bluuebunny/crossref_metadata_2025 huggingface dataset:
The utility of the microvascular anastomotic coupler in free tissue transfer
Authors: Grewal Amandeep S , Erovic Boban , Strumas Nick , Enepekides Danny J , Higgins Kevin M
Published: February 2017

Background

The microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. The microvascular anastomotic coupling device is an elegant, friction-fit ring pin device that is becoming more widely used.

Objective

To systematically review the literature to examine the utility of the microvascular coupler in free tissue transfer.

Methods

A comprehensive database search was performed to identify eligible publications. Inclusion criteria were anastomotic coupler utilization and free-tissue transfer. Recorded information from eligible studies included patient age, follow-up, radiation history, number of free-flaps and failure rates, reconstruction subsites, number of coupled venous and arterial anastomoses, coupling time, conversion to sutured anastomosis, coupler size and thrombosis rates.

Results

Twenty-five studies reporting on 3207 patients were included in the analysis. A total of 3576 free-flaps were performed within the following subsites: 1103 head and neck, 2094 breast, 300 limb or body, and 79 nonspecified. There were only 26 reported flap failures (0.7%). A total of 3497 venous and 342 arterial coupled anastomoses were performed. The primary outcome measure was thrombosis rates, and there were 61 venous (1.7%) and 12 arterial (3.6%) thromboses reported. Mean coupling time was 5 min, and 30 anastomoses (0.8%) were converted to suture.

Conclusion

Flap survival and revision-free application of the microvascular coupler occurred in more than 99% of cases. There is a substantial time savings with coupler use. Venous and arterial thrombosis rates are comparable with the best results achieved by sutured anastomosis and, when used by experienced surgeons, the coupler achieves superior results.
The effect of fibrin sealant on the prevention of seroma formation after postbariatric abdominoplasty
Authors: Lee Johnson C , Teitelbaum Jason , Shajan Josh K , Naram Aparajit , Chao Jerome
Published: February 2017

Background

Seroma formation is one of the most common complications following abdominoplasty. Fibrin sealant/glue has shown mixed results in seroma prevention when used in a variety of procedures. Limited information is available on its effectiveness during postbariatric abdominoplasty.

Methods

A retrospective chart analysis of 65 consecutive patients who underwent postbariatric abdominoplasty over a course of 16 months by a single surgeon was performed. Two sequential groups either receiving or not receiving fibrin sealant treatment were defined. Seroma formation and initial 24 h drain output volumes were recorded.

Results

Three patients in group 1 (9.1%) receiving fibrin sealant developed seroma. Twelve patients in group 2 (28.1%) not receiving fibrin sealant developed seroma; this was statistically significant (P=0.006). Twenty-four hour drain output was also statistically different, with higher initial output in the fibrin sealant group (222.2 mL versus 140.0 mL; P=0.047).

Conclusion

Fibrin sealant was a useful adjunct during surgical wound closure and significantly decreased seroma formation in patients undergoing postbariatric abdominoplasty.
The performance and publication of cost-utility analyses in plastic surgery: Making our specialty relevant
Authors: Thoma Achilleas , Ignacy Teegan A , Ziolkowski Natalia , Voineskos Sophocles
Published: February 2017

Increased spending and reduced funding for health care is forcing decision makers to prioritize procedures and redistribute funds. Decision making is based on reliable data regarding the costs and benefits of medical and surgical procedures; such a study design is known as an economic evaluation. The onus is on the plastic surgery community to produce high-quality economic evaluations that support the cost effectiveness of the procedures that are performed. The present review focuses on the cost-utility analysis and its role in deciding whether a novel technique/procedure/technology should be accepted over one that is prevalent. Additionally, the five steps in undertaking a cost-utility (effectiveness) analysis are outlined.
Challenges and strategies for determining workforce requirements in plastic surgery
Authors: Cheung Kevin , Sweetman Arthur , Thoma Achilleas
Published: February 2017

Background

Accurate projections of the future plastic surgeon workforce are essential to provide a high standard of care and to properly allocate scarce health care resources. This is not a straightforward task. Longstanding concerns over physician surpluses have been replaced by fears of physician shortages.

Methods

A review of previous efforts to predict future plastic surgeon workforce requirements highlights the challenges associated with deriving a solution. Physician workforce is dependent on numerous factors, including both physician-supply factors, such as practice patterns and age, and population-demand factors including disease burden and socioeconomic factors. Factors unique to plastic surgery, such as overlap with other specialties and performance of uninsured services, must also be considered. Previous strategies from other areas of medicine are described with associated strengths and weaknesses. These strategies include needs- and demand-based approaches, economic analysis and benchmarking. Finally, the need for appropriate outcomes from which to assess adequacy of physician supply is discussed.

