bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Split Skin Graft Donor Site: Can Pretreatment with Vitamin a Cream Help?
Authors: Skoll Pj , Soldin M , Grob M , Seymour B , Davies J , Rode H , Hudson Da 
Published: February 2017

Background A skin graft donor site that heals rapidly with less cosmetic sequelae is of particular benefit to children with burns. Vitamin A cream has been shown to speed up healing after controlled ‘burns’ (dermabrasion and CO2 laser) if it is applied six weeks before treatment. Objective To assess whether pretreatment with vitamin A cream increases the rate of healing of split skin graft donor sites in children with burns. Methods Prospective study of children with hot water burns of 8% to 30% that required split thickness skin grafting. Vitamin A cream was applied bidaily to one thigh and/or buttock of each child for five to seven days before skin grafting. At surgery, equal thickness grafts were harvested from both thighs and/or buttocks. Biopsies were taken from each thigh and/or buttock and were sent for histological analysis. The rate of donor site healing was monitored clinically and with serial photographs. Results No difference in the rate of healing was noted between the treated and untreated sides by either histological or clinical criteria. Conclusions Vitamin A cream applied bidaily for a period of five to seven days did not affect the healing rate of the split skin graft donor sites in children with burns.
Reducing Patient Discomfort during Digital Blockade: The Subcutaneous Single Injection Digital Block – A Simple, Safe and Fast Procedure
Authors: Brutus JP , Nikolis A , Baeten Y , Chahidi N , Kinnen L , Ledoux P , Moermans JP 
Published: February 2017

Background Regional anesthesia of a single finger is commonly achieved by the traditional ring block, which requires at least two painful injections in the digit. Single injection digital block techniques have been described to avoid this problem. Among these, the subcutaneous technique described by Harbison appears to be safe and to allow most procedures to be carried out with good tolerance. Objectives A prospective study was designed to evaluate the results of the subcutaneous technique in terms of patient tolerance, distribution of anesthesia and efficiency. Methods All blocks were performed by a single investigator. A visual analog scale was used to evaluate pain associated with the injection. Prick testing was used to evaluate the quality of anesthesia at the volar and dorsal aspects of the phalanxes. Tolerance to the surgical procedure and the need for additional injections were also recorded. Results This technique allowed surgery to be performed without complementary injection most of the time and was very well tolerated. The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory. Conclusion The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows the treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a combined single injection technique or a supplementary dorsal block should be used.
The effects of cold preservation and subimmunosuppressive doses of FK506 on axonal regeneration in murine peripheral nerve isografts
Authors: Myckatyn Terence M , Hunter Daniel A , Mackinnon Susan E 
Published: February 2017

Background FK506 is a frequently used immunosuppressant with neuroregenerative effects. The neuroregenerative and immunosuppressive mechanisms of FK506, however, are distinct, suggesting that FK506 may stimulate nerve regeneration at lower doses than are needed to induce immunosuppression. The effects of cold preservation, a technique known to improve axonal regeneration through nerve allografts, are not well studied in nerve isografts and are also reported here. Objectives To determine the effects of subimmunosuppressive doses of FK506 and cold preservation on nerve regeneration in isografts. Methods The neuroregenerative properties of immunosuppressive and subimmunosuppressive doses of FK506 were compared in a murine model receiving either fresh or cold preserved nerve isografts. Sixty female BALB/cJ mice were randomized into six groups. Animals in groups I, III and V received fresh nerve isografts. Animals in groups II, IV and VI received cold-preserved nerve isografts. Mice in groups I and II received no medical therapy, while those in groups III and IV received subimmunosuppressive doses of FK506, and those in groups V and VI received immunosuppressive doses as confirmed by mixed lymphocyte reactivity assays. Nerve regeneration was evaluated with histomorphometry and functional recovery was evaluated with walking track analysis. Results Pretreatment with cold preservation did not significantly affect neural regeneration. The potent neuroregenerative effect of immunosuppressive doses of FK506 was confirmed, and the ability of subimmunosuppressive doses of FK506 to stimulate axonal regeneration in murine nerve isografts is reported. Conclusions Less toxic subimmunosuppressive doses of FK506 retaining some neuroregenerative properties may have a clinical role in treating extensive nerve injuries.
Early Major Complications of Endoscopic Carpal Tunnel Release: A Review of 1200 Cases
Authors: Tse Raymond W , Hurst Lawrence N , Al-Yafi Tawfeik A 
Published: February 2017

