bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contraction of the composite skin graft and autograft
Authors: Gragnani Alfredo , Morgan Jeffrey R , Ferreira Lydia Masako 
Published: February 2017

Wound contraction as a result of a delay in grafting or second intention healing in an area that there was no graft take is a serious problem because of the sequela to the burned patient. The objective of the present study was to evaluate the contraction of the cultured keratinocytes and human acellular dermis composite graft by tracing the graft with transparent film after transplantation to the back of athymic mice. The evaluation of the contraction of the composite skin grafts and autografts in relation to the original wound area on the back of the athymic mice demonstrated greater contraction of the grafts after the dressings were removed on the seventh day. The composite skin graft contraction was significantly bigger than the autograft contraction. The experimental data suggested that the contraction appeared after dressing removal, but that the macroscopic aspect of the composite skin graft remained normal with no distortion of the graft or the surrounded murine skin.
Transfer of Either Index Finger Extensor Tendon to the Extensor Pollicis Longus Tendon
Authors: Meads Bryce M , Bogoch Earl R 
Published: February 2017

Background: Extensor pollicis longus (EPL) tendon ruptures have been treated succesfully with the transfer of the extensor indicis proprius (EIP) tendon. Situations exist in which, due to intraoperative observations, another tendon transfer may be considered preferable to the standard EIP transfer method. Objectives: To determine whether transfer of the extensor digitorum communis II (EDC II) tendon from the index finger to the EPL tendon, leaving the EIP tendon to the index finger intact, would serve as an equally efficient transfer and not adversely affect the function of the hand. Methods: Two patients who had the EDC II tendon transferred to the ruptured EPL tendon, and two patients who had the EIP tendon transferred, were retrospectively reviewed. In each transfer type, one patient had suffered an EPL tendon rupture after a Colles’ fracture, and the other had rheumatoid arthritis. The rupture occurred on the non-dominant side in one patient in each transfer type. Each patient was examined and subjected to range of motion and power testing at least one year following surgery. Results: All four patients showed a minimal extension lag with the lift off test, but there was no noticeable difference in range of motion, pinch grip and hand grip strength between the transfer types. Both EDC II transfer patients demonstrated an 8° to 15° loss of thumb interphalangeal joint flexion compared with the unoperated side; EIP transfer patients demonstrated less than a 5° loss. Three patients demonstrated a minor extension lag in the index finger and middle finger. Extension power of the thumb and index finger in all patients varied with wrist flexion and extension and ranged from 50% to 150% of the unoperated side. Conclusions: These case reports suggest that either index finger tendon may be successfully transferred in EPL tendon ruptures.
Johanson-Blizzard Syndrome: A Challenge in Nasal Reconstruction
Authors: Timoney Norma , Weinberg Michael J , Ross David A , Thomson Hugh G 
Published: February 2017

Johanson-Blizzard syndrome is rare and involves multiple congenital anomalies, including bilateral absence or deficiency of the nasal alae, giving the affected infant a characteristic appearance. Two cases are described that illustrate the difficulties of nasal reconstruction in young children. Surgical options and the timing of intervention are discussed.
Cutaneous Ganglioneuroma Within a Giant Congenital Nevus
Authors: Jaeger Marcos Ro , Viero Sandra , Zuker Ronald M 
Published: February 2017

Cutaneous ganglioneuroma has only occasionally been reported in the literature. Cutaneous ganglioneuroma is seen even more rarely in association with a giant congenital nevus. Differential diagnosis includes malignancies, especially melanoma and metastatic neuroblastoma. It is essential to rule out malignancy in a solid lesion within a congenital nevus. The present report is possibly the first relating ganglioneuroma and a congenital nevus to a cervical mass detected during routine prenatal ultrasound.
Rate of pediatric tap water scald injuries in eastern Ontario
Authors: Barnsley G Philip , Barnsley Shannon E 
Published: February 2017

