bluuebunny/crossref_metadata_2025 huggingface dataset:
A Cost-Utility Analysis of Open and Endoscopic Carpal Tunnel Release
Authors: Thoma Achilleas , Wong Vanessa H , Sprague Sheila , Duku Eric
Published: February 2017

Background

Open carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. with the advent of minimally invasive surgery, endoscopic carpal tunnel release (ECTR) was introduced.

Objective

To use a decision analytical model to compare ECTR with OCTR in an economic evaluation.

Methods

Direct medical costs were obtained from a Canadian university hospital. Utility values obtained from experts, presented with carpal tunnel syndrome outcome health states, were transformed into quality-adjusted life years (QALYs). The probabilities of the health states associated with both techniques were obtained from the literature.

Results

The incremental cost-utility ratio (ICUR) was $124,311.32/QALY gained, providing strong evidence to reject ECTR when ECTR is performed in the main operating room and OCTR is performed in the day surgery unit. A one-way sensitivity analysis in the present study demonstrated that when both OCTR and ECTR are performed in day surgery unit, the ICUR falls in the ‘win-win’ quadrant, making ECTR both more effective and less costly than OCTR. If the scar tenderness probability is decreased in the ECTR group in a second one-way sensitivity analysis, the ICUR decreases to $100,621.91/QALY gained, providing evidence to reject ECTR. If the reflex sympathetic dystrophy probability is increased in the ECTR group in a third one-way sensitivity analysis, the ICUR increases to $202,657.88/QALY gained, providing strong evidence to reject ECTR.

Conclusions

There is still uncertainty associated with the costs and effectiveness of ECTR and OCTR. To obtain a definitive answer as to whether the ECTR is more effective than the OCTR, it is necessary to perform a large, randomized, controlled trial in which the utilities and resource use are measured prospectively.
Congenital Giant Nevocellular Nevus of the Back with Deep Extension to the Fat and Fascia
Authors: Jaeger Marcos Ro , Zuker Ronald M
Published: February 2017

The presence of deep pigmentation in a giant congenital nevus makes its complete removal very difficult and should be taken into consideration when planning for treatment. A clinical case in which the pigmented lesion was found to extend deep into the muscle fascia is described. The lesion was surgically removed with an acceptable functional and aesthetic result through the utilization of tissue expansion. The development of new surgical techniques and the expansion of laser technology will possibly provide new treatment options in the future. Emphasis should be placed on aesthetics and function, because the excision based only on oncological anticipation is no longer valid. The presence of deep pigmentation makes certain treatment options less effective than surgical ablation.
Pyoderma Gangrenosum Following Reduction Mammaplasty
Authors: Simon Amy M , Khuthaila Dana , Hammond Dennis C , Andres Albert
Published: February 2017

The failure of a postoperative local infection to resolve after appropriate antibiotic therapy should prompt consideration of other diagnoses. Reported here is a case of pyoderma gangrenosum, a rare necrotizing disorder, occurring after reduction mammaplasty the clinical presentation was one of progressive wound deterioration with associated erythema and intense pain. After failure of antibiotic therapy and local wound care, tissue biopsy of the enlarging wound edge confirmed the diagnosis, which then responded rapidly to systemic steroid treatment. Given that the treatment for pyoderma gangrenosum is at odds with the standard treatment for an infection (steroids versus antibiotics), differentiating between the two diagnoses is vital to providing resolution of the process and limiting any untoward scarring resulting from the advancing open wounds that can develop. with this in mind, the physical signs and symptoms that characterize this condition and thus allow early diagnosis are presented, and treatment options discussed.
The Approach to Frostbite in Turkey: A Retrospective Study
Authors: Emsen Ilteris Murat
Published: February 2017

Increased participation in outdoor activities and an epidemic of homelessness have caused the incidence of cold injuries in the civilian population of Turkey to rise dramatically during the past 20 years. Knowledge of treatment is crucial for emergency physicians in rural and urban areas. Recent developments have significantly advanced the understanding of the pathophysiology of hypothermic and frostbite injuries. The authors undertook a retrospective review of frostbite cases in the East Anatolia region of Turkey. The mean altitude of East Anatolia is 1600 m, and temperatures may be –35°C at night and –18°C in the morning in the cities and surrounding villages. Winter is prolonged and harsh, and freezing is a normal condition in this region. The socioeconomic level in this region is lower than other regions of Turkey. During the winter, roads may be closed for as long as five months, and most villages in East Anatolia have no medical units. Erzurum, one of the coldest cities in East Anatolia, is the only city with advanced medical hospitals in this region. Three hospitals in Erzurum were included in the present study: Ataturk University Medical Faculty, Erzurum Numune Hospital and Erzurum SSK Hospital. Frostbite case records and their properties are presented.
Staged Management of a Congenital Nevus of the Breast and Abdomen Presenting in a Female Infant
Authors: Neinstein Ryan M , Borschel Gregory H , Zuker Ronald M
Published: February 2017

