bluuebunny/crossref_metadata_2025 huggingface dataset:
Carboxy-Methyl-Cellulose Hydrogel-Filled Breast Implants – An Ideal Alternative? a Report of Five Years’ Experience with This Device
Authors: Brunner Christina A , Gröner Reinhard W
Published: February 2017

The controversy over the potential health risks from exposure to silicone gel from breast implants has led to extensive research to improve the safety of silicone gel-filled implants. In addition, there has been simultaneous research directed toward the development of alternative filling materials, with the goal of a breast implant that would minimize health risks and maximize cosmetic attributes. In the present study, experience with a filler material that has textural characteristics similar to that of silicone gel, but which is biodegradable and can therefore be eliminated by the body in case of implant failure, is reported.

Since February 2000, the authors have been monitoring carboxy-methyl-cellulose (CMC) hydrogel breast implants as participants in a prospective clinical trial. CMC hydrogel is a biodegradable, nontoxic, nonmutagenic and viscoelastic gel, which has been in clinical use since 1984 and has been available as the Monobloc breast implant since 1994. for the present study, 122 patients who underwent surgery between February 2000 and February 2005 were evaluated. It was determined that CMC hydrogel implants have a higher radiotranslucency than silicone gel, and the integrity of this device was easy to prove by clinical examination. In case of rupture, the implant can be replaced immediately; it is easily inserted and can be placed through a small incision because of its highly elastic shell. The complication rate was very low, and the patients were highly satisfied. In terms of safety, the implant is comparable with saline, and its consistency is comparable with that of silicone gel.
Facial Fractures – Association with Ocular Injuries: A 13-Year Review of One Practice in a Tertiary Care Centre
Authors: Nagase Daniel Y , Courtemanche Douglas J , Peters Daniel A
Published: February 2017

Background

The incidence of ocular injury associated with facial fractures has been reported to be between 0.8% and 30%.

Objective

Because of this wide range of incidences, a system to stratify the risk of ocular injury by type of facial fracture was sought.

Methods

The present study reviewed 266 patients with facial fractures to determine the risk factors for ocular injury. The anatomy of each facial fracture was classified using an orbit-centred approach according to the number of orbital walls fractured. Patients were then grouped using this classification system. Charts documenting follow-up for each patient over a minimum of one year were examined and initial emergency room presentations of patients with subsequent visual impairment were recorded.

Results

The incidence of severe visual impairment and blindness was 4.5% overall. Although all facial fractures (including isolated fractures of the mandible) had a notable incidence of ocular injury, an increased number of orbital wall fractures were correlated with an increased incidence of permanent visual disability. One of 147 (0.68%) patients without an orbital wall fracture sustained permanent severe ocular injury or blindness, while 13.5% (five of 37) of three-wall orbital fracture patients and 25% (four of 16) of four-wall orbital fracture patients sustained the same injury.

Conclusions

The risk of ocular injury in complex facial fractures can be stratified by the degree of orbital wall involvement. However, because all patients with persistent visual impairment had ocular findings on initial examination, it is proposed that oculovisual testing is a more sensitive indicator of lasting ocular injuries than the type of facial fracture.
Secondary Alveolar Bone Grafting: An Outcome Analysis
Authors: Murthy Ananth S , Lehman James A
Published: February 2017

Objective

To review the outcome of secondary alveolar bone grafting in unilateral and bilateral cleft lip and palate.

Design

A surgeon's experience, by retrospective chart review, of 70 consecutive patients at a tertiary care centre.

Outcome Measure

Periapical radiographs were taken at least six months after secondary alveolar bone grafting. The Enemark grading system was used to stratify graft-take.

Results

In unilateral clefts, 33% were level 1, 36% were level 2, 20% were level 3 and 11% were level 4. In bilateral clefts, 29% were level 1, 50% were level 2, 14% were level 3 and 7% were level 4. There was no statistically significant difference between the level of take and the type of cleft. Complications encountered were infection (n=3), fistula (n=3), pain (n=4) and bone graft exposure that led to failure (n=2). Two patients required reoperation for bone grafting.

Conclusions

The iliac crest is a good donor site with excellent results and minimal morbidity.
Diagnosis of Finger Flexor Pulley Injury in Rock Climbers: A Systematic Review
Authors: El-Sheikh Yasser , Wong Ivan , Farrokhyar Forough , Thoma Achilleas
Published: February 2017

Background

Closed injury to the finger flexor pulley system is found frequently in rock climbers. There are no evidence-based published guidelines on the diagnosis and treatment of these injuries.

Objectives

The present systematic review was undertaken to answer the following questions: what are the most commonly recommended diagnostic criteria for finger flexor pulley injury in rock climbers; and, based on the available evidence, what is the best diagnostic test for these injuries?

Methods

Four electronic databases were searched using specific key terms, with limits set for language and date. Two reviewers independently identified potentially relevant titles based on inclusion criteria. Inter-reviewer variability was assessed using the Kappa statistic. The scientific quality of articles was assessed using validated scales.

Results

Of the 93 articles identified, 29 were included in the present analysis. The inter-rater agreement for selection of potentially relevant titles was 88% (kappa=0.74). The most commonly cited diagnostic criterion for closed finger pulley injury was clinical bowstringing of the flexor tendons over the volar aspect of the proximal interphalangeal joint. However, the best study of diagnostic accuracy for these injuries supports the use of dynamic ultrasound.

