bluuebunny/crossref_metadata_2025_split huggingface dataset:
The utility of the microvascular anastomotic coupler in free tissue transfer
Authors: Grewal Amandeep S , Erovic Boban , Strumas Nick , Enepekides Danny J , Higgins Kevin M 
Published: February 2017

Background The microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. The microvascular anastomotic coupling device is an elegant, friction-fit ring pin device that is becoming more widely used. Objective To systematically review the literature to examine the utility of the microvascular coupler in free tissue transfer. Methods A comprehensive database search was performed to identify eligible publications. Inclusion criteria were anastomotic coupler utilization and free-tissue transfer. Recorded information from eligible studies included patient age, follow-up, radiation history, number of free-flaps and failure rates, reconstruction subsites, number of coupled venous and arterial anastomoses, coupling time, conversion to sutured anastomosis, coupler size and thrombosis rates. Results Twenty-five studies reporting on 3207 patients were included in the analysis. A total of 3576 free-flaps were performed within the following subsites: 1103 head and neck, 2094 breast, 300 limb or body, and 79 nonspecified. There were only 26 reported flap failures (0.7%). A total of 3497 venous and 342 arterial coupled anastomoses were performed. The primary outcome measure was thrombosis rates, and there were 61 venous (1.7%) and 12 arterial (3.6%) thromboses reported. Mean coupling time was 5 min, and 30 anastomoses (0.8%) were converted to suture. Conclusion Flap survival and revision-free application of the microvascular coupler occurred in more than 99% of cases. There is a substantial time savings with coupler use. Venous and arterial thrombosis rates are comparable with the best results achieved by sutured anastomosis and, when used by experienced surgeons, the coupler achieves superior results.
The effect of fibrin sealant on the prevention of seroma formation after postbariatric abdominoplasty
Authors: Lee Johnson C , Teitelbaum Jason , Shajan Josh K , Naram Aparajit , Chao Jerome 
Published: February 2017

Background Seroma formation is one of the most common complications following abdominoplasty. Fibrin sealant/glue has shown mixed results in seroma prevention when used in a variety of procedures. Limited information is available on its effectiveness during postbariatric abdominoplasty. Methods A retrospective chart analysis of 65 consecutive patients who underwent postbariatric abdominoplasty over a course of 16 months by a single surgeon was performed. Two sequential groups either receiving or not receiving fibrin sealant treatment were defined. Seroma formation and initial 24 h drain output volumes were recorded. Results Three patients in group 1 (9.1%) receiving fibrin sealant developed seroma. Twelve patients in group 2 (28.1%) not receiving fibrin sealant developed seroma; this was statistically significant (P=0.006). Twenty-four hour drain output was also statistically different, with higher initial output in the fibrin sealant group (222.2 mL versus 140.0 mL; P=0.047). Conclusion Fibrin sealant was a useful adjunct during surgical wound closure and significantly decreased seroma formation in patients undergoing postbariatric abdominoplasty.
Challenges and strategies for determining workforce requirements in plastic surgery
Authors: Cheung Kevin , Sweetman Arthur , Thoma Achilleas 
Published: February 2017

Background Accurate projections of the future plastic surgeon workforce are essential to provide a high standard of care and to properly allocate scarce health care resources. This is not a straightforward task. Longstanding concerns over physician surpluses have been replaced by fears of physician shortages. Methods A review of previous efforts to predict future plastic surgeon workforce requirements highlights the challenges associated with deriving a solution. Physician workforce is dependent on numerous factors, including both physician-supply factors, such as practice patterns and age, and population-demand factors including disease burden and socioeconomic factors. Factors unique to plastic surgery, such as overlap with other specialties and performance of uninsured services, must also be considered. Previous strategies from other areas of medicine are described with associated strengths and weaknesses. These strategies include needs- and demand-based approaches, economic analysis and benchmarking. Finally, the need for appropriate outcomes from which to assess adequacy of physician supply is discussed. Conclusions Projections of future plastic surgeon workforce requirements must not only consider a multitude of physician supply and population demand factors, but also factors unique to plastic surgery. Future strategies to predict workforce requirements should balance the strengths and weaknesses of each approach with the data and outcomes available in plastic surgery.
Iatrogenic comminution of the phalangeal head during reduction or fixation of phalangeal neck fractures
Authors: Al-Qattan Mohammad M 
Published: February 2017

