bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications and Long-Term Outcomes of Free Fibula Reconstruction following Resection of a Malignant Tumor in the Extremities
Authors: Houdek Matthew T. , Wagner Eric R. , Bishop Allen T. , Shin Alexander Y. , Rose Peter S. , Sim Franklin H. , Moran Steven L. 
Published: February 2017

Background:
To achieve limb salvage and provide the patient with a functional extremity, vascularized free fibula transfer has become the workhorse for segmental bony reconstruction. Because of various host factors, there has been a high complication rate following oncologic reconstruction. The authors reviewed the experience of their institution with the use of free fibula reconstruction following an oncologic resection in the extremities.

Methods:
The authors reviewed 56 cases of free fibula transfer performed for limb salvage following oncologic resection from 1994 through 2013. The cohort consisted of 30 male patients and 26 female patients; with a mean age of 19 years and a mean follow-up of 7 years. Sixty-three percent of the tumors were located in the lower extremity.

Results:
The overall 2-, 5-, 10-, and 15-year survival rates were 98, 86, 73, and 73 percent, respectively. With regard to disease-specific survival, the overall 2-, 5-, 10, and 15-year survival rates were 82, 75, 67, and 50 percent, respectively. Seventy-five percent of cases healed primarily, with a mean time to union of 10 months. The overall union rate was 98 percent following supplemental bone grafting. Chemotherapy following the free fibula graft increased the risk (hazard ratio, 2.10; p = 0.03) of a delayed union. The overall rate of limb salvage was 93 percent, with four patients requiring an amputation.

Conclusions:
The free fibula is considered the workhorse vascularized bone graft for extremity reconstruction in limb salvage surgery. In the oncologic setting, a repeated bone grafting procedure was common, and should be expected in patients undergoing chemotherapy. Limb salvage rates are high with this technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
An Oncoplastic Breast Augmentation Technique for Immediate Partial Breast Reconstruction following Breast Conservation
Authors: Barnea Yoav , Friedman Or , Arad Ehud , Barsuk Daphna , Menes Tehillah , Zaretski Arik , Leshem David , Gur Eyal , Inbal Amir 
Published: February 2017

Background:
Patients with a small breast volume and a relative large lumpectomy volume are at risk of developing severe breast deformity and asymmetry following breast conservation, presenting a unique surgical challenge.

Methods:
A series of patients undergoing immediate reconstruction by means of an oncoplastic breast augmentation technique following breast conservation are described. The technique includes local tissue rearrangement and bilateral subpectoral breast augmentation with implants of different sizes and shapes, immediately after lumpectomy for a malignant tumor.

Results:
Twenty-one consecutive patients underwent the oncoplastic breast augmentation technique (mean follow-up, 23 months; range, 12 to 48 months). Three patients (14.3 percent) had tumor-positive surgical margins. Postoperative complications included grade III/IV capsular contracture in five patients (23.8 percent) and breast infection in two patients (10 percent). All patients received postoperative radiation therapy. The cosmetic outcome was evaluated at least 6 months after radiation therapy, and it was favorable according to the reported high patient satisfaction (81 percent) and independent observers’ evaluation scores (76 percent).

Conclusions:
The oncoplastic breast augmentation technique described in this article is an acceptable option in small-breasted patients with a relatively large lumpectomy volume who elect to undergo breast conservation. This technique allows conservation of the affected breast and minimizes potential breast deformation and asymmetry following radiation therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Prophylactic Leukotriene Inhibitor Therapy for the Reduction of Capsular Contracture in Primary Silicone Breast Augmentation: Experience with over 1100 Cases
Authors: Bresnick Stephen D. 
Published: February 2017

Background:
The role of leukotriene inhibitors used immediately postoperatively to potentially influence the development of capsular contracture is unknown. The purpose of this study was to evaluate the incidence of capsular contracture among women undergoing primary smooth silicone gel breast augmentation, with or without postoperative leukotriene inhibitor therapy.

