Plastic Surgery

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Introduction: Rapid climate change poses a major challenge to healthcare. The operating room is especially responsible for carbon emission, with 20% to 70% of hospital waste traced back to the operating room. This literature review aims to suggest changes that can be made in hand surgery for a more sustainable practice. Methods: A literature search was conducted from PubMed, Medline, and other online search engines with the keywords "carbon footprint, environmental health, carbon neutral, plastic surgery, hand surgery, surgery...

Introduction: Pediatric hand fractures are common and routinely referred to surgeons, yet most heal well without surgical intervention. This trend inspired the development of the Calgary Kids' Hand Rule (CKHR), a clinical prediction rule designed to predict "complex" fractures that require surgical referral. The CKHR was adapted into a checklist whereby the presence of any 1 of 6 clinically or radiologically identifiable fracture characteristics predicts a complex fracture. The aim of this study was to assess the accuracy of the CKHR in a prospective sample of children with hand fractures...

Degloving injuries of the thumb pose a significant challenge as replantation is usually unsuccessful. A 60-year-old man was transferred to " Queen Victoria Hospital NHS Trust " four hours after having his left thumb completely avulsed at metacarpophalangeal level. The anastomosis repeatedly failed during urgent replantation and a distally based pedicled RFF was utilized. To achieve accurate flap design, we used the amputated part as a template for the missing tissue. After a longitudinal cut exposing the inner surface, the thumb was placed flat on top of a clean gauze package which was used as a paper template for the skin paddle; the flap was subsequently sutured without tension...

Introduction: Flexor tendon laceration is often followed by retraction of the proximal stump. The goals of this review were to describe the myriad of proximal stump retrieval surgical techniques and where available to provide the clinical evidence associated with each. Methods: A Medline and Web of Science search was performed to identify any publication whose primary purpose was to describe a tendon retrieval technique. The techniques were assigned to 8 groups. Clinical outcomes, where reported, and advantages and disadvantages of the technique as reported by the authors of the articles were analyzed...

Introduction: Reduction mammoplasty (RM) is one of the most common operations performed in plastic surgery. While US national surgical expenditures have risen in recent years, studies have reported decreasing reimbursement rates for plastic surgeons. The purpose of this study is to characterize the trends in charges and payments for a common plastic surgery operation, ambulatory RM, for facilities and physicians. Methods: A Medicare patient records database was used to capture hospital, surgeon, and anesthesiologist charges and payments for ambulatory RM from 2005 to 2014...

Background: Despite its association with obesity, the relation between diabetes and the abdominal panniculectomy is less well-established. The purpose of this study was to evaluate the result of diabetes on post-panniculectomy complications in a large cohort and to establish the risk factors associated with unfavorable post-operative outcomes. Methods: Patients that underwent a panniculectomy between 2010 and 2018 were identified in PearlDiver, a national insurance claims database, and identified by Current Procedural Terminology code 15380...

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Background: This study aimed to explore a low-cost solution for virtual surgical planning/3D printed surgical guides in a training hospital, assessing the impact on intraoperative time and bleeding. Material and Methods : We included a total of 13 patients. 8 who underwent maxillofacial reconstruction surgery with fibula-free flap utilizing virtual surgical planning/3D printed guides (VP/SG), and 5 using conventional surgery (CS) from 2017 to 2020. The surgical time, bleeding, length of hospital stay, and comorbidities were collected and compared in two groups...

Introduction: Oral incompetence (OI) following facial nerve injury or sacrifice remains a frustrating problem for patients and clinicians alike. Dynamic procedures for facial paralysis often do not fully address OI and static surgeries are frequently needed. Current static options frequently involved multiple facial incisions. Methods: We describe a novel technique to address OI due to lower division facial nerve paralysis and report outcomes in an initial series of patients. Results: OI symptoms improved in 94% of patients following a single-stage surgery...

Background: Gender-affirming surgery is becoming more common among reconstructive surgeons. Bibliometric analyses are statistical evaluations of published scientific correspondence and are a validated method of measuring influence in the scientific community. As no such bibliometric analysis has been done as of yet, the purpose of this study is to identify the characteristics of the 50 most-cited peer-reviewed articles on gender-affirming surgery. Methods: The Scopus abstract and citation database was utilized in April 2020 to search for English-language publications related to gender-affirming surgery...

Bilateral defects around the knee joint following fracture of the proximal tibia (Schatzker type V & VI) are difficult to reconstruct because of the unavailability of local tissue. A bicondylar proximal tibial fracture requires a bilateral approach and dual plates for fracture fixation. Because of extensive dissection during plating and extended zone of trauma, the suture lines occasionally dehisce resulting in soft tissue defects on both sides of the proximal tibia. Because of its bilateral nature, the defect requires 2 flaps...

When intraorbital wooden foreign bodies are missed, the consequences can be devastating. While the gold standard diagnostic imaging is computed tomography (CT), it has low sensitivity. We present a 61-year-old man with a bamboo injury to his right eye. He underwent two CT scans that failed to raise the possibility of intraorbital foreign bodies. Upon additional review, a rectangular-shaped pocket of air was identified in the orbit which was most consistent with wooden foreign bodies based on the clinical history...

Purpose: Pediatric hand fractures are frequent presentations to the emergency department. This study set out to evaluate the epidemiology, management, and outcomes, where care was imparted and by whom, and offer resource utilization suggestions regarding pediatric fractures presenting to a Canadian pediatric hospital. Methods: Records of patients from 0 to 18 years of age who presented to the British Columbia Children's Hospital Emergency Department between November 1, 2016, and January 31, 2021, with metacarpal or phalangeal fractures were analyzed...

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Background: We sought to examine the efficacy of the Keystone Design Perforator Island Flap (KDPIF) for the reconstruction of skin cancer excision defects isolated to the upper extremity. In particular, to examine the size of defects repaired and the complications associated with the keystone flap procedure isolated to the upper extremity. Methods: This is a retrospective chart review including all patients older than 18 years of age who received a KDPIF procedure between February 2013 and February 2019 for the oncologic reconstruction of skin cancer defects isolated to the upper extremities by a single surgeon...

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Introduction: Aesthetic liposuction represents one of the most commonly performed cosmetic procedures worldwide. The purpose of this article is to examine and synthesize reported complication rates and explore the analytical prospect of possible patient or procedure-related predictive factors associated with specific complications. Methods: A systematic review was performed using the Pubmed, Cochrane, and Embase databases in line with specific criteria set to ensure an accurate assessment of complication rates; extracted data was synthesized through a random-effects model and meta-analysis of proportions...

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The anatomic subunit approximation approach to unilateral cleft lip repair was developed over 20 years ago. While the underlying principles of the repair are unchanged, its description has been simplified, additional landmarks and creases have been added, and objective analysis of perioperative changes have provided better clarity regarding goals and desired alterations. We review recent insights regarding the deformity; describe the repair in a simplified manner; and link a stepwise approach to foundation-based primary rhinoplasty as a part of the avenue to creating nasolabial balance and harmony...