bluuebunny/crossref_metadata_2025 huggingface dataset:
Le lambeau interosseux postérieur à pédicule externe
Authors: Belmahi Am , Gharib N , Abbassi A
Published: February 2017

The posterior interosseous flap with external pedicle is characterized by the inclusion of the quasi-totality of the posterior forearm fascia to the septum of the posterior interosseous vessels, the flap reaching the defect without tunnelization of this pedicle. The coverage of distal defects in the hand without dangerous dissection of the distal part of the interosseous posterior pedicle, the coverage of large skin defects without sacrificing more skin in the donor area by simply grafting this pedicle, and the possibility of secure immediate defatting of this flap are the main advantages of this technique. From February 1997 to March 2001, there were 12 cases of PIO flaps with external pedicle in patients aged 16 to 65 years. This skin coverage involved the first web space in eight cases, the first and second web spaces in two cases, and the dorsal side of the metacarpophalangeal joints in two other cases. These skin defects were due to severe retractile sequellae of thermic and electrical burns, and their sizes varied from 5×7 cm to 6×12 cm. In all cases, the dissection of the posterior interosseous pedicle stopped 2 cm before its anastomosis with the anterior interosseous artery. In three cases of obese patients, immediate defatting was peformed without any complications. All patients benefitted from an orthesis that kept the wrist in extenstion for three weeks to protect the pedicle, which was sectionned at this date. No complications were reported.
Giant Eccrine Acrospiroma: A Case Report and Review of the Literature
Authors: Koçer UðUr , Aksoy Hasan Mete , TiftikcioðLu YiðIt Özer , Ertoy Dilek , Karaaslan Önder
Published: February 2017

Background

Acrospiromas are histologically distinct cutaneous tumours of sweat duct origin and usually measure 1 to 2 cm in size.

Objective

We describe a patient with a large benign eccrine acrospiroma.

Methods

Case report and literature review.

Results

A 50-year-old woman underwent excision of a 5.5×5.0 cm cystic mass located on the left gluteal region, and the resulting defect was closed by a local flap. A diagnosis of benign eccrine acrospiroma was made after histopathological examination. On histological examination, the lesion was characterized by multilobular dermal masses composed of a biphasic cell population. There was no recurrence five months after the operation.

Conclusion

Although eccrine acrospiromas are usually benign, they can, on rare occasions, undergo malignant transformation. In addition, the clinical appearance of this lesion is not specific and differential diagnosis from other lesions, both benign and malignant, can only be done after the complete removal of the lesion.
Sensitivity and specificity of clinical testing for carpal tunnel syndrome
Authors: Wiesman Irvin M , Novak Christine B , Mackinnon Susan E , Winograd Jonathan M
Published: February 2017

Objective

The present study evaluated the sensitivity, specificity and predictive values of six clinical tests in the diagnosis of carpal tunnel syndrome (CTS).

Methods

There were 29 carpal tunnel syndrome (CTS) subjects (mean age 48 years) and 30 control subjects (mean age 45 years). The six clinical tests included Tinel's sign, wrist flexion with fingers extended, wrist flexion with fingers flexed, wrist extension, combined wrist extension/median nerve pressure and combined wrist flexion/median nerve pressure.

Results

The highest sensitivity and highest negative predictive value was found with wrist flexion with pressure (96%) and wrist extension with pressure (94%) at 60 s. The highest specificity was found with wrist flexion with fingers flexed for 30 s (95%). The highest positive predictive values were found with the wrist flexion with fingers flexed test for 30 s (91%) and the wrist extension test for 30 s (90%).

Conclusion

No one test possesses all the qualities necessary to be the ideal clinical test for the detection of carpal tunnel syndrome.
Thoracoepigastric Flap for the Closure of an Elbow Defect in an Intravenous Drug Abuser: A Case Report and Review of Literature
Authors: Balakrishnan Chenicheri , Bonanno Matthew J , Scaff Nayiri D
Published: February 2017

The reconstruction of large soft tissue defects of the upper extremity is a challenging problem. Although free tissue transfer in a single stage is preferred, the recipient blood vessels usually determine the outcome. Due to venous occlusion from repeated intravenous drug abuse, the use of a thoracoepigastric flap to cover a complex wound of the elbow is reported.
A Giant Lymphangioma Circumscriptum on the Anterior Axilla: A Case Report
Authors: Askar Ibrahim , Kilinc Nihal , Aytekin Sema
Published: February 2017