Conclusions

Dynamic ultrasound is recommended for the diagnosis of closed finger pulley injuries in rock climbers. The prevailing notion that these injuries can be diagnosed by testing for clinical bowstringing is not supported by evidence.
The Epidemiology of Cutaneous Malignant Melanoma in Nova Scotia
Authors: Howlett Andrew L , Dewar Ron AD , Morris Steven F
Published: February 2017

Background

Since 1993, the annual increase in cutaneous malignant melanoma (MM) incidence has been one of the highest for all cancers registered in Canada, with the leading rate in Nova Scotia (NS). The purpose of the present study was to document the pathological and epidemiological data on MM cases found in NS.

Patients and Methods

All MM cases identified by the Nova Scotia Cancer Registry from January 1998 to December 2002 were evaluated. The five-year survival outlook, by major prognostic factors, was also determined. In addition, the annual incidence and mortality rates from 1972 to 2002 were computed.

Results

Between 1998 and 2002, 925 MM cases were recorded. The age-standardized incidence rate for males and females in this period was 19.2 and 16.1 per 100,000 respectively. Men 65 years of age or older had the highest age-specific rate. The most common MM had a Breslow's depth of less than 1.0 mm (61.9%) and was Clark's level II (34.9%). There was no significant seasonal variation noted in the time of diagnosis. Survival analyses indicated that sex, age, tumour location and thickness were significant independent predictors. Despite the increase in incidence, there have only been modest changes in the annual mortality rate.

Conclusion

The incidence of MM in NS increases with age, and is nearly double for men 65 years of age or older, compared with women in the same age group. Thin melanomas on the extremities of young females have the best prognosis in NS, which is similar to other parts of the world. Incidence appears to be unrelated to season. Public health interventions are necessary to reduce the burden of this disease.
A bilobed groin flap for coverage of traumatic injury to both the volar and dorsal hand surfaces
Authors: Brooks Trevor M , Jarman Abdulaziz T , Olson Jaret L
Published: February 2017

Background

There are many methods available for coverage of both the volar and dorsal hand surfaces in traumatic injury. All of these surgical procedures allow for ample coverage of the defect, but have the major drawback of needing multiple donor sites. In the present report, a case of a complex crush injury to the hand in which both volar and dorsal surfaces received traumatic injury is presented. A bilobed groin flap pedicled on the superficial circumflex iliac artery was fashioned to cover the entire defect. Like many other described flaps, the bilobed groin flap resulted in a favourable functional and cosmetic result for the patient, but with the unique advantage of requiring a single donor site.

Methods

A bipedicled groin flap was raised from distal to proximal, and the flaps inset onto both the dorsal and volar hand defects.

Results

The patient regained adequate function of his hand, and was able to return to work full-time as a manual labourer.

Conclusion

The bilobed groin flap appears to be a valuable option for covering complex hand injuries involving both the volar and dorsal surfaces of the hand.
Orthognathic surgery for management of Arthrogryposis Multiplex Congenita: Case report and review of the literature
Authors: Kargel Jennifer S , Dimas Vanessa M , Chang Peter
Published: February 2017

Arthrogryposis Multiplex Congenita is a condition characterized by multiple contractures of the joints. Involvement of the temporomandibular joint is a common complication that limits mandibular opening. A case of Arthrogryposis Multiplex Congenita with anterior open bite and limited maximal incisal opening is presented. Orthognathic surgery, consisting of segmental LeFort I osteotomy and bilateral sagittal split osteotomy, was performed successfully on this patient.
Vertical mammaplasty: Postoperative changes, complications and patient evaluation
Authors: Keck M , Kaye K , Thieme I , Ueberreiter K
Published: February 2017

The aim of the present study was to investigate postoperative changes after vertical mammaplasty. Between 2002 and 2005, 72 consecutive patients aged 15 to 69 years with an average weight of 72 kg underwent bilateral vertical mammaplasty. Forty-two patients attended the regular follow-up one week, four weeks, three months, six months and one year after the operation. Nipple diameter, notch-to-nipple distance, scar length and the number of skin folds along the vertical scar were evaluated. Complications were recorded during the entire follow-up period. A questionnaire was used to document patient satisfaction 12 months after the operation. The main changes took place during the first three months after surgery. Nipple diameter showed an average increase of 28% after surgery, and the notch-to-nipple distance increased by an average of 17% over the intraoperative value. The average increase of the scar length after one year was 22%. The rate of complications was low, and patient satisfaction was high.
Breast autoaugmentation
Authors: Kirwan Laurence
Published: February 2017

A technique using a posteriorly based dermoglandular flap as an augmentation of the superior hemisphere of the breast combined with a periareolar mastopexy and vertical mastopexy is presented. The advantages of combining a periareolar mastopexy, in terms of reducing the length of the vertical scar and preventing areolar distortion, are explained.
Forequarter amputation for malignant tumours of the upper extremity: Case report, techniques and indications
Authors: Dimas Vanessa , Kargel Jennifer , Bauer John , Chang Peter
Published: February 2017

