bluuebunny/crossref_metadata_2025 huggingface dataset:
A Geometric Analysis of Mastectomy Incisions: Optimizing Intraoperative Breast Volume
Authors: Chopp David , Rawlani Vinay , Ellis Marco , A Johnson Sarah , W Buck Donald , Khan Seema , Bethke Kevin , Hansen Nora , Ys Kim John
Published: February 2017

INTRODUCTION

The advent of acellular dermis-based tissue expander breast reconstruction has placed an increased emphasis on optimizing intraoperative volume. Because skin preservation is a critical determinant of intraoperative volume expansion, a mathematical model was developed to capture the influence of incision dimension on subsequent tissue expander volumes.

METHODS

A mathematical equation was developed to calculate breast volume via integration of a geometrically modelled breast cross-section. The equation calculates volume changes associated with excised skin during the mastectomy incision by reducing the arc length of the cross-section. The degree of volume loss is subsequently calculated based on excision dimensions ranging from 35 mm to 60 mm.

RESULTS

A quadratic relationship between breast volume and the vertical dimension of the mastectomy incision exists, such that incrementally larger incisions lead to a disproportionally greater amount of volume loss. The vertical dimension of the mastectomy incision – more so than the horizontal dimension – is of critical importance to maintain breast volume. Moreover, the predicted volume loss is more profound in smaller breasts and primarily occurs in areas that affect breast projection on ptosis.

CONCLUSIONS

The present study is the first to model the relationship between the vertical dimensions of the mastectomy incision and subsequent volume loss. These geometric principles will aid in optimizing intraoperative volume expansion during expander-based breast reconstruction.
Ganglion Cyst in Children: Reviewing Treatment and Recurrence Rates
Authors: Karine Simon Cypel Tatiana , Mrad Amir , Somers Gino , Melvin Zuker Ronald
Published: February 2017

BACKGROUND

Pediatric hand and wrist ganglia seem to have different epidemiological characteristics than those of adults – a majority are found on the volar aspect of the hands and wrists of patients younger than 10 years of age.

OBJECTIVE

To determine the epidemiology, etiological factors, clinical presentation, treatment and outcome of patients with ganglion cysts at the Hospital for Sick Children (Toronto, Ontario).

METHODS

The records of the pathology department at the Hospital for Sick Children were searched for all cases of ganglion cyst operated on between January 2000 and December 2008.

RESULTS

Thirty-seven patients underwent treatment for symptomatic ganglion cyst. The mean age of the patients was 9.6 years, and there were 23 females. A mobile nodule was the initial presentation of the ganglion in 64% of the cases. Pain was the most common indication for surgical removal. Only 11.4% of patients experienced previous trauma. In 70% of the cases, the diagnosis was made clinically. The most common sites of occurrence were volar wrist (25.7%), dorsal wrist (22.8%) and the volar aspect of the base of the ring finger (17.1%). Surgical excision was the treatment of choice for 94.2% of the patients with symptomatic lesions. The minimum follow-up period was 12 months. Only one patient (2.8%) presented with recurrence in the series.

CONCLUSION

Although it is possible that these findings might change with longer follow-up, the present data provide information to help guide the treatment of these cysts. Complete surgical removal is a very effective treatment, with low rates of recurrence.
Management of Pelvic Heterotopic Ossification Post-Myocutaneous Flap Reconstruction of a Sacral Pressure Ulcer
Authors: W Mcinnes Colin , Ak Reynolds Richard , S Arneja Jugpal
Published: February 2017

Heterotopic ossification (HO) is a process whereby lamellar bone forms in the soft tissues surrounding a joint. The most common type of HO is traumatic myositis ossificans, which develops following traumatic injuries, burns or arthroplasty. A variety of other forms of HO also exist, such as those associated with central nervous system injury and systemic forms that can manifest at other joints simultaneously. Clinically, patients can present with decreased range of motion, pressure ulcers, nerve compression, swelling, pain or asymptomatically. Symptomatic patients are most commonly treated with surgical debridement of the affected heterotopic deposits.

Spinal dysraphism (SD) is a term describing a wide range of congenital malformations of the neural tube, ranging from spina bifida occulta to the more severe form, myelomeningocele. The cause of SD is multifactorial and has been associated with chromosomal disorders, teratogenic exposure and folate deficiency. Many patients with SD experience neuropathy below the affected neurological level, making them particularly susceptible to pressure ulcers. If these ulcers are severe and do not respond to conservative therapy, they often require surgical debridement and flap reconstruction – a clinical scenario that rarely results in HO.