Background Tap water scalds can be devastating and are entirely preventable. This topic has received notable attention in Canada in recent years, with a national campaign in 2001 directed at parents recommending that they lower the water temperature of their home water heater. This campaign has been evaluated and reported as a successful population-based intervention. Objectives The present study evaluated the rate of pediatric tap water scalds in Ottawa, Ontario over the 10-year period from 1993 to 2002 in an attempt to identify the impact of this national awareness campaign. Methods Data from the Children's Hospital of Eastern Ontario available in the Canadian Hospitals Injury Reporting and Prevention Program database were used to calculate the yearly incidence density of tap water scalds among children younger than 15 years in the city of Ottawa. Results It was found that there was no statistically significant change in the rate of pediatric tap water scalds following the national campaign, and that the rate of these injuries was already very low (3.73 per 100,000 person-years over the study period). Of these, only 17% required observation or admission to hospital. Conclusions Given the low incidence of these injuries, their priority as a public health concern needs to be re-evaluated. If they continue to be a priority, new preventive strategies need to be used. It is thought that resources used to lobby for legislation of lower hot water temperatures may be more effective in reducing the incidence of these injuries.
An uncommon folliculosebaceous cystic hamartoma on the lower extremity
Authors: Emsen Ilteris Murat , Livaoglu Ayten 
Published: February 2017

Background Folliculosebaceous cystic hamartomas (FSCH) are a recently recognized cutaneous hamartoma comprised of follicular, sebaceous and mesenchymal elements. Only nine cases have been previously reported. The authors present a case of FSCH on the lower extremity in addition to a literature review. Objective To further characterize the clinical, histological and immunohistological features of FSCH. Methods The clinical, histological and immunohistological features of FSCH were evaluated and the literature reviewed. RESULTS: This lesion uncommonly presents as exophytic papules or nodules on the leg, and most commonly presents on the central part of the face. Clinical differential diagnoses included nevus, neurofibroma and adnexal tumour. The diagnostic microscopic features of infundibular cystic structures with attached sebaceous glands and characteristic stroma were present in all lesions. Many of the stromal spindle cells were CD34–positive. Conclusion The FSCH is a recently recognized hamartoma comprised of follicular, sebaceous and mesenchymal elements. Although reported only rarely, its incidence is likely much higher. In the present patient, the FSCH was located in femoral region, which is very rare.
Incidence of Capsular Contracture in Silicone Versus Saline Cosmetic Augmentation Mammoplasty: A Meta-Analysis
Authors: El-Sheikh Yasser , Tutino Roberto , Knight Casey , Farrokhyar Farough , Hynes Nicolas 
Published: February 2017

Introduction Capsular contracture after augmentation mammoplasty occurs at a rate of 15% to 45%. The purpose of the present study was to determine the effect of implant core type (silicone versus saline) on the rate of capsular contracture in augmentation mammoplasty. Methods A systematic review was conducted through a search of three electronic databases. Two reviewers independently scanned titles yielded by the search and identified potentially relevant papers. Inter-reviewer variability and the scientific quality of the articles were assessed. Meta-analysis was performed. Results Eighty-eight titles of potential relevance were selected from the 393 articles yielded by the search. Inter-rater agreement for selection of potentially relevant articles was 84% (κ=0.54). Four comparative studies were included in the analysis. Scientific quality scores of the included studies ranged from 5 of 14 to 9 of 14. Three of the four studies reported a higher rate of capsular contracture in patients with silicone implants. A combined odds ratio calculated on two of the studies found a 2.25-fold increased risk of capsular contracture in patients who received silicone implants. Eight series of patients who received cohesive gel silicone implants reported rates of capsular contracture from 0% to 13.6%. Conclusions Higher rates of capsular contracture were found in patients who received silicone implants when compared with those who received saline implants. However, the scientific quality of the comparative studies to date on this subject is poor. Recent series evaluating cohesive gel implants report relatively low rates of capsular contracture. A randomized controlled trial comparing rates of capsular contracture in cohesive gel and saline implants is recommended.
Infrared surface temperature monitoring in the postoperative management of free tissue transfers
Authors: Papillion Paul , Wong Lesley , Waldrop Jimmy , Sargent Larry , Brzezienski Mark , Kennedy Woody , Rehm Jason 
Published: February 2017

