bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Keratoacanthoma: Is Intralesional Methotrexate An Option?
Authors: P Patel Nima , Lawrence Cervino A 
Published: February 2017

BACKGROUND Keratoacanthomas (KAs) are a variant of squamous cell carcinomas. Some KAs have shown aggressive behaviour, leading to metastasis and death. Surgical excision is the treatment of choice for most KA patients. Intralesional methotrexate (MTX) may also be a potential treatment option for KAs. OBJECTIVE To evaluate intralesional MTX as a treatment modality for KA. METHODS A retrospective chart review of nine patients with KAs treated with intralesional MTX was performed. Each patient had biopsyproven KA. The lesion was initially debulked, and MTX was injected at the base. Patients were seen weekly in the office, and reinjected with intralesional MTX depending on the response of the lesion. Each patient was evaluated for their response to the intralesional MTX injections, the number of injections required and complications. RESULTS Patients required approximately two to four intralesional injections (12.5 mg to 25 mg per injection) before KA resolution. Eight of nine (88.9%) patients experienced complete resolution of their tumours. One patient experienced treatment failure, and underwent surgical excision of the KA. The average follow-up period was 2.8 years, and there were no recurrences. CONCLUSION The results from the present retrospective study show that intralesional MTX injection is an effective treatment option for KAs. The authors propose that intralesional MTX injection with initial debulking of the KA should be used as a first line of treatment when KAs present on the extremities, in cosmetically sensitive areas and in elderly patients with multiple comorbities.
Tuberous Breast: Morphological Study and Overview of a Borderline Entity
Authors: Klinger Marco , Caviggioli Fabio , Klinger Francesco , Villani Federico , Arra Erseida , Di Tommaso Luca 
Published: February 2017

BACKGROUND Tuberous breasts are widely known and described. Several surgical strategies have been proposed; however, few studies explain the origin or structural alterations of this deformity. No histological studies have been performed. The present article describes a morphological and histological study of breast tissue specimens. METHODS Mammary specimens of 22 female and five male patients with tuberous breasts were histologically analyzed and compared with six specimens harvested from normal female breasts and from three cases of true ‘normal’ gynecomastia. RESULTS A high prevalence of one histological subtype was observed, with the presence of collagen fibres among few fibroblasts. Histochemical analysis highlighted alterations of the arrangement and of the quantity of collagen involving breast structures. CONCLUSIONS Results of the present study suggest that collagen deposition alterations can better explain breast parenchyma modifications. Histological features of male subjects support this theory. Additionally, the observation of two cases in male homozygous twins suggests the role of genetic influences.
Juvenile Fibroadenoma of the Breast: Treatment and Literature Review
Authors: K Ng Wendy , Amir Mrad M , H Brown Mitchell 
Published: February 2017

It is uncommon to find palpable breast masses in young patients. Generally, such masses are benign. Juvenile fibroadenoma is the most frequent benign tumour of the breast. The present report describes a case involving a 17-year-old girl with unilateral right breast hypertrophy, for whom resection and breast reduction was effectively achieved. Resection was combined with an aesthetically pleasing outcome through breast reduction, via a wise pattern of reduction with a superior pedicle. While young patients rarely present with breast masses, the consideration of fibroadenoma in these cases is always warranted. The disconcerting appearance of the breasts for adolescents afflicted by such benign masses underscores the importance of achieving aesthetically optimal outcomes and attaining adequate tumour resection for diagnostic purposes through pathological specimens. In the present case, the young patient underwent a procedure that fulfilled both of these valuable goals through careful preoperative planning, pedicle selection and skin resection patterns.
The Effect of Incision Choice On Outcomes of Nipple-Sparing Mastectomy Reconstruction
Authors: Rawlani Vinay , Fiuk Julia , A Johnson Sarah , W Buck Donald , Hirsch Elliot , Hansen Nora , Khan Seema , A Fine Neil , Ys Kim John 
Published: February 2017

