bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Outcomes Between Immediate and Delayed Repair of Mandibular Fractures
Authors: Webb Leland Shayne , Makhijani Sumeet , Khanna Manish , Burstein Mark J , Falk Arthur N , Koumanis Dimitri J , Chao Jerome D
Published: February 2017

Medical records of patients treated with surgical repair of mandible fractures by the otolaryngology and plastic surgery departments at a level 1 trauma centre were obtained and reviewed. Two study groups were compared: patients treated within 72 h of the injury and those treated after this time period. Patient demographics, time to repair, fracture types, substance abuse history, etiology, surgical management, complications and length of hospital stay were assessed. The complication rate was 41% (n=7) within the immediate group and 38% (n=6) within the delayed group (P=0.56). Complications were prevalent in patients with history of substance abuse in both groups. Complication rates did not increase when repair of mandible fractures was delayed beyond 72 h, while substance abuse was a factor in increasing complications rates. Outpatient triage with elective repair of isolated mandibular fractures appears to be more cost-effective than admission with inpatient management.
Acute Carpal Tunnel Syndrome From Burns of the Hand and Wrist
Authors: Balakrishnan Chenicheri , Mussman Jason Lee , Balakrishnan Anila , Khalil Abdullah J
Published: February 2017

Acute median nerve compression usually occurs from increased pressure within the carpal tunnel and forearm compartments. Although the hyperesthesia from burns may mimic symptoms of acute compression neuropathy, clinical diagnosis should be made from history, clinical signs and symptoms. Early recognition and decompression of the carpal tunnel either as part of the burn excision or along with escharotomy usually leads to full recovery.
Intraneural Lipoma of the Radial Nerve Presenting As Wartenberg Syndrome: A Case Report and Review of Literature
Authors: Balakrishnan Chenicheri , Bachusz Rebecca C , Balakrishnan Anila , Elliot David , Careaga Daniel
Published: February 2017

The superficial branch of the radial nerve is highly vulnerable to trauma, irritation and compression due to its anatomical location. Intraneural lipomas and fibrolipomas arising from the supporting tissues of this peripheral nerve can cause compression of the adjacent nerve leading to symptoms of neuritis of the radial nerve or Wartenberg syndrome.
Liposuction Sepsis – Be Alert
Authors: Bell Michael Sg , Doherty Geoffrey P , Gutauskas Andrea
Published: February 2017

Postoperative infection in liposuction patients may be exceedingly difficult to clinically appreciate because of the skin edema, colour changes and even blistering that can occur. The authors outline such a case with practical advice about establishing an accurate and precise diagnosis of an early septic process.
Postoperative Seroma Formation After Abdominoplasty with Placement of Continuous Infusion Local Anesthetic Pain Pump
Authors: Smith Melissa M , Lin Michael P , Hovsepian Raffi V , Wood David , Nguyen Trung , Evans Gregory Rd , Wirth Garrett A
Published: February 2017

The most common complication after abdominoplasty is seroma formation. The incidence of seroma formation in abdominal procedures as a whole, including abdominoplasty, panniculectomy and transverse rectus abdominis myocutaneous flap abdominal donor sites, ranges from 1% to 38%. A recent concern among surgeons is the possibility of a causal relationship between the use of continuous infusion devices such as local anesthetic pain pumps and the development of seromas. A case of postoperative, persistent, recurrent seroma formation after abdominoplasty with the use of continuous infusion local anesthetic pain pump is presented. After several attempts at aspiration and drain catheter placement, only open surgical excision of the seroma cavity was found to be definitively effective in treating the development of seroma.
Removal of Silicone Breast Implants and Review of Literature
Authors: Bell Michael Sg , Doumit Gaby D , Buinewicz Brian R
Published: February 2017

Silicone breast implants have a finite life span and may need changing over the lifetime of the patient. The experience with removing first- and second-generation implants is frustrating, because thick capsules often form, in association with rupture and spread of the silicone gel into the surrounding tissue. Different techniques have been employed to try and avoid an unnecessarily large incision, yet still control the dissection so that entire capsule and contained silicone can be removed en bloc. The authors describe a technique that facilitates atraumatic removal using an effective and time-saving vacuum principle.
Submental Intubation: An Alternative to Tracheostomy When Nasoendotracheal Intubation Is Unsuccessful – a Case Report
Authors: Franco Johnny , Coppage Jeffrey , Fallucco Michael , Ferguson John Scott
Published: February 2017

Submental intubation (SI) has been proposed as an alternative to nasoendotracheal intubation when oral endotracheal intubation is contraindicated. In patients who require intubation for maxillofacial reconstruction, this is an alternative to a traditional tracheostomy. The present case report presents an 18-year-old woman who suffered a comminuted mandibular fracture. Two days after her accident, she was taken to the operating room for open reduction with internal fixation of her mandible; however, the anesthesia staff was unable to nasally intubate the patient. A SI was performed. The procedure was completed without complications and the surgery accomplished with the SI. The patient was able to avoid a tracheostomy for an isolated operation. SI avoids the dangers of nasoendotracheal intubation in patients with midfacial fractures and avoids complications related to tracheostomy. Thus, SI may serve as an alternative to tracheostomy in patients without other medical conditions and indications for long-term intubation.
When a Pack Becomes a Plug
Authors: Bell Michael Sg , Mckee Daniel , Hendry Paul J
Published: February 2017