Background Early identification of failing free flaps may allow for potential intervention and flap salvage. The predictive ability of flap temperature monitoring has been previously questioned. The present study investigated the ability of an infrared surface temperature monitoring device to detect trends in flap temperature and correlation with anastomotic thrombosis and flap failure. Methods Postoperative measurement of surface temperature was obtained in 47 microvascular free flaps. Differences in temperature between survival and failure groups were evaluated for statistical significance using Student's t test (P<0.05). In addition, a single variable analysis was performed on 30 different flap characteristics to evaluate their prediction of flap failure. Results In total, eight flaps failed. Five of these were re-explored, of which one was salvaged. The three other flaps died a progressive death secondary to presumed thrombosis of the microcirculation despite adequate Doppler signals. Temperatures of the flap failure group during the last 24 h yielded a mean difference of 2°C (3.56°F) compared with surviving flaps (P<0.05). The temperature of the failing flaps began to decline at the eighth postoperative hour. Single variable analysis identified prior radiation to be a predictor of flap failure. Conclusions A surface temperature measurement device provides reproducible digital readings without physical contact with the flap. Technical difficulties encountered in previous research with implantable or surface contact temperature probes are obviated with this noncontact technique. Flap temperature monitoring revealed a trend in temperature that correlates with anastomotic thrombosis and eventual flap failure.
Nipple reduction – An adjunct to augmentation mammaplasty
Authors: Fanous Nabil , Tawile Carolyne , Fanous Amanda 
Published: February 2017

Nipple hypertrophy is an occasional deformity in Asians and a rare one in Caucasians. Lately, it has been showing up more often in plastic surgeons' offices across North America and elsewhere, owing to the influx of Asian immigration worldwide, as well as to the rising interest in esthetic surgery among Asian communities. A simplified technique for nipple reduction is described herein. It is very easy to execute, delivers accurate results and is extremely safe. It tackles both the excessive ‘projection’ and the less frequent excessive ‘width’ of the nipple. It may be used separately or incorporated as an adjunct to mammary augmentation or mastopexy. Excellent esthetic results are obtained, while both the nipple innervation and its lactiferous ducts are preserved. The patient's and surgeon's satisfaction is high.
Use of botulinum toxin in cheiloplasty: A new method to decrease tension
Authors: Galárraga Iván Marcelo Cueva 
Published: February 2017

Objective To determine if the use of botulinum toxin during cheiloplasty could help in the management of tension at the surgical wound level. Interventions Five children younger than six months of age, who were born with complete cleft lip and palate, were treated with a dose of 10 units of botulinum toxin injected into the upper lip during surgery. Before the surgery, an electromyographic study was carried out on the patients' upper lips. A Millard-type cheiloplasty was performed and 10 days later, a second electromyographic study was performed on the upper lips of all the patients. Results There was a significant change (P<0.039) in the electromyo-graphic tracing obtained after the application of botulinum toxin, especially during rest. Conclusion As confirmed by electromyography, botulinum toxin effectively inhibits the action of the orbicularis oris muscle, especially when at rest; consequently, the tension is decreased at the level of the surgical wound.
Pedicle Viability As the Determinant Factor for Conversion to Free Nipple Graft
Authors: Cabs Al-Shaham Aa 
Published: February 2017

