bluuebunny/crossref_metadata_2025 huggingface dataset:
What is the Ideal Replacement for the Scapholunate Ligament in a Chronic Dissociation?
Authors: Harvey Ej , Hanel D
Published: February 2017

An ideal replacement for the scapholunate ligament has not been found. The carpometacarpal bone-ligament-bone complex at the base of the third metacarpal can be used as a replacement for the scapholunate ligament. A cadaveric study of matched scapholunate ligament and third metacarpal-capitate was carried out. Data for stiffness and strength were obtained from fresh frozen specimens tested to failure with a hydraulic distractor. The third metacarpal-scaphoid ligament most closely approximated the stiffness and the strength of the scapholunate ligament. Operative replacement of the scapholunate ligament with the third metacarpal-scaphoid replacement was accomplished. Clinically, the performance of the operation is facile and, in the present study, was not associated with increased morbidity or duration of surgery compared with other options.

This study indicates that the third carpometacarpal ligament approximates the mechanical properties of the scapholunate ligament and is a good alternative for replacement surgery.
Unexpected Hematoma Due to Heparin Prophylaxis in Transverse Rectus Abdominis Musculocutaneous Flap Reconstruction
Authors: Shaikh Ayaz , Bain James R
Published: February 2017

Prophylaxis with standard low dose subcutaneous heparin has been shown to significantly decrease the risk of deep vein thrombosis and pulmonary embolism, without major bleeding complications. The present report describes a case of unexpected hematoma formation, possibly secondary to subcutaneous low dose heparin injection that was administered in the anterior abdominal wall in a patient who had previously undergone a transverse rectus abdominis musculocutaneous flap reconstruction.
Part II: Reformers in Medical Education and Practice
Authors: Entin Martin A
Published: February 2017

Background

Part I was published in Can J Plast Surg 2000;8(1):25–29. It established that standards of professional practice shift constantly. When a standard falls short of professional expectation or when a physician becomes more concerned with financial gain rather than patient care, society needs the action of a reformer. Part II continues the study and begins with the contribution of reformer John Hunter (1728–1793), and follows with the contributions of seven other reformers, concluding with Wilder Penfield (1891–1976).

Study Design

The reformers were physicians and scientists who were selected throughout the history of medicine: they conformed to our definition of reformers, namely, a person whose action changed the structure or ideology of medical practice.

Results

The present historical article shows that reforms are produced by people possessing critical judgement and analytical quality who influenced the direction of medical practice.

Conclusion

Reforms have been achieved through intuitive leaps, alterations of conventional practice, painstaking research or administrative restructuring.
Surgical Management of Favre-Racouchot Syndrome
Authors: Skoulakis Charalambos , Manios Andreas , Chimona Theognosia , Tsiftsis Dimitrios
Published: February 2017

Background

Nodular elastosis of the skin or Favre-Racouchot syndrome presents as thick yellow plaques with cysts and comedones around the periorbital area in people with prolonged exposure to ultraviolet radiation.

Objective

To demonstrate the surgical management of Favre-Racouchot syndrome.

Methods

Surgical excision of affected skin in a 55-year-old farmer with Favre-Racouchot syndrome and reconstruction of skin defects by using a local flap and a free graft were performed.

Results

Skin lesions were successfully excised with an acceptable aesthetic result, and the patient's condition was excellent two years after the removal.

Conclusion

Surgical treatment for Favre-Racouchot syndrome is recommended when there are extensive lesions by using either local flaps or free grafts.
Extensor Indicis Proprius Tendon Transfer for Extensor Pollicis Longus Rupture
Authors: Thoma Achilleas , Quttainah Adel
Published: February 2017

Six of 13 patients who underwent extensor indicis proprius (EIP) tendon transfer for extensor pollicis longus (EPL) rupture between 1985 and 1998 were available for long term assessment of the function of the thumb. The presenting problem was the inability to extend the thumb at the interphalangeal (IP) joint. Postoperatively, there was no extension lag at the IP joint of the thumb. Three patients had slightly reduced flexion at the IP joint compared with the unaffected thumb. Five patients showed no extension lag at the metacarpophalangeal (MCP) joint, whereas one patient had an extension lag of 28°. The mean active flexion at the IP joint of the thumb was 64.5° (range 50° to 77.5°). The mean extension deficit of the index finger at the MCP joint was 7° (range 0° to 20°) compared with the unaffected side that was 5° (range 0° to 12°). Measurements of key pinch and pinch grip were 94% and 82% in the unaffected hand, respectively. Subjective assessment by the patients was rated as excellent by four patients and good by two patients. This particular tendon transfer is recommended for the treatment of EPL rupture.
Hand Injuries in Farmers: A 10-Year Review
Authors: Miles Duncan Ag , Bendago Mm , Beveridge Ja , Chang Ps , Lee Ch
Published: February 2017

