bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of accessibility and content of microsurgery fellowship websites
Authors: Hu Jiayi , Zhen Meng , Olteanu Cristina , Avram Ronen 
Published: March 2018

Background Websites for residency and fellowship programs serve as effective educational and recruitment tools. Objective To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development. Methods A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive ‘Google’ search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics using t tests and ANOVA (two-tailed; P<0.05 was considered to be statistically significant). Results A list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed ‘eligibility criteria’ (87%) and ‘general information’ (87%). ‘Evaluation criteria’ were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on ‘extremity’ versus ‘breast’ (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process. Conclusion Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process.
Triangular lipodermal flaps in Wise pattern reduction mammoplasty (superomedial pedicle): A novel technique to reduce T-junction necrosis
Authors: Khalil Haitham H , Malahias Marco , Shetty Geeta 
Published: March 2018

Background Although Wise pattern reduction mammoplasty is one of the most prevalent procedures providing satisfactory cutaneous reduction, it is at the expense of inevitable lengthier scars and wound complications, especially at the inverted T junction. Objective To describe a novel technique providing tension-free closure at the T junction through performing triangular lipodermal flaps. The aim is to alleviate skin tension, thus reducing skin necrosis, dehiscence and excessive scarring at the T junction. Methods One hundred seventy-three consecutive procedures were performed on 137 patients between 2009 and 2013. Data collected included demographics, perioperative morbidity and resected breast tissue weight. The follow-up period ranged from three to 30 months; early and late postoperative complications and patient satisfaction were recorded. Results Superficial epidermolysis without T-junction dehiscence was experienced in eight (4.6%) procedures while five (2.9%) procedures developed full-thickness wound dehiscence. Ninety-four percent of patients were highly satisfied with the outcome. Conclusions The technique is safe, versatile and easy to execute, providing a tension-free zone and acting as internal dermal sling, thus providing better wound healing with more favourable aesthetic outcome and maintaining breast projection.
Spontaneously Resolved Macrocystic Lymphatic Malformations: Predictive Variables and Outcomes
Authors: Phang Michael J. , Courtemanche Douglas J. , Bucevska Marija , Malic Claudia , Arneja Jugpal S. 
Published: March 2018

Introduction: Lymphatic malformations are benign, low-flow vascular malformations that typically present at or near birth. Due to morbidity associated with operative treatment, nonoperative treatment with injection of sclerosant has become the mainstay of therapy. Over the past 15 years, several patients at our centre with macrocystic (>2 cm cyst size) lymphatic malformations have seen their lesions resolve spontaneously while awaiting treatment. In this study, we review features of these patients that may contribute to spontaneous resolution. Method: A retrospective chart review was conducted from our Vascular Anomalies Clinic database (1999-2014) of all macrocystic lymphatic malformations; characteristics of patients with spontaneous resolution were reviewed. Results: Of 61 patients with macrocystic lymphatic malformations, 7 cases (11.5%; 4 females, 3 males) resolved spontaneously. Median age at malformation appearance was 2 years (range: 0-6.5 years), with median age at resolution of 4 years (range: 10 months-7 years). Median time from appearance to resolution was 24 months (range: 3-43 months), with a median follow-up time of 4 years (range: 1-15 years). All but 1 case was associated with local or upper respiratory tract infection antecedent to resolution. Six of the 7 lesions were located in the neck. Conclusion: Among the cases reviewed, there was a common theme of upper respiratory tract or local infection antecedent to spontaneous lesion resolution. Compared to the literature, our proportion of malformations presenting after birth and the proportion of malformations presenting in the neck region were higher than those of other series. Although side effects associated with treatment are generally mild and/or rare, risks related to sclerotherapy and the accompanying requirement for general anesthesia in pediatric populations nevertheless exist. As the median time from lesion appearance to resolution was 24 months, it may be reasonable to observe these malformations for up to 24 months before proceeding with treatment if the lesion does not impair function and disfigurement is not considerable, particularly if the lesion presents after birth and/or is located in the neck region.
The Use of Platelet-Rich Plasma for Storage of Surplus Harvested Skin Grafts
Authors: Keskin Ilknur , Ayturk Nilufer , Sutcu Mustafa , Keskin Mustafa , Mudok Tangul 
Published: March 2018