Although the early benefits of endoscopic carpal tunnel release have been demonstrated, there is great controversy regarding the risks and safety of the technique. The present study reports early major complications in a series of 1278 consecutive cases performed by a single surgeon over a seven-year period. All procedures were performed under local anaesthesia on an outpatient basis using the Agee single portal technique. Mean follow-up was three months. No vascular, tendon or permanent nerve injuries were documented. Recurrent or persistent symptoms occurred in 7% of patients for which 20 of 89 underwent subsequent open carpal tunnel release. No nerve injuries were found on re-exploration. Other complications were consistent with previously reported incidences. This is the largest reported case series by a single surgeon and represents an accumulation of surgical experience at the upper end of the learning curve. Endoscopic carpal tunnel release is a safe procedure in this experienced single surgeon series.
Estimating Implant Size in Chin Augmentation: A Simplified Approach
Authors: Fanous Nabil , Yoskovitch Adi 
Published: February 2017

A receding chin, colloquially known as a weak chin, is a significant aesthetic impediment to a pleasing face. Multiple techniques exist to evaluate the poorly projecting chin, but most are imprecise when it comes to choosing the proper implant size. This choice is further complicated by the impracticality of commercially available chin implants. Most implant manufacturers offer only three to four categories of implants (small, medium, large, etc) that differ in size from one company to another, making the choice of the proper implant size a real challenge. The present paper discusses a new approach to precise sizing of the chin implant, based primarily on the degree of chin convexity (curvature of the chin pad) in the profile view. Examples of mentoplasties performed using the chin convexity principle are presented.
Carpal Tunnel Syndrome and Workers' Compensation: A Cross-Canada Comparison
Authors: Watts Robyn J , Osei-Tutu Kannin B , Lalonde Donald H 
Published: February 2017

Carpal tunnel syndrome (CTS) is the source of substantial workers' compensation claims in industrialized countries. Its pathogenesis, however, continues to be questioned. The purpose of the present study was to assess the attitudes of Canadian plastic surgeons toward Workers' Compensation Board (WCB)-supported claims for CTS and to assess patterns of resource allocation across Canada. Sixty-seven plastic surgeons were asked to read a clinical scenario and respond whether they would support a WCB claim for CTS. Provincial WCB offices were contacted and asked to provide statistics surrounding CTS claims for 1997 to 2001. Fifty-eight per cent (39 of 67) of surgeons surveyed felt that CTS should be covered as a WCB claim, while 42% (28 of 67) felt that it should not be covered by WCB. In British Columbia, 50% (six of 12) of surgeons were in support of the claim compared to 92% (11 of 12) of those from Alberta, 55% (17 of 31) of those from the Central Provinces and 42% (five of 12) of those from the Maritime Provinces. Trends of resource allocation and number of CTS claims per year are presented for the individual provinces for 1997 to 2001. An extensive literature review revealed that there is minimal to no evidence to support the view that CTS should be a compensated claim. As defined by the WCB of Canada, a compensated claim is one that “arises out of, and in the course of, employment and that results from causes and conditions peculiar to the trade, occupation or industry.” The ambiguity in the beliefs of Canadian plastic surgeons in supporting CTS as a WCB claim reflects a situation where many of the decisions to cover CTS as a WCB claim are not evidence based.
Extramammary Paget's disease of the perineum: Avoiding pitfalls in diagnosis and management
Authors: Chandawarkar Rajiv Y , Ricchuiti Daniel , Amjad Ibrahim , Marsico Robert E , Wells Mark D 
Published: February 2017