A retrospective review of hand injuries in farmers was carried out in the Regina Health District. One hundred twelve injuries requiring hospitalization were recorded over 10 years. Injuries presented throughout the year, with a peak in August that was associated with the harvest. An increased rate of injury was also associated with age. Entanglement in machinery comprised 84% of injuries, of which swathers, power take-offs, combines and augers made up the majority of causes. Eighty-one per cent of injuries were open, with injury to the index, long and ring fingers being most common. The overall amputation rate was 30%. Patterns of injury relating to each machine were collected, and from these results a classification system is proposed.
Aesthetic Plastic Surgery Education: The Vancouver Approach
Authors: Mahabir Raman C , Carr Nicholas J , Thompson Robert P , Warren Richard J
Published: February 2017

The challenges in developing resident training in aesthetic surgery persist. To address this issue, the plastic surgery residency program at the University of British Columbia created a senior resident aesthetic clinic in place of the previous preceptor-based program. The clinic is now entering its sixth year. An outline of the program is presented, and issues that are relevant to the design and function of senior resident aesthetic clinics are discussed.
Functional assessment of the sciatic nerve after repair with local delivery of FK 506 in rats
Authors: Nelluri Pramod K , Lyons Robert C , Nastala Chet L , Garza Jaime R
Published: February 2017

Difficulties with nerve repair are addressed principally in two ways – one is a meticulous apposition of nerve fibres by microsurgical techniques and the other is the facilitation of the regeneration of proximal axons by neurotrophic factors. The latter concept essentially involves optimizing the microenvironment at the site of injury by biochemical influences. FK 506 (tacrolimus), an immunosuppressive agent, has been recently found to have nerve regenerative potential in experimental animals; however, the various toxic effects of the drug, when used systemically (which has been the case in all of these experiments), limit its clinical use. To prevent such toxic effects of FK 506 in a nerve injury model, a local drug delivery method was developed by suspending a known concentration of FK 506 in fibrin glue (fibrin sealant) to release slowly 1 mg of the drug at the local site.

Materials and Methods

The sciatic nerve was transected in 18 rats and primary microsurgical repair was performed. Rats in group 1, the control group, had transection and primary repair, those in group 2 had transection and primary repair reinforced with fibrin sealant, and those in group 3 had primary repair that was reinforced with fibrin sealant and FK 506 (1 mg). A walking track analysis was performed, beginning in the second week, to evaluate functional recovery of the sciatic nerve.

Results

Overall, the animals that received FK 506 showed earlier recovery than those in the control group. Further, mean footprint length factors of the rats in group 3 showed significant early improvement between four and five weeks after surgery, whereas the improvements in groups 1 and 2 started toward normalization a week later, between five and six weeks after surgery. The experimental goal of the study was to determine whether locally delivered FK 506 is beneficial to nerve regeneration.
Strain pattern in the upper facial skeleton: Preliminary model development
Authors: Goldberg Cory Scot , Fialkov Jeffrey Allan
Published: February 2017

In the human upper facial skeleton, the patterns of strain caused by physiological loading are not known. It is generally accepted that these patterns can be predicted based on the morphology of the bone, but this is not necessarily the case. The elucidation of these patterns of strain has a significant impact on the plating techniques of facial fractures, the development of bone substitutes and tissue-engineered bone, and the understanding of facial development. The goal of this study was to initiate the development of a model that could be used to measure strain magnitude and direction in the upper facial skeleton from physiological loading of facial musculature.

A strain gauge was bonded to the lateral orbital rim of a cadaveric skull that had been dissected, leaving only muscular origins and insertions intact. Braided nylon straps were sutured to the origins and insertions of the masseter and levator labii superioris, and these were pulled individually using a hydraulic testing machine. When the masseter origin was pulled, the recorded strain increased with increasing force and the angle of the strain corresponded directly to the angle of pull. When the levator labii superioris origin was pulled, the angle of strain was directed anteriorly and inferiorly, but did not correspond with the axis of the muscle or the axis of the lateral orbital rim where the strain gauge was located.

It was concluded that this model is reliable and reproducible for investigating strain magnitude and direction in the human upper facial skeleton.
A superiorly based, externally pedicled nasolabial flap for the repair of complex nasal tip defects
Authors: Krajden Selig , Van Brenk Bert , Semple John L , Brown Mitchell H
Published: February 2017

The reconstruction of nasal tip defects can often be quite challenging. For small or superficial defects, primary closure, secondary healing or skin grafting are common options. For larger, full thickness defects with exposed cartilage, local or distant flaps are usually required. An experience using a superiorly based, externally pedicled nasolabial flap for full thickness nasal tip defects in six patients is described. The reconstruction is performed in three stages, allowing for aggressive thinning and debulking of the flap at the time of final insetting. The flap has good excursion with a wide arc of rotation, allowing it to be used in a variety of complex nasal tip defects. Patient satisfaction with the eventual outcome has been excellent.
Limitations of studying keloid scars using the nude athymic mouse model
Authors: Hillmer Mp , Salama S , Macleod Sm
Published: February 2017

Keloid scars are benign fibroproliferative growths that respond poorly to treatment. This study sought to determine the efficacy of three different glucocorticoids (triamcinolone, methylprednisolone and dexamethasone) in altering human keloid scar tissue implanted in athymic mice.