Conclusions

Projections of future plastic surgeon workforce requirements must not only consider a multitude of physician supply and population demand factors, but also factors unique to plastic surgery. Future strategies to predict workforce requirements should balance the strengths and weaknesses of each approach with the data and outcomes available in plastic surgery.
Forehead reconstruction using a modified dual-plane a to t flap
Authors: Boustany Ashley , Ghareeb Paul , Mcclellan W Thomas
Published: February 2017

Forehead defects often present myriad challenges for the reconstructive surgeon. Many options exist for forehead reconstruction, from primary closure to free flaps. To optimally match colour, contour and texture, the best approach replaces ‘like with like’. When primary closure is not possible due to size limitations, and colour or depth is not suitable for grafts, then locoregional flaps become the mainstay of repair. The authors present three cases in which a dual-plane modified A to T flap is used to reconstruct central and lateral forehead defects up to 8 cm in size with excellent aesthetic results. This technique applies principles of the periglabellar flap, with modifications designed to encompass larger defects as well as defects of the lateral forehead.
Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures
Authors: Al-Qattan Mohammad M
Published: February 2017

Introduction

Iatrogenic comminution of the phalangeal head during management of phalangeal neck fractures has not been previously investigated.

Objective

To investigate the causes and outcomes of this particular iatrogenic complication.

Methods

A database of phalangeal neck fractures over a six-year period (2006 to 2011) was reviewed for this iatrogenic complication. Special attention was devoted to documenting the cause and pattern of comminution of the phalangeal head, as well as the outcome in range of motion.

Results

Of 152 cases treated during the study period, there were five (two children and three adults) with comminution. Two patterns of comminution were encountered: splitting and fragmentation of the phalangeal head. The complication occurred during open reduction and K-wire fixation, or during closed reduction in the emergency room. The outcome was generally poor and worse in patients with fragmentation of the entire head. Two of the five cases ultimately resulted in medicolegal claims.

Conclusion

Comminution of the phalangeal head is a serious iatrogenic complication that may occur during the management of phalangeal neck fractures. Awareness of this complication is important and attempts should be made to avoid it.
Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review
Authors: Bastu Ercan , Akhan Suleyman Engin , Mutlu Mehmet Firat , Nehir Asli , Yumru Harika , Hocaoglu Emre , Gungor-Ugurlucan Funda
Published: February 2017

Background

Congenital vaginal agenesis is a rare malformation with an incidence of one in 4000 to 5000 female newborns. The purpose of vaginal agenesis treatment is not only to create an adequate passageway for penetration but also to facilitate satisfactory sexual intercourse.

Objective

To present the results of a modified McIndoe technique with respect to sexual function, vaginal length and complication rates in patients with vaginal agenesis.

Methods

Between 2002 and 2010, 23 patients with vaginal agenesis were admitted to the Gynecology Clinic of Istanbul University School of Medicine (Istanbul, Turkey) for vaginal reconstruction. All patients underwent a modified McIndoe procedure. The long-term results with a follow-up period ranging from 18 to 118 months are presented.

Results

The postoperative mean vaginal length was 8.4 cm (range 6 cm to 11 cm) in 19 patients who used the mould regularly. Among 14 patients who used the mould regularly and had partners, only one experienced severe pain during intercourse and 13 reported that they were engaging in satisfactory sexual activity with mild or no pain, and with good mucosal sensitivity. Conversely, two of three patients who used the mould irregularly experienced severe pain during intercourse and had a mean vaginal length of 6 cm (range 4 cm to 8 cm).

Conclusion

The findings suggest that a modified McIndoe technique is a simple, effective procedure for the treatment of vaginal agenesis; however, proper mould use after surgery remains the cornerstone of the treatment.
A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance
Authors: Gupta Sandipan , Chattopadhyay Debarati , Murmu Marang B , Gupta Souradip , Singh Hari S
Published: February 2017

Background

Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome.

Methods

The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors' knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction.

Results

The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required.

Conclusions

This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.
Beta-blockers for the treatment of problematic hemangiomas
Authors: Sharma Vishal K , Fraulin Frankie OG , Dumestre Danielle O , Walker Lori , Harrop A Robertson
Published: February 2017

Objective

To examine treatment indications, efficacy and side effects of oral beta-blockers for the treatment of problematic hemangiomas.

Methods

A retrospective review of patients with hemangiomas presenting to the Alberta Children's Hospital Vascular Birthmark Clinic (Calgary, Alberta) between 2009 and 2011 was conducted. The subset of patients treated with oral beta-blockers was further characterized, investigating indication for treatment, response to treatment, time to resolution of indication, duration of treatment, occurrence of rebound growth and side effects of therapy.