Introduction Iatrogenic comminution of the phalangeal head during management of phalangeal neck fractures has not been previously investigated. Objective To investigate the causes and outcomes of this particular iatrogenic complication. Methods A database of phalangeal neck fractures over a six-year period (2006 to 2011) was reviewed for this iatrogenic complication. Special attention was devoted to documenting the cause and pattern of comminution of the phalangeal head, as well as the outcome in range of motion. Results Of 152 cases treated during the study period, there were five (two children and three adults) with comminution. Two patterns of comminution were encountered: splitting and fragmentation of the phalangeal head. The complication occurred during open reduction and K-wire fixation, or during closed reduction in the emergency room. The outcome was generally poor and worse in patients with fragmentation of the entire head. Two of the five cases ultimately resulted in medicolegal claims. Conclusion Comminution of the phalangeal head is a serious iatrogenic complication that may occur during the management of phalangeal neck fractures. Awareness of this complication is important and attempts should be made to avoid it.
Treatment of vaginal agenesis using a modified McIndoe technique: Long-term follow-up of 23 patients and a literature review
Authors: Bastu Ercan , Akhan Suleyman Engin , Mutlu Mehmet Firat , Nehir Asli , Yumru Harika , Hocaoglu Emre , Gungor-Ugurlucan Funda 
Published: February 2017

Background Congenital vaginal agenesis is a rare malformation with an incidence of one in 4000 to 5000 female newborns. The purpose of vaginal agenesis treatment is not only to create an adequate passageway for penetration but also to facilitate satisfactory sexual intercourse. Objective To present the results of a modified McIndoe technique with respect to sexual function, vaginal length and complication rates in patients with vaginal agenesis. Methods Between 2002 and 2010, 23 patients with vaginal agenesis were admitted to the Gynecology Clinic of Istanbul University School of Medicine (Istanbul, Turkey) for vaginal reconstruction. All patients underwent a modified McIndoe procedure. The long-term results with a follow-up period ranging from 18 to 118 months are presented. Results The postoperative mean vaginal length was 8.4 cm (range 6 cm to 11 cm) in 19 patients who used the mould regularly. Among 14 patients who used the mould regularly and had partners, only one experienced severe pain during intercourse and 13 reported that they were engaging in satisfactory sexual activity with mild or no pain, and with good mucosal sensitivity. Conversely, two of three patients who used the mould irregularly experienced severe pain during intercourse and had a mean vaginal length of 6 cm (range 4 cm to 8 cm). Conclusion The findings suggest that a modified McIndoe technique is a simple, effective procedure for the treatment of vaginal agenesis; however, proper mould use after surgery remains the cornerstone of the treatment.
A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance
Authors: Gupta Sandipan , Chattopadhyay Debarati , Murmu Marang B , Gupta Souradip , Singh Hari S 
Published: February 2017

Background Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome. Methods The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors' knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction. Results The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required. Conclusions This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.
Beta-blockers for the treatment of problematic hemangiomas
Authors: Sharma Vishal K , Fraulin Frankie OG , Dumestre Danielle O , Walker Lori , Harrop A Robertson 
Published: February 2017

Objective To examine treatment indications, efficacy and side effects of oral beta-blockers for the treatment of problematic hemangiomas. Methods A retrospective review of patients with hemangiomas presenting to the Alberta Children's Hospital Vascular Birthmark Clinic (Calgary, Alberta) between 2009 and 2011 was conducted. The subset of patients treated with oral beta-blockers was further characterized, investigating indication for treatment, response to treatment, time to resolution of indication, duration of treatment, occurrence of rebound growth and side effects of therapy. Results Between 2009 and 2011, 311 new patients with hemangiomas were seen, of whom 105 were treated with oral beta-blockers. Forty-five patients completed beta-blocker treatment while the remainder continue to receive therapy. Indications for treatment were either functional concerns (68.6%) or disfigurement (31.4%). Functional concerns included ulceration (29.5%), periocular location with potential for visual interference (28.6%), airway interference (4.8%), PHACES syndrome (3.8%), auditory interference (0.95%) and visceral location with congestive heart failure (0.95%). The median age at beta-blocker initiation was 3.3 months; median duration of therapy was 10.6 months; and median maximal treatment dose was 1.5 mg/kg/day for propranolol and 1.6 mg/kg/day for atenolol. Ninety-nine patients (94.3%) responded to therapy with size reduction, colour changes, softened texture and/or healing of ulceration. Rebound growth requiring an additional course of therapy was observed in 23 patients. Side effects from beta-blockers included cool extremities (26.7%), irritability (17.1%), lower gastrointestinal upset (14.3%), emesis (11.4%), hypotension (10.5%), poor feeding (7.6%), lethargy (4.8%), bronchospasm (0.95%) and rash (0.95%). Side effects did not result in complete discontinuation of beta-blocker treatment in any case; however, they prompted a switch to a different beta-blocker preparation in some cases. Resolution of the primary indication, requiring a median time of three months, occurred in 87 individuals (82.9%). Conclusions Treatment of infantile hemangiomas with oral beta-blocker therapy is highly effective and well tolerated, with more than 94% of patients demonstrating a response to treatment and 90% showing resolution of the primary functional indication for treatment.
Contractility of sphincter pharyngoplasty: Relevance to speech outcomes
Authors: Hubbard Bradley A , Rice Gale , Muzaffar Arshad R 
Published: February 2017