Keloid tissue obtained from three patients (one man and two women) who sought cosmetic removal of their scars was implanted into athymic mice for a duration of 15 or 30 days. The keloid tissue was examined histopathologically and evaluated by a dermatopathologist who was blinded to sample identity and who was using predetermined qualitative scoring criteria. The appearance of central calcification, granulation tissue, foreign body granulomatous reaction and acute inflammatory reaction complicated the comparison of the keloid tissue samples. However, on the basis of observations reported in the present paper, it appears that triamcinolone should remain the treatment of choice for keloid scars. The athymic mouse model that is used for studying keloid scars is the best available approach to in vivo studies; however, limitations identified in this study confound the interpretation of experimental data. Ideally, promising and novel therapies should be investigated clinically.
The Split Skin Graft Donor Site: Can Pretreatment with Vitamin a Cream Help?
Authors: Skoll Pj , Soldin M , Grob M , Seymour B , Davies J , Rode H , Hudson Da
Published: February 2017

Background

A skin graft donor site that heals rapidly with less cosmetic sequelae is of particular benefit to children with burns. Vitamin A cream has been shown to speed up healing after controlled ‘burns’ (dermabrasion and CO2 laser) if it is applied six weeks before treatment.

Objective

To assess whether pretreatment with vitamin A cream increases the rate of healing of split skin graft donor sites in children with burns.

Methods

Prospective study of children with hot water burns of 8% to 30% that required split thickness skin grafting. Vitamin A cream was applied bidaily to one thigh and/or buttock of each child for five to seven days before skin grafting. At surgery, equal thickness grafts were harvested from both thighs and/or buttocks. Biopsies were taken from each thigh and/or buttock and were sent for histological analysis. The rate of donor site healing was monitored clinically and with serial photographs.

Results

No difference in the rate of healing was noted between the treated and untreated sides by either histological or clinical criteria.

Conclusions

Vitamin A cream applied bidaily for a period of five to seven days did not affect the healing rate of the split skin graft donor sites in children with burns.
Survival properties of third-generation silicone gel breast implants
Authors: Peters Walter , Lugowski Stanley
Published: February 2017

From 1992 through 2001, 100 third-generation silicone gel breast implants were removed from 50 women who had undergone cosmetic breast augmentation. The main reasons for explantation were: ptosis in 16 patients (32%); to further increase implant size in 15 patients (30%); suspected silicone-related health problems in 11 patients (22%); medical disease in five patients (10%); and breast firmness and pain in three patients (6%). Of the 100 third-generation gel implants, 42 were manufactured by McGhan Medical, 38 by Surgitek, 10 by Cox-Uphoff and 10 by Dow Corning. The 42 McGhan implants had been in place for two to 15 years (mean 8.8 years), the 10 Cox-Uphoff implants for seven to 14 years (mean 9.4 years), and the 10 Dow Corning implants for five to 12 years (mean 8.1 years). All the McGhan, Cox-Uphoff and Dow Corning implants were clinically intact at explantation. By contrast, of the 38 Surgitek third-generation implants, which had been in place for three to 13 years (mean 7.9 years), only 28 were intact. Ten (26%) had already disrupted. A comparison of Kaplan-Meier survival curves indicated that the 62 third-generation gel implants manufactured by McGhan, Cox-Uphoff and Dow Corning were much more durable than 271 previously explanted second-generation gel implants. By contrast, the 38 third-generation Surgitek gel implants were less durable than the 271 second-generation implants.
Bilateral thigh and calf compartment syndromes following elective surgery: Case report and review of the literature
Authors: Bengezi Omar A , Ogilvie Ra , Bain James R
Published: February 2017

Bilateral thigh and calf compartment syndromes are rare in pediatric patients, especially following elective foot surgery. Such a case in a child with attention deficit hyperactivity disorder is described in the present report. This child was taking multiple medications, including Ritalin (methylphenidate hydrochloride), Paxil (paroxetine hydrochloride) and clonidine. Other factors that potentially contribute to the multiple compartment syndromes include pneumatic tourniquet use and caudal block augmentation of general anesthesia. Behaviour associated with attention deficit hyperactivity disorder complicated the detection of the patient's compartment syndromes. The development of the compartment syndromes was delayed more than 48 h on one side. The potential for this patient's pharmacotherapy to have contributed to the development of the compartment syndromes is discussed.
Recurrent Venous Thrombosis following Free Flap Surgery: The Role of Heparin-Induced Thrombocytopenia
Authors: Nikolis Andreas , Christopoulos Apostolos , Saint-Cyr Michel , Cordoba Carlos , Guertin Louis , Harris Patrick G
Published: February 2017

Complications following free tissue transfer have been well established in the literature. Common and rare causes of free flap failure must be addressed by the treating surgeon when microvascular patency is threatened. With the evolution and prevalence of microsurgery, ‘rare’ causes of free flap failure will become increasingly frequent. A high index of suspicion must be established in patients with multiple failed operative interventions. A case of recurrent free flap failure secondary to heparin-induced thrombocytopenia is presented in a patient with a history of squamous cell carcinoma of the floor of the mouth, and a long-standing history of alcohol and tobacco consumption.
Reducing Patient Discomfort during Digital Blockade: The Subcutaneous Single Injection Digital Block – A Simple, Safe and Fast Procedure
Authors: Brutus JP , Nikolis A , Baeten Y , Chahidi N , Kinnen L , Ledoux P , Moermans JP
Published: February 2017

Background

Regional anesthesia of a single finger is commonly achieved by the traditional ring block, which requires at least two painful injections in the digit. Single injection digital block techniques have been described to avoid this problem. Among these, the subcutaneous technique described by Harbison appears to be safe and to allow most procedures to be carried out with good tolerance.

