bluuebunny/crossref_metadata_2025_split huggingface dataset:
Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty
Authors: Gutierrez Santiago , Wuesthoff Carolina 
Published: March 2018

Background Steroids have proven to be of some benefit in rhinoplasty edema and ecchymosis when administered at a high and repeated dose. Objective To evaluate the effects of single-dose, long-acting intramuscular steroids on postoperative edema and ecchymosis after closed rhinoplasty with osteotomies compared with placebo. Methods A randomized, double-blinded, placebo-controlled trial was performed. Fifty-four patients were randomly assigned to two groups: 28 received a single dose of long-acting dexamethasone (mean [± SD] dose 16±4 mg) immediately before anesthetic induction; the remaining 26 received an intramuscular injection of saline solution. The same surgeon performed all surgeries, with patients under general anesthesia. Acetaminophen was the only analgesic used to control postoperative pain. High-resolution digital photographs were taken on postoperative days 1, 3, 7 and 14. Scoring was performed separately for eyelid swelling and ecchymosis by an independent observer using a graded scale (0 to 5) for edema and a scoring system (0 to 13) for ecchymosis. Results No statistically significant differences in terms of age, sex or amount of bleeding during surgery were found between the two groups. No statistically significant difference was observed in the decrease of both ecchymosis and edema between placebo and high-dose, long-acting dexamethasone. A statistically significant difference in operation time was found, favouring the steroid group. No severe complications were observed due to steroid use. Discussion Osteotomies are basically a form of (controlled) trauma, with considerable disruption of the abundant blood vessels in this facial region and, therefore, are associated with with undesirable effects. A recent meta-analysis failed to show benefits of the use of steroids after postoperative day 3. Only a trend toward reduction in edema and ecchymosis with the use of long-acting steroids compared with placebo was demonstrated in the present study. Conclusion There was no benefit in administering single-dose, long-acting steroids in patients undergoing closed rhinoplasty with osteotomies.
Biomechanical analysis of the FlatWire Figure 8 sternal fixation device
Authors: Wilson Ryan M , Ghareeb Paul A , Mcclellan W Thomas , Boustany Ashley N 
Published: March 2018

Objective To determine whether the FlatWire Figure 8 sternal fixation device (Penn United, USA) is mechanically superior to the current standard in sternotomy closure. Description Unstable sternal closure using traditional steel-wire cerclage can increase postoperative pain, bony cut-through and wound dehiscence. The authors present the Figure 8 sternal fixation device to minimize these complications. Biomechanical properties of the device were compared with conventional steel wire sternal repair. Evaluation Using two constructs of both FlatWire and steel wire, pull-to-failure, Hertzian contact and cut-through were compared. Samples were tested to 500,000 cycles or failure. Cyclic comparisons were performed using log-rank t tests and Student's t tests for cut-through analysis. FlatWires were found to have superior biomechanical properties in all categories tested. Conclusion The FlatWire provides superior biomechanical properties compared with conventional steel wire, which may lead to reduced sternal wound complications.
Current biopsy practices for suspected melanoma: A survey of family physicians in Southwestern Ontario
Authors: Lutz Kristina , Hayward Victoria , Joseph Mariamma , Wong Eric , Temple-Oberle Claire 
Published: March 2018

Background Family physicians (FPs) have an opportunity to diagnose pigmented lesions early with a timely biopsy. Objective To assess current biopsy practices used by FPs in diagnosing melanoma. Methods A computer-generated random sample of 200 practicing FPs from large and small communities in Southwestern Ontario was identified from the College of Physicians and Surgeons of Ontario physician directory. Paper-based surveys exploring practice setting, basic melanoma knowledge, biopsy practices and referral wait times were mailed using a modified Dillman protocol. Results The response rate was 50% and respondents reflected the demographic characteristics of FPs nationwide as per the National Physician Survey. Knowledge testing revealed reasonable mean (± SD) scores (3.2±1.03 of 5). Twenty percent of respondents would always perform an excisional biopsy of skin lesions suspicious for melanoma. The remaining 80% would avoid an excisional biopsy in an aesthetically sensitive area and if there was risk of failure to close the defect primarily, among other reasons. If an excisional biopsy were not performed, one-half of respondents would perform an incisional biopsy (eg, punch biopsy). In large communities, 24% of patients were not seen by a surgeon within six months when referred without a tissue biopsy, leading to delayed diagnosis. Discussion Educating and supporting FPs to perform incisional biopsies in cases for which excisional biopsies are inappropriate should result in earlier diagnosis of melanoma. Conclusion FPs appropriately recognize that excisional biopsies are ideal in melanoma management and one-half will move on to an incisional biopsy when excision is not appropriate.
Three-dimensional remodelling to determine best fit for hemihamate autograft arthroplasty
Authors: Shih Jessica , Podolsky Dale , Binhammer Paul 
Published: March 2018