The authors present a case of a surgical wound that was inappropriately packed to the extent that a significant and major deterioration occurred in the expected healing by secondary intention. This is intended to alert surgeons to the fact that careful supervision is required of such seemingly simple and straightforward tasks as the topical treatment of open wounds by inexperienced caregivers.
Analysis of the Effects of Subcutaneous Musculoaponeurotic System Facial Support On the Nasolabial Crease
Authors: J Sundine Michael , F Connell Bruce
Published: February 2017

The idea that traction on the subcutaneous musculoaponeurotic system (SMAS) deepens the nasolabial crease has been propagated through the plastic surgery literature. This notion is contrary to the senior author's experience. The purpose of the present study was to investigate the effects of mobilization of the SMAS on the nasolabial fold and crease. Intraoperative examination on the effect of traction on the SMAS was performed. Ten consecutive primary facelift patients underwent facelift procedures with SMAS support. Following mobilization of the SMAS, traction was placed on the SMAS without traction on the skin. In all cases, the nasolabial fold was effaced and the nasolabial crease did not deepen. The authors concluded that traction on the SMAS did not deepen the nasolabial crease.
Contribution of the Ulnar Digits to Grip Strength
Authors: Methot Jennifer , J Chinchalkar Shrikant , S Richards Robert
Published: February 2017

PURPOSE

To determine the contribution of ulnar digits to overall grip strength.

SUBJECTS

Fifty individuals (25 men and 25 women; 100 hands) with a mean age of 35.6 years (range 19 to 62 years) were tested. Exclusion criteria included previous history of hand injuries, entrapment neuropathies and systemic diseases.

METHODS

Ethics approval was granted before testing. A calibrated Jamar dynamometer (Lafayette Instrument Company, USA) was used to test subjects in three configurations: entire hand – index, middle, ring and little fingers; index, middle and ring fingers; and index and middle fingers. Little and ring fingers were excluded using generic hand-based finger splints. The order of testing was kept constant, and subjects were tested three times on each hand for each configuration. The average of the three trials at each configuration was recorded. Subjects received 1 min of rest between each testing configuration. The data were analyzed using a 3×2 repeated measures ANOVA with hand dominance and configuration as the within-subject factors, followed by two independent sample t tests to compare flexor digitorum superficialis (FDS) independence and FDS nonindependence on right and left hand grip strength measurements in the index, middle, ring and little condition.

RESULTS

Univariate results demonstrated that grip strength was significantly predicted by the interaction between hand dominance and configuration, while the parsing of the interaction term demonstrated greater grip strength across all levels of configuration for the dominant and nondominant hand. There were no significant differences between FDS independence and FDS nonindependence for either hand on grip strength.

DISCUSSION

The results indicate a significant decrease in grip strength as ulnar fingers were excluded. Furthermore, exclusion of the little finger has differing effects on the grip strength of the dominant and nondominant hands – the dominant hand had a greater loss of strength with the little finger excluded than the nondominant hand.

CONCLUSIONS

The ulnar two digits play a significant role in overall grip strength of the entire hand. In the present study, exclusion of the ulnar two digits resulted in a 34% to 67% decrease in grip strength, with a mean decrease of 55%. Exclusion of the little finger from a functional grip pattern decreased the overall grip strength by 33%. Exclusion of the ring finger from a functional grip pattern decreased the overall grip strength by 21%. It is clear that limitation of one or both of the ulnar digits adversely affects the strength of the hand. In addition, there was no significant difference between grip strength of FDS-independent and FDS-nonindependent subjects for either hand.
Epidermodysplasia Verruciformis: An Early and Unusual Presentation
Authors: Murat Emsen Ilteris , Esref Kabalar M
Published: February 2017

Epidermodysplasia verruciformis is a rare, heritable disease characterized by an unusual susceptibility to infection with specific types of human papillomavirus and a propensity for developing malignant skin tumours. Partial defects in cell-mediated immunity have been demonstrated in this disease. In the present report, a young patient with epidermodysplasia verruciformis who was treated successfully with surgical treatment is described.
Invasive Squamous Cell Carcinoma of the Hand in a Patient with Kindler Syndrome: Case Report and Literature Review
Authors: Cardin-Langlois Etienne , Hanna Dominique , St-Amant Maxime , Croteau Fréderic
Published: February 2017

Kindler syndrome is a rare, autosomal, recessive genodermatosis characterized by trauma-induced acral blisters in infancy and childhood, photosensitivity and progressive poikiloderma. Very few cases in the literature report an association with squamous cell carcinoma, even though it is a very well-known, long-term complication. A case involving a 23-year-old woman with a history of Kindler syndrome who was admitted to the department of plastic surgery (Sherbrooke University, Sherbrooke, Quebec) with an extensive ulcerated squamous cell carcinoma of the right hand is presented. A local excision of the tumour was initially performed, but positive margins and clinically palpable axillary lymphadenopathy over the course of hospitalization necessitated below-elbow amputation and lymph node dissection. To the authors’ knowledge, this is the second reported case of aggressive metastatic squamous cell carcinoma of the hand in a patient with Kindler syndrome.
Postoperative Management of Carpometacarpal Joint Fracture Dislocation of the Hand: A Case Report
Authors: Bell Timothy , J Chinchalkar Shrikant , Faber Kenneth
Published: February 2017