Objectives

A prospective study was designed to evaluate the results of the subcutaneous technique in terms of patient tolerance, distribution of anesthesia and efficiency.

Methods

All blocks were performed by a single investigator. A visual analog scale was used to evaluate pain associated with the injection. Prick testing was used to evaluate the quality of anesthesia at the volar and dorsal aspects of the phalanxes. Tolerance to the surgical procedure and the need for additional injections were also recorded.

Results

This technique allowed surgery to be performed without complementary injection most of the time and was very well tolerated. The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory.

Conclusion

The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows the treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a combined single injection technique or a supplementary dorsal block should be used.
The effects of cold preservation and subimmunosuppressive doses of FK506 on axonal regeneration in murine peripheral nerve isografts
Authors: Myckatyn Terence M , Hunter Daniel A , Mackinnon Susan E
Published: February 2017

Background

FK506 is a frequently used immunosuppressant with neuroregenerative effects. The neuroregenerative and immunosuppressive mechanisms of FK506, however, are distinct, suggesting that FK506 may stimulate nerve regeneration at lower doses than are needed to induce immunosuppression. The effects of cold preservation, a technique known to improve axonal regeneration through nerve allografts, are not well studied in nerve isografts and are also reported here.

Objectives

To determine the effects of subimmunosuppressive doses of FK506 and cold preservation on nerve regeneration in isografts.

Methods

The neuroregenerative properties of immunosuppressive and subimmunosuppressive doses of FK506 were compared in a murine model receiving either fresh or cold preserved nerve isografts. Sixty female BALB/cJ mice were randomized into six groups. Animals in groups I, III and V received fresh nerve isografts. Animals in groups II, IV and VI received cold-preserved nerve isografts. Mice in groups I and II received no medical therapy, while those in groups III and IV received subimmunosuppressive doses of FK506, and those in groups V and VI received immunosuppressive doses as confirmed by mixed lymphocyte reactivity assays. Nerve regeneration was evaluated with histomorphometry and functional recovery was evaluated with walking track analysis.

Results

Pretreatment with cold preservation did not significantly affect neural regeneration. The potent neuroregenerative effect of immunosuppressive doses of FK506 was confirmed, and the ability of subimmunosuppressive doses of FK506 to stimulate axonal regeneration in murine nerve isografts is reported.

Conclusions

Less toxic subimmunosuppressive doses of FK506 retaining some neuroregenerative properties may have a clinical role in treating extensive nerve injuries.
Nonsurgical Treatment of Protruding Ears: A Case Report and Review of Literature
Authors: Smith W Gary , Toye Jw , Smith Rw
Published: February 2017

The nonsurgical correction of congenital ear deformities has been reported in the world literature. To date, there has been little interest in this procedure in pediatric centres and no reports in the Canadian literature. Two case reports are presented with a review of the literature. A description of this simple, user friendly office procedure is presented.
Recognition of potential morbidity after use of the radial artery as a conduit for coronary artery revascularization
Authors: Hallock Geoffrey G
Published: February 2017

The use of the radial artery as an alternative vascular conduit for coronary bypass surgery has become increasingly popular. The plastic surgery experience with radial forearm flaps has shown that sacrifice of the radial artery is not always a benign maneuver. The potential morbidity after using this conduit donor site in terms of hand dysfunction or wound healing problems can be significant, and frequently must ultimately be addressed as part of the role of the reconstructive surgeon. Case examples of skin necrosis, subsequent forearm wound infection and hypertrophic scarring after radial artery harvest are presented to introduce this as a real concern and to allow a review of the entire spectrum of potential problems in this regard. Any selection process where the radial artery may be chosen as the coronary revascularization conduit must anticipate these known donor site complications.
Early Major Complications of Endoscopic Carpal Tunnel Release: A Review of 1200 Cases
Authors: Tse Raymond W , Hurst Lawrence N , Al-Yafi Tawfeik A
Published: February 2017

Although the early benefits of endoscopic carpal tunnel release have been demonstrated, there is great controversy regarding the risks and safety of the technique. The present study reports early major complications in a series of 1278 consecutive cases performed by a single surgeon over a seven-year period. All procedures were performed under local anaesthesia on an outpatient basis using the Agee single portal technique. Mean follow-up was three months.

No vascular, tendon or permanent nerve injuries were documented. Recurrent or persistent symptoms occurred in 7% of patients for which 20 of 89 underwent subsequent open carpal tunnel release. No nerve injuries were found on re-exploration. Other complications were consistent with previously reported incidences.