The present article describes a case involving a patient with pelvic HO following myocutaneous flap reconstruction of a pressure ulcer. The patient was successfully treated with oral bisphosphonate and aggressive physiotherapy.
Nipple Reconstruction Using a Two-Step Purse-String Suture Technique
Authors: Van Laeken Nancy , Genoway Krista
Published: February 2017

Formation of an aesthetic nipple areola complex with lasting projection remains a challenging final step in breast reconstruction. Despite the many techniques that have been described, no single approach has emerged as the gold standard. The current study presents a novel technique in nipple areola complex reconstruction. In a two-step fashion, the nipple and areola are reconstructed independently. This aims to create a lasting projection of the nipple while maintaining a natural contour among the nipple, the areola complex and the surrounding breast tissue. with more than 15 years of experience using this technique, the authors believe that it is a straightforward procedure and is reliable in providing satisfactory results to both the surgeon and the patient.
Treatment of Keratoacanthoma: Is Intralesional Methotrexate An Option?
Authors: P Patel Nima , Lawrence Cervino A
Published: February 2017

BACKGROUND

Keratoacanthomas (KAs) are a variant of squamous cell carcinomas. Some KAs have shown aggressive behaviour, leading to metastasis and death. Surgical excision is the treatment of choice for most KA patients. Intralesional methotrexate (MTX) may also be a potential treatment option for KAs.

OBJECTIVE

To evaluate intralesional MTX as a treatment modality for KA.

METHODS

A retrospective chart review of nine patients with KAs treated with intralesional MTX was performed. Each patient had biopsyproven KA. The lesion was initially debulked, and MTX was injected at the base. Patients were seen weekly in the office, and reinjected with intralesional MTX depending on the response of the lesion. Each patient was evaluated for their response to the intralesional MTX injections, the number of injections required and complications.

RESULTS

Patients required approximately two to four intralesional injections (12.5 mg to 25 mg per injection) before KA resolution. Eight of nine (88.9%) patients experienced complete resolution of their tumours. One patient experienced treatment failure, and underwent surgical excision of the KA. The average follow-up period was 2.8 years, and there were no recurrences.

CONCLUSION

The results from the present retrospective study show that intralesional MTX injection is an effective treatment option for KAs. The authors propose that intralesional MTX injection with initial debulking of the KA should be used as a first line of treatment when KAs present on the extremities, in cosmetically sensitive areas and in elderly patients with multiple comorbities.
Tuberous Breast: Morphological Study and Overview of a Borderline Entity
Authors: Klinger Marco , Caviggioli Fabio , Klinger Francesco , Villani Federico , Arra Erseida , Di Tommaso Luca
Published: February 2017

BACKGROUND

Tuberous breasts are widely known and described. Several surgical strategies have been proposed; however, few studies explain the origin or structural alterations of this deformity. No histological studies have been performed. The present article describes a morphological and histological study of breast tissue specimens.

METHODS

Mammary specimens of 22 female and five male patients with tuberous breasts were histologically analyzed and compared with six specimens harvested from normal female breasts and from three cases of true ‘normal’ gynecomastia.

RESULTS

A high prevalence of one histological subtype was observed, with the presence of collagen fibres among few fibroblasts. Histochemical analysis highlighted alterations of the arrangement and of the quantity of collagen involving breast structures.

CONCLUSIONS

Results of the present study suggest that collagen deposition alterations can better explain breast parenchyma modifications. Histological features of male subjects support this theory. Additionally, the observation of two cases in male homozygous twins suggests the role of genetic influences.
Congenital Granular Cell Tumour of the Newborn: A Case Report and Literature Review
Authors: Steckler David , A Sargent Larry , A Turner Leslie
Published: February 2017

A congenital granular cell tumour is rare, and presents in newborns as a mass arising from the alveolus. While its pathogenesis is unclear, it has no malignant potential and may, occasionally, spontaneously regress postpartum. Successful treatment usually consists of conservative simple excision.
Juvenile Fibroadenoma of the Breast: Treatment and Literature Review
Authors: K Ng Wendy , Amir Mrad M , H Brown Mitchell
Published: February 2017

It is uncommon to find palpable breast masses in young patients. Generally, such masses are benign. Juvenile fibroadenoma is the most frequent benign tumour of the breast. The present report describes a case involving a 17-year-old girl with unilateral right breast hypertrophy, for whom resection and breast reduction was effectively achieved.

Resection was combined with an aesthetically pleasing outcome through breast reduction, via a wise pattern of reduction with a superior pedicle. While young patients rarely present with breast masses, the consideration of fibroadenoma in these cases is always warranted. The disconcerting appearance of the breasts for adolescents afflicted by such benign masses underscores the importance of achieving aesthetically optimal outcomes and attaining adequate tumour resection for diagnostic purposes through pathological specimens. In the present case, the young patient underwent a procedure that fulfilled both of these valuable goals through careful preoperative planning, pedicle selection and skin resection patterns.
Delayed Immediate Surgery for Orbital Floor Fractures: Less Can Be More
Authors: T Tang David , F Lalonde Jan , H Lalonde Donald
Published: February 2017