Results

Between 2009 and 2011, 311 new patients with hemangiomas were seen, of whom 105 were treated with oral beta-blockers. Forty-five patients completed beta-blocker treatment while the remainder continue to receive therapy. Indications for treatment were either functional concerns (68.6%) or disfigurement (31.4%). Functional concerns included ulceration (29.5%), periocular location with potential for visual interference (28.6%), airway interference (4.8%), PHACES syndrome (3.8%), auditory interference (0.95%) and visceral location with congestive heart failure (0.95%). The median age at beta-blocker initiation was 3.3 months; median duration of therapy was 10.6 months; and median maximal treatment dose was 1.5 mg/kg/day for propranolol and 1.6 mg/kg/day for atenolol. Ninety-nine patients (94.3%) responded to therapy with size reduction, colour changes, softened texture and/or healing of ulceration. Rebound growth requiring an additional course of therapy was observed in 23 patients. Side effects from beta-blockers included cool extremities (26.7%), irritability (17.1%), lower gastrointestinal upset (14.3%), emesis (11.4%), hypotension (10.5%), poor feeding (7.6%), lethargy (4.8%), bronchospasm (0.95%) and rash (0.95%). Side effects did not result in complete discontinuation of beta-blocker treatment in any case; however, they prompted a switch to a different beta-blocker preparation in some cases. Resolution of the primary indication, requiring a median time of three months, occurred in 87 individuals (82.9%).

Conclusions

Treatment of infantile hemangiomas with oral beta-blocker therapy is highly effective and well tolerated, with more than 94% of patients demonstrating a response to treatment and 90% showing resolution of the primary functional indication for treatment.
Contractility of sphincter pharyngoplasty: Relevance to speech outcomes
Authors: Hubbard Bradley A , Rice Gale , Muzaffar Arshad R
Published: February 2017

Background

Sphincter pharyngoplasty has demonstrated time-tested results as a surgical treatment for velopharyngeal incompetence (VPI). However, controversy surrounding the contractility of the transposed muscles persists. Completely unaddressed in the literature is whether the dynamism of the sphincter affects speech outcomes.

Objective

To determine whether active sphincter contraction following sphincter pharyngoplasty influences velopharyngeal closure, nasal emission and hypernasality.

Methods

A prospective analysis of patients with VPI after cleft palate repair undergoing sphincter pharyngoplasty by a single surgeon was performed. Video nasendoscopy and videofluoroscopy were performed preoperatively and postoperatively at three and 12 months. Eighteen consecutive patients with cleft palate with or without cleft lip and VPI were reviewed. The average age of the patients at initial evaluation was 7.3 years, with a range of three to 19 years. Dynamicity of sphincter pharyngoplasty, velar closing ratio (VCR), and lateral wall movement (LWM) were assessed by nasendoscopy and videofluoroscopy. Nasal emission and hypernasality were assessed by perceptual speech examination.

Results

For longitudinal comparison, three groups were created: dynamic at three and 12 months (n=12); adynamic at three months and dynamic at 12 months (n=4); and adynamic at three and 12 months (n=2). Perceived hypernasality scores significantly improved at three months (P=0.0001) and showed continued improvement at 12 months (P=0.03), despite no change in VCR and LWM from three to 12 months. There were no significant differences among the three groups at any time point.

Discussion

Sphincter pharyngoplasty effectively treats VPI in appropriately selected patients. Although the VCR and LWM remained stable between three months and one year, four of six adynamic sphincters became dynamic. Considering all patients, hypernasality showed continued improvement from three months to one year.

Conclusions

There were no differences between dynamic and adynamic sphincters in terms of speech outcomes or the mechanical properties of velopharyngeal closure.
Post-facelift flap necrosis treatment using charged polystyrene microspheres
Authors: Weissman Oren , Farber Nimrod , Remer Eric , Tessone Ariel , Trivizki Omer , Bank Jonathan , Winkler Eyal , Zilinsky Isaac , Haik Josef
Published: February 2017

Background

Flap necrosis following facial rhytidectomy constitutes a vexing and grievous complication to the patient and the surgeon. Treatment modalities that can expedite wound healing and re-epithelialization rates are highly desired.

Objectives

To assess wound healing and re-epithelialization rates of open wounds following postrhytidectomy flap necrosis treated with commercially available charged polystyrene microspheres (Polyheal-1, Polyheal Ltd, Israel).

Methods

Flap necrosis following rhytidectomy with open wounds in three female patients were treated using dressings soaked with Polyheal-1. Wound closure rates were documented.

Results

The wounds demonstrated both accelerated granulation tissue formation and rapid re-epithelialization rates. No complications or side effects were encountered.

Conclusions

Charged polystyrene microspheres may offer a new and efficacious way to treat open wounds due to flap necrosis following facial rhytidectomy. Further research with larger patient numbers is still needed to verify these findings.
Differences in breast aesthetic outcomes due to radiation: A validated, quantitative analysis of expander-implant reconstruction
Authors: Mioton Lauren M , Gaido Jessica , Small William , Fine Neil A , Kim John Y
Published: February 2017

Background

The potential ramifications of radiation use can be of particular concern in the breast reconstruction population, in which both surgical and aesthetic outcomes are important. Presently, there remains a paucity of data detailing the influence of radiation on specific reconstruction aesthetic outcomes.

Objective

To conduct a quantitative evaluation of aesthetic outcomes for expander-implant breast reconstruction in radiated and nonradiated patients using a validated scoring scale.