Objective To determine the best fit of a hamate osteochondral graft to reconstruct a palmar defect of a middle phalanx articular fracture using three-dimensional remodelling. Methods The proximal middle phalanx and distal hamate articular surfaces of 10 cadaveric right hands were scanned using a three-dimensional laser scanner. A defect was marked on the middle phalanx digital image to simulate a 50% palmar lip fracture. A hemihamate autograft surgical procedure was simulated by aligning the middle phalanx and hamate digital articular surfaces. In addition to the second digit measurements, the midpoint distances of the central ridge of proximal articular surface of the middle phalanx digital image for digits 3, 4 and 5 were recorded for reference value, as well as the offset distances for the long and small finger. Results The mean midpoint distance for the index finger was 2.96 mm (95% CI 2.71 mm to 3.21 mm). The mean angle of offset was 20.09° (95% CI 15.54° to 24.64°). The mean graft offset distance was prominent by 1.23 mm (95% CI 0.57 mm to 1.89 mm). The reference values for the third, fourth and fifth middle phalange midpoint distances were 3.26 mm (95% CI 3.09 mm to 3.43 mm), 3.13 mm (95% CI 2.93 mm to 3.33 mm) and 2.48 mm (95% CI 2.33 mm to 2.63 mm), respectively. The offset distances for digits 3 and 5 were 1.24 mm (95% CI 0.48 mm to 2.00 mm) and 1.08 mm (95% CI 0.48 mm to 1.68 mm), respectively. Conclusions The present study provides information about best fit for placing a hamate autograft for the hemihamate arthroplasty procedure. In this model, the hamate graft must be offset to recreate the curvature of the middle phalanx.
Do plastic surgery division heads and program directors have the necessary tools to provide effective leadership?
Authors: Arneja JS , Mcinnes CW , Carr NJ , Lennox P , Hill M , Petersen R , Woodward K , Skarlicki D 
Published: March 2018

Background Effective leadership is imperative in a changing health care landscape driven by increasing expectations in a setting of rising fiscal pressures. Because evidence suggests that leadership abilities are not simply innate but, rather, effective leadership can be learned, it is prudent for plastic surgeons to evaluate the training and challenges of their leaders because there may be opportunities for further growth and support. Objective To investigate the practice profiles, education/training, responsibilities and challenges of leaders within academic plastic surgery. Methods Following research ethics board approval, an anonymous online survey was sent to division heads and program directors from all university-affiliated plastic surgery divisions in Canada. Survey themes included demographics, education/training, job responsibilities and challenges. Results A response rate of 74% was achieved. The majority of respondents were male (94%), promoted to their current position at a mean age of 48 years, did not have a leadership-focused degree (88%), directly manage 30 people (14 staff, 16 faculty) and were not provided with a job description (65%). Respondents worked an average of 65 h per week, of which 18% was devoted to their leadership role, 59% clinically and the remainder on teaching and research. A discrepancy existed between time spent on their leadership role (18%) and related compensation (10%). Time management (47%) and managing conflict (24%) were described as the greatest leadership challenges by respondents. Conclusions Several gaps were identified among leaders in plastic surgery including predominance of male sex, limitations in formal leadership training and requisite skill set, as well as compensation and human resources management (emotional intelligence). Leadership and managerial skills are key core competencies, not only for trainees, but certainly for those in a position of leadership. The present study provides evidence that academic departments, universities and medical centres may benefit by re-evaluating how they train, promote and support their leaders in plastic surgery.
Intraoperative tissue expansion in the surgical correction of craniosynostosis
Authors: Doshier Laura J , Fowler Daniel , Mcewan Thomas , Baker C Lynette , Muzaffar Arshad R 
Published: March 2018

Background Wound healing complications can occur after calvarial vault expansion due to tension on the scalp flaps. Objectives To compare wound healing outcomes in patients with craniosynostosis undergoing calvarial vault expansion with and without intraoperative tissue expansion of the scalp. Methods The present analysis was an institutional review board-approved, retrospective cohort study involving 40 consecutive patients at the University of Missouri Hospitals and Clinics (Columbia, Missouri, USA) who underwent calvarial vault expansion for nonsyndromic craniosynostosis between June 1, 2009 and June 30, 2012. Patients were divided into two sequential cohorts: the first 20 underwent calvarial vault expansion without intraoperative tissue expansion; the second 20 underwent calvarial vault expansion with intraoperative tissue expansion. The main outcome measures included presence or absence of wound healing complications (persistent scabbing or slow-healing wounds, hardware exposure, need for operative wound revision or healed but widened scars), with documented postoperative follow-up of at least three months. The primary end point was the presence of a well-healed scar; the secondary end point was the need for an operative revision. Results Patients in the intraoperative tissue expansion group had a higher percentage of well-healed scars (73.6%) than those in the nonexpansion group (42.1%) (P=0.0487). This difference was primarily due to scar widening in the nonexpansion group. Conclusions The present study demonstrated that the use of intraoperative tissue expansion in patients with nonsyndromic craniosynostosis who underwent calvarial vault expansion resulted in a greater likelihood of a well-healed incision with a lower rate of poor scarring.
Does preoperative heparin increase the postoperative bleeding risk in women undergoing prosthetic breast implant surgery? A review of the data from a single institution
Authors: Monsivais Sharon E , Roehl Kendall R , Mahabir Raman C 
Published: March 2018