Lymphangioma is a rare benign proliferative lymphatic lesion that appears in chronic lymphedematous states in a variety of settings. Lymphangioma circumscriptum consists of clinically thin-walled, translucent vesicles appearing in groups most commonly located on the axilla, chest, mouth, and tongue. A 12-year-old male patient had been suffering from itching, pink-red colored, translucent vesicular lesions overlying the anterior axilla since birth. The lesions had slowly grown in size and number over the years. The patient had no history of trauma, or cellulites. The physical examination revealed clusters of pink-red colored vesicles, which released a clear exudate when punctured. The lesion was 50×120 mm in size. The lesion was totally excised and repaired with Z-plasty. Histopathological examination revealed slight epidermal acanthosis and enlarged lymph in the upper dermis, impinging directly onto the epidermis. These lymphatics were lined only by endothelium. The lower dermis and subcutis contained abnormally large muscle-coated vessels containing a proteinaceous fluid. Six months later, there was no recurrence and a cosmetically and functionally acceptable postoperative result was obtained.
Unusual complication of radial artery cannulation
Authors: Bengezi Omar A , Dalcin Ariana , Al-Thani Hassan , Bain James R
Published: February 2017

Currently, radial artery cannulation is the preferred method for con-tinuous hemodynamic monitoring in critically ill patients. Reported complications of radial artery cannulation include infection, digital gangrene, thrombosis, pseudoaneurysm, skin necrosis and median nerve palsy Radial artery catheter fracture is a very rare complication. A review of the English language literature revealed only one reported case.

We present an additional case of spontaneous radial artery catheter fracture.
Dimethyl Sulfoxide and Oxidative Stress On Cultures of Human Keratinocytes
Authors: Silva Duarte Ivone Da , Gragnani Alfredo , Ferreira Lydia Masako
Published: February 2017

Objectives:

The aim of the present study was to examine the protective action of the antioxidant dimethyl sulfoxide (DMSO) against the oxidative stress on keratinocyte cultures caused by glucose deprivation and hypoxia, using the concentration of malonyl dialdehyde existing in the cell culture as an indicator of the oxidative stress level.

Methods:

Eighty flasks with cultured human keratinocytes in a confluent layer were divided into eight groups, including the following: culture medium with and without glucose, culture medium with and without the addition of DMSO, culture medium subjected and not subjected to hypoxia, and culture medium with a combination of these factors.

Results and Conclusions:

The statistical analysis of the results showed that DMSO proved to be an effective agent against the oxidative stress on cultures of keratinocytes under the experimental conditions studied.
Why Do Free Flap Vessels Thrombose? Lessons Learned From Implantable Doppler Monitoring
Authors: Williams Jason G , French Rodney J , Lalonde Donald H
Published: February 2017

Background:

Before implantable venous Doppler monitoring, by the time the failing flap was explored, thrombosis had often occurred and therefore the cause of flap flow cessation was often difficult to determine. The Doppler allowed the detection of flow cessation in failing flaps before thrombosis occurred in every case since the authors started using it in 1999.

Objectives:

To review the authors’ experiences with the implantable venous Doppler.

Methods:

The authors reviewed 43 free flaps in 40 consecutive patients (1999 to 2002) in which the implantable venous Doppler was used. All cases were performed at the Saint John Regional Hospital, Saint John, New Brunswick, by the senior author. Data were collected from the hospital and office charts.

Results:

The Doppler detected inadequate blood flow in nine free flaps. In five of the cases, the cause was a kink in the vein. Repositioning the vein to get rid of the kink salvaged all five flaps. In the sixth case, compression of the vein after insetting was detected and successfully corrected. Flow cessation in the seventh case was attributable to arterial vasospasm, which was also salvaged. In the last two cases, the cause was low flow in the flap from the time the vessel clamps were let go. In spite of patent anastomoses, these two flaps were lost because there was not enough flow to sustain them.

Conclusion:

The implantable venous Doppler has allowed intraoperative detection of free flap vessel flow cessation, identification of the reasons for, and the correction of these prethrombotic states.
Lymphedema of the Upper Extremity Following Circumferential Burns
Authors: Balakrishnan Chenicheri , Bradt Lisa M , Khalil Abdullah J , Trupiano John M
Published: February 2017

Lymphedema is characterized by edema of the extremity due to the inability of the lymphatic system to remove lymph into the circulation. This condition can result from destruction of the superficial lymphatics from burn injury and recurrent infection of the extremity. Due to its rare occurrence, two cases of upper extremity lymphedema following burns are reported.
A Rare Case of Pacinian Corpuscle Neuroma
Authors: Narayanamurthy Vb , Winston A Thomas , Gupta Amit
Published: February 2017

The authors discuss an interesting case of a Pacinian corpuscle neuroma in the thumb of an elderly woman who presented with severe digital pain. The pain was initially attributed to osteoarthritis of the interphalangeal joint of the thumb. The clinical signs were very subtle. The patient had complete pain relief following excision of the tumour. Pacinian corpuscle neuromas are rare, with only about 70 cases reported in the literature. The histology, presenting features and associated conditions are discussed in detail. In addition to a neuroma or glomus tumour, Pacinian corpuscle hyperplasia should be considered in the differential diagnosis of digital or palmar pain of unknown etiology.
Masquerading Mycobacterium: Plastic Surgeon to the Rescue
Authors: Kumar V , Coady Mse , Taranu R
Published: February 2017