Forequarter (interscapulothoracic) amputation is a major ablative surgical procedure that was originally described to manage traumatic injuries of the upper extremity. Currently, it is most commonly used in the treatment of malignant tumours of the arm. With the advent of limb-sparing techniques, primary forequarter amputation is performed less frequently, but remains a powerful surgical option in managing malignant tumours of the upper extremity; therefore, surgeons should be familiar with this procedure. A classic case report of forequarter amputation, with emphasis on indications and surgical techniques, is presented.
Extraskeletal Ewing's sarcoma in a great toe of a young boy
Authors: Cypel Tatiana Karine Simon , Meilik Benjamin , Zuker Ronald Melvin
Published: February 2017

Extraskeletal Ewing's sarcoma (EES) is a rare, soft tissue, malignant neoplasm histologically similar to skeletal Ewing's sarcoma. It occurs mainly in adolescents and young adults, and affects extremities in 36% of cases and central locations (commonly paravertebral regions) in the remainder. The differential diagnosis includes other small, blue, round cell tumours. A clinical case of EES involving a great toe in a young boy is reported. EES diagnosis was confirmed by features of histological analysis and immunohistochemistry, and by the presence of the t(11;22) chromosomal translocation.
Lawsuits against plastic surgeons: Does locale affect incidence of claims?
Authors: Kaplan Jonathan L , Hammert Warren C , Zin James E
Published: February 2017

Background

Physicians continue to practice in a very litigious environment. Some physicians try to mitigate their exposure to lawsuits by avoiding geographical locations known for their high incidence of medical malpractice claims. Not only are certain areas of the United States known to have a higher incidence of litigation, but it is also assumed that certain areas of the hospital incur a greater liability. There seems to be a medicolegal dogma suggesting a higher percentage of malpractice claims coming from patients seen in the emergency room (ER), as well as higher settlements for ER claims.

Objective

To determine if there is any validity to the dogma that a higher percentage of malpractice claims arise from the ER.

Methods

An analysis of common plastic surgery consults that result in malpractice claims was performed. The location where the basis for the lawsuit arose – the ER, office (clinic) or the operating room (OR) – was evaluated. The value of the indemnity paid and whether its value increased or decreased based on the location of the misadventure was evaluated.

Results

According to the data, which represented 60% of American physicians, there was a larger absolute number of malpractice claims arising from the OR, not the ER. However, the highest average indemnity was paid for cases involving amputations when the misadventure originated in the ER.

Conclusions

The dogma that a greater percentage of lawsuits come from incidents arising in the ER is not supported. However, depending on the patient's injury and diagnosis, a lawsuit from the ER can be more costly than one from the OR.
Evaluation of three-dimensional computed tomography processing for deep inferior epigastric perforator flap breast reconstruction
Authors: Teoh Raymond , Johnson Raleigh F , Nishino Thomas K , Ethridge Richard T
Published: February 2017

Background

The deep inferior epigastric perforator flap procedure has become a popular alternative for women who require breast reconstruction. One of the difficulties with this procedure is identifying perforator arteries large enough to ensure that the harvested tissue is well vascularized. Current techniques involve imaging the perforator arteries with computed tomography (CT) to produce a grid mapping the locations of the perforator arteries relative to the umbilicus.

Objectives

To compare the time it takes to produce a map of the perforators using either two-dimensional (2D) or three-dimensional (3D) CT, and to see whether there is a benefit in using a 3D model.

Methods

Patient CT abdomen and pelvis scans were acquired from a GE 64-slice scanner. CT image processing was performed with the GE 3D Advantage Workstation v4.2 software. Maps of the perforators were generated both as 2D and 3D representations. Perforators within a region 5 cm rostral and 7 cm caudal to the umbilicus were measured and the times to perform these measurements using both 2D and 3D images were recorded by a stopwatch.

Results

Although the 3D method took longer than the 2D method (mean [± SD] time 1:51±0:35 min versus 1:08±0:16 min per perforator artery, respectively), producing a 3D image provides much more information than the 2D images alone. Additionally, an actual-sized 3D image can be printed out, removing the need to make measurements and producing a grid.

Conclusions

Although it took less time to create a grid of the perforators using 2D axial CT scans, the 3D reconstruction of the abdomen allows the plastic surgeons to better visualize the patient's anatomy and has definite clinical utility.
Ulnar artery pseudoaneurysm in a patient with factor IX deficiency (hemophilia B)
Authors: Plant Mathew A , Scilley Christopher G
Published: February 2017

The hypothenar hammer syndrome describes a constellation of symptoms resulting from repetitive trauma to the hypothenar eminence, often due to the use of the hand as a hammer. Sequelae of this syndrome include both true and false aneurysms, as well as thrombosis of the ulnar artery due to its vulnerability to blunt trauma as it exits Guyon's canal. Although this is a relatively well-documented phenomenon, an extensive review of the literature revealed that no cases have been described involving a patient with hemophilia. The present case describes a 46-year-old farmer with factor IX deficiency (hemophilia B) presenting with a 5 cm × 7 cm pseudoaneurysm of the ulnar artery of the right hand.
Dupuytren'S Contracture Following Burn Injury of the Hand: A Case Report and Review of Literature
Authors: Balakrishnan Chenicheri , Sugg Kristoffer B , Huettner William , Jarrahnejad Payam
Published: February 2017