Background In 2008, the authors' institution adopted a policy requiring that all patients, regardless of preoperative risk, receive both sequential compression devices and a single preoperative subcutaneous 5000 unit injection of heparin. A previously published 12-year review at this same institution before this policy demonstrated a 1.5% 30-day postoperative incidence of hematoma in primary augmentation or delayed tissue expander based breast reconstructions. Objective To determine the incidence of postoperative bleeding complications associated with preoperative administration of 5000 units of subcutaneous heparin and compare that incidence with previously published data. Methods Patient data were collected prospectively and maintained in a secure database at a single institution with institutional review board approval. Current procedural terminology and International Classification of Diseases, Ninth Revision, coding was then used to identify all patients who received either primary breast augmentation or delayed tissue expander based breast reconstruction during a five-year period. The primary outcome was the incidence of postoperative bleeding complication. A bleeding complication was defined as any hemorrhagic event that required a return to the operating room. Results The overall incidence of significant postoperative bleeding was 1.47% (five of 340 [1.16% augmentation, 2.50% expander]). Comparing the current results with the previously published data, demonstrated an OR of 0.98 (95% CI 0.38 to 2.55). Conclusion In women undergoing primary breast augmentation or delayed tissue expander breast reconstruction, heparin prophylaxis did not increase the risk for significant postoperative bleeding compared with historical controls.
The utility of C-reactive protein and procalcitonin for sepsis diagnosis in critically burned patients: A preliminary study
Authors: Egea-Guerrero Juan J , Martínez-Fernández Carmen , Rodríguez-Rodríguez Ana , Bohórquez-López Angélica , Vilches-Arenas Angel , Pacheco-Sánchez María , Guerrero Juan M , Murillo-Cabezas Francisco 
Published: March 2018

Objective To assess the utility of C-reactive protein (CRP) and procalcitonin (PCT) as biomarkers of infection in patients with severe burn injury. Methods The present study included severe burn injury patients consecutively admitted to the Virgen del Rocío University Hospital (Andalucia, Spain) intensive care unit during a 12-month period. The variables of interest were: age, sex, mechanism of injury, percentage of burned body surface area, the Abbreviated Burn Severity Index (ABSI) and the absence/presence of sepsis. The authors analyzed serum levels of CRP and PCT at admission and every 48 h thereafter until intensive care unit discharge or death. Each determination was considered to be a sample or unit of analysis. Results A total of 157 determinations were analyzed from 17 severe burn injury patients. Fifty-four samples were considered to be septic, 25 of which corresponded to the first day of a new onset of sepsis. The mean duration of these symptoms was four days (interquartile range two to five days). Significant differences were found in the distributions of CRP and PCT values between sepsis and no-sepsis samples. Analysis of the changes in these biomarkers over time showed that PCT increase (ΔPCT) differentiated these diagnoses, whereas CRP increase (ΔCRP) did not. ROC curve analysis revealed that ΔPCT could predict positive sepsis samples (area under the curve 0.75 [95% CI 0.58 to 0.90]; P=0.003). Conclusion These preliminary results showed that PCT had a better discriminatory capacity than CRP for identifying infectious processes in patients with severe burn injury. A larger sample size would be needed to confirm these results.
Should ‘smart phones’ be used for patient photography?
Authors: Chan Natalie , Charette Jacob , Dumestre Danielle O , Fraulin Frankie Og 
Published: March 2018