The management of congenital melanocytic nevi is controversial. The authors describe their management of a congenital nevus covering the breast and abdomen of a one-month-old girl over a 16-year period. To prevent damage to the developing breast, a staged approach was used. The nevus over the abdomen was resected first at six years of age and the remaining portion was removed after breast development was complete at 16 years of age. The breast defect was resurfaced with a full thickness skin graft from the groin. The patient was pleased with the postoperative result. This staged approach allowed an optimized aesthetic result.
Bear Maulings Treated in Calgary, Alberta: Their Management and Sequelae
Authors: Frank Ryan C , Mahabir Raman C , Magi Enzio , Lindsay Robert L , Haas William De
Published: February 2017

Background

Between 1994 and 2005, seven patients underwent surgery at the Foothills Medical Centre, Calgary, Alberta, for injuries sustained in bear maulings. The purpose of the present study was to document these cases and add to the literature on the management and the potential complications of bear attacks.

Methods

Data were collected retrospectively from charts.

Results

Seven patients were treated for injuries ranging from lacerations and puncture wounds to fractures and avulsed tissue. On average, patients underwent three operations and spent 22 days in hospital. Mean time from attack to arrival at the trauma centre was 19 h. Irrigation, debridement and intravenous antibiotics did not prevent wound infections in two patients. Six of seven patients developed acute stress disorder, and one of these patients went on to suffer from post-traumatic stress disorder. Complications ranged from infection to pulmonary embolism.

Conclusions

Bear attacks result in a spectrum of injuries. Infections and psychiatric disorders are common sequelae.
Replantation Surgery in Quebec: The Bottlenecks to Rapid Care
Authors: Borsuk Daniel E , Zadeh Teanoosh , Lee Chen , Moore Karl , Tan Grace
Published: February 2017

Introduction

Time delays resulting in prolonged ischemia have a significant impact on the successful reattachment of amputated body parts. No studies have addressed the issues surrounding delays from the time of the accident to the start of replantation surgery. The present paper identifies the bottlenecks that prolong the time before patients are able to gain access to a replant team.

Methods

A total of 50 patients underwent microsurgical replantation, because of traumatic amputation, at a university-based hospital from 1996 to 2003. The charts were analyzed to ascertain individual time intervals from the onset of injury until the beginning of replant surgery.

Results

The average length of time for patients who came directly to the replant centre was 3 h 40 min before surgery began. In contrast, for those referred from outlying hospitals, the elapsed time was 6 h 21 min.

Conclusions

Two major bottlenecks were found. First, for patients who were referred from other health centres, delays were due to a lack of information as to where patients could receive appropriate replant surgery. Second, delays at the replant centre were primarily due to insufficient physical and human resources in the operating room.
Use of Bilateral Groin Flaps in the Closure of Defects of the Perineum: A Case Report
Authors: Balakrishnan Chenicheri , Klein Justin D , Vashi Christopher
Published: February 2017

Reconstruction of perineal and groin defects is a challenging problem. Commonly used methods of reconstruction include skin grafts and local flaps. 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. Due to the location, the donor defect can usually be closed primarily, leaving an acceptable scar. The use of bilateral groin flaps for coverage of defects of the anterior perineum following excision of condylomas is reported.
Application of the Consort Statement to Randomized Controlled Trials Comparing Endoscopic and Open Carpal Tunnel Release
Authors: Thoma Achilleas , Chew Roderick T , Sprague Sheila , Veltri Karen
Published: February 2017

Background

The CONSORT (Consolidated Standards of Reporting Trials) statement was developed by a group of clinical trialists, biostatisticians, epidemiologists and biomedical editors as a means to improve the quality of reports of randomized controlled trials (RCTs). The purpose of the present study is to assess the reporting quality of published RCTs that compare endoscopic carpal tunnel release (ECTR) with open carpal tunnel release (OCTR) using the CONSORT statement.

Methods

A computerized literature search was conducted to identify all RCTs published from January 1989 to November 2004 that compared ECTR with OCTR. Foreign language studies were also included, and translated versions of these studies were obtained. Two investigators independently reviewed each eligible article and determined whether the authors reported on each of the 22 items of the CONSORT statement. Disagreements were resolved by consensus. The mean scores for studies published before the introduction of the CONSORT statement and those published afterward were compared. Similarly, a comparison was made between foreign language studies and those published in English.

Results

Eighteen RCTs comparing ECTR with OCTR met the inclusion criteria. The total scores on the CONSORT checklist ranged from 3 to 20, with a mean score of 9.83±3.79 (the maximum possible score was 22). The six studies published in foreign language journals had a statistically significantly lower mean score than the studies published in English language journals (7.00±2.76 versus 11.25±3.49, respectively; P<0.05). The mean score was higher for studies published after 1996 than for those published in 1996 or earlier (12.14±3.80 versus 8.36±3.11, respectively; P<0.05).

