bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perfusion Pressure Lacks Diagnostic Specificity for the Diagnosis of Acute Compartment Syndrome
Authors: Schmidt Andrew H. , Di Junrui , Zipunnikov Vadim , Frey Katherine P. , Scharfstein Daniel O. , O'Toole Robert V. , Bosse Michael J. , Obremskey William T. , Stinner Daniel J. , Hayda Roman , Karunakar Madhav A. , Hak David J. , Carroll Eben A. , Collins Susan C.J. , MacKenzie Ellen J. ,   METRC
Published: April 2020

Objective:
To evaluate the diagnostic performance of perfusion pressure (PP) thresholds for fasciotomy.

Design:
Prospective observational study.

Setting:
Seven Level-1 trauma centers.

Patients/Participants:
One hundred fifty adults with severe leg injuries and ≥2 hours of continuous PP data who had been enrolled in a multicenter observational trial designed to develop a clinical prediction rule for acute compartment syndrome (ACS).

Main Outcome Measurements:
For each patient, a given PP criterion was positive if it was below the specified threshold for at least 2 consecutive hours. The diagnostic performance of PP thresholds between 10 and 30 mm Hg was determined using 2 reference standards for comparison: (1) the likelihood of ACS as determined by an expert panel who reviewed each patient's data portfolio or (2) whether the patient underwent fasciotomy.

Results:
Using the likelihood of ACS as the diagnostic standard (ACS considered present if median likelihood ≥70%, absent if <30%), a PP threshold of 30 mm Hg had diagnostic sensitivity 0.83, specificity 0.53, positive predictive value 0.07, and negative predictive value 0.99. Results were insensitive to more strict likelihood categorizations and were similar for other PP thresholds between 10- and 25-mm Hg. Using fasciotomy as the reference standard, the same PP threshold had diagnostic sensitivity 0.50, specificity 0.50, positive predictive value 0.04, negative predictive value 0.96.

Conclusion:
No value of PP from 10 to 30 mm Hg had acceptable diagnostic performance, regardless of which reference diagnostic standard was used. These data question current practice of diagnosing ACS based on PP and suggest the need for further research.

Level of Evidence:
Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Brain Injury and Neurologic Outcome in Patients Undergoing Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis
Authors: Migdady Ibrahim , Rice Cory , Deshpande Abhishek , Hernandez Adrian V. , Price Carrie , Whitman Glenn J. , Geocadin Romergryko G. , Cho Sung-Min 
Published: April 2020

Objectives:Extracorporeal cardiopulmonary resuscitation has shown survival benefit in select patients with refractory cardiac arrest but there is insufficient data on the frequency of different types of brain injury. We aimed to systematically review the prevalence, predictors of and survival from neurologic complications in patients who have undergone extracorporeal cardiopulmonary resuscitation.Data Sources:MEDLINE (PubMed) and six other databases (EMBASE, Cochrane Library, CINAHL Plus, Web of Science, and Scopus) from inception to August 2019.Study Selection:Randomized controlled trials and observational studies in patients greater than 18 years old.Data Extraction:Two independent reviewers extracted the data. Study quality was assessed by the Cochrane Risk of Bias tool for randomized controlled trials, the Newcastle-Ottawa Scale for cohort and case-control studies, and the Murad tool for case series. Random-effects meta-analyses were used to pool data.Data Synthesis:The 78 studies included in our analysis encompassed 50,049 patients, of which 6,261 (12.5%) received extracorporeal cardiopulmonary resuscitation. Among extracorporeal cardiopulmonary resuscitation patients, the median age was 56 years (interquartile range, 52–59 yr), 3,933 were male (63%), 3,019 had out-of-hospital cardiac arrest (48%), and 2,289 had initial shockable heart rhythm (37%). The most common etiology of cardiac arrest was acute coronary syndrome (n= 1,657, 50% of reported). The median extracorporeal cardiopulmonary resuscitation duration was 3.2 days (interquartile range, 2.1–4.9 d). Overall, 27% (95% CI, 0.17–0.39%) had at least one neurologic complication, 23% (95% CI, 0.14–0.32%) hypoxic-ischemic brain injury, 6% (95% CI, 0.02–0.11%) ischemic stroke, 6% (95% CI, 0.01–0.16%) seizures, and 4% (95% CI, 0.01–0.1%) intracerebral hemorrhage. Seventeen percent (95% CI, 0.12–0.23%) developed brain death. The overall survival rate after extracorporeal cardiopulmonary resuscitation was 29% (95% CI, 0.26–0.33%) and good neurologic outcome was achieved in 24% (95% CI, 0.21–0.28%).Conclusions:One in four patients developed acute brain injury after extracorporeal cardiopulmonary resuscitation and the most common type was hypoxic-ischemic brain injury. One in four extracorporeal cardiopulmonary resuscitation patients achieved good neurologic outcome. Further research on assessing predictors of extracorporeal cardiopulmonary resuscitation-associated brain injury is necessary.
The Reversed Glove Sleeve: A Readily Available and Cost-effective Way to Achieve “No Touch” Breast Implant Insertion
Authors: Barker Anthony S. , Law Jenaleen , Nicholson Margaret , Collett David , Deva Anand K. 
Published: April 2020

