters Walter , Smith Dennis , Grosman Harvey , Fornasier Victor
Published: February 2017

Mammography is not accurate to predict implant rupture in most patients. Its sensitivity rate is only 11 to 16%. However, two mammographic findings appear to suggest implant rupture: the appearance of large areas of implant herniation, and the appearance of silicone globules lying outside the margins of the implant. Mammography is also helpful to predict capsular calcification and to assess certain complications of retained breast implant capsules. Two patients presented with retained capsules which had not resolved, two and five years after implant removal. One patient developed a spiculated mass, suspicious for carcinoma, that proved to be a cystic mass resulting from persistent serous effusion. The other patient demonstrated a large densely calcified capsule which interfered with breast imaging.
Salvage of three cases of class 2V ring finger avulsion injuries with medicinal leeches
Authors: Sparkes Gerald L , Lalonde Donald H , O'brien James P
Published: February 2017

Three cases of the successful salvage of ring finger degloving injuries using medicinal leeches are described. In each case, good arterial inflow was present in the avulsed soft tissue, but venous insufficiency would have prevented viability. If venous microvascular repair failed, venous return could be temporarily provided by leeches, applied to the finger every 4 to 6 h. The leech drew blood for an average of 20 mins, but the bite site on the finger tip continued to ooze blood slowly as a result of an anticoagulant, hirudin, injected by the leech. This external venous run-off provided the equivalent of internal venous return until vascular ingrowth permitted true internal venous return, five to eight days after injury. Early movement and Coban taping assisted the achievement of a good early range of motion in the three salvaged digits.
Umbilicoplasty: Classification of surgical procedures and a modified technique for the everted umbilicus
Authors: Al-Qattan Mohammed M , El-Bakry Abdul K
Published: February 2017

Umbilicoplasty is a term used to describe several surgical procedures of the umbilicus. A classification of umbilicoplasty procedures is offered, along with a modified technique for correcting the everted or protuberant umbilicus.
Modern and Physiological Concepts of Eyelid Rejuvenation
Authors: Camirand André , Doucet Jocelyne , Harris June
Published: February 2017

Detailed consideration is given to rejuvenation of the upper and lower eyelids and periorbital area using modern and physiological concepts that are based on reversing the effects of ageing. A new idea is proposed for the pathophysiology of herniated fat pads of the lower eyelids. This concept must be kept in mind when considering the management and prevention of enophthalmia. Techniques to improve the infraorbital sulcus, crow's feet and eyebrow ptosis during aesthetic surgery are also presented.
Penis Lengthening – A Retrospective Review of 300 Consecutive Cases
Authors: Stubbs Robert H
Published: February 2017

Between November 1993 and July 1995, 300 patients underwent penis lengthening surgery. Twelve of these patients had previous genital surgery and/or congenital anomalies, and their procedures could be considered reconstructive. The remaining surgical procedureswere cosmetic. Average patient age was 37 years (range 18 to 74 years). The average preoperative erect length was 12.5 cm (range 7.5 to 16 cm, SD 1.5). ‘Locker room phobia’, adverse female comments and body disproportion were common reasons for patients desiring surgery. All racial groups were represented, with European ancestry the most common. Surgery involved releasing all the superficial (fundiform) ligament and most of the deep suspensory ligament. The defect was filled with plicated gracilis muscle along with shifted skin and subcutaneous tissues. Postoperative traction was used to reduce the chance of scar and penis retraction. The most common major complication was wound infection (5.7%). The most frequent minor problem was dermatitis (13%). Long term (mean10months, range sixto18months) objective measurements using the stretch technique were obtained for 42 patients. One patient lost 1 cm in length, while 41 gained length (mean 3.2 cm, range 0.5 to 6 cm). Poor patient compliance with the postoperative protocol appears to be the most significant factor limiting the success of the procedure.
Cost Effectiveness Analysis of Hyperbaric Therapy in Osteoradionecrosis
Authors: Dempsey James , Hynes Nick , Smith Teresa , Sproat Janet E
Published: February 2017

In this time of fiscal restraint it is important to consider the costs and effectiveness of the treatments used whenever more than one treatment option is available. This paper presents an economic evaluation undertaken from a societal perspective to determine the cost effectiveness of using a modified hyperbaric oxygen (HBO) protocol to treat osteoradionecrosis of the mandible. Costs for the study group were obtained froma retrospective study of 21 patients who underwent a modified HBO protocol at the Hamilton Civic Hospitals, Hamilton, Ontario – a tertiary centre. A hypothetical control group was created and matched to the study group. Costs for this hypothetical conservative therapy group were calculated based on expected outcomes obtained from the literature. A sensitivity analysis was performed to determine the sensitivity to changes in the assumptions that were made and the data that were obtained from the literature. The modified HBO protocol was both less expensive and more effective than conservative therapy and, thus, demonstrated dominance. The number of days that each patient spends in the hospital is the key cost driver for conservative therapy treatment for osteoradionecrosis of the mandible. Patients who underwent the modified HBO protocol enjoyed greater pain reduction and increased sleep while requiring fewer narcotics.