Orbital floor fractures can result in diplopia, enophthalmos, hypoglobus and infraorbital dysthesia. Currently, the most common treatment for orbital floor fractures is immediate surgical intervention. However, there are a number of well-documented cases of unoperated orbital floor fractures in the literature, culminating in diplopia or enophthalmos in few patients. of these, none reported the diplopia or enophthalmos to be bothersome. As reported previously in the ophthalmology literature, most orbital floor fracture-induced diplopia resolves as the swelling settles, and the few patients with remaining diplopia can successfully be treated with surgery on the uninvolved eye. It has also been commented that most patients with enophthalmos are asymptomatic. The authors’ institution has more than 50 surgeon-years experience with delaying immediate surgery for two weeks to allow time for the swelling-induced diplopia to resolve. In the authors’ experience, true entrapment of the inferior rectus muscle is rare. The present article describes a study of late follow-up (average 945 days) of 11 nonoperated patients with orbital floor fractures. In the eight patients who initially presented with diplopia, there was resolution of functionally limiting double vision. Only one patient had asymptomatic, but measurably significant, enophthalmos at −3 mm. All patients had full restoration of extraocular movements and resolution of infraorbital dysthesia. None of the patients were exposed to the operative risks of ectropion, infection, implant extrusion, bleeding or blindness. The present study provides level IV evidence that delaying surgery up to two weeks after orbital floor fracture may avoid unnecessary surgical risks and inconveniences in many patients with orbital floor fracture.
Late Presentation of a Complete Complex Thumb Metacarpophalangeal Joint Dislocation: A Case Report
Authors: Izadpanah Arash , Wanzel Kyle
Published: February 2017

Metacarpophalangeal (MP) joint injuries and dislocations of the fingers and thumb are not uncommon. They can be classified directionally as either being volar or dorsal, and are further categorized as incomplete, simple complete or complex complete. Complex dislocations are described as dislocations that are irreducible and often require surgical intervention. This is often because tissue has become entrapped within the MP joint, precluding its anatomical reduction. for the thumb MP joint, anatomical structures that may become trapped include the volar plate, sesamoid bones, bony fracture fragments or the flexor pollicis longus tendon. Both dorsal and volar surgical approaches have been described, and their relative merits will be discussed. The unusual case of a late presentation (two months postinjury) of a complex complete dorsal dislocation of the thumb MP joint approached from a dorsal incision is presented.
Management of Pulmonary Hernia Through a Flail Segment in Closed Thoracic Trauma Using Open Reduction, Internal Fixation and Pectoralis Major Flap Reconstruction: A Case Report
Authors: T Lanier Steven , Wetterau Meredith , Smith-Singares Eduardo , Bilfinger Thomas , Vosswinkel James , J Shapiro Marc , B Dagum Alexander
Published: February 2017

The present article reports on the successful management of a large flail chest with traumatic pulmonary herniation in a patient who could not be weaned from mechanical ventilation following a course of conservative management. Surgical intervention involved open reduction and internal fixation with tubular plates to stabilize the flail segment, followed by a pectoralis major myocutaneous flap to repair the chest wall defect. Following surgical intervention, the patient was able to be weaned from mechanical ventilation and showed remarkable improvement in pulmonary function parameters. To the authors’ knowledge, the present report is the first to describe the use of open reduction and internal fixation of the chest wall and flap reconstruction to treat lung herniation with a flail chest segment.
The Effect of Incision Choice On Outcomes of Nipple-Sparing Mastectomy Reconstruction
Authors: Rawlani Vinay , Fiuk Julia , A Johnson Sarah , W Buck Donald , Hirsch Elliot , Hansen Nora , Khan Seema , A Fine Neil , Ys Kim John
Published: February 2017

INTRODUCTION

The indications for nipple-sparing mastectomy (NSM) are broadening as more breast surgeons appreciate the utility of preserving the nipple-areolar complex. A number of incision locations are available to the mastectomy surgeon, including inframammary, lateral and periareolar approaches. The present study investigated the effect of these three incisions on reconstructive outcomes; specifically, nipple necrosis.

METHODS

A single-centre, retrospective review of 37 breast NSM reconstructions treated with immediate tissue expander reconstruction with acellular dermis between 2007 and 2008 was performed. The primary outcome was the incidence of nipple necrosis associated with periareolar, lateral and inframammary incisions. Secondary outcomes were the effects of radiation, chemotherapy and breast size on nipple necrosis.

RESULTS

Thirty-seven breast procedures performed on 20 patients were included in the present study. Periareolar incisions were used in 21 cases, lateral incisions in 14 and inframammary incisions in two. The periareolar incision was associated with a significantly higher incidence of nipple necrosis compared with lateral or inframammary incisions (38.1% versus 6.3%, P=0.028). Patients receiving breast radiation (45.5% versus 15.4%, P=0.066) and those with larger breast size (540.4 g versus 425.7 g, P=0.130) also demonstrated a modest trend toward an increased rate of nipple necrosis.