Summary:
The reversed glove sleeve technique is a simple, available, reproducible, and cost-effective method of achieving “no touch” breast implant insertion. It allows a new glove to be used for each side, thus reducing the risk of contamination by reusing a sleeve/funnel for the subsequent implant insertion. The link between bacterial contamination of breast implants and capsular contracture is established. Further prospective evaluation of this technique is underway to show if there is benefit in reducing the risk of capsular contracture.
Biplanar Technique for Breast Implant Replacement through Mastectomy Scar
Authors: Kruchevsky Dani , Tobias Tal , Halperin Ben-Ami Tamar , Shoufani Aziz 
Published: April 2020

Background:
Implant-based breast reconstruction is the most commonly used modality for breast reconstruction. A 2-stage reconstruction is employed when the skin envelope is insufficient. In the first stage, a tissue expander is placed in a pocket created beneath the pectoralis major muscle and an acellular dermal matrix (ADM). In the second stage, the expander is replaced with a permanent implant. Though the second stage is safer, some studies have published an immediate complication rate of up to 11.4%, and even higher in the event of prior radiotherapy.

Methods:
We present a novel biplanar technique for implant replacement through the mastectomy scar. The goal of our technique is to make incisions of the skin and the incorporated ADM in 2 separate planes, hopefully lowering the risk for dehiscence, deep infection, and reconstruction failure. We conducted a retrospective review of patients who underwent tissue expander or implant replacement surgery using the biplanar technique between January 2012 and January 2018 by the senior author.

Results:
Eleven consecutively presenting patients underwent 8 tissue expanders and 6 silicone implant replacement surgeries. Three patients had received prior radiation therapy in the operated breast. None of the patients had complications nor needed a revision surgery.

Conclusions:
The biplanar technique for implant or tissue expander replacement through the mastectomy scar following breast reconstruction shows promising results in our series of patients and may prove useful in reducing postoperative incisional dehiscence, deep infection, and implant exposure. Nonetheless, further large-scale studies are required to evaluate the effectiveness of this technique.
Ulnar Nerve Entrapment in Diabetes: Patient-reported Outcome after Surgery in National Quality Registries
Authors: Zimmerman Malin , Anker Ilka , Karlsson Anna , Arner Marianne , Svensson Ann-Marie , Eeg-Olofsson Katarina , Nyman Erika , Dahlin Lars B. 
Published: April 2020

Background:
Ulnar nerve entrapment at the elbow (UNE) is overrepresented in patients with diabetes, but the outcome of surgery is unknown. We aimed to evaluate patient-reported outcome in patients with and without diabetes, and to assess potential sex differences and compare surgical treatment methods.

Methods:
Data on patients operated for UNE (2010–2016, n = 1354) from the Swedish National Registry for Hand Surgery were linked to the Swedish National Diabetes Register. Symptoms were assessed preoperatively (n = 389), and 3 (n = 283), and at 12 months postoperatively (n = 267) by QuickDASH and HQ-8 (specific hand surgery questionnaire—8 questions). Only simple decompressions were included when comparing groups.

