bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obtaining High Cure Rates for Challenging Facial Malignancies: A New Method for Producing Rapid, Accurate, High-Quality Frozen Sections
Authors: Boyd Kirsty , Henderson Colin , Joseph Mariamma , Yardley Nick , Temple Claire 
Published: February 2017

PURPOSE The authors developed a new system to provide rapid, accurate, full-face frozen sections. OBJECTIVE To evaluate the efficacy of the system when applied to the treatment of nonmelanoma cutaneous malignancies using Mohs micrographic surgery (MMS). METHODS Patients undergoing MMS procedures between 2003 and 2007 for nonmelanoma head and neck cutaneous malignancies were prospectively collected. Specimens were prepared either in a traditional cryostat-based manner or using the new system. RESULTS A total of 196 patients with 234 head and neck nonmelanoma cutaneous malignancies were included. The majority of tumours were basal cell carcinomas (89.5%). of these, 38% demonstrated aggressive histologies (sclerosing or micronodular), and 30% were recurrent. On average, two levels (range one to six) and four blocks (range two to 23) were required to obtain clear margins. The mean defect size was 3.68 cm2 (range 0.13 cm2 to 37.68 cm2). Over the five-year study period, there were two recurrences in 234 cases (less than 1%), which compares favourably with other MMS series. The new system was associated with a shorter operative time than traditional specimen preparation (102 min versus 131 min; P=0.004). The new and traditional specimen preparation groups were similar in terms of the number of previous recurrences (29% versus 30%; P=1.00), defect size (3.7 cm2 versus 4.0 cm2; P=0.81) and the number of levels required (1.9 versus 1.5; P=0.05). CONCLUSIONS The new system enables fast, accurate, full-face frozen section specimens that are ideal for MMS. The speed of specimen preparation is demonstrated by faster operative times, and a low recurrence rate attests the accuracy and quality of the sections.
Does Size Matter? Technical Considerations of a Regenerative Tissue Matrix for Use in Reconstructive Surgery
Authors: O Craft Randall , M Rebecca Alanna , Flahive Colleen , J Casey William , Dueck Amylou , L Harold Kristi 
Published: February 2017

INTRODUCTION Acellular dermal matrices have been used with increasing frequency in both reconstructive and cosmetic surgery. While many studies have described the safety and morbidity profiles of these materials, little is known about the relative mechanical properties of individual sheets of allograft harvested from distinct donors. METHODS Sixty-two individual sheets of an acellular dermal matrix from distinct lot numbers (signifying different donors of the dermis) were prospectively analyzed before use. Distribution of thickness according to manufacturer specifications in the dry state were as follows: 0.009 inches to 0.013 inches (1 [1.6%]); 0.79 mm to 1.78 mm (3 [4.8%]); 0.79 mm to 2.03 mm (5 [8%]); 0.8 mm to 3.3 mm (1 [1.6%]); 1.8 mm to 3.3 mm (10 [16.1%]) and 28 mm (6 [9.7%]). The size of the matrix was recorded while dry, after hydration and following stretch. The percentage change in surface area was recorded for each lot. RESULTS The 62 reconstructive cases included breast implant reconstruction (2 [3.2%]); ventral hernia repair (11 [17.7%]); abdominal closure following autologous tissue harvest (6 [9.6%]); autologous breast reconstruction (37 [59.6%]); extremity wound closures (3 [4.8%]) and reinforcement of vertical rectus abdominis muscle closure (3 [4.8%]). The mean percentage change in the size of the acellular dermal matrix to the hydrated state was 58% (36 of 62; thickness 0.06 mm to 3.30 mm); the mean percentage change in size from dry state was 7.14% (range 0% to 18.7%). The mean percentage change in the size of the hydrated matrix to the stretched state was 25.7% (range 0.25% to 70.6%). The variability in elasticity among the individual sheets was significant (P<0.0005). CONCLUSION The acellular dermal matrix displayed highly variable elastic properties among distinct donors. This may be significant in procedures in which symmetry is critical.
Improving Journal Clubs Through the Use of Positive Deviance: A Mixed-Methods Study
Authors: Anzarut Alexander , Martens Benjamin , Tredget Edward 
Published: February 2017