In burn patients, scar contractures adjacent to or across the joints lead to disabling deformities. In Dupuytren's disease, the proliferative process involves the fascia of the palm and fingers, resulting in disabling flexion contractures of the fingers and the palm. A single insult involving the hand or even a more proximal injury may lead to Dupuytren's disease.
Extra-Anatomic Microvascular Second Toe Transfer for Creation of a Helper Hand – a Long-Term Follow-Up
Authors: Webb L Shayne , Dolph James L
Published: February 2017

Mutilating hand injuries can significantly alter a patient's life. Return to work and daily activities remain the ultimate goal. A case report and long-term follow-up of a patient who caught his hand in a generator fan at work is presented. He sustained an injury that left him with a wrist and metacarpal stump. When prostheses failed, an extra-anatomic second toe transfer was used to produce a functional distal extremity. This transfer allowed the patient to return to his job and was surprisingly durable, resulting in a useful helper hand for 15 years.
Post-Traumatic Osteomyelitis of the Clavicle: A Case Report and Review of Literature
Authors: Balakrishnan Chenicheri , Vashi Christopher , Jackson Ollie , Hess Jason
Published: February 2017

Osteomyelitis of the clavicle is a rare form of infection occurring from hematogenous spread or trauma. This has been reported following head and neck surgery, and subclavian catheter placement. In traumatic cases, the management involves removal of bone fixation, debridement of the bone and coverage with a muscle flap.
Acute Carpal Tunnel Syndrome As a Result of Spontaneous Bleeding
Authors: Balakrishnan Chenicheri , Jarrahnejad Payam , Balakrishnan Anila , Huettner William C
Published: February 2017

Acute carpal tunnel syndrome is the most common compression neuropathy of the upper extremity following trauma. A rare occurence of spontaneous bleeding into the carpal tunnel, presenting as acute carpal tunnel syndrome, is presented.
Closed Reduction Internal Fixation Rates and Procedure Times for Metacarpal Fractures Treated in a Minor Surgery Area Before and After the Introduction of a Mini C-Arm Unit
Authors: Mahabir RC , Decroff CM , Thurgood L , Harrop Ar
Published: February 2017

Background

Mini C-arm units are compact, mobile, fluoroscopic imaging systems designed for real-time imaging of the extremities. They deliver the lowest possible radiation exposure to the patient and physician while minimizing operator effort and inconvenience.

Methods

A retrospective chart review was undertaken for consecutive metacarpal fractures requiring internal fixation treated in the minor surgery centre before (n=100) and after (n=100) the introduction of the mini C-arm. Open versus closed approach, procedure time and total operating room time were recorded.

Results

Before the introduction of the mini C-arm, the percutaneous rate was 48% and the average procedure and total operating room times were 55 min and 102 min, respectively. After mini C-arm implementation, the percutaneous rate increased to 59% and the average procedure and total times were 36 min and 78 min, respectively.

Conclusions

The use of a mini C-arm increased the rate of successful closed reduction internal fixation and reduced the procedure time for metacarpal fractures treated in the minor surgery area.
Compartment Syndrome Presenting As Ischemia Following Extravasation of Contrast Material
Authors: Grand Aaron , Yeager Brian , Wollstein Ronit
Published: February 2017

A case of acute compartment syndrome of the forearm, resulting from contrast dye extravasation that presented as upper extremity ischemia, is described. Timely surgical intervention resulted in an excellent outcome. When extravasation of dye occurs, the patient should be evaluated for compartment syndrome despite the possible lack of typical symptoms.
Practice Profiles in Breast Reduction: A Survey Among Canadian Plastic Surgeons
Authors: Nelson Rebecca A , Colohan Shannon M , Sigurdson Leif J , Lalonde Don H
Published: February 2017

Background

Breast reduction is an increasingly common procedure performed by Canadian plastic surgeons. Recent studies in the United States show that use of the inferior/central pedicle inverted T scar method is predominant. However, it is unknown what the practice preferences are among Canadian plastic surgeons.

Objective

The goal of the present study was to assess trends in breast reduction surgery among Canadian surgeons, including patient selection criteria, surgical techniques and outcomes.

Method

Surveys were distributed to plastic surgeons at the Canadian Society for Plastic Surgery meetings in 2005 and 2006. Completed surveys were obtained from 140 respondents, and results were analyzed with Excel and SAS software.

Results

There was a 40% response rate. The majority of surgeons (66%) used more than one technique for breast reduction. Most commonly, surgeons use the inverted T scar technique (66%) followed by vertical scar techniques (26%). The most popular vertical scar techniques included the Hall-Findlay (14%) and Lejour (13%) methods. Most surgeons (55%) reported complication rates of less than 5% and the most common complication reported was wound dehiscence. There was no difference in overall complication rates between inverted T scar and vertical scar surgeries. The majority of surgeons (98%) carried out breast reduction either exclusively as day surgery or in combination with same-day admission. Breast reduction performed as day surgery resulted in cost savings of $873 per patient.