A patient with a Mycobacterium marinum infection of the hand is described. The present case illustrates that M marinum infection may mimic common skin conditions such as eczema, and fungal and parasitic infestations. Key elements in the diagnosis and management of this infection are a high index of suspicion, a detailed history of recreational or occupational exposure to exotic fish, tissue biopsy, wound culture and prompt empirical antibiotic therapy. Once in vitro organism sensitivities are obtained, antibiotic treatment may last for up to 24 months. Surgical drainage and debridement are an important supplement to antimicrobial therapy when subcutaneous structures are involved, as in the present report. Invasive digital and hand infections can rapidly result in permanent residual stiffness, deformity and loss of function; therefore, it is important to raise awareness of the condition among those considered to be at risk.
Groin Flap for Salvage of Upper Extremity Following Necrotizing Fasciitis: A Case Report
Authors: Balakrishnan Chenicheri , Erella Venkata S , Vandemark Shawn , Mussman Jason
Published: February 2017

Necrotizing soft tissue infections are often associated with significant morbidity and mortality Early surgical excision along with antibiotic therapy is the cornerstone of management. Salvage of these extremities is often difficult due to loss of soft tissues, tendons, nerves and blood vessels. Skin grafting of the granulating wound is the common method of closure in these patients. Use of various flaps has improved reconstructive options in these extremities. A case of salvage of upper extremity using a groin flap following extensive debridement is reported.
Solo Hand Surgery
Authors: Bell Michael Sg , Reitsma Bert J
Published: February 2017

Unassisted hand surgery is being undertaken by necessity for both elective and emergency cases, due to hospital resource restrictions. The authors outline the principles of local anesthesia, surgeon-controlled tourniquet techniques, and a number of new instruments which allow a surgeon to work in comfort and safety, unassisted. The traditional surgical instruments designed for the days when trained surgical assistants were available to hold them are no longer suitable. We are entering a new era of surgical design with safer instruments that can complement our skills rather than challenge them. There are significant cost savings and efficiency when hand procedures are undertaken in the emergency and outpatient clinic settings.
Maxillofacial Injuries in Moose-Motor Vehicle Collisions Versus Other High-Speed Motor Vehicle Collisions
Authors: Kim Sharon , Harrop A Robertson
Published: February 2017

Background

Anecdotal experience has suggested that there is a higher frequency of maxillofacial injuries among motor vehicle collisions involving moose.

Objectives

A retrospective cohort study design was used to investigate the incidence of various injuries resulting from moose-motor vehicle collisions versus other high-speed motor vehicle collisions.

Methods

A chart review was conducted among patients presenting to a Canadian regional trauma centre during the five-year period from 1996 to 2000.

Results

Fifty-seven moose-motor vehicle collisions were identified; 121 high-speed collisions were randomly selected as a control group. Demographic, collision and injury data were collected from these charts and statistically analyzed. The general demographic features of the two groups were similar. Moose collisions were typically frontal impact resulting in windshield damage. The overall injury severity was similar in both groups. Likewise, the frequency of intracranial, spinal, thoracic and extremity injuries was similar for both groups. The group involved in collisions with moose, however, was 1.8 times more likely then controls to sustain a maxillofacial injury (P=0.004) and four times more likely to sustain a maxillofacial fracture (P=0.006).

Conclusions

Occupants of motor vehicles colliding with moose are more likely to sustain maxillofacial injuries than those involved in other types of motor vehicle collisions. It is speculated that this distribution of injuries relates to the mechanism of collision with these large mammals with a high centre of gravity.
Constriction Band Syndrome Occurring in the Setting of in Vitro Fertilization and Advanced Maternal Age
Authors: Rinker Brian , Vasconez Henry C
Published: February 2017

The debate as to the pathogenesis of constriction band syndrome began with Hippocrates and continues today the exogenous theory attributes the condition to entanglement of the fetus in the amniotic remnants following premature rupture of the amnion, which is in contrast to the endogenous, or genetic, mechanism.

A case of constriction band syndrome in the setting of in vitro fertilization, where the child was genetically unrelated to the birth mother, is presented. Constriction band syndrome has been reported following amniocentesis and chorionic villus sampling, but it has not heretofore been presented in the setting of in vitro fertilization. In addition, the present case presents an opportunity to separate maternal from genetic factors and, possibly, shed some light on the etiology of the condition.
‘Optimum Mobility’ Facelift. Part 1 – the Theory
Authors: Fanous Nabil
Published: February 2017

Traditional rhytidectomy techniques, such as the cutaneous lift, the superficial musculoaponeurotic system lift, the deep plane lift and the subperiosteal lift, are mostly differentiated by their different planes of dissection. As well, many of these techniques consider the complete mobilization of tissues a prerequisite for obtaining a satisfactory result.