Background: There is a need for improved methods and storage media to sustain the tissue viability of autologous skin grafts. Objective: To compare histological changes in human skin grafts stored in platelet-rich plasma (PRP) with those of grafts stored in saline. Methods: Eight circular, 3-mm full-thickness skin graft samples were harvested from the abdominal skin of each of 5 patients scheduled to undergo an abdominoplasty procedure. Four of these graft samples were stored in saline, and the other 4 were stored in saline mixed with PRP prepared from the patient’s own venous blood. Histological assessment of the microscopic appearance of the samples was performed on days 5, 8, 11, and 14. The integrity of the epidermal–dermal junction, number of keratinocytes with perinuclear halos, collagen organization, and number of fibroblasts per field were assessed. The cellular apoptosis rate was also measured on these same days. Results: On day 5, significant differences were observed microscopically between the PRP- and saline-stored grafts ( P < .05). The grafts preserved in saline exhibited early marked cellular and nuclear swelling with pleomorphism, as well as early nuclear halo formation. The cell viability rate of the PRP group was significantly higher than that of the saline-stored group on day 8 ( P < .05). Conclusion: Platelet-rich plasma and its inherent growth factors supported longer graft survival; however, its effect lasted only until day 8. Platelet-rich plasma may be beneficial if grafts need to be stored for delayed application(s).
Comparison of Resorbable Mesh (Poly L-Lactide/Glycolic Acid) and Porous Polyethylene in Orbital Floor Fractures in an Experimental Model
Authors: Aral Ali Mubin , Özmen Selahattin , Uygur Safak , Kaya Basar , Coskun Neslihan , Ömeroglu Suna , Kılıc Koray 
Published: March 2018

Background: Resorbable mesh and porous polyethylene are frequently used alloplastic materials for the treatment of the orbital blowout fractures. The literature lacks reports comparing their long-term effects on experimental models. Objective: Our aim was to radiologically and histologically evaluate the effectiveness and safety of porous polyethylene and resorbable mesh in a rabbit orbital blowout fracture model. Methods: Twelve New Zealand white rabbits (24 orbits) were randomized to 4 groups. In group 1, only orbital floor dissection was done. In group 2, following orbital floor dissection, a 10-mm defect was created without any extra procedure. In group 3, following a 10-mm defect creation, a 12-mm-round cut porous polyethylene was placed on the defect. In group 4, following a 10-mm defect creation, a 12-mm-round cut resorbable mesh was placed on the defect. Computed tomographic analysis was performed during follow-up period. Orbital floors were evaluated histologically at month 6. Results: No clinical complications were observed during follow-up period. In radiological evaluation, there was no statistically significant difference between groups regarding bone formation. In histological evaluation, the connective tissue was denser, and organized and better bone formation was observed in group 3 and 4 when compared with other groups. Conclusion: Although no significant radiological changes were present, porous polyethylene and resorbable mesh performed better histologically. They were effective and well tolerated for reconstruction of the isolated orbital floor defects.
The Superficial Femoral Artery Flap: A 3-Dimensional Anatomical Study
Authors: El-Hadi Hadal , Morris Steven , Alkhawaji Ali 
Published: March 2018

Background: The superficial femoral artery perforator (SFAP) flap offers advantages for pedicled transfer including consistent perforators and vascular territory, well-hidden donor site scar, and hairless flap skin. This article provides a historical overview of the SFAP flap and describes the vascular anatomy of the SFAP by 3-dimensional analysis and angiography. Methods: Ten fresh cadavers were injected using the lead oxide technique through the femoral artery. Spiral computed tomographic scanning and 3-dimensional evaluation were used to describe the SFAP number, diameter, length, type, and location. Results: A total of 288 perforators in 15 cadaver limbs were identified; 19 ± 8 perforators per thigh ≥0.5 mm in diameter, with an average diameter of 0.8 ± 0.3 mm and a range of 0.5 to 2.1 mm; the mean length of each perforator was 68 ± 31 mm; 45% were septocutaneous and 55% were musculocutaneous. The medial thigh region was divided into 6 areas (anterior and posterior halves, then the proximal third, middle third, and distal third of each). The majority of the perforators were located in the middle and distal thirds of the anteromedial thigh (33% each). Conclusions: Using 3-dimensional vascular anatomical analysis, the number, location, length, type, and diameter of the SFAP were documented. In the literature, relatively few reports of the use of the SFAP flap are available, however, this is a valid donor site with consistent cutaneous perforators suitable for harvest as a local or regional flap transfer. This is the first 3-dimensional vascular anatomical study to comprehensively document the vascular anatomy of the SFAP flap.
Factors Influencing the Rate of Post-Mastectomy Breast Reconstruction in a Canadian Teaching Hospital
Authors: Karunanayake Mihiran , Bortoluzzi Patricia , Chollet André , Lin Jenny C. 
Published: March 2018