Conclusions

Canadian plastic surgeons are performing more vertical scar breast reductions than American surgeons. However, both groups rely predominantly on inverted T scar techniques.
Juvenile Xanthogranuloma of the Ear: A Case Report
Authors: Mrad M Amir , Chan Kevin , Cypel Tatiana Ks , Zuker Ronald M
Published: February 2017

Juvenile xanthogranuloma is a relatively uncommon, benign histiocytic proliferative disorder. A case of juvenile xanthogranuloma in a 13-month-old girl with an unusual clinical form is described. She presented with a yellow-red projecting nodule over the helical rim of her right ear. The lesion was histologically diagnosed as juvenile xanthogranuloma after excisional biopsy. Although primarily a dermatological curiosity, plastic surgeons should be familiar with this entity, and should consider it in the differential diagnosis of benign soft tissue tumours of the ear.
Pediatric Facial Burns: Is Facial Transplantation the New Reconstructive Psychosurgery?
Authors: Hanson Mark D , Zuker Ronald M , Shaul Randi Zlotnik
Published: February 2017

Introduction

Current pediatric burn care has resulted in survival being the expectation for most children. Composite tissue allotransplantation in the form of face or hand transplantation may present opportunities for reconstructive surgery of patients with burns. The present paper addresses the question “Could facial transplantation be of therapeutic benefit in the treatment of pediatric burns associated with facial disfigurement?”

Methods

Therapeutic benefit of facial transplantation was defined in terms of psychiatric adjustment and quality of life (QOL). To ascertain therapeutic benefit, studies of pediatric burn injury and associated psychiatric adjustment and QOL in children, adolescents and adults with pediatric burns, were reviewed.

Results

Pediatric burn injury is associated with anxiety disorders, including post-traumatic stress disorder and depressive disorders. Many patients with pediatric burns do not routinely access psychiatric care for these disorders, including those for psychiatric assessment of suicidal risk. A range of QOL outcomes were reported; four were predominantly satisfactory and one was predominantly unsatisfactory.

Discussion

Facial transplantation may reduce the risk of depressive and anxiety disorders other than post-traumatic stress disorder. Facial transplantation promises to be the new reconstructive psychosurgery, because it may be a surgical intervention with the potential to reduce the psychiatric suffering associated with pediatric burns. Furthermore, patients with pediatric burns may experience the stigma of disfigurement and psychiatric conditions. The potential for improved appearance with facial transplantation may reduce this ‘dual stigmata’. Studies combining surgical and psychiatric research are warranted.
Surgical Management of a Dermal Lymphatic Malformation of the Lower Extremity
Authors: Schneider Lisa F , Chen Constance M , Zurada Joanna M , Walther Robert , Grant Robert T
Published: February 2017

Dermal lymphatic malformations are rare congenital hamartomas of superficial lymphatics characterized by high recurrence rates after excision. The standard therapy for a single lesion is surgical excision with wide margins, which reduces recurrence but can have a potentially unacceptable aesthetic outcome. A case of a 24-year-old woman with a 6 cm × 5 cm dermal lymphatic malformation on her right thigh, diagnosed by clinical history, physical examination, magnetic resonance imaging and pathological findings, is reported. The patient underwent wide local excision with split-thickness skin grafting. After pathological examination revealed negative margins, the patient underwent tissue expander placement and excision of the skin graft with primary closure. The lesion did not recur, and the patient achieved a satisfactory aesthetic result. The present case represents the first report of the use of tissue expanders to treat dermal lymphatic malformations in the lower extremity and demonstrates a safe, staged approach to successful treatment.
Metastatic Cutaneous Breast Carcinoma: A Case Report and Review of the Literature
Authors: Nava Guillermina , Greer Kenneth , Patterson James , Y Lin Kant
Published: February 2017

Cutaneous metastatic carcinoma, also known as carcinoma erysipeloides, is an unusual clinical finding. In women, it is most frequently found in association with breast cancer rather than other visceral malignancies. Breast cancer patients can present with cutaneous manifestations of breast disease at the time of their initial diagnosis; however, cutaneous metastases more often present well after the initial diagnosis and treatment of the breast disease. Prompt recognition of skin metastases by the plastic surgeon, especially during the delayed setting of reconstructive surgery following mastectomy, allows for earlier intervention in treating the systemic spread of the disease. A clinical case of carcinoma erysipeloides presenting in this delayed setting is outlined in the present report, along with a review of the literature.
Perioperative Considerations for Patient Safety During Cosmetic Surgery – Preventing Complications
Authors: A Ellsworth Warren , Bob Basu C , E Iverson Ronald
Published: February 2017

Maintaining patient safety in the operating room is a major concern of surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential, and pressure to avoid these complications in cosmetic surgery is increasing. Traditionally, nursing and anesthesia staff have managed patient positioning and safety issues in the operating room. As the number of office-based procedures in the plastic surgeon's practice increases, understanding and implementing patient safety guidelines by the plastic surgeon is of increasing importance.

A review of the Joint Commission's Universal Protocol highlights requirements set forth to prevent perioperative complications. In the present paper, the importance of implementing these guidelines into the cosmetic surgery practice is reviewed. Key aspects of patient safety in the operating room are outlined, including patient positioning, ocular protection and other issues essential for minimization of postoperative morbidity. Additionally, as the demand for body contouring surgery in the cosmetic practice continues to increase, special attention to safety considerations specific to the obese and massive weight loss patients is mandatory.