Injury to the carpometacarpal joints is rare. The strong ligamentous attachments and carpal bone alignment readily resist displacement. To the authors’ knowledge, there are no studies evaluating postoperative recovery regimens of carpometacarpal fracture dislocations. The present study describes a postoperative hand therapy regimen that used a novel carpometacarpal brace permitting early mobilization.
Keyhole Pattern for Preoperative Marking for Reduction Mammaplasty
Authors: Jardini Barbosa Marcus Vinícius , Xerfan Nahas Fábio , Angelo Sabia Miguel , Masako Ferreira Lydia
Published: February 2017

BACKGROUND

There are many techniques used for reduction mammaplasty; however, the most frequently performed procedures result in an inverted T scar. Preoperative marking is an important step for the success of the procedure, especially for surgeons at the initial learning stage. However, there is no consensus regarding the best method. In 1981, Strömbeck designed a pattern for preoperative marking for reduction mammaplasty. This pattern provides stable parameters that promotes an acceptable symmetry marking.

OBJECTIVE

To evaluate the use of the Strömbeck pattern for preoperative marking for reduction mammaplasty.

METHODS

Fifty-seven patients who underwent reduction mammaplasty between April 2006 and April 2007 were prospectively evaluated. Patient ages ranged from 17 to 61 years; the mean body mass index was 22.2 kg/m2. After defining the standard landmarks of the breast, preoperative markings were made using the Strömbeck pattern. Breast reduction surgery was performed under local anesthesia with sedation. Postoperative results were evaluated according to a numerical visual analogue scale, at the seven-, 15-and 30-day follow-up periods. The Student's t test and the Kruskal-Wallis test were used for statistical analysis (P<0.05).

RESULTS

The mean weight of resected breast tissue was 317.5 g for the right breast and 305.8 g for the left breast (P=0.17). Scores obtained using a visual analogue scale showed a progressive increase in the scores during the postoperative follow-up period (P<0.0001).

CONCLUSION

The use of the Strömbeck pattern enabled surgeons to perform reduction mammaplasty with good postoperative results as seen in the follow-up periods.
Making the V-Y Advancement Flap Safer in Fingertip Amputations
Authors: Thoma Achilleas , Kristine Vartija Larisa
Published: February 2017

Amputation of the fingertip is a common injury of the upper extremity. Over the years, a variety of reconstructive techniques have been described. for dorsal oblique and transverse amputations, the Atasoy V-Y advancement flap is a popular choice because it preserves finger length, sensation and function. However, closure under tension remains a problem, putting the flap at risk of partial or full necrosis. To avoid this untoward complication, the classic V-Y advancement technique has been modified to allow for a tension-free closure.
Vacuum-Assisted Closure As a Surgical Assistant in Life-Threatening Necrotizing Fasciitis in Children
Authors: Al-Subhi Fs , Zuker Rm , Cole Wg
Published: February 2017

Necrotizing fasciitis is a severe soft tissue infection that can involve skin, subcutaneous fat, fascia and muscle. It can result in devastating sequelae including tissue necrosis, sepsis, toxic shock syndrome, cardiopulmonary collapse and death. To control rapidly spreading necrosis, early diagnosis and aggressive surgical treatment with extensive radical debridement of the affected areas is necessary, as well as systemic administration of broad-spectrum antimicrobials and, very often, intensive care support. The subatmospheric negative pressure dressing has been previously used in acute and complex wounds management. The concept of using vacuum-assisted closure dressing as another management component is presented in the current article.
Anterolateral Thigh Flap Salvage Following Failed Deep Inferior Epigastric Artery Perforator Breast Reconstruction
Authors: J Krochmal Daniel , M Rebecca Alanna , J Casey William , A Smith Anthony
Published: February 2017

The deep inferior epigastric artery perforator flap is an option for women desiring autologous tissue breast reconstruction. If this reconstruction fails, other autologous tissue flaps, including the gluteal artery perforator and latis-simus dorsi flaps, may be used for salvage. The anterolateral thigh (ALT) flap offers adequate tissue volume for breast reconstruction, acceptable fat quality and a long vascular pedicle. Other advantages include obviating the need for intraoperative position changes and harvesting tissue outside of the radiation field. Two cases involving ALT flaps used in the setting of deep inferior epigastric artery perforator failure are presented with favourable results. A review of the anatomy of the ALT flap is included.
Obtaining High Cure Rates for Challenging Facial Malignancies: A New Method for Producing Rapid, Accurate, High-Quality Frozen Sections
Authors: Boyd Kirsty , Henderson Colin , Joseph Mariamma , Yardley Nick , Temple Claire
Published: February 2017

PURPOSE

The authors developed a new system to provide rapid, accurate, full-face frozen sections.

OBJECTIVE

To evaluate the efficacy of the system when applied to the treatment of nonmelanoma cutaneous malignancies using Mohs micrographic surgery (MMS).