Results:
Men with diabetes reported higher postoperative QuickDASH scores than men without diabetes. Women scored their disability higher than men on all time-points in QuickDASH, but showed larger improvement between preoperative and 12 months postoperative values. Patients operated with transposition scored 10.8 points higher on QuickDASH than patients who had simple decompression at 12 months (95% confidence interval 1.98–19.6).

Conclusions:
Women with diabetes benefit from simple decompression for UNE to the same extent as women without diabetes. Men with diabetes risk not to benefit from simple decompression as much as women do. Ulnar nerve transposition had a higher risk of residual symptoms compared to simple decompression.
Unusual Intranodular Collagenase Injection: A Case of Bilateral Ledderhose Disease
Authors: De Vitis Rocco , Passiatore Marco , Perna Andrea , Starnoni Marta , Taccardo Giuseppe 
Published: April 2020

Summary:
Ledderhose disease (LD) is a rare plantar fibromatosis of the foot, frequently associated with Dupuytren disease. Collagenase of Clostridium hystoliticum has recently revolutionized the way to treat Dupuytren disease. Nevertheless, the literature is still critically lacking about the use of collagenase injection in LD. We report a case of a man with bilateral symptomatic LD treated with collagenase. Injections (0.58 mg of collagenase of C. hystoliticum) were performed into nodules. Forced extension after injection was not performed. The patient could walk normally immediately after procedure. The procedure was a complete success without side effects or complications on either foot. Currently, at 14 months after treatment of the right foot and 12 months after treatment of the left foot, no recurrence has been observed. Collagenase injection was only effective in treating symptomatic LD in this one patient we reported on.
The Reconstruction after a Giant Phyllodes Tumor Resection Using a DIEP Flap
Authors: Tsuruta Yuki , Karakawa Ryo , Majima Koya , Yamamoto Satoru , Shibata Tomoyoshi , Yoshimatsu Hidehiko , Miyashita Hiroki , Tanakura Kenta , Yano Tomoyuki 
Published: April 2020

Summary:
A phyllodes tumor of the breast is a rare neoplasm, accounting for 0.3%–1% of all breast cancers. The size is 4–5 cm on average but sometimes the tumor grows more and involves the entire breast. As for treatment, complete surgical resection is the standard for localized breast phyllodes tumors. The reconstruction of a large defect is challenging. Herein, we present a case where a deep inferior epigastric artery perforator (DIEP) flap was used in breast reconstruction for a 48-year-old woman who was suffering from a giant phyllodes tumor. Immediate reconstruction was performed after tumor excision; the specimen weighed 4,230 g and the skin defect was 22 × 24 cm. The deep inferior epigastric artery and vein were anastomosed to the right internal mammary artery and vein, and the superficial inferior epigastric vein was anastomosed to the right lateral thoracic vein. The postoperative course was uneventful and the DIEP flap survived completely. In the setting of the reconstruction for a large defect, we must make maximum use of the limited human tissue available and ensure minimum damage, while also considering the functional and aesthetic outcome of the donor site. Various ideas and technologies have been reported that can assist in achieving this goal, but few reports have commented especially on the reconstruction of giant phyllodes tumor using autologous tissues. There were some other options for the way of the reconstruction such as a latissimus dorsi flap and a rectus abdominis flap. Compared with these approaches, using a DIEP flap has some disadvantages such as the need for the microsurgical skill and the risk of postoperative hernia. However, a DIEP flap provides the enough tissue to cover the large defect without any damage of the muscle. To our knowledge, this case was the largest phyllodes tumor reconstruction ever, in terms of the amount of the skin needed and resected tissue involved. Although more studies and longer follow-up will be required in the future, this case may show the usefulness of DIEP flaps for reconstruction of a giant phyllodes tumor.
Lateral Temporal Subcutaneous Brow Lift: Clinical Experience and Systematic Review of the Literature
Authors: Savetsky Ira L. , Matarasso Alan 
Published: April 2020

Background:
Numerous techniques have been described to correct brow aesthetics in facial rejuvenation. We report the senior author’s (A.M.) current approach for eyebrow elevation utilizing a lateral subcutaneous brow lift and, when indicated, a medial subgaleal brow lift. Furthermore, a systematic review of the literature was performed comparing the different surgical approaches and techniques.