INTRODUCTION The indications for nipple-sparing mastectomy (NSM) are broadening as more breast surgeons appreciate the utility of preserving the nipple-areolar complex. A number of incision locations are available to the mastectomy surgeon, including inframammary, lateral and periareolar approaches. The present study investigated the effect of these three incisions on reconstructive outcomes; specifically, nipple necrosis. METHODS A single-centre, retrospective review of 37 breast NSM reconstructions treated with immediate tissue expander reconstruction with acellular dermis between 2007 and 2008 was performed. The primary outcome was the incidence of nipple necrosis associated with periareolar, lateral and inframammary incisions. Secondary outcomes were the effects of radiation, chemotherapy and breast size on nipple necrosis. RESULTS Thirty-seven breast procedures performed on 20 patients were included in the present study. Periareolar incisions were used in 21 cases, lateral incisions in 14 and inframammary incisions in two. The periareolar incision was associated with a significantly higher incidence of nipple necrosis compared with lateral or inframammary incisions (38.1% versus 6.3%, P=0.028). Patients receiving breast radiation (45.5% versus 15.4%, P=0.066) and those with larger breast size (540.4 g versus 425.7 g, P=0.130) also demonstrated a modest trend toward an increased rate of nipple necrosis. CONCLUSION The periareolar incision results in a higher rate of nipple necrosis following NSM and immediate tissue expander breast reconstruction. Using the lateral or inframammary incision reduces the incidence of nipple necrosis and may help improve overall reconstructive and cosmetic outcomes.
The Opportunities and Obstacles in Developing a Vascular Birthmark Database for Clinical and Research Use
Authors: K Sharma Vishal , Og Fraulin Frankie , Robertson Harrop A , F Mcphalen Donald 
Published: February 2017

INTRODUCTION Databases are useful tools in clinical settings. The authors review the benefits and challenges associated with the development and implementation of an efficient electronic database for the multidisciplinary Vascular Birthmark Clinic at the Alberta Children's Hospital, Calgary, Alberta. METHODS The content and structure of the database were designed using the technical expertise of a data analyst from the Calgary Health Region. Relevant clinical and demographic data fields were included with the goal of documenting ongoing care of individual patients, and facilitating future epidemiological studies of this patient population. After completion of this database, 10 challenges encountered during development were retrospectively identified. Practical solutions for these challenges are presented. RESULTS The challenges identified during the database development process included: identification of relevant data fields; balancing simplicity and user-friendliness with complexity and comprehensive data storage; database expertise versus clinical expertise; software platform selection; linkage of data from the previous spreadsheet to a new data management system; ethics approval for the development of the database and its utilization for research studies; ensuring privacy and limited access to the database; integration of digital photographs into the database; adoption of the database by support staff in the clinic; and maintaining up-to-date entries in the database. CONCLUSIONS There are several challenges involved in the development of a useful and efficient clinical database. Awareness of these potential obstacles, in advance, may simplify the development of clinical databases by others in various surgical settings.
A Breast Reconstruction Needs Assessment: How does Self-Efficacy Affect Information Access and Preferences?
Authors: Lam Andrea , Secord Scott , Butler Kate , Hofer Stefan OP , Liu Emily , Metcalfe Kelly A , Zhong Toni 
Published: February 2017

Background Breast cancer patients requiring mastectomy do not consistently receive information about post-mastectomy breast reconstruction (PMBR) surgery from the treatment team. Patients have varying levels of self-efficacy, defined as one's confidence in their ability to gather information and make health-related decisions. The present preliminary study was designed to evaluate the relationship between self-efficacy and access to PMBR information. Methods A qualitative interview study was conducted on a convenience sample of 10 breast cancer patients considering or having already undergone PMBR and six key health care provider informants. The modified six-item Stanford Self-Efficacy Scale for managing chronic disease was administered. Results Patient self-efficacy scores ranged from 5 to 9.3 (out of 10). Two main access to information themes were identified from the patient qualitative data: theme A – difficulty initiating the PMBR discussion; and theme B – perceived lack of access to PMBR information with the sub-themes of timing, modality, quantity and content of resources. All respondents expressed their concern over the absence of a standardized process for initiating the dialogue of PMBR. Patients also reported that credible and easily accessible information was not routinely available and expressed a desire to hear about their PMBR options early in the decision-making process. Conclusions Health care providers may need to assume more responsibility in standardizing information dissemination on PMBR. This information should be distributed early in the consultation process, the content should be complete, and there may be a role for individualizing the delivery of information based on a patient's level of self-efficacy.
What is the ultimate fate of presented abstracts? The conversion rates of presentations to publications over a five-year period from three North American plastic surgery meetings
Authors: Gregory Tournesol N , Liu Tianyi , Machuk Andrew , Arneja Jugpal S 
Published: February 2017