INTRODUCTION Women with extremely large breasts have many complaints. Reduction mammaplasty improves shape and relieves physical symptoms and alleviates psychological complaints. Mammaplasty is a an evolving technique; no single method is ideal or suitable for all breasts. Many techniques are advocated for reduction mammaplasty, including the superior, vertical, horizontal, lateral and inferior (the most popular) pedicle techniques. Even after 60 years of development in breast reduction techniques, there are still reported incidences of nipple-areola complex (NAC) necrosis. Objective To assess the perioperative conversion to free nipple graft to prevent the complication of nipple necrosis when pedicle viability is grossly compromised. Methods Between January 2002 and March 2006, 66 patients (132 breasts) underwent reduction mammaplasty using the inferior pedicle technique. The patients presented with breast gigantism and required excision of more than 1000 g of breast tissue per side. The mean patient age was 34.81 years. Patients had neck, shoulder and back pain as well as psychological complaints. Data regarding sternal notch-to-nipple distances and inframammary fold-to-nipple distances were recorded preoperatively and postoperatively. The weights of the excised breast tissue from either side were recorded. Viability of the pedicle flap was carefully monitored through perioperative clinical observation of skin colour, temperature, capillary refill and bleeding characteristics, and reassessed after pedicle folding and placement inside the newly tailored skin envelope. Nonvital NAC, as evaluated by the surgeon during surgery, necessitated conversion to the free nipple graft technique. Results During the course of the study, two patients (four breasts; 3.03%) exhibited impending gangrene to the NAC, and perioperative conversion to the free nipple graft was performed. In these two patients, the pedicle length ranged from 23 cm to 25 cm, and breast mass reduction ranged from 1950 g to 2250 g. Conclusion Perioperative conversion to a free nipple-areola graft is always a good and safe option when impending gangrene to the NAC is evident during mammaplasty by inferior pedicle technique.
Incorrect Radiographic Evaluation After Vascularized Bone Grafting for Scaphoid Fracture Or Nonunion
Authors: Morin Paul , Reindl Rudy , K Berry Gregory , J Harvey Edward 
Published: February 2017

PURPOSE The present study is a review of patients with scaphoid nonunions treated with a dorsal vascularized bone graft. The study highlights a subset of patients incorrectly diagnosed as graft failures. METHODS A retrospective review of patients who received vascularized grafts for scaphoid nonunions was performed over a four-year period. The vascularized graft of choice for this group was the dorsal radial extensor compartment artery. RESULTS Five patients from a scaphoid fracture group who were treated with vascularized grafts were diagnosed as being failures (average of five months). None of these patients had tenderness on palpation of the scaphoid, and they were scheduled for revised vascularized grafts. All patients at the time of surgery were found to have healed. These patients were treated with arthrolysis, resulting in healing and full range of motion. CONCLUSIONS Scaphoid vascularized grafts may have a markedly delayed radiographic healing time. Reoperation to perform secondary vascularized procedures may result in unnecessary surgery. Early imaging following a scaphoid vascularized graft may be inaccurate and may demonstrate a continued nonunion.
Liposuction Infiltration: The Quito Formula – a New Approach Based On An Old Concept
Authors: Cueva Galárraga Iván Marcelo 
Published: February 2017

INTRODUCTION Liposuction is a highly sought after surgical procedure. Despite its popularity, not all of the factors associated with its execution are well understood. No well-established guidelines exist for plastic surgeons regarding the subcutaneous infiltration of fluid and, thus, the procedure is often performed subjectively. OBJECTIVE To establish the usefulness of the Quito formula (infiltrate volume = weight [kg] × percentage of body surface to be liposuctioned × 2.4 [mL]) for calculating the volume of fluid to be infiltrated subcutaneously during small-volume liposuction performed under epidural anesthesia. METHODS A prospective study was conducted on a group of 50 patients who were candidates for liposuction on multiple body parts between November 2004 and February 2010. RESULTS The maximum volume of infiltrate was 5000 mL and the maximum volume of aspirate was 4500 mL, with a 30% total aspirated area. No patient required blood transfusion, and there were no major complications. However, one patient presented with a small local infection, another with a sacral seroma and two patients had postdural puncture headaches. No patient showed clinical signs consistent with overhydration, dehydration, pulmonary embolism, fat embolism or lidocaine intoxication. CONCLUSIONS When performing small-volume liposuction, subcutaneous infiltration using the Quito formula to calculate the volume of infiltrate proved to be useful, safe and objective.
The New Genetico-Racial Skin Classification: How to Maximize the Safety of Any Peel Or Laser Treatment On Any Asian, Caucasian Or Black Patient
Authors: Fanous Nabil , Côté Valérie , Fanous Amanda 
Published: February 2017