Methods:
A systematic review of the literature was performed using the MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials databases. Studies were included if the content was original, provided outcome data, and complications.

Results:
The senior author (A.M.) has performed over 500 lateral temporal subcutaneous brow lifts for lateral brow ptosis. The vast majority was highly satisfied with the outcome and there were minimal complications. This represents the largest series of patients utilizing this technique. Twenty-six articles were reviewed and 5 met our screening criteria and were analyzed critically for inclusion and further objective review. All of the studies were retrospective in nature and report high patient satisfaction with an acceptable risk profile.

Conclusions:
In this study, we described the largest series of patients undergoing lateral subcutaneous brow lifts (n > 500), as well as a systematic review of the current literature. The current literature described an overall high degree of patient satisfaction with low complication rates, similar to the senior author’s (A.M.) experience. This technique has emerged as a reliable technique for lateral brow elevation with a very low and acceptable risk profile.
Resolution of Thumb Pain following Adoption of Mathieu Needle Holder: An Ergonomic Analysis
Authors: Schuth Olga , Powers Jeremy , Merritt Wyndell , Blanchet Nadia 
Published: April 2020

Background:
As surveys reveal the prevalence of musculoskeletal pain among surgeons, it is important to have an appreciation and understanding of surgical ergonomics to protect against long-term injuries and mitigate the symptoms of existing conditions. Surgeons diagnosed with thumb carpometacarpal (CMC) joint osteoarthritis, a progressive and debilitating condition, can be especially vulnerable to the pain caused by the repetitive manual tasks of operating.

Methods:
In this article, the authors describe a case of occupational thumb CMC arthritis in a right-hand dominant plastic surgeon and provide an ergonomic analysis of the different needle holders.

Results:
Following diagnosis, the simple switch from the traditional Hegar needle holder to the Mathieu needle driver with its palm grip and rotating ratchet lock mechanism stalled the progression of the disease, allowing the surgeon to continue operating pain free.

Conclusions:
This is the first report of utilization of an alternative needle holder leading to the resolution of thumb pain. In sharing this case, the authors hope to bring awareness to the importance of hand ergonomics in the operating room and offer a practical tip to surgeons with CMC arthritis.
Do Microsurgical Outcomes Differ Based on Which Specialty Does the Operation? A NSQIP Analysis
Authors: Zhang Jacques X. , Wan Melissa , Ding Yichuan , Jin Yiwen , Nagarajan Mahesh , Courtemanche Douglas J. , Bedford Julie , Arneja Jugpal S. 
Published: April 2020

Background:
Because plastic surgeons do not “own” a specific anatomic region, other surgical specialties have increasingly assumed procedures historically performed by plastic surgery. Decreased case volume is postulated to be associated with higher complication rates. Herein, we investigate whether volume and surgical specialty have an impact on microsurgical complications, specifically surgical site infection (SSI) and reoperation rates.

Methods:
The 2005–2015 National Surgical Quality Improvement Program participant use file was queried by Current Procedural Terminology code for breast and head/neck microsurgeries. Multivariate logistic regression was performed to compare the outcomes between surgical specialties. A cumulative frequency variable was introduced to investigate the effect of case volume on complication rates.

Results:
We captured 6,617 microsurgical cases. Multivariate logistic regression revealed that although the rate of SSI was lower in plastic surgery compared with otolaryngology for head and neck reconstructions (13.3% versus 10.5%) and compared with general surgery for breast reconstructions (5.4% versus 4.7%), there was no significant difference between specialties (P = 0.13; P = 0.96). Increased case volume is negatively correlated with complications.