Conclusions

The quality of reporting improved over time, but no study met all 22 criteria of the CONSORT statement. The CONSORT scores were higher for studies published after 1996 and for studies published in English language journals. Despite the improvement after 1996, most of these RCTs only reported one-half of the items listed on the CONSORT statement. Future investigators of surgical RCTs should make an effort to comply with the CONSORT checklist.
Atypical Presentation of a Glomus Tumour: A Case Report
Authors: White Colin P , Jewer David D
Published: February 2017

A 46-year-old man presented with an extremely painful, 1 cm, mobile, nodular mass located on the medial side of his right elbow. Symptoms failed to respond to conservative treatment. Ultrasound and Doppler flow imaging revealed a well-defined, round hypoechoic mass. Under local anesthesia, the mass was resected and the wound closed without complication. Final pathology diagnosed the lesion as a glomus tumour, solid type. Histology staining showed the tumour cells were positive for antibodies to vimentin and muscle actin. It is unusual for a glomus tumour to be located anterior to the medial epicondyle of the right arm. Hand surgeons most commonly encounter glomus tumours in the nailbeds of the fingers.
Autoinflation of Saline-Filled Inflatable Breast Implants
Authors: Peters Walter
Published: February 2017

Spontaneous autoinflation of saline-filled breast implants is a rare phenomenon; only 20 cases have been reported in the world literature. Over the past seven years, three patients have presented with significant unilateral autoinflation of their smooth, single-lumen, round, saline-filled implants. This developed at various times: progressively over 23 years with a Simaplast implant; between the ninth and 10th year after augmentation with a leaflet valve implant; and slowly over the first four years with a leaflet valve implant. The etiology of the autoinflation was shown to be different for the two types of implants. The Simaplast implant had likely been injected with a hypertonic filling solution – one that was twice as concentrated as ‘normal saline’. This would have created an osmotic gradient, which would have facilitated autoexpansion by diffusion. The implant solution remained clear and transparent. In addition, there were no detectable levels of glucose, uric acid or albumin in the fluid. By contrast, auto-inflation of the leaflet valve implants likely resulted from mechanical alterations of the valve mechanism. This type of implant is known to have a high deflation rate, with frequent partial deflations. It is interesting that one of the patients with the leaflet valve implants presented with an autoexpansion on one side and a partial deflation on the other side. Both implants were from the same lot number. The same mechanism that caused partial deflations may have also allowed fluid from the implant pocket to pass through the valve into the lumen of these implants. This could allow glucose, protein and cellular elements to enter into the lumen (these would not pass through an intact elastomeric shell) which would create an osmotic gradient, allowing water to enter the elastomeric shell by diffusion. The fluid in these leaflet valve implants was brownish yellow, very viscous and turbid. It contained elevated levels of glucose and uric acid which would not have passed through the elastomeric shell. Over the past 10 years, four different theories have been proposed in an attempt to explain the etiology of autoinflation. However, the findings of the present study indicate that there are only two mechanisms – a hypertonic filling solution and alterations of the valve mechanism.
Scalp Expansion with the Canica Wound Closure System: First Case Report
Authors: Cin Arianna Dal , Seal Shane KF
Published: February 2017

The closure of difficult wounds has been an ongoing challenge to the plastic and reconstructive surgeon. New techniques and technology have created innovative methods for this clinical and surgical problem. The Canica Wound Closure System is an external system of tissue expansion that has previously been shown to be successful for delayed abdominal and extremity fasciotomy closures. The hair-bearing scalp is unique in that no other tissue in the human body can adequately simulate it. The first known case in North America of a patient in whom the Canica Wound Closure System was used for the successful closure of a large scalp defect following a resection for a Clark level V melanoma is presented.
The Essex-Lopresti Injury: More Than Just a Pain in the Wrist
Authors: Hutchinson Shirley , Faber Kenneth J , Gan Bing Siang
Published: February 2017

As the scope of plastic surgical practice expands to include disorders of the carpus and wrist, it has become increasingly important for plastic surgeons to understand pathoanatomy that has not traditionally been considered an integral component of training. The Essex-Lopresti injury consists of a radial head fracture with associated injury to the forearm interosseus membrane and longitudinal instability of the distal radioulnar joint. Early recognition of this disorder usually results in a predictable and satisfactory outcome. However, when this disorder is unrecognized, late reconstruction is challenging and unpredictable, and treatment may be misdirected to the wrist alone if the forearm and elbow are not considered as a component of this injury. The present report describes the importance of examining the elbow in all cases of wrist pain. As well, the literature is reviewed regarding the differences in treatment of acute and chronic Essex-Lopresti injuries. As plastic surgeons become more involved in the treatment of wrist injuries, the conscientious practitioner should be aware of more complicated pathology that may present as a seemingly straightforward wrist problem.
Late Unilateral Breast Enlargement after Insertion of Silicone Gel Implants: A Histopathological Study
Authors: Peters Walter , Fornasier Victor
Published: February 2017