BACKGROUND Plastic surgery journal clubs are often unsatisfactory for both surgeons and residents, leading to frustration and poor surgeon attendance. OBJECTIVE To assess and modify journal clubs using the principles of positive deviance. METHODS Surgeons and residents were surveyed across five domains before and after journal club modification. These included perception of the quality of articles chosen, the quality of the presentations, postpresentation discussions, educational benefit and overall satisfaction. RESULTS Using the principles of positive deviance, the authors were able to identify points of concern with journal clubs and make suggestions for improvement. Postintervention surveys demonstrated a statistically significant improvement in journal clubs across all five domains assessed. CONCLUSIONS Using the principles of positive deviance, journal club satisfaction was improved. The interventions presented could be used to improve journal clubs at other institutions. In addition, the principles of positive deviance can be used to address a variety of administrative and educational challenges faced by plastic surgery programs.
Optimizing Revenue At a Cosmetic Surgery Centre
Authors: M Funk Joanna , N Verheyden Charles , C Mahabir Raman 
Published: February 2017

BACKGROUND The demand for cosmetic surgery and services has diminished with recent fluctuations in the economy. To stay ahead, surgeons must appreciate and attend to the fiscal challenges of private practice. A key component of practice economics is knowledge of the common methods of payment. OBJECTIVE To review methods of payment in a five-surgeon group practice in central Texas, USA. METHODS A retrospective chart review of the financial records of a cosmetic surgery centre in Texas was conducted. Data were collected for the five-year period from 2003 to 2008, and included the method of payment, the item purchased (product, service or surgery) and the dollar amount. RESULTS More than 11,000 transactions were reviewed. The most common method of payment used for products and services was credit card, followed by check and cash. for procedures, the most common form of payment was personal check, followed by credit card and financing. of the credit card purchases for both products and procedures, an overwhelming majority of patients (more than 75%) used either Visa (Visa Inc, USA) or MasterCard (MasterCard Worldwide, USA). If the amount of the individual transaction surpassed US$1,000, the most common method of payment transitioned from credit card to personal check. CONCLUSIONS In an effort to maximize revenue, surgeons should consider limiting the credit cards accepted by the practice and encourage payment through personal check.
P16 Protein Expression in Primary Cutaneous Melanoma with Positive and Negative Lymph Node Biopsies: Particular Aspects of a Study Performed At the Hospital De Clinicas De Porto Alegre, Brazil
Authors: Fauri Jac , Ricardi F , Diehl Es , Cartell A , Furian R , Bakos L , Edelweiss Mi 
Published: February 2017

BACKGROUND Cutaneous melanoma dermal invasion, identified through measurement of maximum tumour thickness and sentinel lymph node (SLN) biopsy, is important to establish melanoma prognosis and progression. P16 protein expression has been shown to be a predictive factor for melanoma evolution and prognosis. OBJECTIVE To investigate p16 protein expression in cutaneous melanomas with and without SLN metastasis. PATIENTS AND METHODS Sixty-seven paraffin-embedded cutaneous melanoma specimens of patients who had undergone SLN investigation were evaluated from 1995 to 2007. SLN biopsy was negative for metastasis in 34 of these patients (controls); in the remaining 33 patients, SLN biopsy was positive (cases). The expression of p16 protein in the primary tumour was measured using an immunohistochemical assay. The samples were classified according to their nuclear expression. RESULTS P16 nuclear expression was absent in 14 cases and in 15 controls; P=0.812. There was no statistically significant difference in p16 nuclear expression between cases and controls. CONCLUSIONS The present study does not support the findings of other studies that suggest p16 protein expression is important in the prognosis of cutaneous melanoma.
Is Radiotherapy An Effective Treatment Option for Recurrent Metastatic Malignant Melanoma? a Case Report of Short-Course, Large-Fraction Radiation and a Literature Review
Authors: Hallock Abhirami , Vujovic Olga , Yu Edward 
Published: February 2017