Conclusions:
Plastic surgery is at risk given case cannibalization by other specialties. We conclude that surgical specialty does not affect the rates of SSI and reoperation. We demonstrate a correlation between lower volumes and increased complications, implying that, once a specialty has amassed critical case experience, complication rates may decrease, and outcomes can be equivalent or superior. Case breadth and volumes should be maintained to preserve skills, optimize outcomes, and maintain the specialty as it currently exists.
Excessive Aesthetic Lower Limb Elongation Management
Authors: Barinov Aleksander S. , Vorobyev Aleksander A. , Shtatov Viktor V. , Barinova Ekaterina A. , Nikolenko Vladimir N. , Barinov Alexey N. , Sinelnikov Mikhail Y. 
Published: April 2020

Summary:
With the evolution of surgical techniques and increased availability of cosmetic orthopedic surgery, new complications manifest. Uncontrolled lower limb elongation without limitations can be achieved by disinformation and undergoing surgery in different countries. Patients receive excessive surgical intervention due to misinforming surgeons and clinics of their previous medical history. We present a previously undocumented case of excessive lower limb elongation in an adult male patient and a treatment method for this novel pathology. Lack of personal constraint and severe aesthetic discomfort led the patient to undergo 3 elongation procedures in 3 clinics in different countries. Correction of excessive elongation is a delicate procedure, which must account for previous medical history, the patient’s psychological status, and strict adherence to anatomical standards. In this case, we managed to correct the complications from hyper-elongation by restoring the normal anatomical proportions of the lower limbs. The patient consented to publication of these findings and has undergone psychiatric evaluation in a specialized clinic after corrective surgery. It is important to properly educate patients of surgical risks and to evaluate all aspects of patient psychosomatic well-being before surgical intervention. Advances in aesthetic medicine underline the development of new iatrogenic pathologies. Excessive lower limb elongation can lead to significant musculoskeletal deformation, requiring precise surgical correction with account to normal anatomical proportions.
Distal Deep Vein Thrombosis Causing Pulmonary Embolism after Outpatient Plastic Surgery: A Case Report
Authors: Swanson Eric 
Published: April 2020

Summary:
A distal deep vein thrombosis is generally believed to be clinically unimportant because of a low incidence of pulmonary emboli. To the author’s knowledge, a symptomatic pulmonary embolism has not been reported in association with an isolated calf deep vein thrombosis in a plastic surgery outpatient. This case report provides the clinical details of a pulmonary embolism occurring after routine ultrasound detection of a distal deep vein thrombosis. Proximal deep venous thromboses originate in the calf and are dangerous because they frequently embolize. Ultrasound surveillance provides early detection of subclinical distal deep vein thromboses. Anticoagulation is initiated, suppressing propagation of the thrombosis to the deep veins of the thigh, and reducing the risk of a catastrophic pulmonary embolism.
Compromise of Personal Protective Clothing from Liquid Exposure
Authors: Schwahn Scott O. , Foster Nathaniel D. 
Published: April 2020

Introduction
Following critiques of multiple personal contamination events from entries into the Oak Ridge National Laboratory’s Spallation Neutron Source Transfer Bay, it was considered that the most likely causes for contamination were personal protective clothing doffing errors or moisture (sweat) allowing contamination to wick through the protective clothing. Radiological protection staff looked more closely, however, at the specific area of the clothing where contamination was highest; under enhanced lighting and photochromic manipulation, there appeared to have been some type of moisture in the area. Recognizing the possibility that moisture may have allowed for migration of contamination through the clothing, further experiments were undertaken to determine under which conditions this transport might have occurred.

Objective
The objective for this work was to identify the susceptibility of different types of personal protective clothing to various liquids encountered in the workplace.

Method
Several tests were performed to determine if perspiration had enabled migration of contamination and to identify what other liquids might have affected contamination transport. Two layers of personal protective clothing were subjected to static conditions and dynamic conditions to include active rubbing of the materials while wet. Food dye added to each of the liquids tested enabled visual indications of liquid breakthrough. Additional tests were conducted to see if solid contamination could be transported through the materials along with the liquids.

Results
All but one type of non-rubberized personal protective clothing in use at Oak Ridge National Laboratory were permanently compromised to some extent by the solvents used for decontamination.

Conclusion
It was determined that most common cleaning agents immediately and permanently destroyed the hydrophobic nature of several of the tested protective clothing materials, potentially allowing for radioactive contamination to penetrate through the material to the worker. Work around wet surfaces or performing wet decontamination will only be performed in protective clothing known to prevent transport of the wetting agent.