Late unilateral breast enlargement after the insertion of silicone gel breast implants is a very rare phenomenon. The present study reports five women who presented with this finding over the past 20 years. Three of these patients presented with late unilateral hematomas, which developed nine, 12 and 14 years, respectively, after initial breast augmentation, in the absence of any known trauma. These patients presented for treatment one, four and 12 months, respectively, after their breast enlargements initially appeared. Two of these patients had developed chronic expanding hematomas. Extensive histopathological analyses of the capsules of all three patients provided explanations for the etiologies and progressions of the findings in these patients. In each of the three patients, the etiology of the hematoma was consistent with erosion of a capsular artery. Numerous large vessels were seen within the wall of the capsules. In each case, there was a class IV capsular contracture, which could have increased the friction of the intact implant against the capsule, and there was both old (hemosiderin deposits) and new bleeding into the pocket from the capsules. This supports the concept that numerous episodes of bleeding had occurred in each case. Histopathology also demonstrated the progression of the hematomas. After four weeks, only liquefied hematoma was present, while after four months, there were both liquefied hematoma and blood clotting. The hematoma on the surface of the capsule was becoming organized peripherally, but not centrally. After 12 months, the hematoma was becoming very well organized compared with the hematoma at four months. In one of the two remaining cases, late infection was the cause of the breast enlargement. Histopathology of this capsule showed that the involved capsule was six times as thick as the other side. It also showed edema and infiltration by scattered mononuclear cells, polymorphonuclear cells, and irregular crenated and degenerating nuclei. In the final patient, chronic inflammation appeared to be the cause of the breast enlargement. The histopathology of this capsule was unique. Its inner surface showed re-epithelialization and metaplasia of the ductal epithelium to form stratified squamous epithelium with early surface keratinization. These findings are consistent with synovial metaplasia. Several areas of the fibrous portion of the capsule showed patchy loss of cellular staining with loss of nuclei, indicative of necrosis. This produced a ‘washed out’ staining appearance. This tissue was paucivascular and fibrotic, and showed areas of fibrinoid necrosis, suggestive of mechanical abrasion and increased pressure.
Silver-coated nylon dressings for pediatric burn victims
Authors: Borsuk Daniel E , Gallant Michel , Richard Diane , Williams H Bruce
Published: February 2017

Background

Silver dressings are a proven method for burn treatment. Current challenges associated with burn treatment include pain management and limited hospital resources. A new silver-coated nylon dressing was used at the Montreal Children's Hospital (Montreal, Quebec) to help reduce traumatic dressing changes and cost.

Methods

Burn victims in a pediatric patient population were followed over two years. Patients were excluded if they were evaluated more than 48 h postburn or if the burn affected less than 5% of the total body surface area. The same burn team admitted and treated all case subjects, and one dressing nurse recorded and monitored all progress throughout the study to ensure standardization.

Results

Fifteen patients were included in the study. The average number of dressing changes needed was 4.13, with a median of three changes. The average total body surface area burned was 8%, with a mean of 13.9 days before superficial wounds were re-epithelialized. The average length of in-hospital stay was four days. The cost was $388 less for silver-coated nylon dressings than for silver sulfadiazine cream for seven days of treatment. Silver-coated nylon dressings did not leave any residue or pseudoeschar on the wounds and were easily maintained at home.

Conclusion

The silver-coated nylon dressings are as effective as other silver dressings used for pediatric burn victims. The dressings are less traumatic, require fewer resources and do not leave wound residue compared with other dressings.
Unilateral cleft lip and palate: Simultaneous early repair of the nose, anterior palate and lip
Authors: Laberge Louise Caouette
Published: February 2017

Unilateral cleft lip and palate is a defect involving the lip, nose and maxilla. These structures are inter-related, and simultaneous early correction of all the aspects of the defect is necessary to obtain a satisfactory result that will be maintained with growth. The surgical technique combining various procedures is presented and compared with previously published reports.
Post-traumatic pseudolipoma of the forehead
Authors: Horovitz David , Matic Damir B
Published: February 2017

A forehead lipoma is a rare finding in a child, and one that penetrates the underlying layers of muscle and bone to attach to dura has not previously been reported. Two such cases, both in children who underwent uneventful deliveries aided by forceps, are presented. Both lesions were present at birth and, based on clinical findings, were originally thought to be dermoid cysts. Dermoid cysts could not be ruled out with computed tomography and magnetic resonance imaging. Histopathology identified fibrofatty tissue consistent with lipoma. Both lesions extended from the subcutaneous tissue through the frontalis muscle and frontal bone to the dura. Given these findings and the history of forceps delivery, the most likely diagnosis is posttraumatic pseudolipoma. This lesion should be considered in the differential diagnosis of congenital lesions of the forehead, particularly if there is a history of forceps delivery or other trauma to the area.
Self-inflicted specific pattern burns in psychiatric patients
Authors: Balakrishnan Chenicheri , Erella Venkata S , Vashi Christopher , Jackson Ollie , Vandemark Shawn
Published: February 2017

Self-inflicted burns represent a major social and medical problem for society. Differences have been demonstrated between patients who attempt suicide and those who deliberately harm themselves without any intention of killing themselves. These self-inflicted injuries may resemble injuries that are intentionally inflicted by others and may require investigation by protective services. Little is known about these specific pattern burn injuries in psychiatric patients.
An Apparent Duplication of the Mouth in a Patient with Midline Dysraphism and a Teratoid Polyp: A 15-Year Postsurgical Follow-up
Authors: Stewart Craig , Hughes Lowell A , Thomson Hugh G , Armstrong Derek , Forte Vito
Published: February 2017