METHODS

Patients undergoing MMS procedures between 2003 and 2007 for nonmelanoma head and neck cutaneous malignancies were prospectively collected. Specimens were prepared either in a traditional cryostat-based manner or using the new system.

RESULTS

A total of 196 patients with 234 head and neck nonmelanoma cutaneous malignancies were included. The majority of tumours were basal cell carcinomas (89.5%). of these, 38% demonstrated aggressive histologies (sclerosing or micronodular), and 30% were recurrent. On average, two levels (range one to six) and four blocks (range two to 23) were required to obtain clear margins. The mean defect size was 3.68 cm2 (range 0.13 cm2 to 37.68 cm2). Over the five-year study period, there were two recurrences in 234 cases (less than 1%), which compares favourably with other MMS series. The new system was associated with a shorter operative time than traditional specimen preparation (102 min versus 131 min; P=0.004). The new and traditional specimen preparation groups were similar in terms of the number of previous recurrences (29% versus 30%; P=1.00), defect size (3.7 cm2 versus 4.0 cm2; P=0.81) and the number of levels required (1.9 versus 1.5; P=0.05).

CONCLUSIONS

The new system enables fast, accurate, full-face frozen section specimens that are ideal for MMS. The speed of specimen preparation is demonstrated by faster operative times, and a low recurrence rate attests the accuracy and quality of the sections.
Does Size Matter? Technical Considerations of a Regenerative Tissue Matrix for Use in Reconstructive Surgery
Authors: O Craft Randall , M Rebecca Alanna , Flahive Colleen , J Casey William , Dueck Amylou , L Harold Kristi
Published: February 2017

INTRODUCTION

Acellular dermal matrices have been used with increasing frequency in both reconstructive and cosmetic surgery. While many studies have described the safety and morbidity profiles of these materials, little is known about the relative mechanical properties of individual sheets of allograft harvested from distinct donors.

METHODS

Sixty-two individual sheets of an acellular dermal matrix from distinct lot numbers (signifying different donors of the dermis) were prospectively analyzed before use. Distribution of thickness according to manufacturer specifications in the dry state were as follows: 0.009 inches to 0.013 inches (1 [1.6%]); 0.79 mm to 1.78 mm (3 [4.8%]); 0.79 mm to 2.03 mm (5 [8%]); 0.8 mm to 3.3 mm (1 [1.6%]); 1.8 mm to 3.3 mm (10 [16.1%]) and 28 mm (6 [9.7%]). The size of the matrix was recorded while dry, after hydration and following stretch. The percentage change in surface area was recorded for each lot.

RESULTS

The 62 reconstructive cases included breast implant reconstruction (2 [3.2%]); ventral hernia repair (11 [17.7%]); abdominal closure following autologous tissue harvest (6 [9.6%]); autologous breast reconstruction (37 [59.6%]); extremity wound closures (3 [4.8%]) and reinforcement of vertical rectus abdominis muscle closure (3 [4.8%]). The mean percentage change in the size of the acellular dermal matrix to the hydrated state was 58% (36 of 62; thickness 0.06 mm to 3.30 mm); the mean percentage change in size from dry state was 7.14% (range 0% to 18.7%). The mean percentage change in the size of the hydrated matrix to the stretched state was 25.7% (range 0.25% to 70.6%). The variability in elasticity among the individual sheets was significant (P<0.0005).

CONCLUSION

The acellular dermal matrix displayed highly variable elastic properties among distinct donors. This may be significant in procedures in which symmetry is critical.
Challenges of Randomized Controlled Trial Design in Plastic Surgery
Authors: H Hassanein Aladdin , A Herrera Fernando , Hassanein Omar
Published: February 2017

Randomized controlled trials are the gold standard of evidence-based medicine. In the field of plastic surgery, designing these studies is much more challenging than in pharmaceutical medicine. Randomized trials in plastic surgery encompass several road blocks including problems shared with other surgical trials: equipoise, high cost, placebo issues and learning curves following the establishment of a novel approach. In addition, plastic surgery has more subjective outcomes, thus making study design even more difficult in assessing the end result.
Improving Journal Clubs Through the Use of Positive Deviance: A Mixed-Methods Study
Authors: Anzarut Alexander , Martens Benjamin , Tredget Edward
Published: February 2017

BACKGROUND

Plastic surgery journal clubs are often unsatisfactory for both surgeons and residents, leading to frustration and poor surgeon attendance.

OBJECTIVE

To assess and modify journal clubs using the principles of positive deviance.

METHODS

Surgeons and residents were surveyed across five domains before and after journal club modification. These included perception of the quality of articles chosen, the quality of the presentations, postpresentation discussions, educational benefit and overall satisfaction.

RESULTS

Using the principles of positive deviance, the authors were able to identify points of concern with journal clubs and make suggestions for improvement. Postintervention surveys demonstrated a statistically significant improvement in journal clubs across all five domains assessed.