After review of the present paper, the reader should be able to introduce the Joint Commission's Universal Protocol into their daily practice. The reader will understand key aspects of patient positioning, airway management and ocular protection in cosmetic surgery. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese, massive weight loss patients and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patient's experience and surgical outcome.
Reconstruction of sacral defects following necrosis of buttocks due to embolization of internal iliac artery using a transverse lumbar flap
Authors: Balakrishnan Chenicheri , Yovino Justin , Adams Peter D , Balakrishnan Anila , Jarrahnejad Payam
Published: February 2017

Fractures of the pelvis associated with uncontrollable hypotension are managed by stabilization of fractures and arteriographic embolization of the bleeding vessels. Embolization of these arteries may result in necrosis of the buttocks. The use of a transverse lumbar artery-based flap can be used for repair of these defects.
Reversed dorsal metatarsal artery flap for reconstruction of a soft tissue defect of the big toe
Authors: Balakrishnan Chenicheri , Chang Yeon-Jeen , Balakrishnan Anila , Careaga Daniel
Published: February 2017

Soft tissue defects of the great toe that include exposed tendon and bone present a reconstructive challenge for plastic surgeons. A distally based dorsalis pedis island flap based on the first dorsal metatarsal artery, which has been successfully used to cover the soft tissue defect following wide excision of melanoma of the big toe, is reported
An Arteriovenous Malformation of the External Ear in the Pediatric Population: A Case Report and Review of the Literature
Authors: Whitty Lisa A , Murray John D , Null W Edward , Elwood Eric T , Jones Glyn E
Published: February 2017

The literature regarding arteriovenous malformations of the external ear is sparse. A case of a patient clinically diagnosed with an arteriovenous malformation of the external ear that was managed empirically with surgical excision, without recurrence, is presented. The pathogenesis, clinical presentation, radiological work up and management options regarding arteriovenous malformations are reviewed.
Neoumbilicoplasty Is a Useful Adjuvant Procedure in Abdominoplasty
Authors: Al-Shaham Aa
Published: February 2017

Background

Neoumbilicoplasties are indicated in congenital conditions associated with umbilical agenesis, umbilical loss due to inflammatory destruction, excision of skin cancer involving the umbilical stump and in surgical procedures for herniorrhaphy, as well as in the rare condition of umbilical endometriosis.

Objective

Neoumbilicoplasty is an adjuvant procedure that may be necessary during abdominoplasty with wide myofascial plication, or repair of concomitant hernias of the abdominal wall. The present article justifies sacrificing the umbilicus followed by neoumbilicoplasty in patients with significant wide myofascial plication or concomitant hernias of the abdominal wall.

Methods

Seventeen patients underwent a combination of abdominoplasty and wide (greater than 10 cm) vertical plication of the myofascial complex and required neoumbilicoplasty. The male to female ratio was 1:16; mean age was 44 years, mean weight 94.1 kg and mean height 160.2 cm. Characteristic body morphology included gross trunk obesity with a prominent anterior abdominal wall. The female patients were multiparous. Sacrificing the umbilici followed by neoumbilicoplasty was required in patients with umbilical hernias and patients who had divarication of the rectus abdominis muscles with short umbilical stumps.

Results

Nine patients had concomitant ventral hernias (52.94%) and eight patients had divarication of the rectus abdominis muscles with short umbilical stumps (47.05%). The mean perioperative myofascial plication distance was 15.41 cm and the gap closure required three to five rows of sutures.

Conclusion

Neoumbilicoplasty is a useful adjuvant procedure during abdominoplasty with wide myofascial plication or repair of concomitant hernias of the abdominal wall.
Seal Finger: A Case Report and Review of the Literature
Authors: White Colin P , Jewer David D
Published: February 2017

A recent case of seal finger which was misdiagnosed and hence mistreated at the patient's first presentation is described. The patient was eventually referred to a hand specialist and after the correct treatment with tetracycline, responded well without any long-term sequelae. Seal finger is an occupational injury that occurs to those who work directly or indirectly with seals. The disease entity has been described in both Scandinavian and Canadian literature. The causative microorganism was unknown until 1991, when Mycoplasma phocacerebrale was isolated from both the finger of a patient with seal finger and from the mouth of a seal that bit the patient. Although rare, the disease is not uncommon in marine workers, biologists and veterinarians. Prompt identification based on patient history and treatment with oral tetracycline is pendant to a favourable patient outcome.
Diagnosis and Excision of An Ulnar Artery Aneurysm in a Two-Year-Old Boy
Authors: Amjad Ibrahim , Murphy Travis , Zahn Evan
Published: February 2017

Ulnar artery aneurysms in children younger than 10 years of age are rare, with fewer than 10 reported cases worldwide. Unlike adult arterial aneurysms, the etiology of these lesions in children is not well understood, and there is no accepted method for treating these lesions. The method of diagnosis and excision of an ulnar artery aneurysm that showed a favourable outcome in a two-year-old boy is presented. Different approaches to treating similar lesions have been reported, and these approaches are briefly reviewed.
Phosphodiesterase Inhibitors in Vascular Ischemia: A Case Report and Review of Their Use in Ischemic Conditions
Authors: Ky Ng Wendy , Rosenblatt Yishai , B Brock Gerald , B O'gorman David , Siang Gan Bing
Published: February 2017

