bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lawsuits against plastic surgeons: Does locale affect incidence of claims?
Authors: Kaplan Jonathan L , Hammert Warren C , Zin James E 
Published: February 2017

Background Physicians continue to practice in a very litigious environment. Some physicians try to mitigate their exposure to lawsuits by avoiding geographical locations known for their high incidence of medical malpractice claims. Not only are certain areas of the United States known to have a higher incidence of litigation, but it is also assumed that certain areas of the hospital incur a greater liability. There seems to be a medicolegal dogma suggesting a higher percentage of malpractice claims coming from patients seen in the emergency room (ER), as well as higher settlements for ER claims. Objective To determine if there is any validity to the dogma that a higher percentage of malpractice claims arise from the ER. Methods An analysis of common plastic surgery consults that result in malpractice claims was performed. The location where the basis for the lawsuit arose – the ER, office (clinic) or the operating room (OR) – was evaluated. The value of the indemnity paid and whether its value increased or decreased based on the location of the misadventure was evaluated. Results According to the data, which represented 60% of American physicians, there was a larger absolute number of malpractice claims arising from the OR, not the ER. However, the highest average indemnity was paid for cases involving amputations when the misadventure originated in the ER. Conclusions The dogma that a greater percentage of lawsuits come from incidents arising in the ER is not supported. However, depending on the patient's injury and diagnosis, a lawsuit from the ER can be more costly than one from the OR.
Evaluation of three-dimensional computed tomography processing for deep inferior epigastric perforator flap breast reconstruction
Authors: Teoh Raymond , Johnson Raleigh F , Nishino Thomas K , Ethridge Richard T 
Published: February 2017

Background The deep inferior epigastric perforator flap procedure has become a popular alternative for women who require breast reconstruction. One of the difficulties with this procedure is identifying perforator arteries large enough to ensure that the harvested tissue is well vascularized. Current techniques involve imaging the perforator arteries with computed tomography (CT) to produce a grid mapping the locations of the perforator arteries relative to the umbilicus. Objectives To compare the time it takes to produce a map of the perforators using either two-dimensional (2D) or three-dimensional (3D) CT, and to see whether there is a benefit in using a 3D model. Methods Patient CT abdomen and pelvis scans were acquired from a GE 64-slice scanner. CT image processing was performed with the GE 3D Advantage Workstation v4.2 software. Maps of the perforators were generated both as 2D and 3D representations. Perforators within a region 5 cm rostral and 7 cm caudal to the umbilicus were measured and the times to perform these measurements using both 2D and 3D images were recorded by a stopwatch. Results Although the 3D method took longer than the 2D method (mean [± SD] time 1:51±0:35 min versus 1:08±0:16 min per perforator artery, respectively), producing a 3D image provides much more information than the 2D images alone. Additionally, an actual-sized 3D image can be printed out, removing the need to make measurements and producing a grid. Conclusions Although it took less time to create a grid of the perforators using 2D axial CT scans, the 3D reconstruction of the abdomen allows the plastic surgeons to better visualize the patient's anatomy and has definite clinical utility.
Closed Reduction Internal Fixation Rates and Procedure Times for Metacarpal Fractures Treated in a Minor Surgery Area Before and After the Introduction of a Mini C-Arm Unit
Authors: Mahabir RC , Decroff CM , Thurgood L , Harrop Ar 
Published: February 2017

Background Mini C-arm units are compact, mobile, fluoroscopic imaging systems designed for real-time imaging of the extremities. They deliver the lowest possible radiation exposure to the patient and physician while minimizing operator effort and inconvenience. Methods A retrospective chart review was undertaken for consecutive metacarpal fractures requiring internal fixation treated in the minor surgery centre before (n=100) and after (n=100) the introduction of the mini C-arm. Open versus closed approach, procedure time and total operating room time were recorded. Results Before the introduction of the mini C-arm, the percutaneous rate was 48% and the average procedure and total operating room times were 55 min and 102 min, respectively. After mini C-arm implementation, the percutaneous rate increased to 59% and the average procedure and total times were 36 min and 78 min, respectively. Conclusions The use of a mini C-arm increased the rate of successful closed reduction internal fixation and reduced the procedure time for metacarpal fractures treated in the minor surgery area.
Practice Profiles in Breast Reduction: A Survey Among Canadian Plastic Surgeons
Authors: Nelson Rebecca A , Colohan Shannon M , Sigurdson Leif J , Lalonde Don H 
Published: February 2017