Methods

A series of consecutive expander-implant breast reconstruction operations performed by the senior author between 2004 and 2012 were reviewed. Four blinded members of the Division of Plastic and Reconstructive Surgery at Northwestern University (Illinois, USA) independently rated postoperative photographs of patients' breasts using a validated scoring scale with respect to five distinct aesthetic domains.

Results

Of the 206 patients meeting the inclusion criteria, 69 received radiotherapy and 137 did not. The radiated cohort had lower scores in each aesthetic domain, with significant differences in contour (1.33 versus 1.51; P=0.041) and placement (1.45 versus 1.73; P<0.001). Linear regression analysis revealed a significant association between placement scores and radiation, and radiated patients had a significantly higher overall rate of complications.

Discussion

Variances in scores may represent the relative difficulty of expansions and proper implant placement in irradiated tissue, with possible skin fibrosis and decreased flexibility hindering prosthesis manipulation.

Conclusion

Radiation adversely impacts breast contour and placement, with possible negative contributions to volume, scarring and inframammary fold definition, and results in higher rates of complications. Such detailed evaluation of the impact of radiation on aesthetics will enhance the management of patient expectations.
Implant-associated anaplastic large cell lymphoma of the breast: Insight into a poorly understood disease
Authors: Weathers William M , Wolfswinkel Erik M , Hatef Daniel A , Lee Edward I , Hollier Larry H , Brown Rodger H
Published: February 2017

Implant-associated anaplastic large cell lymphoma (ALCL) is the subject of much debate in the field of plastic surgery. Only a few published cases have been reported and the rarity of the disease may make proving causality exceedingly difficult. Despite this, it is of utmost importance that full attention be devoted to this subject to ensure the safety and well-being of patients. The authors report one new case of implant-associated ALCL that recently presented to their institution. Implant-associated ALCL is a poorly understood disease. It should likely be considered its own clinical entity and categorized into two subtypes: one presenting as a seroma and the other as a distinct mass or masses. When reported, only textured implants have been associated with ALCL. The United States Food and Drug Administration and American Society of Plastic Surgeons have initiated a registry and have collected critical data to gain further understanding of this disease.
Elevation as a treatment for fasciotomy wound closure
Authors: Bengezi Omar , Vo Anthony
Published: February 2017

There are currently numerous techniques described in the literature that attempt to optimize wound closure following a fasciotomy. However, primary closure of fasciotomy wounds continues to be difficult to accomplish successfully because of the underlying edema sustained from the compartment syndrome. The approach described in the present report is simple and physiologically sound, and addresses the underlying pathology. The authors focus on alleviating edema by strictly elevating the limb, followed by primary closure. Twelve consecutive fasciotomy wounds, referred from 2005 to 2012, were closed using this approach. The average wound closure time was 3.4 days (range three to five days) following the initial consultation. All 12 fasciotomy wounds responded with no revisions, complications, failures or loss of skin sensation. The approach was successful in all anatomical locations that were closed and conversion to any techniques currently available in the literature was not necessary. There are no costs associated with this approach, making it practical in settings with limited resources. It has a high success rate, superior cosmetic results and, most importantly, it achieves an efficient closure time. Therefore, this approach is superior to current techniques and should be a part of a plastic surgeon's armamentarium.
The differing perceptions of plastic surgery between potential applicants and current trainees: The importance of clinical exposure and electives for medical students
Authors: Tahiri Youssef , Lee James , Kanevsky Jonathan , Thibaudeau Stephanie , Gilardino Mirko
Published: February 2017

Background

Exposure to plastic surgery during medical school is limited. Most interested applicants form their perceptions of careers in this surgical specialty during elective rotations.

Objective

To investigate the perceptions of Canadian medical students considering a career in plastic surgery. The results obtained were then compared with current Canadian plastic surgery residents' perceptions.

Methods

The data were collected via two separate self-administered online surveys that were distributed to either Canadian plastic surgery residents or medical students. The questionnaires were similar and focused on three aspects: applicant details; driving force behind interest in the field; and essential character traits and competencies related to successful matching.

Results

Fifty-nine plastic surgery residents and 477 medical students participated in the online survey. The most commonly reported driving forces for interest in a plastic surgery career in both groups were variety of career choice, complexity of the field, future lifestyle and enjoyable rotations in plastic surgery. Despite these similarities, the proportion of medical students and residents who opted for future lifestyle and enjoyable rotations differed in a statistically significant manner (P=0.015 and P=0.029, respectively). In terms of the essential competencies to match into a plastic surgery training spot, the groups differed statistically in their opinions on the relevance of intellect (P<0.001), manual dexterity (P<0.001), spatial sense (P<0.001) and clerkship grades (P=0.004).