CONCLUSIONS

Using the principles of positive deviance, journal club satisfaction was improved. The interventions presented could be used to improve journal clubs at other institutions. In addition, the principles of positive deviance can be used to address a variety of administrative and educational challenges faced by plastic surgery programs.
Massive Localized Lymphedema: A Case Series and Literature Review
Authors: James Evans Robin , Scilley Chris
Published: February 2017

A large, deep, soft tissue mass is often malignant in nature; however, a recent study described a large soft tissue mass present in morbidly obese patients that was found to be benign. Massive localized lymphedema (MLL) is a large pedunculated lymphadematous mass found in the lower extremity of morbidly obese patients. MLL often enlarges over many years and may interfere with mobility. Although histologically similar to well-differentiated liposarcoma, MLL has recently emerged as a separate, benign clinical entity. The pathophysiology of MLL is yet to be understood. A literature review, and the authors’ experiences are discussed to assist in clinical decision making.
Optimizing Revenue At a Cosmetic Surgery Centre
Authors: M Funk Joanna , N Verheyden Charles , C Mahabir Raman
Published: February 2017

BACKGROUND

The demand for cosmetic surgery and services has diminished with recent fluctuations in the economy. To stay ahead, surgeons must appreciate and attend to the fiscal challenges of private practice. A key component of practice economics is knowledge of the common methods of payment.

OBJECTIVE

To review methods of payment in a five-surgeon group practice in central Texas, USA.

METHODS

A retrospective chart review of the financial records of a cosmetic surgery centre in Texas was conducted. Data were collected for the five-year period from 2003 to 2008, and included the method of payment, the item purchased (product, service or surgery) and the dollar amount.

RESULTS

More than 11,000 transactions were reviewed. The most common method of payment used for products and services was credit card, followed by check and cash. for procedures, the most common form of payment was personal check, followed by credit card and financing. of the credit card purchases for both products and procedures, an overwhelming majority of patients (more than 75%) used either Visa (Visa Inc, USA) or MasterCard (MasterCard Worldwide, USA). If the amount of the individual transaction surpassed US$1,000, the most common method of payment transitioned from credit card to personal check.

CONCLUSIONS

In an effort to maximize revenue, surgeons should consider limiting the credit cards accepted by the practice and encourage payment through personal check.
P16 Protein Expression in Primary Cutaneous Melanoma with Positive and Negative Lymph Node Biopsies: Particular Aspects of a Study Performed At the Hospital De Clinicas De Porto Alegre, Brazil
Authors: Fauri Jac , Ricardi F , Diehl Es , Cartell A , Furian R , Bakos L , Edelweiss Mi
Published: February 2017

BACKGROUND

Cutaneous melanoma dermal invasion, identified through measurement of maximum tumour thickness and sentinel lymph node (SLN) biopsy, is important to establish melanoma prognosis and progression. P16 protein expression has been shown to be a predictive factor for melanoma evolution and prognosis.

OBJECTIVE

To investigate p16 protein expression in cutaneous melanomas with and without SLN metastasis.

PATIENTS AND METHODS

Sixty-seven paraffin-embedded cutaneous melanoma specimens of patients who had undergone SLN investigation were evaluated from 1995 to 2007. SLN biopsy was negative for metastasis in 34 of these patients (controls); in the remaining 33 patients, SLN biopsy was positive (cases). The expression of p16 protein in the primary tumour was measured using an immunohistochemical assay. The samples were classified according to their nuclear expression.

RESULTS

P16 nuclear expression was absent in 14 cases and in 15 controls; P=0.812. There was no statistically significant difference in p16 nuclear expression between cases and controls.

CONCLUSIONS

The present study does not support the findings of other studies that suggest p16 protein expression is important in the prognosis of cutaneous melanoma.
Radial Forearm Free Flap Morbidity: A Rare Case of a Normal Preoperative Arteriogram and Acute Intraoperative Hand Ischemia
Authors: W Bruner Terrence , M Hanasono Matthew , J Skoracki Roman
Published: February 2017

Since its first description in 1981, the radial forearm free flap has become a valuable tool for reconstructive microsurgery. However, there are potential complications associated with the flap – the most feared being hand ischemia from sacrifice of the radial artery. Fortunately, acute ischemic complications are exceedingly rare, with only two cases reported in the literature. Options for preoperative evaluation of the donor extremity include the Allen's test, ultrasonography and angiography. A preoperative arteriogram is considered to be the definitive method to evaluate arterial anatomy, patency, and collateralization between the radial and ulnar arteries. The current article presents the authors’ experience with a patient who had a delayed Allen's test and a normal arteriogram of his left upper extremity, and who developed acute intraoperative hand ischemia, requiring reconstruction of his radial artery, after elevation of a radial forearm free flap. Although exceedingly rare, the occurrence of acute vascular insufficiency is always a possibility and must be kept in mind when harvesting a radial forearm free flap. The surgeon should be prepared to perform an interposition vein graft reconstruction to avoid any potential complications. Clinical examination and judgment may be more important than radiological studies in certain cases.
The Split Breast Flap: Revisited – a Medieval Or An Ideal Solution in the Selected Case?
Authors: Degreef Andre
Published: February 2017

In assessing a patient requiring palliative reconstruction of the anterior chest wall, a host of techniques engulf the reconstructive surgeon, who has to evaluate the local situation, the tissue lost, the tissue required and the tissue available. The patient's general condition is usually a major influence on this decision. The split breast flap is an often forgotten, simple means of palliative reconstruction.
Beard Reconstruction Using Hair Grafts in a Free Flap
Authors: Y Levesque Andre , J Schalet Benjamin , L Dolph James
Published: February 2017