Background Advancements in clinical decision-making are influenced by presentations made at scientific conferences or publications in journals with extensive readership. However, many ideas shared at annual conferences fail to be published, and most surgeons attend these meetings only sporadically. Objective To quantify the conversion rates of meeting presentations to publications in North American plastic surgery. Methods MEDLINE (OvidSP) and PubMed databases were cross-referenced with abstracts accepted for podium presentation at the Canadian Society of Plastic Surgeons, American Society of Plastic Surgeons, and American Association of Plastic Surgeons annual meetings from 2003 to 2007. Parameters reviewed included publication rate, time to publication, subspecialty, trial type, publication journal and journal impact factor. Results Over the five-year study period, 45.00% of the 888 presentations were published in peer-reviewed journals. The mean time to publication was 22 months (range 1.00 to 85.90 months). In total, 57.00% of the 400 publications appeared in Plastic and Reconstructive Surgery; 47.20% of publications were case series study design. The majority of publications were of the reconstruction subspecialty (31.00%). Abstracts from the American Society of Plastic Surgeons had the highest conversion rate (57.70%). Publications based on abstracts presented at the American Association of Plastic Surgeons had the highest mean journal impact factor (2.33). The Canadian Society of Plastic Surgeons had the highest total number of publications (n=161). Conclusions From the three North American annual general meetings reviewed, there was a modest conversion rate of mainly reconstructive case series published predominantly in a single journal, Plastic and Reconstructive Surgery. Several years often pass from the genesis of a research hypothesis to final publication, and because the majority of presentations fail to be published, presentations should be observed with a critical eye given the more stringent peer review process and time required for final publication. In an effort to improve conversion rates, departments and faculty members must foster a culture that prioritizes publication.
Revisiting Gavello's procedure for single-stage reconstruction of the earlobe: The vascular basis, technique and clinical uses
Authors: Chattopadhyay Debarati , Gupta Souradip , Murmu Marang Buru , Guha Goutam , Gupta Sandipan 
Published: February 2017

Background Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello's procedure was one of the earliest. Objective To revisit Gavello's procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice. Methods The authors discuss the vascular basis of Gavello's flap, and describe the clinical application of the single-stage Gavello's procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe. Results Excellent cosmetic results have been achieved in all different clinical situations in the authors' experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area. Discussion Gavello's procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite. Conclusion The simple, century-old Gavello's procedure is still of great value for reconstruction of earlobe defects of diverse etiology.
Limited surgical treatment of suspected necrotizing fasciitis of the upper extremity with a benign clinical presentation
Authors: Gander Brian , Kaye Marc , Wollstein Ronit 
Published: February 2017

Necrotizing fasciitis is a rapidly evolving, potentially fatal infection. Current recommendations advocate antibiotic administration and early aggressive surgical debridement. Aggressive surgery is associated with significant morbidity, leaving patients with substantial tissue loss and complex wounds. A case of suspected necrotizing fasciitis treated with minimal surgery is described. A previously healthy 48-year-old man presented with increased erythema, swelling and blistering of his left upper extremity. Despite a benign systemic clinical presentation, the hand and forearm were suspicious for necrotizing fasciitis, prompting surgical treatment. Surgical exploration found a significant amount of intradermal and subdermal clear fluid. It was decided to limit the amount of debridement. The diagnosis was Wells syndrome, eosinophilic cellulitis. Treated with steroids, the wounds healed uneventfully. It is important to consider the complete clinical picture before aggressive surgical treatment. A negative history for diabetes, atypical clinical presentation and benign operative findings are suggestive of a more benign diagnosis.
Preoperative pregnancy testing
Authors: Maher Janae L , Mahabir Raman C 
Published: February 2017

Background In up to 2% of all pregnancies, the need for general anesthesia in a nonobstetrical surgery arises. Surgery on a pregnant woman may have significant implications for the fetus, patient, physician and hospital. On review of the plastic surgery literature, the authors were unable to find current guidelines or recommendations for preoperative pregnancy testing in the plastic surgery patient population. Methods Literature regarding maternal and fetal risk during anesthesia and surgery, as well as preoperative pregnancy testing was identified by performing a PubMed, OVID and MEDLINE key word search. The current literature was subsequently reviewed and summarized. Results A report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation allows physicians and hospitals to implement their own policies and practices with regard to preoperative pregnancy testing. The overall frequency of an incidentally found positive preoperative pregnancy test ranges from 0.34% to 2.4%. Discussion Various studies have reported increased rates of spontaneous abortions, congenital anomalies, such as neural tube defects, and low and very low birth weight infants born to mothers exposed to anesthesia and surgery during pregnancy. Because the accepted practice is to postpone elective surgery during pregnancy, identifying these patients before surgery is critical. Conclusions Based on the current evidence, the authors' best practice recommendation for preoperative pregnancy testing is provided.
Reconstructive or cosmetic plastic surgery? Factors influencing the type of practice established by Canadian plastic surgeons
Authors: Mcinnes Colin W , Courtemanche Douglas J , Verchere Cynthia G , Bush Kevin L , Arneja Jugpal S 
Published: February 2017