Methods:
Between 2007 and 2013, 1122 consecutive women undergoing primary silicone gel breast augmentation were evaluated retrospectively. All underwent augmentation with smooth, Mentor Memory Gel implants, using a dual-plane technique, with periareolar or inframammary approaches. Patients were treated voluntarily with either no leukotriene inhibitor, montelukast (Singulair), or zafirlukast (Accolate) for 3 months. All patients received informed consent for the off-label use of leukotriene inhibitors. Liver function studies were obtained for all patients undergoing Accolate therapy after 1 month of therapy. The presence of capsular contracture was measured by the Baker scale at 1 year postoperatively.

Results:
Patients receiving Accolate therapy (n = 520) demonstrated an encapsulation rate of 2.19 percent. Women receiving Singulair therapy (n = 247) had an encapsulation rate of 3.27 percent. Patients not receiving leukotriene inhibitor therapy had an encapsulation rate of 5.02 percent. There were no long-term complications among patients evaluated.

Conclusions:
Accolate therapy used for 3 months postoperatively was associated with significantly lower capsular contracture rates compared with untreated patients at 1-year follow-up (p < 0.05). Patients treated with Singulair demonstrated lower contracture rates compared with controls, but the differences were not statistically significant. The findings suggest that Accolate therapy, with monitoring and consent, reduces the incidence of capsular contracture following primary smooth silicone gel breast augmentation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Accurate Prediction of Tissue Viability at Postoperative Day 7 Using Only Two Intraoperative Subsecond Near-Infrared Fluorescence Images
Authors: Wada Hideyuki , Vargas Christina R. , Angelo Joseph , Faulkner-Jones Beverly , Paul Marek A. , Ho Olivia A. , Lee Bernard T. , Frangioni John V. 
Published: February 2017

Background:
The ability to predict the future viability of tissue while still in the operating room and able to intervene would have a major impact on patient outcome. Although several objective methods to evaluate tissue perfusion have been reported, none to date has sufficient accuracy.

Methods:
In eight Sprague-Dawley rats, reverse McFarlane dorsal skin flaps were created. Continuous near-infrared fluorescence angiography using indocyanine green was performed immediately after surgery, for a total of 30 minutes. These dynamic measurements were used to quantify indocyanine green biodistribution and clearance, and to develop a simple metric that accurately predicted tissue viability at postoperative day 7. The new metric was compared to previously described metrics.

Results:
Reproducible patterns of indocyanine green biodistribution and clearance from the flap permitted quantitative metrics to be developed for predicting flap viability at postoperative day 7. Previously described metrics, which set the boundary between healthy and necrotic tissue as either 17 or 25 percent of peak near-infrared fluorescence at 2 minutes after indocyanine green injection, underestimated the area of necrosis by 75 and 48 percent, respectively. Our data suggest that both the shape and area of clinical necrosis occurring at postoperative day 7 can be predicted intraoperatively, with the boundary defined as near-infrared fluorescence intensities of 40 to 55 percent of peak fluorescence measured at 5 minutes.

Conclusion:
Two 750-msec intraoperative near-infrared fluorescence images obtained at time 0 and at 5 minutes after injection of indocyanine green accurately predicted skin flap viability 7 days after surgery.
Infant Robotic Cleft Palate Surgery: A Feasibility Assessment Using a Realistic Cleft Palate Simulator
Authors: Podolsky Dale J. , Fisher David M. , Wong Riff Karen W. Y. , Looi Thomas , Drake James M. , Forrest Christopher R. 
Published: February 2017

Background:
A surgical robot offers enhanced precision, visualization, and access and the potential to improve outcomes in cleft palate surgery. The goal of this study was to investigate the feasibility of using the da Vinci robot for cleft palate repair in infants using a cleft palate simulator test bed.

Methods:
A high-fidelity cleft palate simulator was developed that allows performance of a robotic cleft palate repair procedure. A complete cleft palate repair was performed with the da Vinci Si with 5-mm instruments and the da Vinci Xi with 8-mm instruments. The advantages of the robotic approach were assessed in comparison with using standard instruments. For each system, arm repositioning, collisions, instrument and endoscope excursion, wrist orientation, and vision were compared for 12 steps of the repair.