CONCLUSION

The periareolar incision results in a higher rate of nipple necrosis following NSM and immediate tissue expander breast reconstruction. Using the lateral or inframammary incision reduces the incidence of nipple necrosis and may help improve overall reconstructive and cosmetic outcomes.
The Koebner Phenomenon and Breast Reconstruction: Psoriasis Eruption Along the Surgical Incision
Authors: Alolabi Noor , P White Colin , Dal Cin Arianna
Published: February 2017

The present report describes a recent case of recurrent infection in a breast reconstruction patient with a history of psoriasis. Following surgery, the patient developed psoriatic plaques along the incision scars. This phenomenon is known as Koebnerization, and has been found to affect surgical incisions. Cases of psoriatic patients being denied surgical procedures because of their inherent risk to Koebnerize have been previously reported. Similarly, such patients have been denied surgical procedures because of their increased risk of infection. The present case and literature review on this subject is described.
The Opportunities and Obstacles in Developing a Vascular Birthmark Database for Clinical and Research Use
Authors: K Sharma Vishal , Og Fraulin Frankie , Robertson Harrop A , F Mcphalen Donald
Published: February 2017

INTRODUCTION

Databases are useful tools in clinical settings. The authors review the benefits and challenges associated with the development and implementation of an efficient electronic database for the multidisciplinary Vascular Birthmark Clinic at the Alberta Children's Hospital, Calgary, Alberta.

METHODS

The content and structure of the database were designed using the technical expertise of a data analyst from the Calgary Health Region. Relevant clinical and demographic data fields were included with the goal of documenting ongoing care of individual patients, and facilitating future epidemiological studies of this patient population. After completion of this database, 10 challenges encountered during development were retrospectively identified. Practical solutions for these challenges are presented.

RESULTS

The challenges identified during the database development process included: identification of relevant data fields; balancing simplicity and user-friendliness with complexity and comprehensive data storage; database expertise versus clinical expertise; software platform selection; linkage of data from the previous spreadsheet to a new data management system; ethics approval for the development of the database and its utilization for research studies; ensuring privacy and limited access to the database; integration of digital photographs into the database; adoption of the database by support staff in the clinic; and maintaining up-to-date entries in the database.

CONCLUSIONS

There are several challenges involved in the development of a useful and efficient clinical database. Awareness of these potential obstacles, in advance, may simplify the development of clinical databases by others in various surgical settings.
A Breast Reconstruction Needs Assessment: How does Self-Efficacy Affect Information Access and Preferences?
Authors: Lam Andrea , Secord Scott , Butler Kate , Hofer Stefan OP , Liu Emily , Metcalfe Kelly A , Zhong Toni
Published: February 2017

Background

Breast cancer patients requiring mastectomy do not consistently receive information about post-mastectomy breast reconstruction (PMBR) surgery from the treatment team. Patients have varying levels of self-efficacy, defined as one's confidence in their ability to gather information and make health-related decisions. The present preliminary study was designed to evaluate the relationship between self-efficacy and access to PMBR information.

Methods

A qualitative interview study was conducted on a convenience sample of 10 breast cancer patients considering or having already undergone PMBR and six key health care provider informants. The modified six-item Stanford Self-Efficacy Scale for managing chronic disease was administered.

Results

Patient self-efficacy scores ranged from 5 to 9.3 (out of 10). Two main access to information themes were identified from the patient qualitative data: theme A – difficulty initiating the PMBR discussion; and theme B – perceived lack of access to PMBR information with the sub-themes of timing, modality, quantity and content of resources. All respondents expressed their concern over the absence of a standardized process for initiating the dialogue of PMBR. Patients also reported that credible and easily accessible information was not routinely available and expressed a desire to hear about their PMBR options early in the decision-making process.

Conclusions

Health care providers may need to assume more responsibility in standardizing information dissemination on PMBR. This information should be distributed early in the consultation process, the content should be complete, and there may be a role for individualizing the delivery of information based on a patient's level of self-efficacy.
Delayed breast reconstruction using the inverted latissimus dorsi musculocutaneous flap: A novel approach to create ptosis and projection
Authors: Alrasheed Taiba A , Ahmad Jamil , Zhong Toni , Hofer Stefan OP
Published: February 2017

The latissimus dorsi musculocutaneous flap is commonly used for delayed breast reconstruction. The authors present several technical refinements to better address the requirements for an aesthetically pleasing breast in delayed breast reconstruction including flap recipient site preparation, flap inset and breast shaping. The authors describe their modified technique using the inverted latissimus dorsi musculocutaneous flap and their experience in 27 consecutive patients following this type of delayed breast reconstruction. This novel approach provides improved breast ptosis and projection in delayed breast reconstruction.
The usefulness of the bilobed flap for lateral cheek defects
Authors: White Colin P , Rosen Nathan , Muhn Channy Y
Published: February 2017