Background: Post-mastectomy breast reconstruction (PMBR) improves psychosocial well-being, quality of life, and body image. Reconstruction rates vary widely (up to 42% in the United States), but the few Canadian studies available report rates of 3.8% to 7.9%. We sought to evaluate the current state of breast reconstruction in 1 Canadian teaching hospital and factors determining patients’ access to reconstruction. Methods: We performed a retrospective chart review of all patients with breast cancer undergoing mastectomy alone or mastectomy and reconstruction at a Canadian hospital between 2010 and 2013. We calculated rates of breast reconstruction and compared patient characteristics between the 2 groups, and then performed a multiple logistic regression to determine factors increasing the odds of receiving breast reconstruction. Results: A total of 152 patients underwent 154 total or modified radical mastectomies. We obtained a rate of PMBR of 21%, 14% immediate reconstruction, and 8% delayed. Statistical analysis showed that compared to patients with mastectomy alone, patients who received PMBR were significantly younger, with a larger percentage having bilateral mastectomies, non-invasive breast cancer, and residing further from the hospital. Patients less than 50 years old and those with bilateral mastectomies had significantly greater odds of having a reconstruction. Conclusions: Our Canadian tertiary care institution has a high volume of breast surgery and an active breast reconstruction team. However, the rate of immediate reconstruction remains low compared to similar centers in the United States. We recommend a united effort to increase awareness regarding PMBR and address common misconceptions hindering patients’ access to breast reconstruction. Level of Evidence: Epidemiologic study, Level III
How Many Trigger Fingers Resolve Spontaneously Without Any Treatment?
Authors: McKee Daniel , Lalonde Jan , Lalonde Don 
Published: March 2018

Introduction: There is very little information in the literature evaluating the natural history of adult trigger fingers and their rate of spontaneous resolution over time. Methods: A consecutive case series of patients with trigger finger was generated. For each patient, we recorded whether the patient’s disease resolved from either no treatment versus active treatment options and over what time period. Results: Three hundred forty-three patients with trigger finger were included in the study. Fifty-two percent of patients resolved without any treatment whatsoever after waiting a mean (and median) of 8 months from initial consultation. The thumb was the most frequent digit to resolve without treatment (72%). Conclusions: We found that just over half of patients with trigger fingers who are referred to our office resolve spontaneously without any intervention.
An Evaluation of h-Index as a Measure of Research Productivity Among Canadian Academic Plastic Surgeons
Authors: Hu Jiayi , Gholami Arian , Stone Nicholas , Bartoszko Justyna , Thoma Achilleas 
Published: March 2018

Background: Evaluation of research productivity among plastic surgeons can be complex. The Hirsch index (h-index) was recently introduced to evaluate both the quality and quantity of one’s research activity. It has been proposed to be valuable in assessing promotions and grant funding within academic medicine, including plastic surgery. Our objective is to evaluate research productivity among Canadian academic plastic surgeons using the h-index. Methods: A list of Canadian academic plastic surgeons was obtained from websites of academic training programs. The h-index was retrieved using the Scopus database. Relevant demographic and academic factors were collected and their effects on the h-index were analyzed using the t test and Wilcoxon Mann-Whitney U test. Nominal and categorical variables were analyzed using χ2 test and 1-way analysis of variance. Univariate and multivariate models were built a priori. All P values were 2 sided, and P < .05 was considered to be significant. Results: Our study on Canadian plastic surgeons involved 175 surgeons with an average h-index of 7.6. Over 80% of the surgeons were male. Both univariable and multivariable analysis showed that graduate degree ( P < .0001), academic rank ( P = .03), and years in practice ( P < .0001) were positively correlated with h-index. Limitations of the study include that the Scopus database and the websites of training programs were not always up-to-date. Conclusion: The h-index is a novel tool for evaluating research productivity in academic medicine, and this study shows that the h-index can also serve as a useful metric for measuring research productivity in the Canadian plastic surgery community. Plastic surgeons would be wise to familiarize themselves with the h-index concept and should consider using it as an adjunct to existing metrics such as total publication number.
Canadian Plastic Surgery Resident Work Hour Restrictions: Practices and Perceptions of Residents and Program Directors
Authors: McInnes Colin W. , Vorstenbosch Joshua , Chard Ryan , Logsetty Sarvesh , Buchel Edward W. , Islur Avinash 
Published: March 2018