Background Some argue that the specialty of plastic surgery is facing a changing identity. Challenged by factors such as increasing competition in the cosmetic marketplace and decreasing reimbursement for reconstructive procedures, many American plastic surgeons have increasingly adopted cosmetic-focused practices. The present study investigated the currently unknown practice profiles of Canadian plastic surgeons to determine the reconstructive-cosmetic mix, as well as factors that influence practice type to determine whether a similar pattern exists in Canada. Methods An anonymous online survey regarding practice profiles was distributed to all 352 Canadian plastic surgeons with e-mail accounts registered with the Canadian Society of Plastic Surgeons and/or the Canadian Society for Aesthetic Plastic Surgery. Results The survey response rate was 34% (120 responses), of which 75% of respondents currently had a reconstructive practice and 25% had a cosmetic practice. Reconstructive surgeons had more educational debt following their training, spent more time on emergency call, academics and teaching and, when deciding which type of practice to establish, were more influenced by academic opportunities and less influenced by financial and nonfinancial metrics. Similarities between the groups included hours worked per week and academic achievements. Conclusions The field of reconstructive plastic surgery appears to be thriving in Canada. While a transition from reconstructive to cosmetic practice is common, compared with their American colleagues, a greater proportion of Canadian plastic surgeons maintain reconstructive practices. Differences between reconstructive and cosmetic plastic surgeons are discussed.
The effects of topical collagen treatment on wound breaking strength and scar cosmesis in rats
Authors: Sinno Hani , Malhotra Meenakshi , Lutfy Justyn , Jardin Barbara , Winocour Sebastian , Brimo Fadi , Beckman Lorne , Watters Kevin , Philip Anie , Williams Bruce , Prakash Satya 
Published: February 2017

Background Topical application of collagen has been suggested to enhance wound healing; however, its long-term effect on wounds has not been studied in a rat model. Hypothesis Topical application of collagen type I will not facilitate incision healing or cosmesis in rats up to 28 days postwounding. Methods The effects of bovine collagen type I (6 mg/mL) on the rat surgical paired skin incision model were examined. Each rat served as its own control in which topical collagen was applied to one incision while normal saline (0.9%) was applied to the other incision. Rats were euthanized three (n=6), seven (n=6) and 28 (n=5) days after wounding. Tissue harvested from each time point was examined for maximal breaking strength, and for biochemical and histological analysis. Results There were no statistically significant differences (ie, P<0.05) in maximum wound breaking strength between the collagen- and saline-treated wounds at all time points. Histological analysis revealed a similar infiltration of inflammatory cells and fibroblasts in the wound edges of all incisions when matched with time of wounding. Western blot analysis revealed no differences in fibronectin or collagen I content in all wounds in each rat. Conclusions The topical application of collagen did not facilitate wound healing from three to 28 days in the rat wound model.
Plastic surgery wait times in Ontario: A potential surrogate for workforce demand
Authors: Cheung Kevin , Sweetman Arthur , Thoma Achilleas 
Published: February 2017

Background Accurate projections of plastic surgeon workforce requirements are essential to ensure a high standard of care and to properly allocate health care resources. Wait-time data were used to identify geographical areas that may benefit from additional plastic surgeons. Methods Plastic surgery wait times were analyzed using data from Ontario's Wait Time Information System for 2009 to 2010. Data were compared with benchmarks published by the Canadian Society of Plastic Surgeons, and plastic surgeon density was captured by the Ontario Physician Human Resources Data Centre. Results Aggregate plastic surgery wait times at the 90th percentile failed to meet targets based on priority. For priority 2 (target = 28 days) and priority 3 cases (target = 84 days), wait times were 35 and 101 days, respectively (P<0.05). Wait times also consistently exceeded provincial standards in the southwestern (Local Health Integration Network [LHIN] 2), eastern (LHINs 10 and 11) and northeastern (LHIN 13) regions of Ontario. A negative correlation (r=-0.37; P<0.05) between wait times and surgeon density for priority 4 cases was observed, suggesting that more surgeons per capita is associated with shorter wait times for these lower-priority cases. In contrast, a positive correlation was observed for priority 2 (r=0.50; P<0.05) and priority 3 cases (r=0.35; P<0.05). Conclusion Plastic surgery wait times in Ontario exceeded benchmarks in several geographical regions. Paradoxically, for high-priority cases, wait times were longer in LHINs with a higher density of plastic surgeons. Further investigation into patient mobility, physician practice patterns and the availability of hospital resources, such as hospital beds or operating room time, is required.