The cheek and nose are common areas for skin cancers. There are multiple approaches to surgical excision and reconstruction, depending on the size of defect, tissue quality, adjacent cosmetic units and hairline. An effective solution to skin defects of the lateral cheek is the bilobed flap. This flap tends to be underused in the lateral cheek area because primary closure and skin grafts are perceived to be easier methods of reconstruction. However, the use of the bilobed flap for lateral cheek and other defect closures is encouraged. There are several basic principles that are key when performing this flap. These components of the procedure are highlighted.
What is the ultimate fate of presented abstracts? The conversion rates of presentations to publications over a five-year period from three North American plastic surgery meetings
Authors: Gregory Tournesol N , Liu Tianyi , Machuk Andrew , Arneja Jugpal S
Published: February 2017

Background

Advancements in clinical decision-making are influenced by presentations made at scientific conferences or publications in journals with extensive readership. However, many ideas shared at annual conferences fail to be published, and most surgeons attend these meetings only sporadically.

Objective

To quantify the conversion rates of meeting presentations to publications in North American plastic surgery.

Methods

MEDLINE (OvidSP) and PubMed databases were cross-referenced with abstracts accepted for podium presentation at the Canadian Society of Plastic Surgeons, American Society of Plastic Surgeons, and American Association of Plastic Surgeons annual meetings from 2003 to 2007. Parameters reviewed included publication rate, time to publication, subspecialty, trial type, publication journal and journal impact factor.

Results

Over the five-year study period, 45.00% of the 888 presentations were published in peer-reviewed journals. The mean time to publication was 22 months (range 1.00 to 85.90 months). In total, 57.00% of the 400 publications appeared in Plastic and Reconstructive Surgery; 47.20% of publications were case series study design. The majority of publications were of the reconstruction subspecialty (31.00%). Abstracts from the American Society of Plastic Surgeons had the highest conversion rate (57.70%). Publications based on abstracts presented at the American Association of Plastic Surgeons had the highest mean journal impact factor (2.33). The Canadian Society of Plastic Surgeons had the highest total number of publications (n=161).

Conclusions

From the three North American annual general meetings reviewed, there was a modest conversion rate of mainly reconstructive case series published predominantly in a single journal, Plastic and Reconstructive Surgery. Several years often pass from the genesis of a research hypothesis to final publication, and because the majority of presentations fail to be published, presentations should be observed with a critical eye given the more stringent peer review process and time required for final publication. In an effort to improve conversion rates, departments and faculty members must foster a culture that prioritizes publication.
Revisiting Gavello's procedure for single-stage reconstruction of the earlobe: The vascular basis, technique and clinical uses
Authors: Chattopadhyay Debarati , Gupta Souradip , Murmu Marang Buru , Guha Goutam , Gupta Sandipan
Published: February 2017

Background

Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello's procedure was one of the earliest.

Objective

To revisit Gavello's procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice.

Methods

The authors discuss the vascular basis of Gavello's flap, and describe the clinical application of the single-stage Gavello's procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe.

Results

Excellent cosmetic results have been achieved in all different clinical situations in the authors' experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area.

Discussion

Gavello's procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite.

Conclusion

The simple, century-old Gavello's procedure is still of great value for reconstruction of earlobe defects of diverse etiology.
Limited surgical treatment of suspected necrotizing fasciitis of the upper extremity with a benign clinical presentation
Authors: Gander Brian , Kaye Marc , Wollstein Ronit
Published: February 2017

Necrotizing fasciitis is a rapidly evolving, potentially fatal infection. Current recommendations advocate antibiotic administration and early aggressive surgical debridement. Aggressive surgery is associated with significant morbidity, leaving patients with substantial tissue loss and complex wounds. A case of suspected necrotizing fasciitis treated with minimal surgery is described.

A previously healthy 48-year-old man presented with increased erythema, swelling and blistering of his left upper extremity. Despite a benign systemic clinical presentation, the hand and forearm were suspicious for necrotizing fasciitis, prompting surgical treatment. Surgical exploration found a significant amount of intradermal and subdermal clear fluid. It was decided to limit the amount of debridement. The diagnosis was Wells syndrome, eosinophilic cellulitis. Treated with steroids, the wounds healed uneventfully.

It is important to consider the complete clinical picture before aggressive surgical treatment. A negative history for diabetes, atypical clinical presentation and benign operative findings are suggestive of a more benign diagnosis.
Preoperative pregnancy testing
Authors: Maher Janae L , Mahabir Raman C
Published: February 2017

Background

In up to 2% of all pregnancies, the need for general anesthesia in a nonobstetrical surgery arises. Surgery on a pregnant woman may have significant implications for the fetus, patient, physician and hospital. On review of the plastic surgery literature, the authors were unable to find current guidelines or recommendations for preoperative pregnancy testing in the plastic surgery patient population.