Background Sphincter pharyngoplasty has demonstrated time-tested results as a surgical treatment for velopharyngeal incompetence (VPI). However, controversy surrounding the contractility of the transposed muscles persists. Completely unaddressed in the literature is whether the dynamism of the sphincter affects speech outcomes. Objective To determine whether active sphincter contraction following sphincter pharyngoplasty influences velopharyngeal closure, nasal emission and hypernasality. Methods A prospective analysis of patients with VPI after cleft palate repair undergoing sphincter pharyngoplasty by a single surgeon was performed. Video nasendoscopy and videofluoroscopy were performed preoperatively and postoperatively at three and 12 months. Eighteen consecutive patients with cleft palate with or without cleft lip and VPI were reviewed. The average age of the patients at initial evaluation was 7.3 years, with a range of three to 19 years. Dynamicity of sphincter pharyngoplasty, velar closing ratio (VCR), and lateral wall movement (LWM) were assessed by nasendoscopy and videofluoroscopy. Nasal emission and hypernasality were assessed by perceptual speech examination. Results For longitudinal comparison, three groups were created: dynamic at three and 12 months (n=12); adynamic at three months and dynamic at 12 months (n=4); and adynamic at three and 12 months (n=2). Perceived hypernasality scores significantly improved at three months (P=0.0001) and showed continued improvement at 12 months (P=0.03), despite no change in VCR and LWM from three to 12 months. There were no significant differences among the three groups at any time point. Discussion Sphincter pharyngoplasty effectively treats VPI in appropriately selected patients. Although the VCR and LWM remained stable between three months and one year, four of six adynamic sphincters became dynamic. Considering all patients, hypernasality showed continued improvement from three months to one year. Conclusions There were no differences between dynamic and adynamic sphincters in terms of speech outcomes or the mechanical properties of velopharyngeal closure.
Post-facelift flap necrosis treatment using charged polystyrene microspheres
Authors: Weissman Oren , Farber Nimrod , Remer Eric , Tessone Ariel , Trivizki Omer , Bank Jonathan , Winkler Eyal , Zilinsky Isaac , Haik Josef 
Published: February 2017

Background Flap necrosis following facial rhytidectomy constitutes a vexing and grievous complication to the patient and the surgeon. Treatment modalities that can expedite wound healing and re-epithelialization rates are highly desired. Objectives To assess wound healing and re-epithelialization rates of open wounds following postrhytidectomy flap necrosis treated with commercially available charged polystyrene microspheres (Polyheal-1, Polyheal Ltd, Israel). Methods Flap necrosis following rhytidectomy with open wounds in three female patients were treated using dressings soaked with Polyheal-1. Wound closure rates were documented. Results The wounds demonstrated both accelerated granulation tissue formation and rapid re-epithelialization rates. No complications or side effects were encountered. Conclusions Charged polystyrene microspheres may offer a new and efficacious way to treat open wounds due to flap necrosis following facial rhytidectomy. Further research with larger patient numbers is still needed to verify these findings.
Differences in breast aesthetic outcomes due to radiation: A validated, quantitative analysis of expander-implant reconstruction
Authors: Mioton Lauren M , Gaido Jessica , Small William , Fine Neil A , Kim John Y 
Published: February 2017