This is the largest reported case series by a single surgeon and represents an accumulation of surgical experience at the upper end of the learning curve. Endoscopic carpal tunnel release is a safe procedure in this experienced single surgeon series.
Estimating Implant Size in Chin Augmentation: A Simplified Approach
Authors: Fanous Nabil , Yoskovitch Adi
Published: February 2017

A receding chin, colloquially known as a weak chin, is a significant aesthetic impediment to a pleasing face. Multiple techniques exist to evaluate the poorly projecting chin, but most are imprecise when it comes to choosing the proper implant size. This choice is further complicated by the impracticality of commercially available chin implants. Most implant manufacturers offer only three to four categories of implants (small, medium, large, etc) that differ in size from one company to another, making the choice of the proper implant size a real challenge.

The present paper discusses a new approach to precise sizing of the chin implant, based primarily on the degree of chin convexity (curvature of the chin pad) in the profile view. Examples of mentoplasties performed using the chin convexity principle are presented.
Free flaps for head and neck cancer reconstruction: Does the use of both large cervical vessels as recipient vessels and the employment of end-to-side technique enhance flap survival?
Authors: Hashem Fk
Published: February 2017

This study specifically investigates whether the use of both large cervical vessels (the external carotid artery and the internal jugular vein) as recipient vessels with end-to-side anastomosis enhance free flap survival in head and neck cancer reconstruction, when compared with the use of other standard smaller neck recipient vessels and end-to-end anastomosis. A total of 84 consecutive patients were included and were divided into two groups (42 in each group) according to the recipient vessels. The overall vessel thrombosis rate was 6% (five of 84 cases) and the overall flap loss rate was 2.4% (two of 84 cases) yielding a flap salvage rate of 60%. Vessel thrombosis occurred in three cases of the smaller vessels group and in two cases of the large cervical vessels group. This was not statistically significant.
Carpal Tunnel Syndrome and Workers' Compensation: A Cross-Canada Comparison
Authors: Watts Robyn J , Osei-Tutu Kannin B , Lalonde Donald H
Published: February 2017

Carpal tunnel syndrome (CTS) is the source of substantial workers' compensation claims in industrialized countries. Its pathogenesis, however, continues to be questioned. The purpose of the present study was to assess the attitudes of Canadian plastic surgeons toward Workers' Compensation Board (WCB)-supported claims for CTS and to assess patterns of resource allocation across Canada.

Sixty-seven plastic surgeons were asked to read a clinical scenario and respond whether they would support a WCB claim for CTS. Provincial WCB offices were contacted and asked to provide statistics surrounding CTS claims for 1997 to 2001. Fifty-eight per cent (39 of 67) of surgeons surveyed felt that CTS should be covered as a WCB claim, while 42% (28 of 67) felt that it should not be covered by WCB. In British Columbia, 50% (six of 12) of surgeons were in support of the claim compared to 92% (11 of 12) of those from Alberta, 55% (17 of 31) of those from the Central Provinces and 42% (five of 12) of those from the Maritime Provinces. Trends of resource allocation and number of CTS claims per year are presented for the individual provinces for 1997 to 2001.

An extensive literature review revealed that there is minimal to no evidence to support the view that CTS should be a compensated claim. As defined by the WCB of Canada, a compensated claim is one that “arises out of, and in the course of, employment and that results from causes and conditions peculiar to the trade, occupation or industry.” The ambiguity in the beliefs of Canadian plastic surgeons in supporting CTS as a WCB claim reflects a situation where many of the decisions to cover CTS as a WCB claim are not evidence based.
Extramammary Paget's disease of the perineum: Avoiding pitfalls in diagnosis and management
Authors: Chandawarkar Rajiv Y , Ricchuiti Daniel , Amjad Ibrahim , Marsico Robert E , Wells Mark D
Published: February 2017

Extramammary Paget's disease (EMPD) is a rare entity, especially in the perinoscrotal region, and typically presents in elderly white patients as a pruritic white or red patch in the area of distribution of apocrine glands. Typically, it affects a single site. Since its manifestations are insidious and easily misdiagnosed, the appropriate manage-ment is delayed. Management of this problem is complex and effective treatment can not only lower recurrence rates but also pro-vide an optimal reconstructive result.

The present report describes three patients with scrotal EMPD. Based on literature search, the etiopathology, diagnosis and management of these lesions is discussed. Reconstructive options, with special emphasis on scrotal lesions, are also discussed.
Graves' exophthalmos: Volumetric assessment of orbital expansion
Authors: Grover Ramon S , Mainprize James , Ing Edsel , Antonyshyn Oleh M
Published: February 2017

Introduction

Graves' ophthalmopathy is characterized by an increase in the volume of orbital soft tissue contents and an associated increase in intraorbital pressure. Surgical expansion of bony orbital volume is therefore an effective method of treating moderate to severe exophthalmos. Numerous correlations between specific decompression procedures and reduction of proptosis have been made. The main emphasis of the majority of these studies, however, appears to be of a qualitative nature rather than quantitative.

Objectives

To quantitatively examine the consequences of surgical orbital decompression in the treatment of severe Graves' exophthalmos, with respect to changes in ocular globe projection and orbital soft tissue and bony volume.