Background Within the field of plastic surgery, clinical photography is an essential tool. ‘Smart phones’ are increasingly being used for photography in medical settings. Objective To determine the prevalence of smart phone use for clinical photography among plastic surgeons and plastic surgery residents in Canada. Methods In 2014, a survey was distributed to all members of the Canadian Society of Plastic Surgeons. The questions encompassed four main categories: smart phone use for clinical photos; storage of photos; consent process; and privacy issues. The survey participation rate was 27% (147 of 545) with 103 surgeons and 44 residents. In total, 89.1% (131 of 147) of respondents have taken photographs of patients using smart phones and 57% (74 of 130) store these photos on their phones. In addition, 73% (74 of 102) of respondents store these photos among personal photos. The majority of respondents (75% [106 of 142]) believe obtaining verbal consent before taking clinical photographs is sufficient to ensure privacy is respected. Written consent is not commonly obtained, but 83% (116 of 140) would obtain it, if it could be done more efficiently. Twenty-six percent (31 of 119) of respondents have accidentally shown a clinical photograph on their phone to friends or family. A smart phone application that incorporates a written consent process, and allows photos to be immediately stored externally, is perceived by 59% (83 of 140) to be a possible way to address these issues. Conclusion Smart phones are commonly used to obtain clinical photographs in plastic surgery. There are issues around consent process, storage of photos and privacy that need to be addressed.
Is antibiotic prophylaxis in breast augmentation necessary? A prospective study
Authors: Keramidas E , Lymperopoulos Ns , Rodopoulou S 
Published: March 2018

Background The role of prophylactic antibiotics in breast augmentation remains controversial. However, the majority of surgeons are administering antibiotics. Objective To investigate the effect of antibiotic(s) use in the incidence of infection and capsular contracture following breast augmentation. Methods From September 2004 to November 2010, 180 patients underwent primary bilateral breast augmentation. They were prospectively divided into two equal groups: in group A (n=90), no antibiotics were given and, in group B (n=90), only one intravenous dose of cephalosporin was administered during the induction of general anesthesia. Preoperative data included age, body mass index, smoking status, medical history and implant volume. All operations were performed by the same surgeon using the same surgical technique and implant type. No drains were used. Operative data included operative time and estimated blood loss. Patients were evaluated for complications such as infection, hematoma and capsular contracture. The study concluded when all of the patients underwent the one-year follow-up. The Student's t test was used to analyze the results. Results All patients completed the study and both groups had similar demographic data. No differences in operative data were observed. The mean operative time was 35 min and the mean blood loss was found to be minimal. In group A, no implant infections were reported, while a wound infection that occurred was treated successfully with oral antibiotics. In group B, no implant or wound infection was noticed. No capsular contractures or hematomas were observed. Conclusions The number of patients who underwent primary breast augmentation without antibiotics (n=90) was insufficient to draw any definitive conclusions. However, the present prospective study demonstrated that prophylactic use of antibiotics in breast augmentation had no significant effect on infection and capsular contracture rates. Further randomized clinical trials, in combination with guidelines from aesthetic plastic surgery societies, appear to be warranted.
Medical Student Perception of Plastic Surgery and the Impact of Mainstream Media
Authors: Fraser S. J. , Al Youha S. , Rasmussen P. J. , Williams J. G. 
Published: March 2018

Background: Plastic surgery as a discipline is poorly understood by many, including primary care physicians, nurses, medical students, and the public. These misconceptions affect the specialty in a number of ways, including referral patterns and recruitment of medical students into residency programs. The reason for these commonly held misconceptions has not yet been addressed in the plastic surgery literature. As such, we assessed medical students’ knowledge and perceptions of plastic surgery as a discipline and explored factors influencing these opinions. Methods: To assess medical students’ knowledge and perceptions of plastic surgery, we conducted an online survey. A total of 231 medical students responded. Interviews were then conducted with 2 focus groups, in which we explored the survey results and reasons behind these misconceptions. Results: As with previous studies, medical students showed a gap in knowledge with respect to plastic surgery. Although they were generally aware that plastic surgeons perform cosmetic procedures and treat burns, they were largely unaware that plastic surgeons perform hand and craniofacial surgeries. Focus groups revealed that television plays a large role in shaping their ideas of plastic surgery. Conclusion: Medical students have a skewed perception of the discipline of plastic surgery, and this is largely influenced by television. Interventions aimed at educating medical students on the matter are recommended, including a greater presence in the preclerkship medical school curriculum.
The Keystone Flap—A Case Series Demonstrating Practical Design, Use, and Applications
Authors: Pripotnev Stahs , White Colin 
Published: March 2018

Introduction: The keystone design perforator island flap is a trapezoidal-shaped random perforator island flap with many advantages over primary closure, skin grafting, and other local flaps for soft tissue reconstruction commonly encountered with cancer excisions. Methods: This case series of 39 keystone flaps in 37 patients reviews the practical design, use, and applications of the flap while highlighting certain important considerations. Keystone flaps were designed as in the original description, with a minor modification in the lower extremity where a higher flap to defect width ratio was used. Results: Defects varying in size from 6 to 63 cm2 were reconstructed in 23 males and 14 females ranging in age from 49 to 89. In all 39 cases, there were 2 minor complications of partial flap dehiscence and no major complications such as partial or complete flap loss. Conclusion: The keystone flap is a versatile and reliable flap with applications almost anywhere on the body. A higher ratio of flap width to defect width up to 1:3 is more appropriate for the lower extremity where tension is higher.