Results:
The cleft palate simulator provided a reproducible platform for testing robotic cleft palate surgery. The advantages of the robotic approach were the ability to articulate a miniature wrist intraorally with superior visualization, increased ambidexterity, and improved ergonomics compared with using standard instruments. Cleft palate repair with the Xi was superior to the Si with respect to arm repositioning, instrument collisions and excursion, and wrist orientation. However, Xi performance remained suboptimal because of the larger instruments.

Conclusions:
Robotic cleft palate repair using the da Vinci system offers advantages compared with the traditional approach. Cleft palate repair is more feasible with the Xi and 8-mm instruments. However, performance is limited by the instrumentation, which requires modification to ensure safety and efficacy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Pedicled Temporalis Muscle Flap for Craniofacial Reconstruction: A 35-Year Clinical Experience with 366 Flaps
Authors: Spanio di Spilimbergo Stefano , Nordera Paolo , Mardini Samir , Castiglione Giusy , Chim Harvey , Pinna Vittore , Brunello Massimo , Cusino Claudio , Roberto Squaquara , Baciliero Ugo 
Published: February 2017

Background:
In the past 130 years, the temporalis muscle flap has been used for a variety of different indications. In this age of microsurgery and perforator flaps, the temporalis muscle flap still has many useful applications for craniofacial reconstruction.

Methods:
Three hundred sixty-six temporalis muscle flaps were performed in a single center between 1978 and 2012. The authors divided the cases into two series—before and after 1994—because, after 1994, they started to perform free flap reconstructions, and indications for reconstruction with a temporalis muscle flap were changed

Results:
In the series after 1994, flaps were most commonly used for reconstruction of defects in the maxilla, mandible, and oropharynx, in addition to facial reanimation and filling of orbital defects. Complications included total flap necrosis (1.6 percent) and partial flap necrosis (10.7 percent). The rate of material extrusion at the donor site decreased after porous polyethylene was uniformly used for reconstruction from 17.1 to 7.9 percent.

Conclusions:
The pedicled temporalis muscle flap continues to have many applications in craniofacial reconstruction. With increasing use of free flaps, the authors’ indications for the pedicled temporalis muscle flap are now restricted to (1) orbital filling for congenital or acquired anophthalmia; (2) filling of unilateral maxillectomy defects; and (3) facial reanimation in selected cases of facial nerve palsy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Daily Suction Provided by External Volume Expansion Inducing Regeneration of Grafted Fat in a Murine Model
Authors: Ye Yuan , Liao Yunjun , Lu Feng , Gao Jianhua 
Published: February 2017

Background:
Fat grafting has variable and sometimes poor outcomes, and therefore new methods are needed. Multiple studies have demonstrated the excellent performance of external volume expansion and focused only on preexpansion with emphasis on the recipient.

Methods:
Two mouse models (a suction model and a fat-exchange transplantation model) were established to investigate changes in the origins and biological behaviors of regeneration-related cells in grafted fat under daily suction provided by external volume expansion.

Results:
Blood supply increased from new host-derived capillaries or macrophage infiltration under suction. CD34-positive cells showed increased migration from the host into the grafts under suction. At week 12, nearly half of the mature adipocytes regenerated in the grafts in the suction group were derived from the host. Peroxisome proliferator-activated receptor γ expression of the suction group was significantly higher than that of controls at weeks 2 and 4 during adipogenesis. The normalized sample weight of the grafted fat was significantly greater than that of controls at 1 (0.081 ± 0.001 versus 0.072 ± 0.005; p < 0.001), 4 (0.060 ± 0.002 versus 0.048 ± 0.001; p = 0.002), 8 (0.060 ± 0.001 versus 0.046 ± 0.001; p < 0.001), and 12 weeks (0.060 ± 0.001 versus 0.046 ± 0.001; p = 0.002).