However, is it true that the result of a rhytidectomy is linked to the choice of the dissection plane? Also, is it true that the adequacy of the surgical mobilization of tissues is vital to the outcome? the present paper discusses the above questions and introduces a factor that is believed to be crucial to the planning and success of a rhytidectomy: facial tissue mobility. The analysis of this mobility is presented and leads to the development of three theories: ‘intrinsic mobility’, ‘surgically induced mobility’ and ‘optimum mobility points’. These theories form the foundation of a rhytidectomy technique termed ‘optimum mobility’ facelift.
Reconstruction of An Abdominal Wall Defect Following Wide Excision of Metastatic Squamous Cell Carcinoma At the Percutaneous Gastrostomy Site in a Head and Neck Cancer Patient
Authors: Balakrishnan Chenicheri , Sugg Kristopher B , Vashi Christopher
Published: February 2017

Cancer metastasis to an enterostomy site is a rare and serious complication. The incidence seems to be on the rise due to increased acceptance of the percutaneous endoscopic gastrostomy procedure. Because this may be associated with synchronous distant metastasis, full metastatic workup is required. Resections of these metastatic lesions require full-thickness abdominal wall reconstruction.
Soft Tissue Coverage of the Knee Joint Following Burns
Authors: Balakrishnan Chenicheri , Flanagan Thomas L , Klein Justin D , Erella Venkata S , Saini Manmit S
Published: February 2017

Full-thickness burns around the knee joint are usually associated with exposure of bone, tendon or ligaments. Following excision of the deep burns, there is no viable wound bed to which skin grafts can be applied. Although vacuum-assisted closure has been used to encourage granulation tissue, exposure of the tendons and ligaments following excision usually requires muscle flaps or fasciocutaneous flaps.
Anomalous flexor digitorum superficialis muscle belly presenting as a mass within the palm
Authors: Stephens Nicholas , Marques Eric , Livingston Christopher
Published: February 2017

Anomalies of the flexor digitorum superficialis muscle are extremely uncommon and usually present as a painful mass or pseudotumour within the palm. Diagnosis may be difficult because many other soft tissue tumours (lipomas, ganglions, giant cell tumours and hamartomas) may present similarly. Magnetic resonance imaging helps to define the extent and characteristics of this anomalous muscle belly and to distinguish it from a soft tissue sarcoma, whereas plain radiographs are of little value. Three types of flexor digitorum superficialis muscle anomalies have been described, and treatment consists of subtotal or total surgical debulking of the mass if symptoms persist or if the diagnosis is in question. Most patients have complete resolution and full recovery. To date, 20 cases have been reported in the literature, usually involving the right small finger. In the present paper, the case of an anomalous flexor digitorum superficialis muscle in a 17-year-old male patient's left index finger is reported. Symptoms were relieved following surgical debulking and hand-based occupational therapy.
Basal cell carcinoma masquerading as a hallux valgus
Authors: Hallock Geoffrey G , Bulatao Imelda S
Published: February 2017

The incidence of primary skin cancers of the foot is exceedingly low; conversely, problems associated with a hallux valgus are common. A nonhealing ulcer overlying a hallux valgus managed conservatively with ointments and orthotic adjustments, and even with skin grafts, did not resolve over a period of 10 years. Ultimately, a shave biopsy revealed that the lesion was a basal cell carcinoma. Wide local excision and another skin graft resulted in tumour eradication and, finally, healing. Basal cell carcinoma associated with a hallux valgus has not been previously reported, and this reinforces the concept that malignant degeneration as the cause of any chronic ulceration should not be overlooked.
Facial paralysis for the plastic surgeon
Authors: Kosins Aaron M , Hurvitz Keith A , Evans Gregory Rd , Wirth Garrett A
Published: February 2017

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis.

The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain.

With respect to facial paralysis, surgeons tend to focus on the surgical, or ‘hands-on’, aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and bot-ulinum toxin injection, but these are beyond the scope of the present paper.
The versatile rhomboid (Limberg) flap
Authors: Chasmar Leslie R
Published: February 2017

The rhomboid (Limberg) flap can be used to close defects almost anywhere on the body. It is versatile in that a random pattern flap can be raised from any one or all corners of the rhomboid. The defect is filled with tissue of the same thickness and colour, and with good vascularity. The present paper demonstrates the versatility of the rhomboid flap.
Giant lipomas of the upper extremity
Authors: Allen Brian , Rader Christine , Babigian Alan
Published: February 2017

Lipomas are slow-growing soft tissue tumours that rarely reach a size larger than 2 cm. Lesions larger than 5 cm, so-called giant lipomas, can occur anywhere in the body but are seldom found in the upper extremities. The authors present their experiences with eight patients having giant lipomas of the upper extremity. In addition, a review of the literature, and a discussion of the appropriate evaluation and management are included.
Pilomatricoma: Experience of the Hospital for Sick Children
Authors: Cypel Tatiana Karine Simon , Vijayasekaran Vijith , Somers Gino R , Zuker Ronald Melvin
Published: February 2017

Background

Pilomatricoma (calcifying epithelioma of Malherbe) is a common skin neoplasm in the pediatric population that is often misdiagnosed as other skin conditions or tumours.