True median cleft of the upper and lower lip occurs very rarely. Complete or partial facial duplication is an extremely rare malformation. Approximately 26 cases have been reported since 1900, spanning a wide spectrum of clinical severity. Most cases appear to share a number of features, including cleft palate, duplication of the tongue, orbital hypertelorism and macrostomia. An unusual patient with midline clefts of the upper and lower lips with an apparent duplication of the mouth and a teratoid polyp, with fusion of the maxilla and mandible, is reported. The early management and surgical intervention is discussed. Furthermore, postoperative outcomes are reviewed as part of a 15-year postsurgical follow-up.
Giant submental lipoma: Case report and review of the literature
Authors: Medina Carlos R , Schneider S , Mitra A , Spears J , Mitra A
Published: February 2017

Lipomas may be located in all parts of the body and may be confused clinically with other soft tissue masses. They infrequently occur in the head and neck. A large neck mass (greater than 10 cm) with a rapid growth rate should raise concerns about a possible malignancy. Failure to distinguish a liposarcoma from a lipoma may represent a medicolegal pitfall. Surgical excision of a lipoma is often used as the definitive treatment modality, and alternative treatments described for lipomas range from liposuction to steroid injections. In the present study, a 60-year-old man who presented with a rapidly enlarging submental mass is described. A 15 cm × 12 cm mass was successfully removed. The surgery produced excellent cosmetic results and no functional impairment. An integrated review of the literature regarding etiology, epidemiology, diagnostic and treatment modalities of submental lipomas follows.
The ‘Bikini Lip Reduction’: A Detailed Approach to Hypertrophic Lips
Authors: Fanous Nabil , Brousseau Valérie J , Yoskovitch Adi
Published: February 2017

Excessively large lips represent an occasional but significant challenge in aesthetic surgery. Previously described techniques focus largely on the simple excision of a strip of tissue to reduce the lips, without specific attention to the resultant lip contour or to the volume relationship between the lips. The present paper describes a new technique for lip reduction, called the ‘bikini lip reduction’. This technique not only reduces the volume of the lips, but also restores an attractive labial contour, as well as an ideal volume relationship between the upper and lower lips. Because it is based on aesthetic analysis, this technique consistently yields both smaller and more aesthetically appealing lips. Simply stated, the bikini lip reduction consists of excision of a ‘bikini top’ (two cups and a middle strap) from the upper lip and a ‘bikini bottom’ (a triangle) from the lower lip. The aesthetic results and the patient satisfaction achieved through the bikini lip reduction technique have been very satisfactory.
A Geometric Method for Nipple Localization
Authors: Khan Humayun Ayub , Bayat Ardeshir
Published: February 2017

Background

An important part of preoperative assessment in breast reduction surgery is to locate the site of the nipple-areola complex for the newly structured breast. Inappropriate location is difficult to correct secondarily. Traditional methods of nipple localization taught and practiced suggest the nipple to be located anterior to the inframammary fold. Trying to project this point on the anterior surface of the breast requires either large calipers or feeling the posteriorly placed finger on the anterior surface of a large breast. This certainly introduces some subjectivity to the calculation.

Objectives

To introduce an easy and accurate method of nipple localization to reduce the learning curve for trainee surgeons.

Methods

Aesthetic placement of the nipples is at the lower angles of an equilateral or a short isosceles triangle on the chest with its apex at the sternal angle. This triangle can be thought of as two right-angled triangles with their Y-axis on the median plane. The base and vertical limb are measured, and the hypotenuse is calculated. The location of the lower angle is marked on the anterior surface of the breast and represents the new position of the nipple.

Results

Forty patients had nipple localization performed in the above-described manner, with satisfactory placement of the nipple-areola complex.

Conclusions

The above technique introduces some objective measurements to the localization of the nipple in breast reduction surgery. It is easy to practice, and infuses confidence in trainees marking their initial breast reductions.
A New Technique of Internal Suture Mastopexy for Mild to Moderate Breast Ptosis
Authors: Mahabir Raman Chaos , Zamboni William A
Published: February 2017

Background

Current mastopexy techniques rely on incisions on the breast to correct ptosis. Trading a ptotic breast for a visibly scarred breast can be a difficult choice.

Objective and Methods

A technique of internal suture mastopexy that consists of plicating sutures placed in the superficial fascia of the breast from the deep surface is presented. The procedure leaves no scar on the breast and may be safer than other techniques when combining mastopexy with augmentation.

Results

The senior author has performed this procedure on over 120 patients, with a mean follow-up of two years. Patients and the surgeon have expressed satisfaction with the procedure.