Conclusions:
The mechanical effect of daily suction provided by external volume expansion favors the regeneration of grafted fat and improves retention by promoting the migration of regeneration-related cells and the differentiation of adipocytes. Thus, more mature fat tissue with a well-organized structure was formed under suction.
Identification of Key Modules and Hub Genes of Keloids with Weighted Gene Coexpression Network Analysis
Authors: Liu Wenhui , Huang Xiaolu , Liang Xiao , Zhou Yiwen , Li Haizhou , Yu Qingxiong , Li Qingfeng 
Published: February 2017

Background:
Keloid scarring impairs patients’ quality of life, and although many therapeutic strategies have been developed, most remain unsatisfactory because of limited understanding of the mechanisms underlying keloid development.

Methods:
A microarray gene expression data set from keloid tissue was acquired from the Gene Expression Omnibus. Differentially expressed genes in fibroblasts and keratinocytes underwent functional annotation and pathway analysis. Weighted gene coexpression network analysis was applied to identify the gene targets of keloid scars within differentially expressed genes. Modules and hub genes for keloids were identified. Enrichment analysis was undertaken to verify the modules’ and hub genes’ relationship with keloids.

Results:
Enrichment analysis and pathway analysis showed gene ontology terms and pathways related to keloids. Each cell type generated three modules in weighted gene coexpression network analysis, with one module most related to keloids. Enrichment analysis showed that the modules concerned are enriched with terms related to keloids. Three hub genes were selected for fibroblasts and keratinocytes, and their relationship to keloids was verified. Immunohistochemical staining verified expression change of some hub genes.

Conclusions:
This is the first study to describe the gene networks underlying keloids. Modules and hub genes generated in the present study are highly related to keloids and may identify novel therapeutic targets for treatment of keloids.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Public Perception of Cosmetic Surgeons versus Plastic Surgeons: Increasing Transparency to Educate Patients
Authors: Shah Ajul , Patel Anup , Smetona John , Rohrich Rod J. 
Published: February 2017

Background:
The American Society of Plastic Surgeons’ “Do Your Homework” campaign strives to educate the public on how to identify providers who can safely perform aesthetic/cosmetic/plastic surgery. Although the campaign continues to heighten awareness, misperceptions remain in determining who these providers are. This study aims to examine whether the general public is confused by the titles “plastic surgeon” or “cosmetic surgeon,” and accordingly, evaluates whether misperceptions need to be remedied to have an informed and safe patient.

Methods:
A 19-question survey was created under the guidance of a survey methodologist. Responses were obtained and cross-tabulation analyses were performed with statistical analysis.

Results:
Five thousand one hundred thirty-five individuals completed the survey. Eighty-seven percent of patients either believed that surgeons must be appropriately credentialed to legally advertise themselves, or were unsure. The majority of respondents were uncomfortable with obstetrician-gynecologists (92 percent), dermatologists (68 percent), general surgeons (74 percent), and family practice physicians (93 percent) performing surgery to improve their appearance. Persons with lower education and lower income levels were more likely to believe that surgeons must be appropriately credentialed to legally market themselves, and were more likely to assume that to legally perform aesthetic surgery, one must be board certified in plastic surgery.

Conclusion:
The authors’ data demonstrate that the combination of problematic medical marketing, recognized and unrecognized boards, and varying categorizations of surgeons has made it increasingly difficult for a patient to interpret the necessary information to decide which physician can safely perform surgery to improve one’s appearance.
Facial Reanimation: Basic Surgical Tools and Creation of an Effective Toolbox for Treating Patients with Facial Paralysis. Part A: Functional Muscle Transfers in the Long-Term Facial Palsy Patient
Authors: Rozen Shai M. 
Published: February 2017