Objectives

The objective of the present retrospective study was to review the clinical and histopathological presentation of this neoplasm in children.

Methods

The records of the pathology department at The Hospital for Sick Children, Toronto, Ontario, were searched for all cases of pilomatricoma between 2001 and 2006. The records of these patients were reviewed to determine sex, age, location and size of the tumour, pathological features and recurrence rate. All patients underwent surgical excision of the lesions.

Results

A total of 93 lesions in 85 patients were identified. The median age was 8.7 years. Of the 85 patients diagnosed with pilomatricoma, 44 (52%) were female. In all cases, the initial presentation was an asymptomatic, slow growing, superficial hard mass with bluish discolouration. The most common sites of occurrence were the face (48%), neck (21%) and upper limbs (18%). The size of the surgical specimens collected ranged from 0.1 cm to 2.6 cm. The diagnosis was confirmed by histopathological examination in all cases. Ghost cells and basaloid cells were described in most of the cases (83%). There were no recurrences in this series.

Conclusions

This entity should be considered with other benign or malignant conditions in the clinical differential diagnosis of solitary firm skin nodules, especially those on the face, neck and upper limbs. The diagnosis can generally be made by clinical examination. The treatment of choice is surgical excision, and the recurrence rate is very low.
Management of fulminant dissecting cellulitis of the scalp in the pediatric population: Case report and literature review
Authors: Arneja Jugpal S , Vashi Christopher N , Gursel Eti , Lelli Joseph L
Published: February 2017

A case of fulminant dissecting cellulitis of the scalp in a fifteen-year-old African American male is reported. The presentation was refractory to standard medical treatment such that treatment required radical subgaleal excision of the entire hair-bearing scalp. Reconstruction was in the form of split-thickness skin grafting at the level of the pericranium following several days of vacuum-assisted closure dressing to promote an acceptable wound bed for skin grafting and to ensure appropriate clearance of infection. Numerous nonsurgical modalities have been described for the treatment of dissecting cellulitis of the scalp, with surgical intervention reserved for patients refractory to medical treatment. The present paper reports a fulminant form of the disease in an atypical age of presentation, adolescence. The pathophysiology, etiology, natural history, complications and treatment options for dissecting cellulitis of the scalp are reviewed, and the authors suggest this method of treatment to be efficacious for severe presentations refractory to medical therapy.
Management of proximal interphalangeal joint injuries
Authors: Freiberg Arnis
Published: February 2017

Injuries to the proximal interphalangeal joint are common but frequently missed. They are often overtreated by prolonged immobilization, resulting in stiffness, which may be permanent. The purpose of the present article is to briefly review the relevant anatomy and biomechanics, present an approach to physical examination and diagnosis, and propose a practical clinical classification. The treatment of the most severe injury – the intra-articular fracture dislocation – is controversial. The various treatment options are discussed, based on personal experience and a review of the literature. A list of relevant references is presented.
Melanotic Neuroectodermal Tumour of Infancy
Authors: Hamilton Scott , MacRae Duncan , Agrawal Sumit , Matic Damir
Published: February 2017

Melanotic neuroectodermal tumour of infancy is an extremely rare neoplasm arising in newborns and young children, typically involving the face or cranium. A case arising from the maxilla, requiring extensive resection with a near-total maxillectomy, is presented. A thorough review of the literature on this unusual tumour is provided, with emphasis on prognostic factors and appropriate treatment.
Predicting Breast Reduction Weight Using the Mass of Breast Ptosis
Authors: Murray John D , Elwood Eric T , Barrick Rebecca , Feng Jack
Published: February 2017

Background

The preoperative prediction of therapeutic breast reduction weights, to achieve both relief of breast weight symptoms and yet achieve excellent breast shape, remains a challenge.

Objectives

To design a simple clinical method to preoperatively predict and quantify therapeutic breast reduction weights.

Methods

In 31 women who underwent therapeutic bilateral reduction mammaplasty, the mass of the hypertrophic breast hanging below the inframammary fold was preoperatively weighed and then compared with the mass of the reduction specimen. Thirty patients underwent breast reduction using a superomedial nipple-areolar pedicle. Postoperative breast weight-related symptoms and breast shape findings were then noted. Statistical analysis relied on mean, SD, sample size, Mann-Whitney test for medians, Levene's test for variances and regression analysis.

Results

The average clinical follow-up was 160 days, with all patients achieving satisfactory breast size and shape from both the patient and surgeon's perspectives. All patients reported improvement of back pain, shoulder pain and lower neck pain. Two breasts developed delayed healing of the lateral skin flap, necessitating debridement and reclosure, followed by uneventful ongoing healing. There was no significant difference in preoperative ptotic breast mass and resectional breast mass (all P>0.05).