Conclusion

Based on this experience with over 120 patients, the authors believe that internal suture mastopexy is an effective alternative in selected patients.
Client Satisfaction of Hand Therapy Intervention: An Evaluation of the Effectiveness of Therapy for Clients Recovered From Complex Regional Pain Syndrome
Authors: Zagzoog Nirmeen , Chinchalkar Shrikant J , Sumsion Thelma
Published: February 2017

Complex regional pain syndrome (CRPS) is a neuropathic pain condition that may develop following trauma to an extremity. Clients treated for CRPS at St Joseph's Health Care London – Hand and Upper Limb Centre, London, Ontario, were asked to evaluate their level of satisfaction with the treatment they had received by comparing their pain, functional status and emotional status before and after receiving therapy. The results indicated a high level of satisfaction among clients, attributable to the unique nature of the therapy program in use at this facility, where the occupational therapist works in close collaboration with the surgeon and pain specialists, and the therapy regimen is designed for each client individually according to his or her needs. The unique contribution of the present study to the body of clinical literature on CRPS is that it introduces a focus on client functionality and on client satisfaction with therapy received.
Identification of Mandibular Fracture Epidemiology in Canada: Enhancing Injury Prevention and Patient Evaluation
Authors: Czerwinski M , Parker WL , Chehade A , Williams HB
Published: February 2017

Background

Mandibular fractures can lead to significant functional and aesthetic sequelae if treated improperly. They may act as an indicator of concomitant trauma and are very demanding on the public health care system. Thus, knowledge of mandibular fracture epidemiology is critical to effective prevention, as well the establishment of accurate trauma evaluation protocols.

Objectives

To identify the epidemiology of mandibular fractures treated at a level 1 Canadian trauma centre, clarify the pathogenesis of these epidemiological patterns and suggest potential targets for preventive efforts.

Methods

A retrospective review of all mandibular fracture patients presenting to the Montreal General Hospital between 1998 and 2003 was performed. Medical records and digitized radiographic imaging were used to collect patient demographics and injury data.

Results

The chart review identified 181 patients with 307 mandibular fractures. Fifty-two per cent of the fractures occurred in individuals 21 to 40 years of age, 78% of patients were male, and there was wide ethnic diversity. Sixty percent of patients had multiple mandibular fractures; 29% were symphyseal/parasymphyseal fractures, 25% were condylar fractures and 23% were angle fractures. Assault was the most common mechanism of injury, with 29% of fractures involving alcohol or illegal drug use. Thirty percent of patients had an associated facial fracture, and more than one-third had another major injury.

Conclusions

The present epidemiological review reveals several potential prevention targets as well as significant trends. Further research into the impact of these preventive measures could more objectively identify their impact on mandibular trauma.
The Combined Plastic Surgery/Physical Medicine and Rehabilitation Amputee Clinic At the University of Western Ontario
Authors: Neinstein Ryan , Death A Barry , Gan Bing Siang
Published: February 2017

Since the autumn of 2001, a multidisciplinary plastic surgery (PS) and physical medicine and rehabilitation (PMR) outpatient amputee clinic has been in place at St Joseph's Health Centre/Parkwood Hospital in London, Ontario. To date, more than 140 new patients have been seen in combined consultations. The present paper reviews the demographics, interventions and outcomes of the patients seen between 2001 and 2005. The majority of primary PMR patients had problems that prevented optimal use of their lower extremity prostheses. These problems included nonhealing pressure ulcers, infections, painful neuromas, amputation stump shape abnormalities and fixed joint contractures. Most patients had surgical intervention. In terms of overall clinical success, 53% of the PMR patients and 77% of the PS patients had their problems resolved. The multidisciplinary collaboration in the PS/PMR outpatient amputee clinic provides a unique service that benefits upper and lower extremity amputees.
Economic Analysis of Open Approach Versus Conventional Methods of Zygoma Fracture Repair
Authors: Czerwinski Marcin , Ma Stephanie , Motakis Dimitrios , Lee Chen
Published: February 2017

Background

As resource allocations in health care are being increasingly guided by cost containment issues, surgical professionals must consider the costs associated with various procedures. The present study identifies the financial costs attributed to the two principal treatment options available for zygoma fractures: The Gillie's method and open reduction and internal fixation (ORIF).

Methods

Patients were included if they sustained an isolated zygoma fracture and were treated within 10 days of injury using either ORIF or the Gillie's method. Those who suffered concomitant injuries or required orbital floor exploration and repair were excluded. The end point, which consisted of the total cost required to bring a patient to preinjury facial appearance and function, incorporated the cost of primary treatment and that of any secondary procedures required to correct unfavourable outcomes.

Results

In total, 45 patients were included: 25 were treated with Gillie's method and 20 were treated with ORIF. The cost associated with the primary treatment of zygoma fractures was found to be higher for ORIF than Gillie's method, amounting to $1,811 and $715, respectively. However, when taking into account potential repair of unsatisfactory results, the final sum totalled $1,930 and $3,725, respectively. This difference was statistically significant.