BACKGROUND Malignant melanoma is regarded to be radiation resistant. A case of recurrent malignant melanoma with in-transit metastasis treated with short-course, high-fraction palliative radiation is presented to illustrate the effectiveness of radiotherapy. METHOD An 80-year-old woman initially treated surgically for a primary malignant melanoma of the left lower leg presented with multiple in-transit metastases. Palliative radiation was offered to treat two fungating in-transit masses that were resistant to treatments of isolated limb infusion and intralesional interleukin-2. RESULTS Treatment consisted of short-course, high-fraction radiation with 800 cGy fractions given over three weeks on days 0, 7 and 21, for a total dose of 2400 cGy. She experienced a complete response that was maintained for six months. CONCLUSIONS Radiation is an effective treatment option for palliation of recurrent malignant melanoma. Complete response is possible even with short-course, high-fraction radiation.
Cosmetic outcomes following head and neck melanoma reconstruction: The patient's perspective
Authors: Buck Donald , Rawlani Vinay , Wayne Jeffrey , Dumanian Gregory A , Mustoe Thomas A , Fine Neil A , Galiano Robert , Kim John YS 
Published: February 2017

Background While studies have compared aesthetic outcomes following wide local excision of head and neck melanoma, none have evaluated this important outcome from the patient's perspective. Indeed, one could argue that the psychosocial impact of head and neck melanoma excision and reconstruction is more accurately assessed by deriving patient-based as opposed to surgeon-based outcome measures. Objective To evaluate aesthetic outcomes following wide local excision of head and neck melanoma from the patient's perspective. Methods Fifty-one patients who underwent excision of 57 head and neck melanomas followed by immediate closure by primary repair, skin grafting, local flap coverage or free tissue transfer were asked to complete a written survey at least six months after their surgery. A visual analogue scale (VAS) was used to assess the patient's perception of appearance alteration, satisfaction with his or her appearance, and emotional impairment. An ordinal scale was used to evaluate several criteria of the reconstructive outcome (pain, itching, colour, scarring, stiffness, thickness and irregularity). Results Forty-two patients (82.4%) completed the survey. There were significant correlations between VAS scores reported for appearance alteration, satisfaction with outcome and emotional impairment (P=0.001). Patients who received skin grafts reported significantly unfavourable VAS scores compared with other methods of reconstruction (P=0.046). Moreover, skin grafts received significantly worse ordinal scale ratings for itching (P=0.043), colour (P=0.047), scarring (P=0.003) and stiffness (P=0.041) compared with other methods of reconstruction. Both skin grafts and free flaps were reported to have significantly less favourable thickness (P=0.012) and irregularity (P=0.036) than primary closure or local tissue transfer. There was no significant difference between patients undergoing primary closure with local tissue transfer (P>0.413). Other factors related to the patient's VAS scores included location of the melanoma (P=0.033), size of defect (P=0.037) and recurrence of melanoma (P=0.042). Conclusion The degree of emotional impairment following reconstruction of head and neck melanoma excision defects was correlated with the patient's perception of appearance alteration. From the patient's perspective, primary closure and local tissue transfer appeared to result in the highest aesthetic satisfaction.
Facial soft tissue augmentation with Artecoll®: A review of eight years of clinical experience in 153 patients
Authors: Solomon Philip , Sklar Michael , Zener Rebecca 
Published: February 2017