Hair transplantation using micrografts or minigrafts is a standard procedure used for hair restoration in androgenic, burn scar and cicatricial alopecia. These grafts have also been used to reconstruct the eyebrow, eyelash, mustache, beard and pubic escutcheon. A patient who underwent successful micrograft and minigraft hair transplantation into a free osteocutaneous mandibular flap reconstruction is presented. The patient was very satisfied with his reconstruction, and the hair transplants provided excellent camouflage for the flap.
Hyaluronic Acid Used for the Correction of Nasal Deviation in An 18-Year-Old Middle Eastern Man
Authors: Piggott JR , Yazdani A
Published: February 2017

The use of fillers for nonsurgical rhinoplasty has advanced in both materials and methods, and continues to gain popularity in North America. This technique is most often used for secondary revisions, although reports of fillers used in primary rhinoplasty in selected patients have been recently described. The present report details the use of a hyaluronic acid dermal filler in a young Middle Eastern man for a post-traumatic crooked nose deformity. Primary correction of the patient's right-sided nasal bone deviation using hyaluronic acid as a soft tissue filler was achieved with excellent results and patient satisfaction. The current use of fillers in nasal contouring is reviewed.
Is Radiotherapy An Effective Treatment Option for Recurrent Metastatic Malignant Melanoma? a Case Report of Short-Course, Large-Fraction Radiation and a Literature Review
Authors: Hallock Abhirami , Vujovic Olga , Yu Edward
Published: February 2017

BACKGROUND

Malignant melanoma is regarded to be radiation resistant. A case of recurrent malignant melanoma with in-transit metastasis treated with short-course, high-fraction palliative radiation is presented to illustrate the effectiveness of radiotherapy.

METHOD

An 80-year-old woman initially treated surgically for a primary malignant melanoma of the left lower leg presented with multiple in-transit metastases. Palliative radiation was offered to treat two fungating in-transit masses that were resistant to treatments of isolated limb infusion and intralesional interleukin-2.

RESULTS

Treatment consisted of short-course, high-fraction radiation with 800 cGy fractions given over three weeks on days 0, 7 and 21, for a total dose of 2400 cGy. She experienced a complete response that was maintained for six months.

CONCLUSIONS

Radiation is an effective treatment option for palliation of recurrent malignant melanoma. Complete response is possible even with short-course, high-fraction radiation.
Review of Thumb Carpometacarpal Arthritis Classification, Treatment and Outcomes
Authors: Gillis Joshua , Calder Kevin , Williams Jason
Published: February 2017

Thumb carpometacarpal osteoarthritis (CMC OA) is a common disease, affecting up to 11% and 33% of men and women in their 50s and 60s, respectively, which leads to pain, laxity and weakness of the CMC joint. Based on the staging of the CMC OA, different forms of treatment can be used, including both conservative and surgical measures. Surgical options include osteotomy, trapezial excision, ligament reconstruction with or without tendon interposition, and various prosthetic interpositional implants with or without trapezial excision. The present article reviews the staging of CMC OA, the evaluation of hand function using patient-reported questionnaires, and outcomes of both conservative and surgical treatments. The present review also introduces a commercially available interpositional spacer surgical technique for CMC OA and the early evidence that the literature has shown for improving hand function, strength and stability of the thumb CMC joint postoperatively.
Cosmetic outcomes following head and neck melanoma reconstruction: The patient's perspective
Authors: Buck Donald , Rawlani Vinay , Wayne Jeffrey , Dumanian Gregory A , Mustoe Thomas A , Fine Neil A , Galiano Robert , Kim John YS
Published: February 2017

Background

While studies have compared aesthetic outcomes following wide local excision of head and neck melanoma, none have evaluated this important outcome from the patient's perspective. Indeed, one could argue that the psychosocial impact of head and neck melanoma excision and reconstruction is more accurately assessed by deriving patient-based as opposed to surgeon-based outcome measures.

Objective

To evaluate aesthetic outcomes following wide local excision of head and neck melanoma from the patient's perspective.

Methods

Fifty-one patients who underwent excision of 57 head and neck melanomas followed by immediate closure by primary repair, skin grafting, local flap coverage or free tissue transfer were asked to complete a written survey at least six months after their surgery. A visual analogue scale (VAS) was used to assess the patient's perception of appearance alteration, satisfaction with his or her appearance, and emotional impairment. An ordinal scale was used to evaluate several criteria of the reconstructive outcome (pain, itching, colour, scarring, stiffness, thickness and irregularity).

Results

Forty-two patients (82.4%) completed the survey. There were significant correlations between VAS scores reported for appearance alteration, satisfaction with outcome and emotional impairment (P=0.001). Patients who received skin grafts reported significantly unfavourable VAS scores compared with other methods of reconstruction (P=0.046). Moreover, skin grafts received significantly worse ordinal scale ratings for itching (P=0.043), colour (P=0.047), scarring (P=0.003) and stiffness (P=0.041) compared with other methods of reconstruction. Both skin grafts and free flaps were reported to have significantly less favourable thickness (P=0.012) and irregularity (P=0.036) than primary closure or local tissue transfer. There was no significant difference between patients undergoing primary closure with local tissue transfer (P>0.413). Other factors related to the patient's VAS scores included location of the melanoma (P=0.033), size of defect (P=0.037) and recurrence of melanoma (P=0.042).