Conclusion

Interested applicants should be encouraged to obtain as much elective experience as possible to assist both students in their career choice and selection committees in identifying capable applicants.
The transverse upper gracilis flap: Efficiencies and design tips
Authors: Buchel Edward W , Dalke Kimberly R , Hayakawa Thomas Ej
Published: February 2017

The transverse upper gracilis free flap is a well-described option for breast reconstruction. The technique is a secondary choice for autologous breast reconstruction because the abdomen remains the primary donor site for breast reconstruction. However, in appropriately selected patients, the authors believe that the transverse upper gracilis flap remains a reliable flap for breast reconstruction. Its consistent anatomy, potentially reasonable donor site scar, limited functional morbidity and simultaneous two-team surgical approach make this flap a viable option for many patients. The technique, however, is not without drawbacks – known numbness of the medial thigh and the potential for chronic lymphedema of the lower leg, contour deformities of the medial thigh, and widening of the medial thigh scar need to be considered.

The current article presents a harvest technique that is reliable, rapid and addresses each of the above-mentioned limitations with specific changes in the traditional technique. The article provides video documentation of the modified harvest technique using only monopolar cautery for the dissection.
Twelve-year delay of a nipple-sharing graft: A case report
Authors: Cypel Tatiana KS , Brown Mitchell
Published: February 2017

The present report describes the use of a nipple-sharing technique for nipple areolar reconstruction using a donor nipple that was initially grafted from the contralateral and healthy breast 12 years earlier. There are many different techniques available to reconstruct the nipple. Although nipple sharing is not feasible to use in all patients, when available, it is an ideal approach for matching the contralateral nipple in terms of shape, colour, texture and long-term projection.
Long Term Results Following Immediate Reconstruction of Orbital Fractures: A Critical Morphometric Analysis
Authors: Dawar Meenakshi , Antonyshyn Oleh M
Published: February 2017

M Dawar, OM Antonyshyn. Long term results following immediate reconstruction of orbital fractures: A critical morphometric analysis. Can J Plast Surg 1993; 1(1):24-29. The purpose of this study is to review the long term morphological results following primary reconstruction and bone grafting of orbital fractures. All patients presenting to the Victoria General Hospital in Halifax, Nova Scotia between July 1988 and December 1990 with orbital fractures of sufficient severity to require immediate reconstruction were included in the study. The series consists of 39 fractured orbits in 29 patients. In all patients, a standardized data sheet was used in recording patient demographics, and clinical and intraoperative findings. The surgical management of orbital fractures and in particular the redraping of periorbital soft tissues was performed according to a standard protocol. Long term morphometric assessment was performed between 11 and 38 months postoperatively, with a mean follow-up of 27 months. A McCoy facial trisquare and Hertel exophthalmometer were used in the anthropometric evaluation of ocular globe position and position of the periorbital soft tissue landmarks. Postoperative assessment of globe position revealed a 5% incidence of enophthalmos and an 11 % incidence of hyperophthalmia. Minor asymmetries in globe position measuring less than 2 mm were noted in a further 61 % of patients. Ectropion was documented in 8% of patients, but an asymmetry in the height of the palpebral fissure was noted in a further 34% of patients. In terms of canthal relations, lateral canthal dystopia was the most commonly observed deformity, with vertical dystopia occurring in 18% of patients and transverse dystopia in 33% of patients. The observed sequelae and complications of orbital fractures are discussed and possible causative factors identified.
The Double Microhook: A Simple Device to Facilitate Microanastomosis
Authors: Frcsc Tim R Sproule Md
Published: February 2017

TR Sproule. The double microhook: A simple device to facilitate microanastomosis. Can J Plast Surg 1993;1(1):47-49. Inherent tissue elasticity has always been a difficult factor to overcome in surgery, and this is particularly so in microsurgery. Vessel and nerves tend to retract once they are divided, and this elastic retraction must be reversed in order to accomplish an anastomosis. A simple concept, easily applied in any operating room, is presented in several variant forms that is of great use in microsurgical procedures, particularly those performed in difficult situations or without experienced assistants.
Remote Acute Suppurative Tenosynovitis Secondary to Carpal Tunnel Release Under Local Anaesthesia
Authors: Hughes Lowell A , Knutson Gordon H
Published: February 2017

LA Hughes, GH Knutson. Remote acute suppurative tenosynovitis secondary to carpal tunnel release under local anaesthesia. Can J Plast Surg 1993; 1(2):95-97. A case of acute suppurative tenosynovitis following carpal tunnel release under local anaesthesia is presented. This complication is believed to have resulted from injection contamination of the flexer tendon sheath during the administration of local anaesthesia. This is supported by the fact that the incisional wound remained healthy and healed uneventfully.
Comparison of Functional Recovery Following Median And/Or Ulnar Nerve Repair in Children and Adults
Authors: Joubert Diane , Caouette-Laberge Louise , Wood-Dauphinee Sharon , Jones Lynette A
Published: February 2017

D Joubert, L Caouette-Laberge, S Wood-Dauphinee, LA Jones. Comparison of functional recovery following median and/or ulnar nerve repair in children and adults. Can J Plast Surg 1993;1(3): 123-127. Functional recovery was investigated in a group of 17 children and 17 adults with a median or ulnar nerve microsurgical repair performed at least one year before the assessment. Motor and sensory function, tactile gnosis, manual dexterity, pain and perception of disability were assessed. Statistically significant differences were found between the two groups with respect to two-point discrimination, tactile gnosis, manual dexterity, pain and self-report of performance in daily activities, with the children demonstrating better functional recovery than the adults. There was little difference between the two groups when motor recovery was studied. The widely accepted belief that children recuperate better than adults after a nerve injury may not apply to all aspects of recovery.
Mastoid Skin Island Flap: A Simple Technique for Conchal Defect Reconstruction
Authors: Antonyshyn O
Published: February 2017