Extramammary Paget's disease (EMPD) is a rare entity, especially in the perinoscrotal region, and typically presents in elderly white patients as a pruritic white or red patch in the area of distribution of apocrine glands. Typically, it affects a single site. Since its manifestations are insidious and easily misdiagnosed, the appropriate manage-ment is delayed. Management of this problem is complex and effective treatment can not only lower recurrence rates but also pro-vide an optimal reconstructive result. The present report describes three patients with scrotal EMPD. Based on literature search, the etiopathology, diagnosis and management of these lesions is discussed. Reconstructive options, with special emphasis on scrotal lesions, are also discussed.
Graves' exophthalmos: Volumetric assessment of orbital expansion
Authors: Grover Ramon S , Mainprize James , Ing Edsel , Antonyshyn Oleh M 
Published: February 2017

Introduction Graves' ophthalmopathy is characterized by an increase in the volume of orbital soft tissue contents and an associated increase in intraorbital pressure. Surgical expansion of bony orbital volume is therefore an effective method of treating moderate to severe exophthalmos. Numerous correlations between specific decompression procedures and reduction of proptosis have been made. The main emphasis of the majority of these studies, however, appears to be of a qualitative nature rather than quantitative. Objectives To quantitatively examine the consequences of surgical orbital decompression in the treatment of severe Graves' exophthalmos, with respect to changes in ocular globe projection and orbital soft tissue and bony volume. Material and Methods A series of three patients (five orbits) with severe exophthalmos were evaluated. All patients were operated on by a single surgeon using a standard technique of orbitozygmatic osteotomy in conjunction with three-wall orbital decompression and release of periorbita. Data obtained from standardized preoperative and three-month postoperative computed tomography scans were transferred to an offline computer workstation. Scalar and volumetric parameters were quantitatively analyzed to determine changes in globe projection in relation to intraorbital volume differences. Results Following surgery, mean globe retrodisplacement from the lateral orbital rim and from the optic foramen were 6.7 mm and 3.3 mm, respectively. Osteotomy and decompression were effective in producing an 18.6% increase in bony orbital volume. However, the volume of intraorbital soft tissues increased substantially following surgery, with a 23.4% increase in orbital fat volume and a 12.2% increase in neurovascular tissue volume. Conclusions The degree of globe retrodisplacement achieved by surgical expansion of the bony orbital cavity in patients with Graves' ophthalmopathy may be less than anticipated, due to a post-operative increase in the intraorbital soft tissue volumes.
Can Reduction Mammoplasty Patients Be Promised a Particular Size Postoperatively?
Authors: Cin Arianna Dal , Jeans Elizabeth Rose 
Published: February 2017

This retrospective study used self-reported bra sizes, heights and weights pre- and postoperatively in patients who underwent reduction mammoplasty by one surgeon between 2001 and 2003. Preoperative data were collected on 91 patients. Postoperative data were collected from 69 respondents by telephone survey. Bra sizes were standardized according to cup size. In bra-making, the cup is the same size for decreasing cup letter size as the band size increases. The most common standardized cup size was seven, representing bra sizes 34 F, 36 E, 38 D, 40 C, etc. The range of preoperative cup sizes was five (34 D) to 17 (42 L). The mass of tissue removed from each breast was averaged for each patient and ranged from 147 g to 2453 g (mean 522 g). The average body mass index was 29.6 kg/m preoperatively and 29.3 kg/m2 postoperatively, with six patients reporting weight gain, 13 reporting weight loss and 50 reporting no change at all. Postoperative standardized cup sizes ranged from five (34 D) to 14 (44 H). The difference between pre- and postoperative cup size ranged from zero to eight as follows: for no cup size change (n=17), mean tissue removed per breast was 577.1 g; decrease by one cup size (n=23), 489.2 g; decrease by two cup sizes (n=25), 425.8 g. These data indicate that when self-reported data from patients are used, a plastic surgeon may find that as many as 25% report no change in bra size after reduction mammoplasty, even when more than 500 g of tissue is removed from each breast, which may adversely affect patients’ satisfaction with the surgical results. Future studies will determine the cause of the apparent discrepancy between operative and self-reported results.
Congenital Arteriovenous Malformations: A Follow-Up of Treatment
Authors: Phillips Jh , Tang Cl , Armstrong D , Chalain T De , Zuker R 
Published: February 2017