The treatment of digital ischemia remains difficult. Sildenafil (Viagra, Pfizer UK), a selective phosphodiesterase inhibitor, increases blood flow and is currently marketed for the treatment of erectile dysfunction. A case of a 57-year-old man with progressive episodic ischemia and pain of the fingertips resulting in finger tip ulceration is presented. After failure of medical and surgical management, a trial of oral sildenafil resulted in marked symptomatic improvement of his bilateral digital ischemia. Review of the literature shows that, particularly in patients with an underlying disease such as scleroderma with a vasospastic component, a marked improvement in digital blood flow may be observed with sildenafil use. Overall, based on a number of case reports and preliminary animal studies in the literature, sildenafil appears to have a growing significance in the treatment of hand ischemia. Similarly, there is evidence that phosphodiesterase 5 inhibitors may be used as an adjunct to improving skin flap survival.
Scar Endometriosis – a Rare Cause for a Painful Scar: A Case Report and Review of the Literature
Authors: J Danielpour Payman , C Layke Do John , Durie Nicole , T Glickman Laurence
Published: February 2017

Endometriosis is described as the presence of functioning endometrial tissue outside the uterine cavity. Scar endometriosis is a rare disease, and is difficult to diagnose. The symptoms are nonspecific, typically involving abdominal wall pain at the incision site at the time of menstruation. It commonly follows obstetrical and gynecological surgeries. The diagnosis is frequently made only after excision of the diseased tissue. A case report of a patient with a troublesome scar after a caesarian section is presented. Surgical excision led to the diagnosis of scar endometriosis. The pathogenesis, diagnosis and treatment of this somewhat rare condition are discussed.
Successful Surgical Treatment of Advanced Erythema Elevatum Diutinum
Authors: Ronald Rinard Jeremy , Chaos Mahabir Raman , F Greene John , Grothaus Peter
Published: February 2017

Erythema elevatum diutinum is a rare, chronic cutaneous vasculitis that presents with plaques or nodules on the extensor surfaces of extremities. Although the exact pathogenesis is unknown, patients usually have an underlying systemic medical problem such as malignancy, autoimmune disease or HIV. Management of the cutaneous manifestations is aimed at controlling the underlying disease process, in addition to medical therapy directed at suppressing the lesions. The difficult case of a 60-year-old man, who was not a candidate for medical therapy but has undergone successful surgical therapy of this rare disease for 10 years, is presented.
Acute Symptomatic Hematoma with Defined Etiology Seven Years After Breast Reconstruction: A Case Report and Literature Review
Authors: K Seth Akhil , Ys Kim John
Published: February 2017

Augmentation mammaplasty with implants can be complicated by hematoma formation. The majority of hematomas occur in the immediate postoperative period. There are, however, some reports of hematomas with a delayed presentation. These hematomas in the late postoperative period are rare, and many of these cases do not have a definitive mechanism of injury or develop symptoms immediately after the triggering event. A case of late capsular hematoma seven years after breast reconstruction with a saline implant following mastectomy is presented. In contrast to the majority of published cases, the patient presented with both a known and traceable cause of her bleed and with symptoms that developed immediately after the initial event. Furthermore, the mechanism of her injury was consistent with a bleeding capsular tear that was observed intraoperatively. The present case emphasizes the importance of thorough evaluation and management of patients with a history of breast reconstruction.
Mucormycosis Infection Following Intravenous Access in the Forearm
Authors: Wollstein Ronit , Palekar Alka
Published: February 2017

Mucormycosis is an opportunistic infection that is often fatal, requiring aggressive local control as well as systemic therapy. A rare case of a forearm infection originating in a traumatic intravenous access portal is described in the present study. The Mucor species infection prevented liver transplant, and the patient passed away. In the present case, it was decided to limit the resection to the skin and subcutaneous tissue based on a frozen section and the viability of the biopsied tissue. with consistently rising numbers of immunocompromised patients, awareness and familiarity with mucormycosis in the extremities is important. Knowing that a minimal traumatic event may precede the infection could assist in prevention and early diagnosis. Guidelines for pathological and clinical diagnosis and treatment need to be further clarified.
Histological Assessment of Tangentially Excised Burn Eschars
Authors: Gurfinkel Reuven , Rosenberg Lior , Cohen Sarit , Cohen Arnon , Barezovsky Alex , Cagnano Emanuela , J Singer Adam
Published: February 2017

BACKGROUND

The burn eschar serves as a medium for bacterial growth and a source of local and systemic infection. To prevent or minimize these complications, it is important to debride the eschar as early as possible.

OBJECTIVE

To identify the presence of viable skin within the excisions by examining tangentially excised burn eschars.

METHODS

A total of 146 samples of burned human tissue were removed during 54 routine sharp tangential excision procedures (using dermatomes). The samples were histologically examined to identify the relative thickness of the dead, intermediate and viable layers.