Objective Artecoll (Canderm Pharma Inc, Canada) is a semipermanent, injectable, soft tissue filler composed of uniform polymethylmethacrylate microspheres in a bovine collagen gel, which has been used in Europe over the past decade. The authors review their experience using Artecoll as an injectable material for the correction of deep static folds of the face, improvement of nasal asymmetries following rhinoplasty, depressed acne scars and augmentation of the lip. Method A retrospective chart review, subjective patient satisfaction feedback and objective findings noted by the senior author were performed over an eight-year period. A total of 153 patients were treated with Artecoll injections; 74 underwent lip augmentation, 21 underwent deep nasolabial fold augmentation, eight underwent glabellar fold augmentation, 26 were treated for minor nasal dorsal irregularities and 24 were treated for depressed acne scars. Results No early or delayed allergic responses were reported. Complications occurred most commonly with lip augmentation, in which 13.5% of patients noted significant noticeable bruising postinjection that resolved completely within one week, 51.3% had detectable implant on palpation, and 13.1% required further intervention with massage, steroid injection and/or local excision to correct for lumpiness. Sixty per cent of patients requiring further intervention responded successfully, while local excision was performed on the two patients who failed to respond after six months of massage and steroid therapy. Overall, a total of 11 patients (14.9%) had minor asymmetries or less than optimal results within the lip augmentation study group. Among other sites, the most common complaint was undercorrection of the fold or wrinkle. Conclusion Based on the authors' experience, Artecoll is a safe, viable option for long-term treatment of deep facial wrinkles, nasal asymmetry, hypoplastic or atrophic lips, and depressed acne scars, and the results have been accompanied by a high degree of patient satisfaction. Although the implant is often palpable, rarely does it cause significant visible lumps. Its use and applications as a semipermanent injectable agent certainly warrant further investigation.
Outcome analysis of ulnar shortening osteotomy for ulnar impaction syndrome
Authors: Fulton Courtney , Grewal Ruby , Faber Kenneth J , Roth James , Gan Bing Siang 
Published: February 2017

Background Ulnar-sided wrist pain is a common problem in the upper extremity. It affects a broad patient population and can be difficult to treat. Ulnar impaction syndrome (UIS) is major cause of ulnar-sided wrist pain and a number of different operations have been used to correct it, including ulnar shortening osteotomy (USO). Objective To retrospectively review functional outcomes and complication rates of USO for UIS at the Hand and Upper Limb Centre (London, Ontario) over a two-year period. Methods Twenty-eight patients who underwent USO between 2007 and 2009 participated in the present study. Ulnar variance pre- and post-surgery was assessed using standard radiographic examination. Patient-rated outcomes were measured using a visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) survey for functional outcomes. Objective grip strength and range of motion were compared with the contralateral extremity. Results On average, USO achieved a 3.11 mm reduction in ulnar variance. Nonunion occurred in five patients and required a secondary bone grafting procedure. All USO eventually healed. Overall, pain improved by 47.2% and the mean DASH score after surgery was 37.21. Flexion, extension and supination range of motion decreased by 10° compared with the unaffected side. Eleven patients (39%) elected to undergo a second surgery for hardware removal. Patients receiving compensation from the Workplace Safety and Insurance Board experienced significantly higher residual pain (VSA 5.24 versus 1.97) and disability levels (DASH 60.23 versus 25.70). Smokers also experienced worse outcomes in terms of pain (VSA 4.43 versus 2.36) and disability (DASH 51.06 versus 29.67). In this cohort, smoking was not associated with a higher rate of nonunion. Conclusion USO is effective in reducing pain in UIS and improves disability, at the price of a small decrease in range of motion. Smokers and people receiving compensation from the Workplace Safety and Insurance Board, however, have significantly worse subjective outcomes (VAS and DASH), but similar objective outcomes (range of motion).
The cardiac implications of breast reconstruction using the internal mammary artery as the recipient vessel
Authors: Fortin Amanda J , Evans H Brian , Chu Michael WA 
Published: February 2017