Background Breast reduction is an increasingly common procedure performed by Canadian plastic surgeons. Recent studies in the United States show that use of the inferior/central pedicle inverted T scar method is predominant. However, it is unknown what the practice preferences are among Canadian plastic surgeons. Objective The goal of the present study was to assess trends in breast reduction surgery among Canadian surgeons, including patient selection criteria, surgical techniques and outcomes. Method Surveys were distributed to plastic surgeons at the Canadian Society for Plastic Surgery meetings in 2005 and 2006. Completed surveys were obtained from 140 respondents, and results were analyzed with Excel and SAS software. Results There was a 40% response rate. The majority of surgeons (66%) used more than one technique for breast reduction. Most commonly, surgeons use the inverted T scar technique (66%) followed by vertical scar techniques (26%). The most popular vertical scar techniques included the Hall-Findlay (14%) and Lejour (13%) methods. Most surgeons (55%) reported complication rates of less than 5% and the most common complication reported was wound dehiscence. There was no difference in overall complication rates between inverted T scar and vertical scar surgeries. The majority of surgeons (98%) carried out breast reduction either exclusively as day surgery or in combination with same-day admission. Breast reduction performed as day surgery resulted in cost savings of $873 per patient. Conclusions Canadian plastic surgeons are performing more vertical scar breast reductions than American surgeons. However, both groups rely predominantly on inverted T scar techniques.
Pediatric Facial Burns: Is Facial Transplantation the New Reconstructive Psychosurgery?
Authors: Hanson Mark D , Zuker Ronald M , Shaul Randi Zlotnik 
Published: February 2017

Introduction Current pediatric burn care has resulted in survival being the expectation for most children. Composite tissue allotransplantation in the form of face or hand transplantation may present opportunities for reconstructive surgery of patients with burns. The present paper addresses the question “Could facial transplantation be of therapeutic benefit in the treatment of pediatric burns associated with facial disfigurement?” Methods Therapeutic benefit of facial transplantation was defined in terms of psychiatric adjustment and quality of life (QOL). To ascertain therapeutic benefit, studies of pediatric burn injury and associated psychiatric adjustment and QOL in children, adolescents and adults with pediatric burns, were reviewed. Results Pediatric burn injury is associated with anxiety disorders, including post-traumatic stress disorder and depressive disorders. Many patients with pediatric burns do not routinely access psychiatric care for these disorders, including those for psychiatric assessment of suicidal risk. A range of QOL outcomes were reported; four were predominantly satisfactory and one was predominantly unsatisfactory. Discussion Facial transplantation may reduce the risk of depressive and anxiety disorders other than post-traumatic stress disorder. Facial transplantation promises to be the new reconstructive psychosurgery, because it may be a surgical intervention with the potential to reduce the psychiatric suffering associated with pediatric burns. Furthermore, patients with pediatric burns may experience the stigma of disfigurement and psychiatric conditions. The potential for improved appearance with facial transplantation may reduce this ‘dual stigmata’. Studies combining surgical and psychiatric research are warranted.
Perioperative Considerations for Patient Safety During Cosmetic Surgery – Preventing Complications
Authors: A Ellsworth Warren , Bob Basu C , E Iverson Ronald 
Published: February 2017