The popular skin classifications, notably the ‘Fitzpatrick’ and ‘Obaji’ classifications, are primarily based on skin colour. Other criteria are occasionally considered, such as the degree of skin oiliness, thickness, sensibility, etc. Although these classifications are easy to understand and apply, their simplicity limits their precision, sophistication and applicability. The new genetico-racial skin classification proposed herein suggests that skin response to any peel or laser treatment is genetically programmed and is, therefore, linked to the genetic and racial origin of the patient. In other words, in addition to skin colour, the patient's facial features and ancestry should be taken into account when classifying any skin. The new genetico-racial skin classification enables the physician to determine with great precision, and before any peel or laser treatment, the level of the patient's suitability and the expected postoperative outcomes; therefore, reducing the likelihood of complications.
Primary Cutaneous B-Cell Lymphoma: Role of Surgery
Authors: Parbhakar Sam , Dal Cin Arianna 
Published: February 2017

PURPOSE To evaluate the role of surgery in patients diagnosed with primary cutaneous B-cell lymphoma (PCBCL) – a rare disease entity. The authors offer a rationale for the use of primary surgical excision in the treatment of isolated cutaneous lymphomas. METHODS A literature review examining the use of primary surgical excision in the treatment of PCBCL was conducted. The lymphoma database at the Juravinski Cancer Centre (Hamilton, Ontario) was searched from January 1995 to July 2008, generating a list of 4924 patients. A simulated computer program was subsequently designed to search for all possible PCBCLs. A retrospective chart review was then conducted on the new list of 1325 patients, identifying 25 patients diagnosed with PCBCL. RESULTS The mean age of the 25 patients with PCBCL was 59.9 years; nine (36%) were treated with surgery, and sixteen (64%) with radiation. The average follow-up period for patients was 3.6 years. Twenty-four of the 25 patients were completely cured, with only one patient recurring in the radiation subgroup. There were no complications in the surgery subgroup. There were two local complications in the radiation subgroup consisting of chronic ulcerations. CONCLUSIONS Primary surgical excision is an effective management option in the treatment of PCBCL, particularly the marginal zone and follicle centre subtypes.
Delayed Two-Stage Breast Reconstruction with Implants: The Authors’ Recent Experience
Authors: Rykała Jan , Szychta Paweł , Kruk-Jeromin Julia 
Published: February 2017

BACKGROUND Presently, breast cancer detection is delayed in Poland and, thus, the only other option for patients is amputation and breast reconstruction (immediate or delayed). Reconstructive methods are based on using the patient's own tissue (pedicled or free myocutaneous flaps) or implants (a tissue expander, which is later exchanged for a prosthesis or an expandable implant). OBJECTIVE To evaluate the aesthetic results of a delayed two-stage breast reconstruction with the use of implants (expander and prosthesis) in patients who have previously undergone cancer-related mastectomy. METHODS From 2006 to 2009, 54 patients (34 to 65 years of age) underwent reconstruction at least one year after their mastectomy and adjuvant chemotherapy; three women also received x-ray therapy. All women underwent a two-stage treatment with a tissue expander, which was later exchanged for a prosthesis. RESULTS Outcomes of the surgery (evaluated by the physician and the patient at least six months after all stages of reconstruction) were found to be very good in 42 patients and good in 12 patients. After amputation and x-ray therapy in two cases, a fistula developed, which necessitated implant removal. CONCLUSIONS After amputation, breast reconstruction with implants (expander and prosthesis) provides good aesthetic results. The method is mildly burdening to the patient and does not cause severe scarring. Symmetrization of the second breast is often recommended; however, the cost is not covered by the national health system. In principle, earlier x-ray therapy disqualifies the application of implants. Dividing reconstruction into two stages (expander and prosthesis) allows for possible correction of prosthesis placement.