Summary:
The literature on facial paralysis is vast; however, detailed videos of the basic tools of dynamic reanimation within the context of patient scenarios accompanied by detailed narrative emphasizing both technique and thought processes are not common. Although not all scenarios of facial paralysis can be discussed in one setting, videographic visualization of basic surgical procedures, including facial marking, facial dissection, donor nerve preparation, cross-facial nerve graft, nerve transfers, and muscle harvest and inset, may provide a strong toolbox. Using these tools in various combinations depending on the unique case details enables the surgeon to treat a great majority of facial palsy patients. Part A, with the first of two videos, concentrates on free functional muscle transfer in the setting of longstanding facial paralysis. It includes preoperative markings, preparation of the patient in the operating room before incision, facial dissection including exposure of the masseter nerve, partial gracilis muscle harvest, and perhaps most importantly, the inset of the muscle on the paralyzed side. Part B (with the second video) concentrates on the cross-facial nerve graft and nerve transfers, used in the context of acute facial palsy, providing the short-term goal of mimetic musculature salvage in addition to longer term specific regional reinnervation by means of cross-facial nerve grafting. We hope that these videos provide a strong learning tool for enthusiastic novice medical students, residents, and fellows wishing to prepare for their cases, and faculty level physicians who wish to use them as a refresher before surgery.
Excess Dermal Tissue Remodeling In Vivo: Does It Settle?
Authors: Leavitt Tripp , Hu Michael S. , Zielins Elizabeth R. , Barnes Leandra A. , Marshall Clement D. , Wan Derrick C. , Lorenz H. Peter , Gurtner Geoffrey C. , Longaker Michael T. 
Published: February 2017

Background:
Surgical manipulation of skin may result in undesired puckering of excess tissue, which is generally assumed to settle over time. In this article, the authors address the novel question of how this excess tissue remodels.

Methods:
Purse-string sutures (6-0 nylon) were placed at the midline dorsum of 22 wild-type BALB/c mice in a circular pattern marked with tattoo ink. Sutures were cinched and tied under tension in the treatment group, creating an excess tissue deformity, whereas control group sutures were tied without tension. After 2 or 4 weeks, sutures were removed. The area of tattooed skin was measured up to 56 days after suture removal. Histologic analysis was performed on samples harvested 14 days after suture removal.

Results:
The majority of excess tissue deformities flattened within 2 days after suture removal. However, the sutured skin in the treatment group decreased in area by an average of 18 percent from baseline (n = 9), compared to a 1 percent increase in the control group (n = 10) at 14 days after suture removal (p < 0.05). This was similarly observed at 28 days (treatment, −11.7 percent; control, 4.5 percent; n = 5; p = 0.0243). Despite flattening, deformation with purse-string suture correlated with increased collagen content of skin, in addition to increased numbers of myofibroblasts. Change in area did not correlate with duration of suture placement.

Conclusions:
Excess dermal tissue deformities demonstrate the ability to remodel with gross flattening of the skin, increased collagen deposition, and incomplete reexpansion to baseline area. Further studies will reveal whether our findings in this mouse model translate to humans.
Revision Buttock Implantation: Indications, Procedures, and Recommendations
Authors: Senderoff Douglas M. 
Published: February 2017

Background:
Buttock implant studies have focused largely on safety, efficacy, and complication rates of primary surgery. The revision buttock implant surgical experience has to date not been published.

Methods:
A retrospective chart review was conducted to collect data from patients who underwent revision buttock implantation surgery performed by the author over a 12-year period from June of 2003 through December of 2015. Inclusion criteria consisted of any patient for whom an implant was either removed and replaced, exchanged, or repositioned after prior buttock implant surgery. The indications, types of procedures, and results of revision buttock implantation surgery based on the author’s experience are described.

Results:
Forty-three patients (32 women and 11 men) underwent revision buttock implantation surgery. Indications included replacement after removal (n = 18), asymmetry (n = 16), and size change (n = 9). Revision buttock implantation procedures included implant removal (n = 24), implant replacement (n = 19), implant exchange (n = 18), capsulotomy (n = 6), site change (n = 5), and capsulorrhaphy (n = 1). The overall complication rate was 17.8 percent. Complications were highest after unilateral implant replacement (n = 5).

Conclusions:
Revision buttock implantation is often necessary to correct or improve the results of primary buttock augmentation. Implants should be removed as soon as diagnosed in case of infection to reduce additional complications and permit successful reimplantation. Surgeons performing buttock implant surgery should be aware of the common indications, surgical procedures, and complications associated with revision buttock implantation surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.