Conclusion

To the authors’ knowledge, this is the first study to objectively examine the cost of the Gillie's method and ORIF in the repair of zygoma fractures. Although the initial cost of ORIF is higher, the final cost of the Gillie's method is greater. Thus, surgeons should not allow higher initial costs to deter them from using more extensive and accurate techniques.
Juvenile Xanthogranuloma: Case Report and Review of the Literature
Authors: Cypel Tatiana Karine Simon , Zuker Ronald Melvin
Published: February 2017

The present case report describes a juvenile xanthogranuloma in a five-month-old girl. A circumscribed papule was located below the right nasal ala and above the right vermilion border. The lesion was histologically diagnosed as a juvenile xanthogranuloma after surgical resection of the mass. Juvenile xanthogranuloma is an uncommon diagnosis, with the head, neck and trunk being the most common sites.
Porcine Wound Healing in Full-Thickness Skin Defects Using Integra™ with and Without Fibrin Glue with Keratinocytes
Authors: Melendez Mark M , Martinez Rodrigo R , Dagum Alexander B , Mcclain Steve A , Simon Marcia , Sobanko Joseph , Zimmerman Thomas , Wetterau Meredith , Muller Douglas , Xu Xiaoti , Singer Adam J , Arora Balvantray
Published: February 2017

Background

An artificial dermal matrix such as Integra (Integra Life Sciences Corporation, USA) provides a wound bed template for vascular and fibrocyte ingrowth as well as collagen remodelling. Dermal repair leads to epidermal and basement membrane regeneration. Burn wounds in particular have been shown to benefit from Integra by enhanced wound healing.

Objective

To evaluate the effect of fibrin glue to modify the integration of Integra in large excised cutaneous wounds. It was hypothesized that applying fibrin glue on a wound bed would reduce the time needed for matrix vascularization and incorporation of Integra and take of the cultured keratinocytes.

Methods

Four separate full-thickness wounds were created on the dorsum of two swine. Wound beds were randomly assigned to either application of fibrin glue or no application of fibrin glue before application of Integra. Full-thickness biopsies were performed at days 7, 14, 21, 29 and 35. On day 21, keratinocytes were applied either as sheets or aerosolized fibrin glue suspension.

Results

Histological analysis revealed a wave of inflammatory cells and early granulation tissue ingrowth into the Integra from the fascia below on day 7. Only this initial phase was augmented by application of fibrin glue to the wound bed. By day 14, most and by day 21, all of the Integra thickness was incorporated. Accelerated dermal repair proceeded from the base with new collagen deposition in Integra spaces. There was no evidence of keratinocyte engraftment, although re-epithelialization occurred at wound edges extending onto the incorporated Integra.

Conclusions

It appears there is an acceleration of early phase (day 7 to day 21) dermal incorporation with fibrin glue application to the wound bed, perhaps secondary to increased cellular migration. Day 21 appears to be too early to apply cultured keratinocytes either as sheets or aerosolized suspension.
Triple-Flap Medial Canthal Reconstruction
Authors: Berry Mg , Fernandes Anthony El
Published: February 2017

A patient with a medial facial defect, following oncological resection involving the medial canthus, nose, upper and lower eyelids, and the cheek, is presented. The defect was reconstructed using a combination of local flaps to provide tissue similar to native tissue, addressing both functional and aesthetic aspects.
Are There Any Correlations Between Social and Hand Functions in Patients with Carpal Tunnel Release Surgery Postoperatively?
Authors: Marchie Alfonse , Mahoney James
Published: February 2017

Background

Carpal tunnel syndrome is one of the most common and disabling work injuries in North America. Patients with carpal tunnel syndrome are often associated with substantial productivity loss and cost both at work and at home. Several studies have examined the relationship of social supports as a predictor of returning to work following carpal tunnel release surgery (CTRS). However, no studies published to date have examined the relationship between social support and the ability to perform activities of daily living after having CTRS.

Objective

To examine whether a correlation exists between the degree of social support and hand function in terms of the ability to perform activities of daily living in patients who have had CTRS.

Methods

Patients in the present cross-sectional study were evaluated with two standardized questionnaires at least two months postoperatively following CTRS. The questionnaires consisted of the Multidimensional Scale of Perceived Social Support, which evaluated social support, and QuickDASH, which evaluated hand function. A correlation analysis was then performed to identify any relationships between the two questionnaires.

Results

In a sample of 20 patients, correlation analyses revealed that perceived social support was significantly associated with hand function scores postoperatively (r=−0.73, P<0.01). In addition, a statistically significant relationship existed between social support and the preoperative self-rating pain scores (r=−0.51, P<0.05). These results indicate that there is a strong association between the degree of social support and the ability to perform hand activities of daily living following CTRS.
Surgical Correction of Congenital Constriction Band Syndrome in Children: Replacing Z-Plasty with Direct Closure
Authors: Choulakian Mazen Yohanness , Williams H Bruce
Published: February 2017

Congenital constriction band syndrome is a sporadic condition that may also be present in association with other congenital anomalies. It has an incidence varying from one in 1200 to one in 15,000 live births. There is a significant predilection for the upper extremities and distal limbs. The two main objectives for the treatment of congenital constriction band syndrome are improvement of function and improvement of cosmetic appearance. Different surgical techniques, such as Z-plasty, have been described and used for decades; however, direct closure after the excision of the constricting band seems to be the simplest and most appropriate, allowing the fatty tissue to naturally reposition itself under the skin. This technique is used in a two-stage approach to avoid affecting distal circulation to the limb.
Transfixion Incision As An Initial Technique in Nasal Tip Deprojection
Authors: Solomon Philip , Rival Richard , Mabini Aimee , Boyd Jennifer
Published: February 2017

Background

The overprojected nasal tip presents a significant challenge to the surgeon performing rhinoplasty. Full transfixion incision as a means of dealing with this deformity has been studied only in combination with other surgical methods.