Conclusion

The degree of emotional impairment following reconstruction of head and neck melanoma excision defects was correlated with the patient's perception of appearance alteration. From the patient's perspective, primary closure and local tissue transfer appeared to result in the highest aesthetic satisfaction.
Facial soft tissue augmentation with Artecoll®: A review of eight years of clinical experience in 153 patients
Authors: Solomon Philip , Sklar Michael , Zener Rebecca
Published: February 2017

Objective

Artecoll (Canderm Pharma Inc, Canada) is a semipermanent, injectable, soft tissue filler composed of uniform polymethylmethacrylate microspheres in a bovine collagen gel, which has been used in Europe over the past decade. The authors review their experience using Artecoll as an injectable material for the correction of deep static folds of the face, improvement of nasal asymmetries following rhinoplasty, depressed acne scars and augmentation of the lip.

Method

A retrospective chart review, subjective patient satisfaction feedback and objective findings noted by the senior author were performed over an eight-year period. A total of 153 patients were treated with Artecoll injections; 74 underwent lip augmentation, 21 underwent deep nasolabial fold augmentation, eight underwent glabellar fold augmentation, 26 were treated for minor nasal dorsal irregularities and 24 were treated for depressed acne scars.

Results

No early or delayed allergic responses were reported. Complications occurred most commonly with lip augmentation, in which 13.5% of patients noted significant noticeable bruising postinjection that resolved completely within one week, 51.3% had detectable implant on palpation, and 13.1% required further intervention with massage, steroid injection and/or local excision to correct for lumpiness. Sixty per cent of patients requiring further intervention responded successfully, while local excision was performed on the two patients who failed to respond after six months of massage and steroid therapy. Overall, a total of 11 patients (14.9%) had minor asymmetries or less than optimal results within the lip augmentation study group. Among other sites, the most common complaint was undercorrection of the fold or wrinkle.

Conclusion

Based on the authors' experience, Artecoll is a safe, viable option for long-term treatment of deep facial wrinkles, nasal asymmetry, hypoplastic or atrophic lips, and depressed acne scars, and the results have been accompanied by a high degree of patient satisfaction. Although the implant is often palpable, rarely does it cause significant visible lumps. Its use and applications as a semipermanent injectable agent certainly warrant further investigation.
Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome
Authors: Fulton Courtney , Grewal Ruby , Faber Kenneth J , Roth James , Gan Bing Siang
Published: February 2017

Background

Ulnar-sided wrist pain is a common problem in the upper extremity. It affects a broad patient population and can be difficult to treat. Ulnar impaction syndrome (UIS) is major cause of ulnar-sided wrist pain and a number of different operations have been used to correct it, including ulnar shortening osteotomy (USO).

Objective

To retrospectively review functional outcomes and complication rates of USO for UIS at the Hand and Upper Limb Centre (London, Ontario) over a two-year period.

Methods

Twenty-eight patients who underwent USO between 2007 and 2009 participated in the present study. Ulnar variance pre- and post-surgery was assessed using standard radiographic examination. Patient-rated outcomes were measured using a visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) survey for functional outcomes. Objective grip strength and range of motion were compared with the contralateral extremity.

Results

On average, USO achieved a 3.11 mm reduction in ulnar variance. Nonunion occurred in five patients and required a secondary bone grafting procedure. All USO eventually healed. Overall, pain improved by 47.2% and the mean DASH score after surgery was 37.21. Flexion, extension and supination range of motion decreased by 10° compared with the unaffected side. Eleven patients (39%) elected to undergo a second surgery for hardware removal. Patients receiving compensation from the Workplace Safety and Insurance Board experienced significantly higher residual pain (VSA 5.24 versus 1.97) and disability levels (DASH 60.23 versus 25.70). Smokers also experienced worse outcomes in terms of pain (VSA 4.43 versus 2.36) and disability (DASH 51.06 versus 29.67). In this cohort, smoking was not associated with a higher rate of nonunion.

Conclusion

USO is effective in reducing pain in UIS and improves disability, at the price of a small decrease in range of motion. Smokers and people receiving compensation from the Workplace Safety and Insurance Board, however, have significantly worse subjective outcomes (VAS and DASH), but similar objective outcomes (range of motion).
The cardiac implications of breast reconstruction using the internal mammary artery as the recipient vessel
Authors: Fortin Amanda J , Evans H Brian , Chu Michael WA
Published: February 2017

Background

Microsurgical breast reconstruction is a popular choice in breast reconstruction. Recipient vessel use for these autologous tissue reconstructions has shifted from the thoracodorsal to the internal mammary vessels. Coronary artery bypass (CAB) surgery remains the optimal revascularization strategy in patients with significant, diffuse coronary artery disease. The conduits of choice for coronary revascularization are the internal mammary arteries (IMA) because of their superior long-term graft patency rate and improved patient survival.

Objective

To review the cardiac risk factors in the breast reconstruction population, and to report the incidence of postoperative cardiac events at the London Health Sciences Centre, London, Ontario. The authors present the index cases illustrating cardiac complications following the use of internal mammary vessels.