Methods

Literature regarding maternal and fetal risk during anesthesia and surgery, as well as preoperative pregnancy testing was identified by performing a PubMed, OVID and MEDLINE key word search. The current literature was subsequently reviewed and summarized.

Results

A report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation allows physicians and hospitals to implement their own policies and practices with regard to preoperative pregnancy testing. The overall frequency of an incidentally found positive preoperative pregnancy test ranges from 0.34% to 2.4%.

Discussion

Various studies have reported increased rates of spontaneous abortions, congenital anomalies, such as neural tube defects, and low and very low birth weight infants born to mothers exposed to anesthesia and surgery during pregnancy. Because the accepted practice is to postpone elective surgery during pregnancy, identifying these patients before surgery is critical.

Conclusions

Based on the current evidence, the authors' best practice recommendation for preoperative pregnancy testing is provided.
Reconstruction of the chin using an expanded deltopectoral flap following multiple recurrences of oral cancer
Authors: Balakrishnan Chenicheri , Hackenson David , Balakrishnan Anila , Elliott David , Careaga Daniel
Published: February 2017

An important alternative to free tissue transfer in patients requiring correction of soft tissue chin defects are local and regional flaps, such as the pectoralis major myocutaneous flap and deltopectoral flap. With predictable vascular supply, potential for large size, and good aesthetic match for facial and cervical skin, the deltopectoral flap can offer the reconstructive surgeon additional options in patients who lack vessels suitable for free tissue transfer. The use of an expanded deltopectoral flap for a staged reconstruction of the chin in a patient with cancer recurrences, concomitant resections, radiation and multiple reconstructions is reported.
Reconstructive or cosmetic plastic surgery? Factors influencing the type of practice established by Canadian plastic surgeons
Authors: Mcinnes Colin W , Courtemanche Douglas J , Verchere Cynthia G , Bush Kevin L , Arneja Jugpal S
Published: February 2017

Background

Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada.

Methods

An anonymous online survey regarding practice profiles was distributed to all 352 Canadian plastic surgeons with e-mail accounts registered with the Canadian Society of Plastic Surgeons and/or the Canadian Society for Aesthetic Plastic Surgery.

Results

The survey response rate was 34% (120 responses), of which 75% of respondents currently had a reconstructive practice and 25% had a cosmetic practice. Reconstructive surgeons had more educational debt following their training, spent more time on emergency call, academics and teaching and, when deciding which type of practice to establish, were more influenced by academic opportunities and less influenced by financial and nonfinancial metrics. Similarities between the groups included hours worked per week and academic achievements.

Conclusions

The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.
The effects of topical collagen treatment on wound breaking strength and scar cosmesis in rats
Authors: Sinno Hani , Malhotra Meenakshi , Lutfy Justyn , Jardin Barbara , Winocour Sebastian , Brimo Fadi , Beckman Lorne , Watters Kevin , Philip Anie , Williams Bruce , Prakash Satya
Published: February 2017

Background

Topical application of collagen has been suggested to enhance wound healing; however, its long-term effect on wounds has not been studied in a rat model.

Hypothesis

Topical application of collagen type I will not facilitate incision healing or cosmesis in rats up to 28 days postwounding.

Methods

The effects of bovine collagen type I (6 mg/mL) on the rat surgical paired skin incision model were examined. Each rat served as its own control in which topical collagen was applied to one incision while normal saline (0.9%) was applied to the other incision. Rats were euthanized three (n=6), seven (n=6) and 28 (n=5) days after wounding. Tissue harvested from each time point was examined for maximal breaking strength, and for biochemical and histological analysis.

Results

There were no statistically significant differences (ie, P<0.05) in maximum wound breaking strength between the collagen- and saline-treated wounds at all time points. Histological analysis revealed a similar infiltration of inflammatory cells and fibroblasts in the wound edges of all incisions when matched with time of wounding. Western blot analysis revealed no differences in fibronectin or collagen I content in all wounds in each rat.

Conclusions

The topical application of collagen did not facilitate wound healing from three to 28 days in the rat wound model.
An analysis of quantitative measurements of drainage exudate using negative suction in 96 microtia ear reconstructions
Authors: Xu Zhicheng , Zhang Ruhong , Zhang Qun , Xu Feng
Published: February 2017