Objectives

To determine whether transfixion incision alone would result in significant nasal tip deprojection, and if skin thickness had an effect on the extent of deprojection the procedure yielded.

Method

Seventy-two consecutive patients with an aesthetic goal of nasal tip deprojection were enrolled. The sole surgical means of deprojection used was transfixion incision. Subjects were categorized as thin-, medium- or thick-skinned based on the surgeon's analysis. These groups were compared in terms of their postprocedural nasal tip deprojection.

Results

Using transfixion incision as the sole means of correcting this deformity resulted in a mean nasal tip deprojection of 1.6 mm (ranging from 0 mm to 3 mm). Patients in the thin skin group had a mean deprojection of 2.12 mm. This was significantly greater than for both the medium- and thick-skinned groups. There was no significant difference between the medium- and thick-skinned groups.

Conclusions

Surgeons may use skin thickness when planning interventions for correcting nasal tip overprojection. When used alone, transfixion incision resulted in tip deprojection comparable with that achieved when combined with other methods, particularly for thin-skinned patients. Surgeons can thus use a graduated approach in which transfixion incision, the least destructive method, is used before proceeding with other interventions.
Decreasing Expander Breast Infection: A New Drain Care Protocol
Authors: D Murray John , T Elwood Eric , E Jones Glyn , Barrick Pa-C Rebecca , Feng Jack
Published: February 2017

BACKGROUND

Risk factors for expander reconstruction infection are well known. However, drain use as a risk factor for the development of infection is unclear.

OBJECTIVE

To review a simple method for drain use to help reduce rates of infection in expander breast reconstruction.

METHODS

Two hundred consecutive single-surgeon (JDM) immediate first-stage expander breast reconstructions were retrospectively reviewed. The records were reviewed for history and physical examination, intraoperative technique, perioperative management, adjuvant therapy, and outcome with respect to expander infection necessitating premature explantation within the first eight weeks. Infection was defined on clinical basis, with or without culture positivity. All expanders (Mentor, USA) were the same model (textured, port-integrated and biodimensional). Two consecutive series of reconstructions were then created. The first series included 177 reconstructions while the second series included 23 reconstructions. Unlike the first series, the second series introduced a protocol in which all reconstructions received mupirocin 2% cream to the drain sites and all drains were removed at the end of the first week. Additionally, in the second series, all expanders were secluded from direct in vivo contact with the closed suction drain either by the use of an intervening Alloderm sling (LifeCell Corporation, USA, 15 of 23 breasts) or by subdermally tunnelling the drain superficial to an adequate fatty subcutaneous layer (eight of 23 breasts).

RESULTS

Patients who developed infection in the first series and all patients in the second series shared statistically the same level of aggregate risk factors (P=0.531). The infection rate (5.65%, 10 infections in 177 breasts) in the first series was statistically greater than in the second series (0%, 0 in 23 breasts, P=0.001).

CONCLUSIONS

The present study found that percutaneous closed suction drains do serve as an increased risk for expander infection. However, early results indicate that in vivo protection of the expander with Alloderm or subdermal tunnelling, topical antibiotic ointment use and early drain removal may significantly reduce expander infection.
Hand Injuries in Foreign Labour Workers in An Irish University Hospital
Authors: Sattler Thorsten , Tobbia Dalia , O'shaughnessy Michael
Published: February 2017

The present study reports on a new, rapidly growing patient subpopulation presenting with hand injuries to the Department of Plastic Surgery in Cork University Hospital (Ireland). The impact of the 10 new European Union accession states on the trauma workload is examined. The associated growth in expenditure on interpreter services is also examined. Potential risk factors in the foreign workers’ new working environment is explored.
Complications from injectable materials used for breast augmentation
Authors: Peters Walter , Fornasier Victor
Published: February 2017

Fewer surgical procedures have a history as fascinating and as terrifying as breast augmentation. Initial efforts at augmentation involved injection of substances such as paraffin or oil into the breast tissue, or the implantation of substances including ivory or glass balls, or rubber. More recent efforts have included the injection of liquid silicone or polyacrylamide hydrogel. The current paper reviews four distinct eras of breast augmentation, and provides the current status of these injection materials. A case report is presented on a woman whose breasts were injected with polyacrylamide hydrogel in Iran. The current status of this group of materials is also presented. During the past 110 years, history has repeated itself during each of the four eras of injection.