Material and Methods

A series of three patients (five orbits) with severe exophthalmos were evaluated. All patients were operated on by a single surgeon using a standard technique of orbitozygmatic osteotomy in conjunction with three-wall orbital decompression and release of periorbita. Data obtained from standardized preoperative and three-month postoperative computed tomography scans were transferred to an offline computer workstation. Scalar and volumetric parameters were quantitatively analyzed to determine changes in globe projection in relation to intraorbital volume differences.

Results

Following surgery, mean globe retrodisplacement from the lateral orbital rim and from the optic foramen were 6.7 mm and 3.3 mm, respectively. Osteotomy and decompression were effective in producing an 18.6% increase in bony orbital volume. However, the volume of intraorbital soft tissues increased substantially following surgery, with a 23.4% increase in orbital fat volume and a 12.2% increase in neurovascular tissue volume.

Conclusions

The degree of globe retrodisplacement achieved by surgical expansion of the bony orbital cavity in patients with Graves' ophthalmopathy may be less than anticipated, due to a post-operative increase in the intraorbital soft tissue volumes.
Necrotizing Fasciitis Following a Motor Vehicle Accident with Candida Species As the Sole Organisms
Authors: Eisen Daniel Brian , Brown Erin
Published: February 2017

Necrotizing soft-tissue infections exclusively due to Candida species are rare and not usually considered in the differential diagnosis of this devastating condition. When documented previously, Candida species are generally proposed to be a saprophytic component of multibacterial synergistic infection often associated with streptococcal species. We report a case of a 51-year-old man who developed necrotizing fasciitis secondary to Candida infection following a motor vehicle accident. His clinical presentation was very similar to that of clostridial gas gangrene. The only organisms isolated from tissue culture were Candida albicans and Candida tropicalis. Histopathology confirmed yeast forms and pseudohyphae within the debrided tissue specimens. No bacteria were identified on any of the wound swabs or tissue specimens. Our report is the first that reveals Candida as the sole identifiable cause for necrotizing fasciitis following trauma. Candida should be considered in the differential diagnosis of causative organisms for necrotizing fasciitis and infective myonecrosis.
Use of Groin Flap in the Closure of Through and Through Defect of a Forearm: A Case Report
Authors: Balakrishnan Chenicheri , Pane Thomas A , Khalil Abdullah J
Published: February 2017

The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. It is used regularly by many reconstructive surgeons for covering soft tissue defects of the hand. Although the development of various fasciocutaneous free flaps during the 1980s decreased the attractiveness of the groin flap, these flaps can be used in reconstructing significant defects of the forearm and hand where free tissue transfer is not feasible.
Avulsion of the Flexor Digitorum Tendon Secondary to Enchondroma of the Distal Phalanx
Authors: Wong Winnie , Cross Karen , Mahoney James
Published: February 2017

Flexor digitorum profundus (FDP) tendon avulsion is a common injury in sports. This is secondary to forced extension against flexor digitorum profundus contraction. However, avulsion injury of the FDP tendon secondary to an enchondroma of the distal phalanx is extremely rare. There have only been three previous reports of such an occurrence. This report describes a fourth case of an avulsion injury of the FDP tendon secondary to enchondroma of the distal phalanx of the fourth digit.
Acute Median Nerve Compression Neuropathy From a Foreign Body in the Forearm
Authors: Balakrishnan Chenicheri , Mercurio Jeffrey De , Gursel Eti
Published: February 2017

Acute compression of the median nerve in the forearm usually occurs from compartment syndrome. A case of acute compression neuropathy of the median nerve from a foreign body, where there was no evidence of compartment syndrome, is reported. The diagnosis was made from the patient's symptoms and radiographs. Early recognition and decompression of the forearm with removal of the foreign body led to full recovery.
Necrotizing Fasciitis: Diagnosis and Management of An Occult Infective Focus
Authors: Chandawarkar Rajiv Y , Jessie Timothy A , Pennington Gary A , Wells Mark D , Cervino A Lawrence
Published: February 2017

Necrotizing fasciitis is a life-threatening, fulminant disease that is a diagnostic and therapeutic challenge. Presenting with a triad of findings including progressive erythema, severe dermatological edema and severe pain disproportionate to the physical findings, this disease is a surgical emergency. Delayed diagnosis and surgical debridement lead to higher mortality. Early extensive surgical debridement, aggressive antibiotic therapy, invasive monitoring and intensive care management determine the outcome in most cases. In patients who fail to demonstrate clinical improvement, profound sepsis and its sequela – systemic inflammatory response – have frequently been implicated. It is these patients that need to be carefully re-evaluated for hidden’ foci of infection that may be the real cause of the patient's decline. Once detected, these occult foci can be surgically debrided, resulting in dramatic improvement. Two illustrative cases, one with occult endo- and panophthalmitis and the other with an unusual involvement of deeper muscle planes and the nodal basin, demonstrate this point. This consumptive process gathers momentum at an alarming speed, hence, the treatment must be aggressive and prompt.
Extensor Quadriga: Pathomechanics and Treatment
Authors: Chinchalkar Shrikant J , Gan Bing Siang , Mcfarlane Robert M , King Graham J , Roth James H
Published: February 2017