Negative suction drainage is commonly used for the prevention of seromas or hematomas in auricular reconstruction surgery; however, there are few reports regarding the quantitative measurement of negative suction and its relation to disposed time, patient age or microtia type. In the present study, the authors recorded the volume of suction exudate in microtia reconstruction and elaborate on the relevant details of controlling negative suction. A negative suction drainage system was applied in 96 microtia patients between 2007 and 2010. Two small polyethylene drains were inserted adjacent to the concha and the scapha, respectively. The volume of exudate was recorded for three days after surgery and was analyzed according to disposed time, patient age and microtia type. The drains were removed on the third postoperative day, when only a small amount of exudate remained. A significant change in drainage was observed over three days postoperatively, and the quantity decreased progressively on the third postoperative day. Comparison of age groups showed that the volume of drainage from adults was greater than that from children or adolescents in the first two postoperative days, regardless of whether the drains were inserted in the scapha or concha. No statistical differences were found on the third postoperative day. A comparison of drain types revealed no statistically significant differences between scapha and concha drains three days postoperatively. The analysis demonstrated that drainage quantity is related to disposed time and patient age, but not to microtia type. The authors recommend removal of suction drains on the third postoperative day. Moreover, individualized negative suction treatment according to age or microtia type provides a safe and consistent approach to achieving acceptable results and fewer complications.
Factors that motivate people to undergo cosmetic surgery
Authors: Furnham Adrian , Levitas James
Published: February 2017

A sample of 204 British participants completed a questionnaire that assessed their attitude toward cosmetic surgery as well as measures of self-esteem, life satisfaction, self-rated physical attractiveness, religiosity and media consumption. Two factors emerged from a factor analysis of their attitudes toward surgery: likelihood to undergo, and benefits of undergoing, cosmetic surgery. Females with low self-esteem, low life satisfaction, low self-rated attractiveness and little religious beliefs who were heavy television watchers reported a greater likelihood of undergoing cosmetic surgery. Stepwise regression analysis with the two attitude factors as criterion variables showed two major predictors for likelihood: religiousness and low self-esteem, and four major predictors for benefit: religousness, media consumption, life satisfaction and sex. The role of religion is considered in this context.
Nonprogessive size reduction of limbs involved in giant congenital nevi: A magnetic resonance imaging study
Authors: De Greef Andre
Published: February 2017

Giant congenital nevi are hamartomas of neuroectodermal origin predominantly involving the trunk; two or more body segments are also commonly involved. A feature observed when giant congenital nevi are involved in a limb is a nonprogressive reduction in limb size. This feature has been evaluated, and demonstrates alterations only in the skin and subcutaneous tissue of the affected limb, with all other structures normal compared with the unaffected contralateral limb. The present magnetic resonance imaging study clearly demonstrates the substitution of subcutaneous tissue and fat cells by nevus cells, leading to a dramatic volume reduction in these tissues. The volumes of the deeper structures were not affected.
Plastic surgery wait times in Ontario: A potential surrogate for workforce demand
Authors: Cheung Kevin , Sweetman Arthur , Thoma Achilleas
Published: February 2017

Background

Accurate projections of plastic surgeon workforce requirements are essential to ensure a high standard of care and to properly allocate health care resources. Wait-time data were used to identify geographical areas that may benefit from additional plastic surgeons.

Methods

Plastic surgery wait times were analyzed using data from Ontario's Wait Time Information System for 2009 to 2010. Data were compared with benchmarks published by the Canadian Society of Plastic Surgeons, and plastic surgeon density was captured by the Ontario Physician Human Resources Data Centre.

Results

Aggregate plastic surgery wait times at the 90th percentile failed to meet targets based on priority. For priority 2 (target = 28 days) and priority 3 cases (target = 84 days), wait times were 35 and 101 days, respectively (P<0.05). Wait times also consistently exceeded provincial standards in the southwestern (Local Health Integration Network [LHIN] 2), eastern (LHINs 10 and 11) and northeastern (LHIN 13) regions of Ontario. A negative correlation (r=-0.37; P<0.05) between wait times and surgeon density for priority 4 cases was observed, suggesting that more surgeons per capita is associated with shorter wait times for these lower-priority cases. In contrast, a positive correlation was observed for priority 2 (r=0.50; P<0.05) and priority 3 cases (r=0.35; P<0.05).

Conclusion

Plastic surgery wait times in Ontario exceeded benchmarks in several geographical regions. Paradoxically, for high-priority cases, wait times were longer in LHINs with a higher density of plastic surgeons. Further investigation into patient mobility, physician practice patterns and the availability of hospital resources, such as hospital beds or operating room time, is required.
Concomitant sublay mesh repair of umbilical hernia and abdominoplasty
Authors: Mcknight Catherine L , Fowler James L , Cobb William S , Smith Dane E , Carbonell Alfredo M
Published: February 2017

Concomitant mesh repair of large umbilical hernias and abdominoplasty pose a serious risk of devascularizing the umbilical stalk. A technique of placing mesh in a sublay manner, deep to the fascial defect, for an umbilical herniorrhaphy to avoid damage to the deep umbilical perforators during an abdominoplasty is described.
A revised classification of the cleft lip and palate
Authors: Khan Mansoor , Ullah Hidayat , Naz Shazia , Iqbal Tariq , Ullah Tahmeed , Tahir Muhammad , Ullah Obaid
Published: February 2017

Background

Submucous cleft palate is characterized by muscular diastasis of the velum in the presence of intact mucosa with variable combinations of bifid uvula and hard palatal defect. Submucous cleft palate is indicated as a separate entity in most previous classifications but it has never been properly classified on an anatomical basis.