Background: The impact of resident work hour restrictions on training and patient care remains a highly controversial topic, and to date, there lacks a formal assessment as it pertains to Canadian plastic surgery residents. Objective: To characterize the work hour profile of Canadian plastic surgery residents and assess the perspectives of residents and program directors regarding work hour restrictions related to surgical competency, resident wellness, and patient safety. Methods: An anonymous online survey developed by the authors was sent to all Canadian plastic surgery residents and program directors. Basic summary statistics were calculated. Results: Eighty (53%) residents and 10 (77%) program directors responded. Residents reported working an average of 73 hours in hospital per week with 8 call shifts per month and sleep 4.7 hours/night while on call. Most residents (88%) reported averaging 0 post-call days off per month and 61% will work post-call without any sleep. The majority want the option of working post-call (63%) and oppose an 80-hour weekly maximum (77%). Surgical and medical errors attributed to post-call fatigue were self-reported by 26% and 49% of residents, respectively. Residents and program directors expressed concern about the ability to master surgical skills without working post-call. Conclusions: The majority of respondents oppose duty hour restrictions. The reason is likely multifactorial, including the desire of residents to meet perceived expectations and to master their surgical skills while supervised. If duty hour restrictions are aggressively implemented, many respondents feel that an increased duration of training may be necessary.
Functional Classification of the Medial Ulnar Collateral Ligament: An In Vivo Kinematic Study With Computer-Aided Design
Authors: Kholinne Erica , Zulkarnain Rizki Fajar , Lee Hyun-Joo , Adikrishna Arnold , Jeon In-Ho 
Published: March 2018

Background: It has been widely accepted that the anterior and posterior bundles of the medial ulnar collateral ligament (MUCL) tighten at extension and flexion, respectively. However, this belief is based on anatomic data acquired from cadaveric studies. The advancement of 3-dimensional (3D) model technology has made possible the simulation of dynamic movement that includes each ligament bundle fiber to analyze its functional properties. To date, no study has analyzed ligament kinematics at the level of the fibers while also focusing on their functional properties. Purpose: To propose a new classification for functional properties of the MUCL based on its kinematic pattern. Study Design: Descriptive laboratory study. Methods: Five healthy elbow joints were scanned by use of computed tomography, and 3D models were rendered and translated into vertex points for further mathematical analysis. The humeral origin and ulnar insertion of the MUCL fiber groups were registered. Each vertex point on the origin side was randomly connected to the insertion side, with each pair of corresponding points defined as 1 ligament fiber. Lengths of all the fibers were measured at 1° increments of elbow range of motion (ROM). Ligament fibers were grouped according to their patterns. Mean coverage area for each group, expressed as the percentage of ligament fibers per group to the total number of fibers, was calculated. Results: Four major bundle groups were found based on fiber length properties. Kinematic simulation showed that each group had a different kinematic function throughout elbow ROM. Mean coverage area of groups 1, 2, 3, and 4 was 8% ± 4%, 10% ± 5%, 42% ± 6%, and 40% ± 8%, respectively. Each group acted as a dominant stabilizer in certain arcs of motion. Reciprocal activity was observed between groups 1 and 3 along with groups 2 and 4 to produce synergistic properties of maintaining elbow stability. Conclusion: Detailed analysis of fibers of the MUCL allows for further understanding of its kinematic function. This study provides MUCL group coverage area and kinematic function for each degree of motion arc, allowing selective reconstruction of the MUCL according to mechanism of injury. Clinical Relevance: Understanding the dominant functional fibers of the MUCL will benefit surgeons attempting MUCL reconstruction and will enhance further anatomic study.
Evaluation of Shape of Foveal Avascular Zone by Optical Coherence Tomography Angiography in Eyes With Branch Retinal Vein Occlusion
Authors: Shiihara Hideki , Terasaki Hiroto , Sonoda Shozo , Kakiuchi Naoko , Sakamoto Taiji 
Published: March 2018

Purpose: To determine the relationship between morphological parameters of the foveal avascular zone (FAZ) in the optical coherence tomography angiographic (OCTA) images and the best-corrected visual acuity (BCVA) in branch retinal vein occlusion (BRVO). Methods: This was a retrospective cross-sectional study. Eyes with BRVO without apparent macular edema were studied. The superficial FAZ in 3 × 3 mm OCTA images were delineated manually. The size and shape, the circularity and axial ratio, of the FAZ were determined, and the values were compared to that of the controls. The correlation of these parameters with the BCVA was analyzed. Results: The mean FAZ area was larger in BRVO eyes than in controls, but the larger size was not correlated with the BCVA (BRVO, 0.49 ± 0.12 mm2; control, 0.38 ± 0.12 mm2; P = .135). The axial ratio of the BRVO eyes was significantly larger than that of controls ( P < .001). The axial ratio was significantly correlated with BCVA ( R = .382, P = .050). Although the circularity was significantly smaller in the BRVO eyes than that in controls ( P < .001), it was not significantly correlated with the BCVA. Conclusion: The shape of the FAZ would be a more appropriate parameter than the size in determining BCVA in eyes with BRVO.