Due to the rarity of arteriovenous malformations (AVMs), there is a paucity of information on the outcomes of various treatments. Presently, the mainstays of treatment of an AVM are embolization, surgical excision or a combination of both. A retrospective study of 26 patients with AVMs treated at the Hospital for Sick Children, Toronto, Ontario between 1985 and 1995 was performed. The treatment strategies and patient outcomes were compared in terms of efficacy, complications and the response of patients and their families to their overall treatment. The overall findings showed that embolization alone was effective in controlling symptoms, but may be associated with an increased AVM size. A partial excision of an AVM does not appear to exacerbate recurrence, as has been previously reported. In fact, even after what appears to be a complete excision of the AVM, recurrence may still occur. Complications from a surgical excision of the AVM are more frequent but less devastating than complications from embolization of the lesion. The overall patient or parent satisfaction with treatment was high with respect to improvement in outcome. It is expected that with an increasing understanding of vascular malformations, and the evolution of interventional radiological techniques, complications will decrease and results as a whole will improve.
Patterns of Sensory and Autonomic Reinnervation of Long-Standing Myocutaneous Microvascular Flaps and Split-Skin Grafts Applied to Fascial Beds
Authors: Juma A , Oudit D , Ellabban M 
Published: February 2017

Background: There is a paucity of reports in the literature examining the pattern of sensory and autonomic neural recovery of myocutaneous microvascular flaps and skin grafts to the lower limbs after a prolonged period of time. Objectives: To investigate the recovery of sensation and autonomic nerve activity in long-standing split-skin grafts applied to fascial beds and in myocutaneous microvascular flaps. Methods: The patients were divided into two groups: group a consisted of patients with a split-skin graft applied to a fascial bed (n=11) and group B consisted of patients with free microvascular flaps (n=4). Patients in both groups underwent various clinical subjective and objective tests, including the measurement of electrical resistance and thermal sensory analysis. Laser Doppler flowmetry was used to investigate the blood flow patterns. Results: Patients in both groups showed significantly reduced sensory modalities. However, the findings of both the electrical resistance and laser Doppler flowmetry were significantly different among the patients in group a compared with controls. In contrast, electrical resistance and laser Doppler flowmetry test results were similar in group B and controls. Conclusions: Both split-skin grafts applied to fascial beds and microvascular flaps on the lower limb had poor sensory recovery. However, after 15 years, the microvascular flaps regained the ability to sweat and some degree of thermoregulatory function. This may imply that the long-standing myocutaneous free flaps regained some aspects of their autonomic innervation, whereas the split-skin grafts had not.
Narrowing of the Wide Nasal Dorsum in the ‘Minimal-Hump’ Nose: A Simplified Universal Approach
Authors: Fanous Nabil , Amar Yannick G 
Published: February 2017

The operative procedure frequently used to narrow the nasal pyramid in the context of a regular rhinoplasty is well known to all rhinoplastic surgeons. It consists of hump removal, followed by lateral osteotomies and medialization of the nasal bones. However, narrowing of a wide nasal pyramid, in the absence of an appreciable dorsal hump, as in the case of an ideal dorsal height or a mild hump, presents a different challenge. The present article describes a simplified approach to the ‘nasal plateau resection’, a technique that allows the creation of an open nasal roof, without hump removal and without compromising dorsal projection. This permits the medialization of the lateral nasal bones and the subsequent narrowing of the wide pyramid, while preserving the height of the nasal dorsum as viewed in profile.
A Cost-Utility Analysis of Open and Endoscopic Carpal Tunnel Release
Authors: Thoma Achilleas , Wong Vanessa H , Sprague Sheila , Duku Eric 
Published: February 2017