Objectives

To revise the Smith-modified Kernahan ‘Y’ classification of cleft lip and palate deformities, and to describe the different anatomical subtypes of submucous cleft palate.

Methods

The present study was conducted in Hayatabad Medical Complex, Abasin Hospital and Aman Hospital Peshawar, Pakistan, from November 2010 to December 2011. All patients who presented to the outpatient departments with cleft lip and palate, with the exception of previously operated cases, were included. All cases were described according to the Smith-modified Kernahan ‘Y’ classification and the authors' revised Smith-modified Kernahan ‘Y’ classification. All of the data were organized and analyzed using SPSS version 17 (IBM Corporation, USA).

Results

A total of 163 cases of cleft lip and palate deformities were studied, of which 59.5% were male and 40.5% were female. Smith modification of the Kernahan ‘Y’ classification completely described the cleft deformities in 93.9% of patients. However, while the Kernahan ‘Y’ classification represented the submucous cleft palate, it did not describe its different anatomical subtypes in 6.13% of patients. The revised Smith-modified Kernahan ‘Y’ classification completely described the cleft deformities of the entire study population, including the different submucous cleft palate patients.

Discussion

The Smith alphanumeric modification of the Kernahan ‘Y’ classification of cleft lip and palate came into existence after a long search and a series of modifications over the past century. This classification system describes the cleft region, site of the cleft, degree of the cleft, rare and asymmetrical clefts, and are computer database friendly. However, this classification did not describe the different anatomical subtypes of submucous cleft palate that have variable relationships with velopharyngeal insufficiency.

Conclusion

The revised Smith-modified Kernahan ‘Y’ classification described in the present study can describe all types of cleft lip and palate deformities in addition to the different types of submucous cleft palate deformities.
Breast reduction surgery in Ontario: Changes in practice, 1992 to 2008
Authors: Alshanawani Bisher , Alarfaj Nawarah , Alshomer Feras , Mamdani Muhammad , Gomes Tara , Mahoney James
Published: February 2017

Background

Symptomatic mammary hypertrophy impacts physical function and patient quality of life. Breast reduction mammoplasty, a surgical procedure performed to reduce breast size, has been used for many years to reduce these symptoms.

Objective

To evaluate variations in the surgical practice of breast reduction mammoplasty among women ≥15 years of age (approximately 6.4 million population in 2008) over a 17-year period in Ontario.

Method

A population-based, cross-sectional time series analysis was conducted to examine temporal trends in 87,049 breast reduction surgeries performed between January 1, 1992 and December 30, 2008.

Results

Breast reduction rates have been relatively stable over time, with 83 per 100,000 of the female population undergoing breast reduction surgery annually. However, a significant decrease in the rate of inpatient surgeries were observed over the study period (from 69.3 per 100,000 in 1992 to 25.7 per 100,000 in 2008). At the beginning of the study period, the highest annual rates of this procedure were observed among women 21 to 30 years of age (116.6 procedures per 100,000); however, by the end of the observation period, this shifted to women 31 to 50 years of age (109.9 procedures per 100,000). Furthermore, the annual procedure rate among women ≥51 years of age almost doubled, rising from 36.4 procedures per 100,000 in 1992 to 66.6 procedures per 100,000 in 2008. This was likely related to changing demographics and social factors.

Conclusion

These data suggest that breast reduction mammoplasty will continue to be requested, with an increased proportion of patients who are older and desire improved quality of life and physical function.
Computed tomography-based preoperative vascular imaging in autologous breast reconstruction: A Canadian perspective
Authors: Symonette Caitlin Jane , Gan Bing Siang
Published: February 2017

There appears to be increased use of computed tomography angiography (CTA) in the preoperative planning of autologous perforator flap breast reconstruction. Despite the advantages of providing superior anatomical detail, concerns regarding cost and radiation exposure of this technique remain. In the current study, a paper-based survey was distributed to 44 plastic surgeons with a special interest in breast reconstruction at 19 different centres across Canada to collect their perspectives and practice characteristics with respect to the use of CTA as a preoperative imaging modality in breast reconstruction. The response rate of the survey was 75%. The majority of respondents commonly use perforator flap breast reconstruction and CTA in their breast reconstruction practice. Surgeons identified particular benefits of CTA in patients who had previously undergone abdominal surgery. However, more than one-half of the overall cohort was concerned about radiation exposure associated with CTA. A review of the literature suggests that it may be worthwhile to reduce the unnecessary risks of additional radiation exposure to the breast cancer population. A prospective study may help to better define the group of patients in whom CTA will provide optimal benefits in terms of reducing perioperative microvascular morbidity.