The extensor tendons to the index, long, ring and small fingers are motored by the common extensor digitorum communis muscle body. Effective function of this muscle can only occur if the gliding amplitude of each of its four extensor tendons is normal. As a corollary, limitation of the excursion of any of the individual tendons by adhesions at a fracture or tendon repair site, a fixed flexion contracture at the metacarpophalangeal joint, or by rupture, attenuation or laceration of a saggital band or juncturae tendinum, will result in reduction of the excursion of the adjacent extensor tendons. This pathological state has been termed the extensor quadriga because of its similarities to the analogous pathology affecting the flexor digitorum profundus system. Improper management of this clinical entity may lead to an abnormal pathomechanical kinematic chain imbalance. Early identification and treatment is critical to address this entity appropriately.
Acute Ligation of the Radial and Ulnar Arteries: A Case Report and Review of Literature
Authors: Balakrishnan Chenicheri , Mercurio Jeffrey De , Gursel Eti
Published: February 2017

Isolated injury to the radial or ulnar artery results in no significant complications in patients who undergo repair or ligation of the injured artery. However, ligation of both infrabrachial vessels of the upper extremity is associated with limb loss from ischemia due to lack of collateral circulation. A rare case of acute ligation of both the radial and ulnar arteries in a drug abuser where collateral vessels preserved the circulation to the hand is reported.
Anomalous Flexor Digitorum Superficialis Muscle Transposition for Vascular Coverage of the Median Nerve in Recurrent Carpal Tunnel Syndrome
Authors: Neumeister Michael W , Mowlavi Arian , Russell Robert C , Wilhelmi Bradon J
Published: February 2017

Recurrent carpal tunnel syndrome is uncommon yet troublesome. Significant adhesions and scarring around the median nerve can render it relatively ischemic. A number of vascular flaps have been described to provide vascular coverage in attempts to decrease further cicatricial adhesions and to improve local blood supply around the median nerve. A rare case of an anomalous muscle in the distal forearm used as tissue to provide good vascularized coverage of the median nerve that was severely scarred in its bed is reported. The anomalous muscle was distal to the flexor digitorum superficialis tendon and inserted in the palmar fascia on the ulnar aspect of the hand. Referring branches from the ulnar artery provided vascular supply to the anomalous muscle. The muscle on these vascular pedicles was transposed over the median nerve, providing good, stable, unscarred coverage. The patient had an excellent result with resolution of the carpal tunnel symptoms. The redundant anomalous muscle provided a unique vascularized source for coverage of the median nerve in recurrent carpal tunnel syndrome.
Can Reduction Mammoplasty Patients Be Promised a Particular Size Postoperatively?
Authors: Cin Arianna Dal , Jeans Elizabeth Rose
Published: February 2017

This retrospective study used self-reported bra sizes, heights and weights pre- and postoperatively in patients who underwent reduction mammoplasty by one surgeon between 2001 and 2003. Preoperative data were collected on 91 patients. Postoperative data were collected from 69 respondents by telephone survey. Bra sizes were standardized according to cup size. In bra-making, the cup is the same size for decreasing cup letter size as the band size increases. The most common standardized cup size was seven, representing bra sizes 34 F, 36 E, 38 D, 40 C, etc. The range of preoperative cup sizes was five (34 D) to 17 (42 L). The mass of tissue removed from each breast was averaged for each patient and ranged from 147 g to 2453 g (mean 522 g). The average body mass index was 29.6 kg/m preoperatively and 29.3 kg/m2 postoperatively, with six patients reporting weight gain, 13 reporting weight loss and 50 reporting no change at all. Postoperative standardized cup sizes ranged from five (34 D) to 14 (44 H). The difference between pre- and postoperative cup size ranged from zero to eight as follows: for no cup size change (n=17), mean tissue removed per breast was 577.1 g; decrease by one cup size (n=23), 489.2 g; decrease by two cup sizes (n=25), 425.8 g.

These data indicate that when self-reported data from patients are used, a plastic surgeon may find that as many as 25% report no change in bra size after reduction mammoplasty, even when more than 500 g of tissue is removed from each breast, which may adversely affect patients’ satisfaction with the surgical results. Future studies will determine the cause of the apparent discrepancy between operative and self-reported results.
Congenital Arteriovenous Malformations: A Follow-Up of Treatment
Authors: Phillips Jh , Tang Cl , Armstrong D , Chalain T De , Zuker R
Published: February 2017

Due to the rarity of arteriovenous malformations (AVMs), there is a paucity of information on the outcomes of various treatments. Presently, the mainstays of treatment of an AVM are embolization, surgical excision or a combination of both.

A retrospective study of 26 patients with AVMs treated at the Hospital for Sick Children, Toronto, Ontario between 1985 and 1995 was performed. The treatment strategies and patient outcomes were compared in terms of efficacy, complications and the response of patients and their families to their overall treatment.