Background Microsurgical breast reconstruction is a popular choice in breast reconstruction. Recipient vessel use for these autologous tissue reconstructions has shifted from the thoracodorsal to the internal mammary vessels. Coronary artery bypass (CAB) surgery remains the optimal revascularization strategy in patients with significant, diffuse coronary artery disease. The conduits of choice for coronary revascularization are the internal mammary arteries (IMA) because of their superior long-term graft patency rate and improved patient survival. Objective To review the cardiac risk factors in the breast reconstruction population, and to report the incidence of postoperative cardiac events at the London Health Sciences Centre, London, Ontario. The authors present the index cases illustrating cardiac complications following the use of internal mammary vessels. Method A retrospective, single-centre, cumulative audit of breast reconstruction practice from 2005 to 2009 was conducted. A total of 81 patients undergoing autologous breast reconstruction were reviewed. Two women were noted to have experienced postoperative myocardial infarction requiring intervention. Both were noted to have triple-vessel disease, an indication for CAB; however, during the breast reconstruction, their IMAs had been utilized. As a result, both women subsequently underwent triple-vesssel percutaneous intervention, with one woman later requiring CAB without IMA because of recurrent ischemia. Conclusion While there is limited overlap with the breast reconstruction and cardiac disease population, there can be significant cardiac health implications in the postoperative status (both short and long term) of women undergoing autologous breast reconstruction using the IMAs as recipient vessels.
Diagnosis and management of eosinophilic cellulitis (Wells' syndrome): A case series and literature review
Authors: Sinno Hani , Lacroix Jean-Philip , Lee James , Izadpanah Ali , Borsuk Ronnie , Watters Kevin , Gilardino Mirko 
Published: February 2017

Introduction Eosinophilic cellulitis (Wells' syndrome) is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis due to its similarity in presentation. Misdiagnosis leads to delay of correct treatment and inappropriate use of antibiotics. Methods A case series of eosinophilic cellulitis and a literature review are presented. Results Patients with Wells' syndrome may present with a variety of nonspecific symptoms, such as fever, arthralgia and malaise, as well as myriad cutaneous lesions with associated erythema, presenting as blisters, bullae, papules and/or nodules. Several treatment modalities have been used to treat eosinophilic cellulitis and have been met with variable success rates; these include systemic corticosteroids, topical corticosteroids and antihistamines, with success rates of 91.7%, 50% and 25%, respectively. Conclusions A high degree of clinical suspicion must be exercised to diagnose this rare condition. Cellulitis with an atypical presentation or not responding to appropriate antibiotic treatment should trigger suspicion of Wells' syndrome. To date, the most successful treatment method is a short course of systemic corticosteroids.
Helical advancement: Pearls and pitfalls
Authors: Al-Shaham AA 
Published: February 2017

Background Reconstruction of acquired auricular defects is a challenging procedure. Since its emergence, the helical advancement technique has proved to be an excellent method of repairing many auricle defects. This technique may occasionally result in an alteration in the dimensions of the neoauricle, with subsequent deformity. However, the advantages of this technique are well known, while the pitfalls are scarce. Objective To critically review the selection criteria of patients with acquired auricular defects to determine which are eligible for helical advancement technique without subsequent deformity. Methods From March 2004 to January 2006, 18 patients with three types of upper one-third auricle defects underwent the helical advancement procedure. All patients were male, with mean age of 33.5 years. The defects ranged from 1.2 cm to 4.3 cm in length. Two helical flaps (one on either side of the injury) were advanced along the helical margin to ensure closure. The vertical and horizontal auricular axes were measured before and after surgery, and the actual reduction in millimetres was calculated. Patients were followed up for three months postoperatively. Assessment of the surgical outcome was performed by surgeon (with patient feedback) in the final patient visit. Results The principle pitfall in the form of small neoauricle with or without cupping was reported in five patients (27.77%). The defects in these cases were >2.8 cm and the mean resultant reduction in vertical axes was >5 mm. Statistical analysis resulted in χ2=4.24 and P=0.04 Conclusion The three varieties of upper one-third auricle defects can best be corrected by the helical advancement technique when the defect is <2.8 cm. Furthermore, perioperative reduction in the vertical axis of the neoauricle >5 mm was an important predictive factor in the development of subsequent deformity.