Conclusions

Simple preoperative weighing of the ptotic portion of the hypertrophic breast can serve as a goal for the reduction weight, while creating pleasing breast proportions and improving breast weight-related symptoms. Preoperative quantification of the ptotic breast mass may guide the reduction technique and assist insurance precertification efforts.
A Comparison of the Superficial Inferior Epigastric Artery Flap and Deep Inferior Epigastric Perforator Flap in Postmastectomy Reconstruction: A Cost-Effectiveness Analysis
Authors: Thoma Achilleas , Jansen Leigh , Sprague Sheila , Duku Eric
Published: February 2017

Purpose

To perform a cost-effectiveness analysis comparing the superficial inferior epigastric artery (SIEA) and deep inferior epigastric perforator (DIEP) flaps in postmastectomy reconstruction.

Methods

A decision analytic model with seven clinically important health outcomes (health states) was used, incorporating the Ontario Ministry of Health's perspective. Direct medical costs were estimated from a university-based hospital. The utilities of each health state converted into quality-adjusted life years (QALYs) were obtained from previously published data. Health state probabilities were computed from a systematic literature review. Analyses yielded SIEA and DIEP expected costs and QALYs allowing calculation of the incremental cost-utility ratio (ICUR). One-way sensitivity analyses were conducted under five plausible scenarios, assessing result robustness.

Results

Five SIEA and 27 DIEP studies were identified. The baseline SIEA expected cost was slightly higher than that for the DIEP ($16,107 versus $16,095), with slightly higher QALYs (33.14 years versus 32.98 years), giving an ICUR of $77/QALY. Taking into account conversions from SIEA to DIEP, the ICUR increased to $4,480/QALY. Sensitivity analysis gave ICURs ranging from $2,614/QALY to ‘dominant’, all consistent with the adoption of the SIEA over the DIEP.

Conclusion

The best available evidence suggests the SIEA is a cost-effective procedure. However, given the high SIEA to DIEP conversion rates and small marginal differences in cost and effectiveness, the ICUR may be sensitive to minor changes in costs or QALYs. The ‘truth’ can only be obtained from a randomized, controlled trial comparing both techniques side by side, simultaneously capturing the costs of the competing interventions.
Predicting the Results of Rhinoplasty Before Surgery: Easy Noses Versus Difficult Noses
Authors: Fanous Nabil , Brousseau Valérie Julie , Karsan Naznin , Fanous Amanda
Published: February 2017

A major problem for many rhinoplastic surgeons is the ability to predict, before surgery, the difficulty of the procedure (whether the rhinoplasties will be technically easy or technically difficult to perform) and the success rate of the result (whether the rhinoplasty will likely give good results or poor ones).

The present paper outlines a systematic approach to nasal analysis, allowing the surgeon to consistently estimate, before surgery, the degree of technical difficulty of each rhinoplasty, as well as predicting its future result in terms of patient satisfaction. This preoperative evaluation is based on the analysis of the skin texture and the osteocartilagenous framework on lateral and frontal views. It allows for the nose to be classified as green (easy), yellow (moderate) or red (difficult), depending on two factors: The degree of surgical difficulty and the expected patient's satisfaction with the result.

The essence of the present paper is to introduce a simple, systematic approach to assist the novice rhinoplastic surgeon to assess the complexity, the risks and the expected outcome of a rhinoplasty in the preoperative period, rather than postoperatively.
Empirical Antibiotics Use in Soft Tissue Infections
Authors: Shortt Rodger , Thoma Achilleas
Published: February 2017

Purpose

Various antibiotics are available to treat soft-tissue infections. However, it is unclear if the empirical antibiotic is always appropriate or the most economical.

Objective

To determine the percentage of empirically treated wounds susceptible to the antibiotic therapy prescribed, and to determine the percentage of wounds treated with the most economical antibiotic therapy.

Methods

A retrospective chart review was performed on all charts with a diagnosis of ‘soft-tissue infection’ between January 1, 2005, and June 30, 2005, at St Joseph's Hospital, Hamilton, Ontario. Eligible charts were identified using the medical diagnosis coding system. The following diagnoses (including subheadings) were included: cellulitis, lymphangitis, abscess, carbuncle or furuncle. The following was extracted: patient demographics; soft-tissue diagnosis; name, dose and duration of antibiotics used; culture results; and Gram-stain results. A comparison between the empirical antibiotic prescribed and the microbiology result was made. An assessment was performed on the cost of the initial empirical antibiotic treatment compared with less-expensive effective alternatives.

Results

For soft-tissue infections with positive culture growth, empirical antibiotic treatment was appropriate in all abscess cases, 50% of ulcer cases and 83% of cellulitis cases. for cellulitis patients receiving a single empirical antibiotic, it was appropriate in 89% of cases. Only 42% of culture-positive patients were treated with the most economical regimen, multiple antibiotics being the most common fault.