Maintaining patient safety in the operating room is a major concern of surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential, and pressure to avoid these complications in cosmetic surgery is increasing. Traditionally, nursing and anesthesia staff have managed patient positioning and safety issues in the operating room. As the number of office-based procedures in the plastic surgeon's practice increases, understanding and implementing patient safety guidelines by the plastic surgeon is of increasing importance. A review of the Joint Commission's Universal Protocol highlights requirements set forth to prevent perioperative complications. In the present paper, the importance of implementing these guidelines into the cosmetic surgery practice is reviewed. Key aspects of patient safety in the operating room are outlined, including patient positioning, ocular protection and other issues essential for minimization of postoperative morbidity. Additionally, as the demand for body contouring surgery in the cosmetic practice continues to increase, special attention to safety considerations specific to the obese and massive weight loss patients is mandatory. After review of the present paper, the reader should be able to introduce the Joint Commission's Universal Protocol into their daily practice. The reader will understand key aspects of patient positioning, airway management and ocular protection in cosmetic surgery. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese, massive weight loss patients and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patient's experience and surgical outcome.
Neoumbilicoplasty Is a Useful Adjuvant Procedure in Abdominoplasty
Authors: Al-Shaham Aa 
Published: February 2017

Background Neoumbilicoplasties are indicated in congenital conditions associated with umbilical agenesis, umbilical loss due to inflammatory destruction, excision of skin cancer involving the umbilical stump and in surgical procedures for herniorrhaphy, as well as in the rare condition of umbilical endometriosis. Objective Neoumbilicoplasty is an adjuvant procedure that may be necessary during abdominoplasty with wide myofascial plication, or repair of concomitant hernias of the abdominal wall. The present article justifies sacrificing the umbilicus followed by neoumbilicoplasty in patients with significant wide myofascial plication or concomitant hernias of the abdominal wall. Methods Seventeen patients underwent a combination of abdominoplasty and wide (greater than 10 cm) vertical plication of the myofascial complex and required neoumbilicoplasty. The male to female ratio was 1:16; mean age was 44 years, mean weight 94.1 kg and mean height 160.2 cm. Characteristic body morphology included gross trunk obesity with a prominent anterior abdominal wall. The female patients were multiparous. Sacrificing the umbilici followed by neoumbilicoplasty was required in patients with umbilical hernias and patients who had divarication of the rectus abdominis muscles with short umbilical stumps. Results Nine patients had concomitant ventral hernias (52.94%) and eight patients had divarication of the rectus abdominis muscles with short umbilical stumps (47.05%). The mean perioperative myofascial plication distance was 15.41 cm and the gap closure required three to five rows of sutures. Conclusion Neoumbilicoplasty is a useful adjuvant procedure during abdominoplasty with wide myofascial plication or repair of concomitant hernias of the abdominal wall.
Histological Assessment of Tangentially Excised Burn Eschars
Authors: Gurfinkel Reuven , Rosenberg Lior , Cohen Sarit , Cohen Arnon , Barezovsky Alex , Cagnano Emanuela , J Singer Adam 
Published: February 2017

BACKGROUND The burn eschar serves as a medium for bacterial growth and a source of local and systemic infection. To prevent or minimize these complications, it is important to debride the eschar as early as possible. OBJECTIVE To identify the presence of viable skin within the excisions by examining tangentially excised burn eschars. METHODS A total of 146 samples of burned human tissue were removed during 54 routine sharp tangential excision procedures (using dermatomes). The samples were histologically examined to identify the relative thickness of the dead, intermediate and viable layers. RESULTS The mean (± SD) thickness of the excised samples was 1.7 ± 1.1 mm. The sacrificed viable tissue (mean thickness 0.7+0.8 mm) occupied 41.2% of the entire thickness of the excision. In 32 biopsies (21.8%; 95% CI 16.0 to 29.3), the excision did not reach viable skin. Only eight biopsies (5.4%; 95% CI 2.8 to 10.1) contained all of the necrotic tissue without removing viable tissue. CONCLUSIONS The thickness of a single tangentially excised layer of eschar is not much greater than the actual thickness of the entire skin and often contains viable tissue. Because surgical debridement is insufficiently selective, more selective means of debriding burn eschars should be explored.
Adenoid Involvement in Velopharyngeal Closure in Children with Cleft Palate
Authors: A Hubbard Bradley , B Rice Gale , R Muzaffar Arshad 
Published: February 2017