The overall findings showed that embolization alone was effective in controlling symptoms, but may be associated with an increased AVM size. A partial excision of an AVM does not appear to exacerbate recurrence, as has been previously reported. In fact, even after what appears to be a complete excision of the AVM, recurrence may still occur. Complications from a surgical excision of the AVM are more frequent but less devastating than complications from embolization of the lesion. The overall patient or parent satisfaction with treatment was high with respect to improvement in outcome.

It is expected that with an increasing understanding of vascular malformations, and the evolution of interventional radiological techniques, complications will decrease and results as a whole will improve.
Patterns of Sensory and Autonomic Reinnervation of Long-Standing Myocutaneous Microvascular Flaps and Split-Skin Grafts Applied to Fascial Beds
Authors: Juma A , Oudit D , Ellabban M
Published: February 2017

Background:

There is a paucity of reports in the literature examining the pattern of sensory and autonomic neural recovery of myocutaneous microvascular flaps and skin grafts to the lower limbs after a prolonged period of time.

Objectives:

To investigate the recovery of sensation and autonomic nerve activity in long-standing split-skin grafts applied to fascial beds and in myocutaneous microvascular flaps.

Methods:

The patients were divided into two groups: group a consisted of patients with a split-skin graft applied to a fascial bed (n=11) and group B consisted of patients with free microvascular flaps (n=4). Patients in both groups underwent various clinical subjective and objective tests, including the measurement of electrical resistance and thermal sensory analysis. Laser Doppler flowmetry was used to investigate the blood flow patterns.

Results:

Patients in both groups showed significantly reduced sensory modalities. However, the findings of both the electrical resistance and laser Doppler flowmetry were significantly different among the patients in group a compared with controls. In contrast, electrical resistance and laser Doppler flowmetry test results were similar in group B and controls.

Conclusions:

Both split-skin grafts applied to fascial beds and microvascular flaps on the lower limb had poor sensory recovery. However, after 15 years, the microvascular flaps regained the ability to sweat and some degree of thermoregulatory function. This may imply that the long-standing myocutaneous free flaps regained some aspects of their autonomic innervation, whereas the split-skin grafts had not.
Selecting Optimal Access for Facial Cyst Removal: A Case Report and Literature Review
Authors: Grob Marion , Soldin Mark George
Published: February 2017

Benign subcutaneous facial cysts are common in children and young adults. They are largely of cosmetic concern. Removal of sebaceous and epidermoid cysts in this population can leave unsightly scars, occasionally worse in appearance than the original pathology. In the present case report, the technique of cyst excision via an intaoral route is outlined. The literature review emphasizes the importance of placing facial incisions in inconspicuous areas.
Alternative Techniques for Pedicle Transfer of An Island Flap and a Free Flap
Authors: Classen Dale A
Published: February 2017

Alternative techniques for pedicle transfer of a reverse radial forearm flap for hand coverage, and a latissimus dorsi myocutaneous free flap for pelvic wound coverage, are illustrated. Exteriorization of the vascular pedicle of a reverse radial forearm flap allows a greater arc of movement of the flap for more distal coverage, and avoids the potential vascular compromise of tunnelling under a tight skin bridge. Two-stage transfer of a latissimus dorsi myocutaneous free flap on a wrist carrier pedicle may be useful in circumstances when local recipient vessels are inadequate for free flap transfer. Although both of these vascular pedicle modifications have drawbacks, they may be of value in limited circumstances. Their advantages and limitations are discussed.
Narrowing of the Wide Nasal Dorsum in the ‘Minimal-Hump’ Nose: A Simplified Universal Approach
Authors: Fanous Nabil , Amar Yannick G
Published: February 2017

The operative procedure frequently used to narrow the nasal pyramid in the context of a regular rhinoplasty is well known to all rhinoplastic surgeons. It consists of hump removal, followed by lateral osteotomies and medialization of the nasal bones. However, narrowing of a wide nasal pyramid, in the absence of an appreciable dorsal hump, as in the case of an ideal dorsal height or a mild hump, presents a different challenge.

The present article describes a simplified approach to the ‘nasal plateau resection’, a technique that allows the creation of an open nasal roof, without hump removal and without compromising dorsal projection. This permits the medialization of the lateral nasal bones and the subsequent narrowing of the wide pyramid, while preserving the height of the nasal dorsum as viewed in profile.
Reconstruction of a Transmetatarsal Amputation Stump Using a Salvaged Peroneal Artery Fasciocutaneous Flap From the Opposite Leg: A Case Report
Authors: Balakrishnan Chenicheri , Altman Gil , Khalil Abdullah J
Published: February 2017

During lower extremity amputation, the objective is to provide a functional residual limb that permits maximum patient mobility and independence. Preservation of length of the fore part of the foot using salvageable tissue from the amputated part in young patients prevents equines deformity and revision of amputation to a higher level. This can be achieved using tissue available from the amputated part. The spare part concept in reconstructive surgery should be integrated into the trauma algorithm to avoid additional donor site morbidity. Reported here is a young adult patient with crush injuries to both feet, which resulted in amputations. A fasciocutaneous flap raised from one extremity was used to facilitate transmetatarsal amputation stump length preservation of the other extremity.