RESULTS

The mean (± SD) thickness of the excised samples was 1.7 ± 1.1 mm. The sacrificed viable tissue (mean thickness 0.7+0.8 mm) occupied 41.2% of the entire thickness of the excision. In 32 biopsies (21.8%; 95% CI 16.0 to 29.3), the excision did not reach viable skin. Only eight biopsies (5.4%; 95% CI 2.8 to 10.1) contained all of the necrotic tissue without removing viable tissue.

CONCLUSIONS

The thickness of a single tangentially excised layer of eschar is not much greater than the actual thickness of the entire skin and often contains viable tissue. Because surgical debridement is insufficiently selective, more selective means of debriding burn eschars should be explored.
Adenoid Involvement in Velopharyngeal Closure in Children with Cleft Palate
Authors: A Hubbard Bradley , B Rice Gale , R Muzaffar Arshad
Published: February 2017

OBJECTIVE

To assess the role of the adenoid pad in velopharyngeal (VP) closure.

DESIGN

A retrospective review of patients with cleft palate (CP) who underwent nasendoscopy and multiview videofluoroscopy during evaluation for VP insufficiency (VPI) from January 2006 to March 2008.

PATIENTS

Thirty-two consecutive patients were identified. None of the patients were lost to follow-up. Five patients were excluded: two for advanced age, two due to mental disabilities and one with a submucous cleft.

INTERVENTION

Video nasendoscopy and multiview videofluoroscopy were performed for evaluation of VPI.

OUTCOME MEASURES

Adenoid size based on nasendoscopy studies, and adenoid involvement in VP closure based on videofluoroscopy were recorded.

RESULTS

The average patient age was 6.6 years (range three to 13 years). Seventy-eight per cent of patients had small adenoid volumes (less than 50% obstruction of the choanae), and six patients (two unilateral cleft lip and palate patients, one bilateral cleft lip and palate patient, two isolated CP patients and one cleft of secondary palate patient) had large adenoid volumes (50% or greater obstruction of the choanae); the adenoid pads of these patients were almost always (five of six patients) involved in their VP closure patterns. Videofluoroscopy showed that 26% (95% CI 9% to 40%) of patients did not significantly use their adenoid pad in VP closure. Forty-three per cent of those not using their adenoids attempted contact with a Passavant's ridge.

CONCLUSIONS

In general, the adenoid pad should be maintained in CP patients. However, not all CP patients in the present study used their adenoid pad in attempted VP closure. If adenoidectomy is medically indicated, a percentage of these patents might be considered to be at lower risk for the development of postadenoidectomy VPI.
Breast Augmentation: A Geographical Comparison
Authors: L Maher Janae , C Bennett Della , L Bennett Laura , Grothaus Peter , C Mahabir Raman
Published: February 2017

OBJECTIVE

To describe and compare physical characteristics and implant details of women undergoing primary cosmetic breast augmentation in different geographical locations.

METHODS

Three cohorts of 100 consecutive breast augmentation cases in university settings were retrospectively reviewed for patient demographic and implant information in Kelowna (British Columbia), Loma Linda (California, USA) and Temple (Texas, USA). Statistical analysis was performed with a Kruskal-Wallis test without normality assumption (P<0.05 was considered to be significant). Pearson correlation coefficients were also determined for body mass index (BMI) versus implant volume at each of the sites.

RESULTS

The three group medians were significantly different for weight, BMI and implant volume. Kelowna's average patient was 33 years of age, had a BMI of 20.8 kg/m2 and an implant volume of 389 mL. Loma Linda's average patient was 32 years of age, had a BMI of 21.6 kg/m2 and an implant volume of 385 mL. Temple's average patient was 36 years of age, had a BMI of 22.6 kg/m2 and an implant volume of 335 mL. Pearson correlations for BMI versus implant volume were statistically significant in the Loma Linda and Temple groups.

CONCLUSION

Patients from different geographical locations undergoing breast augmentation were similar in age, height and parity, but varied in weight, BMI and implant volume. A positive linear correlation between BMI and implant volume was found in the American cohorts.
Reconstruction of a Congenitally Absent Flexor Pollicis Longus in An Adult
Authors: Shamsian Negin , Exton Rebecca , Shibu Mm
Published: February 2017

Congenital absence of the flexor pollicis longus (FPL) is an unusual finding that is frequently associated with thumb hypoplasia. Isolated FPL absence is the rarest of the congenital thumb anomalies. The present article describes a patient with a congenitally absent FPL, and discusses the chosen method of reconstruction.
Umbilical Endometriosis: A Rare Diagnosis in Plastic and Reconstructive Surgery
Authors: Daniel Malebranche A , Bush Kevin
Published: February 2017

Umbilical endometriosis infrequently presents to the plastic surgeon. As such, the diagnosis is difficult to make because it is often overlooked. The current report presents a 35-year-old nulligravid woman with a six-month history of a firm, cyclically swelling lesion in her umbilical region. None of the signs characteristic of pelvic endometriosis except dysmenorrhea and a one-year history of infertility were present. Biopsy of the lesion revealed umbilical endometriosis (grade IV), and laparoscopy uncovered extensive disease. Monopolar cautery with coagulating current umbilical excision and reconstruction with a purse-string suture was used. The results underscore the importance of a broad differential diagnosis for an umbilical lesion in a middle-age woman. They also highlight the importance of early recognition and appropriate surgical intervention to minimize morbidity and mortality associated with umbilical endometriosis.