O Antonyshyn. Mastoid skin island flap: A simple technique for conchal defect reconstruction. Can J Plast Surg 1993; 1(3): 137-140. Conchal defects resulting from tumour excision can pose a difficult reconstructive problem. These defects generally involve the entire concha and occasionally extend to the external auditory canal. Under these circumstances, skin graft reconstruction is unsuitable. A simple technique of conchal reconstruction using a mastoid skin island flap is described. The flap provides a reliable one-stage reconstruction of the concha and posterior conchal wall.
The Modified Open Rhinoplasty
Authors: Glickman Laurence T , Lee Gene W
Published: February 2017

LT Glickman, GW Lee. The modified open rhinoplasty. Can J Plast Surg 1993;1(3):131-136. Despite considerable attention in the past 10 to 20 years, the open rhinoplasty remains a controversial procedure. Advocates of this technique argue that the exposure and thus the surgical manoeuvres it makes are unequalled. Detractors argue that the transcolumellar scar left by the procedure is unacceptable and is most often unnecessary. This report describes a modification of the open rhinoplasty which has most of the advantages of the open approach, but is performed without the external incision. The procedure, its advantages and drawbacks, and comparisons among the modified open, open and closed rhinoplasty are described. It is concluded that the modified open rhinoplasty is an excellent surgical approach that can be used on most patients and that it provides wide exposure without an external incision.
The Seamless Bra: Early Impressions of Endoscopic Augmentation Mammaplasty
Authors: Mclean Hugh A
Published: February 2017

HA McLean. The seamless BRA: Early impressions of endoscopic augmentation mammaplasty. Can J Plast Surg 1993; 1(3): 113-115. This is a personal observation of early experience with breast augmentation by remote access (bra) with endoscopic visual assistance. The purpose is to inform readers of this recently developed technique as seen from a ‘learning curve’ of 15 cases. The nature, purpose, limitations, difficulties and anticipated benefits are briefly described. Scientific conclusions are neither possible nor attempted at this time.
Facial Fractures: Associated Injuries and Complications
Authors: Thomson J Grant , Brown Harvey C , Brown Rea A , Fleiszer David M
Published: February 2017

JG Thomson, HC Brown, RA Brown, DM Fleiszer. Facial fractures: Associated injuries and complications. Can J Plast Surg 1994;1(4):160-165. The forces necessary to produce a facial fracture are often high enough to cause other severe, life-threatening injuries. Despite this knowledge, little is known about the frequency or nature of these injuries. A retrospective chart review was performed on 162 facial fracture patients for associated injuries and complications. These patients were divided into high velocity (n=95) and low-velocity (n=67) groups based on the mechanism of injury, and were compared with a group of 346 multiple trauma patients who did not sustain any facial fracture. Those patients involved in high-velocity accidents had a significantly higher proportion of multiple facial fractures (40%), presence of associated injury (84%), complication rate (38%), mortality rate (9.5%), mean hospital stay (45 days), and mean trauma score (20.1±1.3) when compared with patients in low-velocity accidents (10%, 12%, 10%, 4.3 days and 4.7±0.6, respectively). Although high-G facial bone fractures were more frequent in high-velocity accidents, high-G fractures were not an independent indicator of the severity of injury as measured by the trauma score. The most significant indicator of severity of injury was the mechanism of injury. Pulmonary (15%), cerebral (11 %), septic (7%), abdominal (7%) and cardiac (2%) complications after high-velocity injuries were more frequent than previously reported. Although cervical spine injury has traditionally been associated with facial fractures, the results of this study demonstrated that spinal injury can occur at any vertebral level, and was equal in frequency in patients with and without facial fractures. Statistical analysis of occupant restraint revealed that there was no significant difference between the numbers of patients wearing their seat belts (11) and those not using them (12), the proportions with high-G, low-G, or multiple facial fractures, the incidence of head injury or other associated injuries, the trauma score, and the times spent in the surgical intensive care unit and hospital. Although the lack of significance is probably attributable to the low documentation of seat belt use, the question of the efficacy of seat belts in preventing facial fractures and associated injuries is raised. Patients with facial fractures had a significantly higher mean trauma score (27.9±1.4) and incidence of head injury (54%) compared with patients without facial fractures (23.2±0.7 and 11%, respectively). The surgical treatment of this group of facial fracture patients was analyzed.
Malignant Tumours of the External Ear
Authors: Karsli Cengiz H , Antonyshyn Oleh M , Forrest Christopher R , Assaad Dalai , Ackerman Ida
Published: February 2017