Background Open carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. with the advent of minimally invasive surgery, endoscopic carpal tunnel release (ECTR) was introduced. Objective To use a decision analytical model to compare ECTR with OCTR in an economic evaluation. Methods Direct medical costs were obtained from a Canadian university hospital. Utility values obtained from experts, presented with carpal tunnel syndrome outcome health states, were transformed into quality-adjusted life years (QALYs). The probabilities of the health states associated with both techniques were obtained from the literature. Results The incremental cost-utility ratio (ICUR) was $124,311.32/QALY gained, providing strong evidence to reject ECTR when ECTR is performed in the main operating room and OCTR is performed in the day surgery unit. A one-way sensitivity analysis in the present study demonstrated that when both OCTR and ECTR are performed in day surgery unit, the ICUR falls in the ‘win-win’ quadrant, making ECTR both more effective and less costly than OCTR. If the scar tenderness probability is decreased in the ECTR group in a second one-way sensitivity analysis, the ICUR decreases to $100,621.91/QALY gained, providing evidence to reject ECTR. If the reflex sympathetic dystrophy probability is increased in the ECTR group in a third one-way sensitivity analysis, the ICUR increases to $202,657.88/QALY gained, providing strong evidence to reject ECTR. Conclusions There is still uncertainty associated with the costs and effectiveness of ECTR and OCTR. To obtain a definitive answer as to whether the ECTR is more effective than the OCTR, it is necessary to perform a large, randomized, controlled trial in which the utilities and resource use are measured prospectively.
Bear Maulings Treated in Calgary, Alberta: Their Management and Sequelae
Authors: Frank Ryan C , Mahabir Raman C , Magi Enzio , Lindsay Robert L , Haas William De 
Published: February 2017

Background Between 1994 and 2005, seven patients underwent surgery at the Foothills Medical Centre, Calgary, Alberta, for injuries sustained in bear maulings. The purpose of the present study was to document these cases and add to the literature on the management and the potential complications of bear attacks. Methods Data were collected retrospectively from charts. Results Seven patients were treated for injuries ranging from lacerations and puncture wounds to fractures and avulsed tissue. On average, patients underwent three operations and spent 22 days in hospital. Mean time from attack to arrival at the trauma centre was 19 h. Irrigation, debridement and intravenous antibiotics did not prevent wound infections in two patients. Six of seven patients developed acute stress disorder, and one of these patients went on to suffer from post-traumatic stress disorder. Complications ranged from infection to pulmonary embolism. Conclusions Bear attacks result in a spectrum of injuries. Infections and psychiatric disorders are common sequelae.
Replantation Surgery in Quebec: The Bottlenecks to Rapid Care
Authors: Borsuk Daniel E , Zadeh Teanoosh , Lee Chen , Moore Karl , Tan Grace 
Published: February 2017

Introduction Time delays resulting in prolonged ischemia have a significant impact on the successful reattachment of amputated body parts. No studies have addressed the issues surrounding delays from the time of the accident to the start of replantation surgery. The present paper identifies the bottlenecks that prolong the time before patients are able to gain access to a replant team. Methods A total of 50 patients underwent microsurgical replantation, because of traumatic amputation, at a university-based hospital from 1996 to 2003. The charts were analyzed to ascertain individual time intervals from the onset of injury until the beginning of replant surgery. Results The average length of time for patients who came directly to the replant centre was 3 h 40 min before surgery began. In contrast, for those referred from outlying hospitals, the elapsed time was 6 h 21 min. Conclusions Two major bottlenecks were found. First, for patients who were referred from other health centres, delays were due to a lack of information as to where patients could receive appropriate replant surgery. Second, delays at the replant centre were primarily due to insufficient physical and human resources in the operating room.