OBJECTIVE To assess the role of the adenoid pad in velopharyngeal (VP) closure. DESIGN A retrospective review of patients with cleft palate (CP) who underwent nasendoscopy and multiview videofluoroscopy during evaluation for VP insufficiency (VPI) from January 2006 to March 2008. PATIENTS Thirty-two consecutive patients were identified. None of the patients were lost to follow-up. Five patients were excluded: two for advanced age, two due to mental disabilities and one with a submucous cleft. INTERVENTION Video nasendoscopy and multiview videofluoroscopy were performed for evaluation of VPI. OUTCOME MEASURES Adenoid size based on nasendoscopy studies, and adenoid involvement in VP closure based on videofluoroscopy were recorded. RESULTS The average patient age was 6.6 years (range three to 13 years). Seventy-eight per cent of patients had small adenoid volumes (less than 50% obstruction of the choanae), and six patients (two unilateral cleft lip and palate patients, one bilateral cleft lip and palate patient, two isolated CP patients and one cleft of secondary palate patient) had large adenoid volumes (50% or greater obstruction of the choanae); the adenoid pads of these patients were almost always (five of six patients) involved in their VP closure patterns. Videofluoroscopy showed that 26% (95% CI 9% to 40%) of patients did not significantly use their adenoid pad in VP closure. Forty-three per cent of those not using their adenoids attempted contact with a Passavant's ridge. CONCLUSIONS In general, the adenoid pad should be maintained in CP patients. However, not all CP patients in the present study used their adenoid pad in attempted VP closure. If adenoidectomy is medically indicated, a percentage of these patents might be considered to be at lower risk for the development of postadenoidectomy VPI.
Breast Augmentation: A Geographical Comparison
Authors: L Maher Janae , C Bennett Della , L Bennett Laura , Grothaus Peter , C Mahabir Raman 
Published: February 2017

OBJECTIVE To describe and compare physical characteristics and implant details of women undergoing primary cosmetic breast augmentation in different geographical locations. METHODS Three cohorts of 100 consecutive breast augmentation cases in university settings were retrospectively reviewed for patient demographic and implant information in Kelowna (British Columbia), Loma Linda (California, USA) and Temple (Texas, USA). Statistical analysis was performed with a Kruskal-Wallis test without normality assumption (P<0.05 was considered to be significant). Pearson correlation coefficients were also determined for body mass index (BMI) versus implant volume at each of the sites. RESULTS The three group medians were significantly different for weight, BMI and implant volume. Kelowna's average patient was 33 years of age, had a BMI of 20.8 kg/m2 and an implant volume of 389 mL. Loma Linda's average patient was 32 years of age, had a BMI of 21.6 kg/m2 and an implant volume of 385 mL. Temple's average patient was 36 years of age, had a BMI of 22.6 kg/m2 and an implant volume of 335 mL. Pearson correlations for BMI versus implant volume were statistically significant in the Loma Linda and Temple groups. CONCLUSION Patients from different geographical locations undergoing breast augmentation were similar in age, height and parity, but varied in weight, BMI and implant volume. A positive linear correlation between BMI and implant volume was found in the American cohorts.
A Geometric Analysis of Mastectomy Incisions: Optimizing Intraoperative Breast Volume
Authors: Chopp David , Rawlani Vinay , Ellis Marco , A Johnson Sarah , W Buck Donald , Khan Seema , Bethke Kevin , Hansen Nora , Ys Kim John 
Published: February 2017