Conclusions

To be most economical, a single empirical antibiotic should be used to treat cellulitis. Culture results should be used to guide any antibiotic changes.
Preoperative Treatment of a Parotid Hemangioma with 100% Ethyl Alcohol
Authors: Emsen Ilteris Murat
Published: February 2017

Hemangiomas are one of the most common childhood neoplasms, occurring in approximately 12% of infants younger than one year of age. The lesions typically appear shortly after birth, increase in size over the first year and characteristically regress over the next decade. Because hemangiomas can be visible during an important stage of a child's social development, numerous authors have pursued alternative treatment strategies to avoid or reduce this lengthy involution process. Unfortunately, no effective medical treatment has been reported for children with large, deforming hemangiomas of the parotid gland and overlying cheek. In the present case, a patient with a large parotid hemangioma was treated preoperatively with an intralesional injection of 100% ethyl alcohol solution to reduce the size of the mass. The mass was removed 28 days later with no major postoperative complications.
Anatomical variations of the carpal tunnel structures
Authors: Mitchell Ryan , Chesney Amy , Seal Shane , Mcknight Leslie , Thoma Achilleas
Published: February 2017

There are many anatomical variations in and around the carpal tunnel that affect the nerves, tendons and arteries in this area. Awareness of these variations is important both during the clinical examination and during carpal tunnel release. The purpose of the present review is to highlight recognized anatomical variations within the carpal tunnel including variation in nerve anatomy, tendon anatomical variants, vascular anatomical variations and muscle anatomical variations.
Acute Carpal Tunnel Syndrome Secondary to Radiation Treatment: A Case Report
Authors: Franco Johnny , Kumpf Andrew Silver Arthur , Ferguson John Scott
Published: February 2017

Carpal tunnel syndrome has a prevalence of 1% to 10%, and while acute carpal tunnel syndrome makes up the minority of cases of this compression neuropathy, it is important to recognize as a distinct entity because prompt surgical treatment can decrease long-term morbidity. The most common causes of acute carpal tunnel syndrome are trauma to the hand or wrist, infection, and disorders of rheumatological, hemorrhagic and vascular origin. The present case report demonstrates the role of radiation therapy as a cause for acute carpal tunnel syndrome, a cause that has not been reported previously.
Median Nerve Reconstruction After Entrapment in the Elbow
Authors: Korus Lisa , Morhart Mike , Jarman Abdulaziz , Olson Jaret
Published: February 2017

Median nerve entrapment in the elbow is a known but rare complication of pediatric elbow dislocations. It is classified on the anatomical basis of entrapment. Due to a variety of factors, it is often diagnosed late. Because of this, substantial injury occurs to the nerve, requiring some form of restorative surgery in addition to release from the joint. Such nerve injury has been treated in a variety of ways including neurolysis, end-to-end anastomosis and nerve grafting. To date, there has been no conclusive evidence in the literature that one method should be preferred over another. A case of median nerve entrapment that was treated with sural nerve grafting is presented. In a review of the literature, previous treatment of such cases is discussed and compared.
Single-Stage Immediate Breast Reconstruction Using a Skin-Sparing Incision and Definitive Saline Implants Compared with a Two-Stage Reconstruction Using Tissue Expansion Plus Implants
Authors: Plant Mathew A , Scilley Christopher G , Speechley Mark
Published: February 2017

Background

Losing a breast to cancer has significant psychological ramifications, and it has been shown that minimizing this loss can have a profound impact. As a result, breast-conserving therapy or mastectomy followed by breast reconstruction have become the preferred surgical treatments for breast cancer. Limited available breast skin following mastectomy has traditionally necessitated the use of autologous tissue or tissue expansion; however, when reconstructing larger breasts, autologous tissue grafts rarely provide enough tissue and tissue expanders can often take several months to achieve the necessary tissue volume. The skin-sparing mastectomy offers a solution to this lack of skin, and as a result many new options for immediate breast reconstruction have presented. The present pilot study looks at a new method of immediate breast reconstruction involving a Wise pattern skin-sparing mastectomy with placement of a definitive, submuscular saline implant as a way to maintain a large breast size without requiring the patient to undergo a long and painful tissue expansion process.

Methods

A retrospective, case-control study was performed on 12 women who had undergone bilateral mastectomies with immediate reconstruction either with a tissue expander and later placement of definitive saline implant (control group) (n=5) or who had undergone a single-stage reconstruction involving the placement of a definitive submuscular saline implant (experimental group) (n=7). Patients were compared with respect to change in breast size, number of reoperations and operations in total, as well as satisfaction with their reconstruction.

Results

Patient satisfaction in both groups was relatively high and there was no statistically significant difference found between the two groups. The experimental group decreased in bra size by 1.4 cup sizes on average whereas the control group experienced no change on average; however, one-third of patient data had to be discarded for various reasons, making the change in size measurement inconclusive. Finally, the average number of reoperations was higher in the experimental group than the control (1.57 versus 1.00); however, the total number of operations required was less (2.57 versus 2.80).