Method

A retrospective, single-centre, cumulative audit of breast reconstruction practice from 2005 to 2009 was conducted. A total of 81 patients undergoing autologous breast reconstruction were reviewed. Two women were noted to have experienced postoperative myocardial infarction requiring intervention. Both were noted to have triple-vessel disease, an indication for CAB; however, during the breast reconstruction, their IMAs had been utilized. As a result, both women subsequently underwent triple-vesssel percutaneous intervention, with one woman later requiring CAB without IMA because of recurrent ischemia.

Conclusion

While there is limited overlap with the breast reconstruction and cardiac disease population, there can be significant cardiac health implications in the postoperative status (both short and long term) of women undergoing autologous breast reconstruction using the IMAs as recipient vessels.
Acellular dermal matrices: Use in reconstructive and aesthetic breast surgery
Authors: Macadam Sheina A , Lennox Peter A
Published: February 2017

Acellular dermal matrices (ADMs) were first described for use in breast surgery in 2001. Since this initial report, ADMs have become an increasingly common component of implant-based breast procedures. ADMs have shown promise for use in both aesthetic and reconstructive breast surgery; however, concerns about their use remain because of the significant costs associated with these products. The present article reviews the history of ADM use in breast surgery and the outcomes reported to date. Common techniques for placement of ADMs in aesthetic revisionary and breast reconstruction surgery are provided, and use in the setting of chest wall irradiation and capsular contracture is discussed. Finally, the authors comment on the cost implications of these products in the Canadian and American health care systems.
Diagnosis and management of eosinophilic cellulitis (Wells' syndrome): A case series and literature review
Authors: Sinno Hani , Lacroix Jean-Philip , Lee James , Izadpanah Ali , Borsuk Ronnie , Watters Kevin , Gilardino Mirko
Published: February 2017

Introduction

Eosinophilic cellulitis (Wells' syndrome) is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis due to its similarity in presentation. Misdiagnosis leads to delay of correct treatment and inappropriate use of antibiotics.

Methods

A case series of eosinophilic cellulitis and a literature review are presented.

Results

Patients with Wells' syndrome may present with a variety of nonspecific symptoms, such as fever, arthralgia and malaise, as well as myriad cutaneous lesions with associated erythema, presenting as blisters, bullae, papules and/or nodules. Several treatment modalities have been used to treat eosinophilic cellulitis and have been met with variable success rates; these include systemic corticosteroids, topical corticosteroids and antihistamines, with success rates of 91.7%, 50% and 25%, respectively.

Conclusions

A high degree of clinical suspicion must be exercised to diagnose this rare condition. Cellulitis with an atypical presentation or not responding to appropriate antibiotic treatment should trigger suspicion of Wells' syndrome. To date, the most successful treatment method is a short course of systemic corticosteroids.
Helical advancement: Pearls and pitfalls
Authors: Al-Shaham AA
Published: February 2017

Background

Reconstruction of acquired auricular defects is a challenging procedure. Since its emergence, the helical advancement technique has proved to be an excellent method of repairing many auricle defects. This technique may occasionally result in an alteration in the dimensions of the neoauricle, with subsequent deformity. However, the advantages of this technique are well known, while the pitfalls are scarce.

Objective

To critically review the selection criteria of patients with acquired auricular defects to determine which are eligible for helical advancement technique without subsequent deformity.

Methods

From March 2004 to January 2006, 18 patients with three types of upper one-third auricle defects underwent the helical advancement procedure. All patients were male, with mean age of 33.5 years. The defects ranged from 1.2 cm to 4.3 cm in length. Two helical flaps (one on either side of the injury) were advanced along the helical margin to ensure closure. The vertical and horizontal auricular axes were measured before and after surgery, and the actual reduction in millimetres was calculated. Patients were followed up for three months postoperatively. Assessment of the surgical outcome was performed by surgeon (with patient feedback) in the final patient visit.

Results

The principle pitfall in the form of small neoauricle with or without cupping was reported in five patients (27.77%). The defects in these cases were >2.8 cm and the mean resultant reduction in vertical axes was >5 mm. Statistical analysis resulted in χ2=4.24 and P=0.04

Conclusion

The three varieties of upper one-third auricle defects can best be corrected by the helical advancement technique when the defect is <2.8 cm. Furthermore, perioperative reduction in the vertical axis of the neoauricle >5 mm was an important predictive factor in the development of subsequent deformity.
Lower extremity anterior compartment syndrome complicating bilateral mastectomy and immediate breast reconstruction: A case report and literature review
Authors: Tashakkor A Yashar , Macadam Sheina A
Published: February 2017

‘Well leg compartment syndrome’ refers to compartment syndrome occurring in a nontraumatic setting. This occurs most commonly in the lower limb during surgery performed with the patient in an anatomically vulnerable position. While this complication is well documented in the setting of orthopedic, urological and gynecological surgeries, it is an exceptionally rare complication in plastic surgery; only seven cases have been published on compartment syndrome complicating an operation performed on a supine patient. A case involving a 56-year-old woman who developed an anterior compartment syndrome of her right lower leg following a bilateral mastectomy with immediate breast reconstruction is presented. A detailed literature review is also included.