CH Karsli, OM Antonyshyn, CR Forrest, D Assaad, I Ackerman. Malignant tumours of the external ear. Can J Plast Surg 1994;1(4): 177-183. This study employs a retrospective chart review to describe the demographic features, clinical presentation and treatment of malignant tumours of the external ear. This series includes 129 tumours of the external ear in as many consecutive patients presenting to the Toronto Bayview Regional Cancer Centre between January 1986 and December 1991. Sixty-seven per cent of those tumours were basal cell carcinomas, 32% were squamous cell carcinomas, and a single case of Kaposi's sarcoma was encountered. The majority of patients was male and the mean age was 70.1 years. The helical rim was the most common site of involvement, followed by the postauricular, conchal and antihelical regions. Small tumours were located in the visually obvious areas of the ear, namely the helix and lobule, whereas larger tumours were found in the deeper central portions such as the concha and external auditory meatus. Twelve per cent of squamous cell carcinomas were metastatic at the time of treatment. Treatment methods included electrodesiccation and curettage, surgical excision with or without frozen sections, radiotherapy or combination therapy. Surgical excision, with frozen section control in carefully selected cases, remains the treatment of choice for the majority of external ear tumours. Various methods of reconstruction of the resulting defects are described.
Relief of Sympathetically Maintained Pain Associated with a Venous Malformation of the Hand Using Intravenous Regional Guanethidine
Authors: Hopper Richard A , Anderson Kenneth
Published: February 2017

RA Hopper, K Anderson. Relief of sympathetically maintained pain associated with a venous malformation of the hand using intravenous regional guanethidine. Can J Plast Surg 1994;1(4):188-190. A 28-year-old woman with a venous malformation of the hand, unresponsive to previous surgical therapy, experienced significant relief from her incapacitating symptoms after a series of four intravenous regional guanethidine blocks. The effects of the blocks lasted an average of six weeks each. Continuation of the treatments was delayed following an unexpected hypersensitivity reaction to the last block. The case would suggest a sympathetic component to this malformation-associated pain. Further assessment of the effect of this relatively simple, easily repeated treatment on other malformations is indicated.
Teflon prosthesis in orbital floor fracture
Authors: Harris Patrick G , Delorme Roger-Paul , Charbonneau Roland , Ciaburro Hugo , Frenette Gilles
Published: February 2017

Primary bone grafting is the recommended treatment for orbital floor fractures with bone defects, but this technique has a greater operative morbidity than the simpler use of the Teflon prosthesis. This study evaluates the use of the Teflon prosthesis. In 9 years, 110 patients with 115 orbital floor fractures were treated with Teflon prostheses. Of those, 90 patients had only orbital floor or orbito-zygomatic fractures and 20 had panfacial fractures. The mean operative time was 87 mins. Seventy-seven patients had good results. Complications included diplopia, ectropion, enophthalmia and palpable prosthesis. Seven prostheses required removal between three and 11 months postoperatively. No prosthesis became infected. Orbital floor reconstruction with a Teflon prosthesis is a relatively simple and short procedure associated with a low morbidity, giving good results except in cases of severe floor defects.
Does Silicone Gel Migrate Via Lymphatics After Subcutaneous Injection?
Authors: Narini Philip P , Semple John L , Hay John B , Lugowski Stan J , Smith Dennis
Published: February 2017

PP Narini, JL Semple, JB Hay, SJ Lugowski, D Smith. Does silicone gel migrate via lymphatics after subcutaneous injection? Can J Plast Surg 1994;2(2):67-70. Reports have documented the presence of elemental silicon, evidence of silicone elastomer, or silicone polymers (gel) in lymph nodes and other sites distant from implanted prostheses. It has been suggested that this occurs via the lymphatic system; however, the mechanism of spread or migration of silicone has not been previously studied. This study investigated the possible role of lymphatics in the migration of silicone gel. In the sheep model, it is possible to obtain continuous samples of both afferent and efferent lymph by cannulating lymphatic vessels. The drainage areas of subcutaneous lymph nodes in the sheep have previously been studied. In our model, the efferent lymphatic vessel from the prefemoral lymph node was cannulated to obtain samples of lymph (efferent and ‘pseudoafferent’). After baseline samples were collected, 3 to 5 mL of free silicone gel was injected subcutaneously in the drainage area of this node. Samples (5 to 10 ml.) of lymph were continuously collected (for up to 50 days), sealed, stored at −20°C, and then submitted as a group for trace element analysis to quantitate the levels of elemental silicon. No statistically significant increase was seen in baseline levels of elemental silicon after silicone gel injections. Statistically significant higher levels of silicon were found in afferent (mean 799 ± 22 part per billion [ppb]) compared with efferent lymph (mean 607 ± 19 ppb). This experimental study did not identify significant increases in elemental silicon levels in lymphatic vessels after the subcutaneous introduction of free silicone gel. Higher levels were found in afferent versus efferent lymph. This implies that migration of silicone gel does not occur soon after the exposure of a subcutaneous space to free silicone gel, or that the migration of silicone gel may occur by a cellular mechanism that can bypass the lymphatic vessels.
Extensor Digitorum Brevis Manus - Report of a Case and Treatment Planning
Authors: Glickman Laurence T , Brewer Bruce W
Published: February 2017