Conclusions

Immediate breast reconstruction using a definitive submuscular saline implant is a viable option for reconstruction in women with larger breasts that deserves further study on a larger scale. Although limited by sample size, the present pilot study showed, with a large effect size, that this new procedure reduces the total number of operations required for reconstruction when compared with a tissue expander followed by an implant while maintaining an equally high level of patient satisfaction.
A New Method in the Treatment of Postburn and Post-Traumatic Scar Contractures: Double-Opposing Z- and V- (K-M-N) Plasty
Authors: Murat Emsen Ilteris
Published: February 2017

BACKGROUND

To date, many techniques for the surgical treatment of postburn scar contractures have been described. Some of the most popular techniques are Z-plasty, V-Y-plasty and their analogues. A major limitation of these techniques is that the excess tissue requires excision of the dog ear. The current study presents a new modification of the double-opposing Z- and V-plasty, called ‘K-M-N plasty’.

METHODS

Twenty postburn scar contractures were successfully treated with K-M-N plasty. The postoperative results depict the versatility of this technique in the surgical treatment of postburn scar contractures, especially in the upper and lower extremities.

RESULTS

There was no distal flap necrosis, and postoperative recovery was uneventful in all operated patients. K-M-N plasty is an effective and alternative method for the surgical treatment of postburn scar contractures. In addition, drawing and flap transpositions were not complicated.

DISCUSSION

There are many advantages to using this technique: K-M-N plasty can be safely used when skin tension crosses the contracture line; it is superior to other local flaps because of its rich vascularity and mobility for superficial scars; it can be recommended to the inexperienced surgeon because it can be performed with ease; it is also an effective procedure for the pericontracture area due to its V limb (it can prevent recontracture); the colour and texture matches are more cosmetically acceptable, and the resultant contracture release is similar to other techniques; the dog ear formation is not seen; it can be performed under local anesthesia in most cases (not in children); and it has a shorter period of operation and hospitalization than other techniques.
A Case of Autologous Microfat Grafting in Lip Reconstruction of a Whistle Deformity Following Cancer Treatment
Authors: Belyea James , Hart Robert , Trites Jonathan , Taylor Sm
Published: February 2017

A whistle deformity is defined as a deficiency in the vertical length of the lip so that the free margins of the upper and lower lips do not meet normally, giving the appearance of whistling. This is a common secondary deformity of the vermilion in patients with cleft lip. A case involving a 61-year-old man who developed a whistle deformity as a result of two wedge resections and postoperative radiotherapy for treatment of squamous cell carcinoma of the lower lip is presented. Hyaluronic acid-based tissue filler and autologous microfat transplantation to the lower lip were used for definitive management of the patient's whistle deformity. After one year of follow-up, the patient was pleased with the overall result and noted marked improvement of his oral competence and overall appearance of the lip. The present case demonstrates that microfat transplantation is a viable option for correcting a whistle deformity, not only after surgery, but also following adjuvant radiotherapy – both of which potentially reduce graft viability secondary to decreased vascularity of the recipient site.
Bilateral and Multifocal Phyllodes Tumours of the Breast: A Case Report
Authors: Kf Seal Shane , Kuusk Urve , A Lennox Peter
Published: February 2017

Phyllodes tumours are rare breast neoplasms that present as painless breast masses. They are classified as benign, malignant and borderline. More rare presentations of these tumours include bilateral asynchronous disease and unilateral multifocal disease. Surgical excision with clear margins remains the treatment of choice for these tumours. The present case report is the first to be discussed in the literature. It describes a patient presenting with synchronous bilateral, multifocal breast phyllodes tumours who underwent immediate reconstruction with tissue expanders at the time of her mastectomies.
Bilateral Pulmonary Emboli After Bilateral Mastectomy in a 15-Year-Old Boy with Hypogonadism: A Case Report
Authors: Piggott JR , Yazdani Arjang
Published: February 2017

Pulmonary emboli are rare, yet serious, complications of body contouring surgery. When they occur, they more often follow as complications of long, invasive procedures in adults. The present report details a case of bilateral pulmonary emboli in an obese 15-year-old boy with hypogonadism undergoing bilateral mastectomy for gynecomastia. The diagnosis of bilateral pulmonary emboli was made on the basis of clinical presentation and positive ventilation/perfusion scan. The patient responded well to heparin anticoagulation treatment. The relevance of pediatric obesity, pediatric body contouring surgery and the risk of thromboembolic events in pediatric patients are discussed.
Beyond the Borders of Keloid Formation: A Case Report
Authors: Cugno S , Rizis D , Cordoba C
Published: February 2017

The keloid scar is a cutaneous mass characterized by nodular fibroblastic proliferation of dermis and a predilection for distinctive anatomical locations. However, keloid extension to neighbouring tissue as a nonsyndromic entity has not been described. In the present report, a case involving a 48-year-old woman with extensive bilateral keloids of the ear lobules and neck following ear piercing is presented.