INTRODUCTION The advent of acellular dermis-based tissue expander breast reconstruction has placed an increased emphasis on optimizing intraoperative volume. Because skin preservation is a critical determinant of intraoperative volume expansion, a mathematical model was developed to capture the influence of incision dimension on subsequent tissue expander volumes. METHODS A mathematical equation was developed to calculate breast volume via integration of a geometrically modelled breast cross-section. The equation calculates volume changes associated with excised skin during the mastectomy incision by reducing the arc length of the cross-section. The degree of volume loss is subsequently calculated based on excision dimensions ranging from 35 mm to 60 mm. RESULTS A quadratic relationship between breast volume and the vertical dimension of the mastectomy incision exists, such that incrementally larger incisions lead to a disproportionally greater amount of volume loss. The vertical dimension of the mastectomy incision – more so than the horizontal dimension – is of critical importance to maintain breast volume. Moreover, the predicted volume loss is more profound in smaller breasts and primarily occurs in areas that affect breast projection on ptosis. CONCLUSIONS The present study is the first to model the relationship between the vertical dimensions of the mastectomy incision and subsequent volume loss. These geometric principles will aid in optimizing intraoperative volume expansion during expander-based breast reconstruction.
Ganglion Cyst in Children: Reviewing Treatment and Recurrence Rates
Authors: Karine Simon Cypel Tatiana , Mrad Amir , Somers Gino , Melvin Zuker Ronald 
Published: February 2017

BACKGROUND Pediatric hand and wrist ganglia seem to have different epidemiological characteristics than those of adults – a majority are found on the volar aspect of the hands and wrists of patients younger than 10 years of age. OBJECTIVE To determine the epidemiology, etiological factors, clinical presentation, treatment and outcome of patients with ganglion cysts at the Hospital for Sick Children (Toronto, Ontario). METHODS The records of the pathology department at the Hospital for Sick Children were searched for all cases of ganglion cyst operated on between January 2000 and December 2008. RESULTS Thirty-seven patients underwent treatment for symptomatic ganglion cyst. The mean age of the patients was 9.6 years, and there were 23 females. A mobile nodule was the initial presentation of the ganglion in 64% of the cases. Pain was the most common indication for surgical removal. Only 11.4% of patients experienced previous trauma. In 70% of the cases, the diagnosis was made clinically. The most common sites of occurrence were volar wrist (25.7%), dorsal wrist (22.8%) and the volar aspect of the base of the ring finger (17.1%). Surgical excision was the treatment of choice for 94.2% of the patients with symptomatic lesions. The minimum follow-up period was 12 months. Only one patient (2.8%) presented with recurrence in the series. CONCLUSION Although it is possible that these findings might change with longer follow-up, the present data provide information to help guide the treatment of these cysts. Complete surgical removal is a very effective treatment, with low rates of recurrence.
Management of Pelvic Heterotopic Ossification Post-Myocutaneous Flap Reconstruction of a Sacral Pressure Ulcer
Authors: W Mcinnes Colin , Ak Reynolds Richard , S Arneja Jugpal 
Published: February 2017

Heterotopic ossification (HO) is a process whereby lamellar bone forms in the soft tissues surrounding a joint. The most common type of HO is traumatic myositis ossificans, which develops following traumatic injuries, burns or arthroplasty. A variety of other forms of HO also exist, such as those associated with central nervous system injury and systemic forms that can manifest at other joints simultaneously. Clinically, patients can present with decreased range of motion, pressure ulcers, nerve compression, swelling, pain or asymptomatically. Symptomatic patients are most commonly treated with surgical debridement of the affected heterotopic deposits. Spinal dysraphism (SD) is a term describing a wide range of congenital malformations of the neural tube, ranging from spina bifida occulta to the more severe form, myelomeningocele. The cause of SD is multifactorial and has been associated with chromosomal disorders, teratogenic exposure and folate deficiency. Many patients with SD experience neuropathy below the affected neurological level, making them particularly susceptible to pressure ulcers. If these ulcers are severe and do not respond to conservative therapy, they often require surgical debridement and flap reconstruction – a clinical scenario that rarely results in HO. The present article describes a case involving a patient with pelvic HO following myocutaneous flap reconstruction of a pressure ulcer. The patient was successfully treated with oral bisphosphonate and aggressive physiotherapy.