LT Glickman, BW Brewer. Extensor digitorum brevis manus – Report of a case and treatment planning. Can J Plast Surg 1994;2(2):95-96. The extensor digitorum brevis manus muscle (edbm) is an anomalous extrinsic extensor that may occur in up to 3% of the population and may produce symptoms and signs that are very similar to those of a dorsal ganglion. We report a case of edbm in a male whose diagnosis was made intraoperatively. He remains symptom free following surgical resection.
Injury to the Collateral Ligaments of the Metacarpophalangeal Joints of the Fingers
Authors: Harris Patrick G , Mosher John F
Published: February 2017

PG Harris, JF Mosher. Injury to the collateral ligaments of the metacarpophalangeal joints of the fingers. Can J Plast Surg 1994;2(3): 125-129. Injury to the collateral ligaments of metacarpophalangeal (mcp) joints of the fingers has not been given much attention in the literature compared with the more frequently encountered lesion involving the thumb (‘game keeper's’ or ‘skier's’ thumb). Nevertheless, such lesions can result in significant disability if not appropriately treated. To prevent this, awareness of the pathology is required. Pain and lateral instability at the mcp joints may be the only signs. The anatomical lesions vary in sites. Instability to laterally directed stress in full mcp flexion is diagnostic. Most lesions heal with corrective immobilization with the mcp joint at 40° or 45° and ‘buddy taping’ of the fingers. Surgery, through a dorsal approach, is required in cases of rotated or significantly displaced bony attachment and in chronic instability.
A Granular Cell Tumour of the Digital Nerve – An Unusual Occurrence
Authors: Al-Qattan MM , Born T , Thomson HG , Becker LE
Published: February 2017

MM Al-Qattan, T Born, HG Thomson, LE Becker. A granular cell tumour of the digital nerve - An unusual occurrence. Can J Plast Surg 1994;2(4): 177-178. Granular cell tumours most frequently occur in the head and neck. Granular cell tumours of peripheral nerves are rare and, to our knowledge, have not been previously described involving digital nerves. A case of a benign granular cell tumour of the ulnar digital nerve of the little finger is described along with a review of granular cell tumours of the hand.
Enhanced Peripheral Neovascularization of Musculocutaneous Flaps Following Pedicle Ligation in the Pig
Authors: Clarke Howard M , Chen Guozhang
Published: February 2017

HM Clarke, G Chen. Enhanced peripheral neovascularization of musculocutaneous flaps following pedicle ligation in the pig. Can J Plast Surg 1994:2(4): 159-163. The augmentation of blood flow from the periphery following dominant pedicle ligation was studied in island latissimus dorsi muscle and musculocutaneous flaps in the pig. In the first study, a musculocutaneous flap and a muscle flap covered with a skin graft were raised on two sides of the same pig (n=25). Silicone rubber sheeting inhibited revascularization from the base. From one to seven days later the dominant vascular pedicles were ligated and blood flow from neovascularization to the flap was assessed immediately using radiolabelled 15 μm microspheres. The peripheral neovascularization of muscle and musculocutaneous flaps was not different when assessed at the time of pedicle ligation. Comparison with a previous study of flap survival, however, revealed that increased blood flow was seen in flaps in which the pedicle had been ligated two days prior to rather than at the time of assessment. Therefore, in a second study, musculocutaneous flaps were raised bilaterally and from one to eight days later the pedicle was ligated on one side only (n=29). After two days of further neovascularization the blood flow to the components of the flaps was assessed using 15 μm microspheres. Significant enhancement of peripheral neovascularization was seen in all animals in which two days had elapsed between pedicle ligation and the assessment of neovascularization (P<0.05). In addition, the flows seen in the skin component of the flaps were substantially greater than normal, suggesting a delay-like phenomenon.
Lightning Injury: A Review and Case Presentations
Authors: Edelstein Jerome , Peters Walter , Cartotto Robert
Published: February 2017

J Edelstein, W Peters, R Cartotto. Lightning injury: A review and case presentations. Can J Plast Surg 1994;2(4):164-168. Lightning injuries are relatively uncommon, although thousands are affected each year. Many patients are left with permanent sequelae. This type of injury is very different from other high voltage electrical injuries. Lightning burns are usually superficial and only about one quarter of those struck by lightning will actually die. The number of deaths can be reduced if proper early resuscitative methods are used. Two lightning-strike victims are presented. The first patient suffered transient neurological abnormalities, eye and ear injuries including permanent sensorineural hearing loss, and superficial burns over 70% of his body surface area. The second patient, who wore bilateral arm prostheses, was struck by lightning while driving his motor boat. The lightning welded one of his prostheses to the steering wheel of the boat. He sustained a 10% partial thickness burn, but had no permanent sequelae. A review of the current literature is presented, including the pathophysiology, multisystem clinical features and treatment of lightning injury.