Background The potential ramifications of radiation use can be of particular concern in the breast reconstruction population, in which both surgical and aesthetic outcomes are important. Presently, there remains a paucity of data detailing the influence of radiation on specific reconstruction aesthetic outcomes. Objective To conduct a quantitative evaluation of aesthetic outcomes for expander-implant breast reconstruction in radiated and nonradiated patients using a validated scoring scale. Methods A series of consecutive expander-implant breast reconstruction operations performed by the senior author between 2004 and 2012 were reviewed. Four blinded members of the Division of Plastic and Reconstructive Surgery at Northwestern University (Illinois, USA) independently rated postoperative photographs of patients' breasts using a validated scoring scale with respect to five distinct aesthetic domains. Results Of the 206 patients meeting the inclusion criteria, 69 received radiotherapy and 137 did not. The radiated cohort had lower scores in each aesthetic domain, with significant differences in contour (1.33 versus 1.51; P=0.041) and placement (1.45 versus 1.73; P<0.001). Linear regression analysis revealed a significant association between placement scores and radiation, and radiated patients had a significantly higher overall rate of complications. Discussion Variances in scores may represent the relative difficulty of expansions and proper implant placement in irradiated tissue, with possible skin fibrosis and decreased flexibility hindering prosthesis manipulation. Conclusion Radiation adversely impacts breast contour and placement, with possible negative contributions to volume, scarring and inframammary fold definition, and results in higher rates of complications. Such detailed evaluation of the impact of radiation on aesthetics will enhance the management of patient expectations.
The differing perceptions of plastic surgery between potential applicants and current trainees: The importance of clinical exposure and electives for medical students
Authors: Tahiri Youssef , Lee James , Kanevsky Jonathan , Thibaudeau Stephanie , Gilardino Mirko 
Published: February 2017

Background Exposure to plastic surgery during medical school is limited. Most interested applicants form their perceptions of careers in this surgical specialty during elective rotations. Objective To investigate the perceptions of Canadian medical students considering a career in plastic surgery. The results obtained were then compared with current Canadian plastic surgery residents' perceptions. Methods The data were collected via two separate self-administered online surveys that were distributed to either Canadian plastic surgery residents or medical students. The questionnaires were similar and focused on three aspects: applicant details; driving force behind interest in the field; and essential character traits and competencies related to successful matching. Results Fifty-nine plastic surgery residents and 477 medical students participated in the online survey. The most commonly reported driving forces for interest in a plastic surgery career in both groups were variety of career choice, complexity of the field, future lifestyle and enjoyable rotations in plastic surgery. Despite these similarities, the proportion of medical students and residents who opted for future lifestyle and enjoyable rotations differed in a statistically significant manner (P=0.015 and P=0.029, respectively). In terms of the essential competencies to match into a plastic surgery training spot, the groups differed statistically in their opinions on the relevance of intellect (P<0.001), manual dexterity (P<0.001), spatial sense (P<0.001) and clerkship grades (P=0.004). Conclusion Interested applicants should be encouraged to obtain as much elective experience as possible to assist both students in their career choice and selection committees in identifying capable applicants.
The transverse upper gracilis flap: Efficiencies and design tips
Authors: Buchel Edward W , Dalke Kimberly R , Hayakawa Thomas Ej 
Published: February 2017

The transverse upper gracilis free flap is a well-described option for breast reconstruction. The technique is a secondary choice for autologous breast reconstruction because the abdomen remains the primary donor site for breast reconstruction. However, in appropriately selected patients, the authors believe that the transverse upper gracilis flap remains a reliable flap for breast reconstruction. Its consistent anatomy, potentially reasonable donor site scar, limited functional morbidity and simultaneous two-team surgical approach make this flap a viable option for many patients. The technique, however, is not without drawbacks – known numbness of the medial thigh and the potential for chronic lymphedema of the lower leg, contour deformities of the medial thigh, and widening of the medial thigh scar need to be considered. The current article presents a harvest technique that is reliable, rapid and addresses each of the above-mentioned limitations with specific changes in the traditional technique. The article provides video documentation of the modified harvest technique using only monopolar cautery for the dissection.
How to Centre the Umbilicus Following Rectus Abdominous Myocutaneous Flap Transfers
Authors: Drever J Michael , Habiballah J 
Published: February 2017

JM Drever, J Habiballah. How to centre the umbilicus following rectus abdominous myocutaneous flap transfers. Can J Plast Surg 1998;6(1):37-40. Rectus abdominous myocutaneous and transverse rectus abdominous myocutaneous (TRAM) flaps are increasingly used for breast reconstruction. The navel tends to deviate to one side, mostly in unilateral pedicle cases, when pulled by the muscle closure side. These sequela can be avoided by amputating the umbilicus and reconstructing a new one with a ‘U′-shaped flap or by dragging navels that have a long stalk to the midline. To avoid scar contracture, a ‘V′-shaped flap is inset into the umbilicus.
Misdiagnosis of Breast Implant Rupture with Mammography
Authors: Van Brenk Bert , Mahoney James L 
Published: February 2017

B Van Brenk, JL Mahoney. Misdiagnosis of breast implant rupture with mammography. Can J Plast Surg 1998;6(1):17-18. Diagnosis of intracapsular ruptures of silicone breast implants with mammography can be difficult. A case is presented where mammography was used to diagnose an implant rupture with both a false positive and false negative result in the same patient. The mammographic features of breast implant ruptures are discussed.