Plastic Surgery / Chirurgie Plastique

Various antibiotics are available to treat soft-tissue infections. However, it is unclear if the empirical antibiotic is always appropriate or the most economical.

To determine the percentage of empirically treated wounds susceptible to the antibiotic therapy prescribed, and to determine the percentage of wounds treated with the most economical antibiotic therapy.

A retrospective chart review was performed on all charts with a diagnosis of ‘soft-tissue infection’ between January 1, 2005, and June 30, 2005, at St Joseph's Hospital, Hamilton, Ontario. Eligible charts were identified using the medical diagnosis coding system. The following diagnoses (including subheadings) were included: cellulitis, lymphangitis, abscess, carbuncle or furuncle. The following was extracted: patient demographics; soft-tissue diagnosis; name, dose and duration of antibiotics used; culture results; and Gram-stain results. A comparison between the empirical antibiotic prescribed and the microbiology result was made. An assessment was performed on the cost of the initial empirical antibiotic treatment compared with less-expensive effective alternatives.

For soft-tissue infections with positive culture growth, empirical antibiotic treatment was appropriate in all abscess cases, 50% of ulcer cases and 83% of cellulitis cases. for cellulitis patients receiving a single empirical antibiotic, it was appropriate in 89% of cases. Only 42% of culture-positive patients were treated with the most economical regimen, multiple antibiotics being the most common fault.

To be most economical, a single empirical antibiotic should be used to treat cellulitis. Culture results should be used to guide any antibiotic changes.

Current pediatric burn care has resulted in survival being the expectation for most children. Composite tissue allotransplantation in the form of face or hand transplantation may present opportunities for reconstructive surgery of patients with burns. The present paper addresses the question “Could facial transplantation be of therapeutic benefit in the treatment of pediatric burns associated with facial disfigurement?”

Therapeutic benefit of facial transplantation was defined in terms of psychiatric adjustment and quality of life (QOL). To ascertain therapeutic benefit, studies of pediatric burn injury and associated psychiatric adjustment and QOL in children, adolescents and adults with pediatric burns, were reviewed.

Pediatric burn injury is associated with anxiety disorders, including post-traumatic stress disorder and depressive disorders. Many patients with pediatric burns do not routinely access psychiatric care for these disorders, including those for psychiatric assessment of suicidal risk. A range of QOL outcomes were reported; four were predominantly satisfactory and one was predominantly unsatisfactory.

Facial transplantation may reduce the risk of depressive and anxiety disorders other than post-traumatic stress disorder. Facial transplantation promises to be the new reconstructive psychosurgery, because it may be a surgical intervention with the potential to reduce the psychiatric suffering associated with pediatric burns. Furthermore, patients with pediatric burns may experience the stigma of disfigurement and psychiatric conditions. The potential for improved appearance with facial transplantation may reduce this ‘dual stigmata’. Studies combining surgical and psychiatric research are warranted.

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.

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.

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%.

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.

Carpal tunnel syndrome is one of the most common and disabling work injuries in North America. Patients with carpal tunnel syndrome are often associated with substantial productivity loss and cost both at work and at home. Several studies have examined the relationship of social supports as a predictor of returning to work following carpal tunnel release surgery (CTRS). However, no studies published to date have examined the relationship between social support and the ability to perform activities of daily living after having CTRS.

To examine whether a correlation exists between the degree of social support and hand function in terms of the ability to perform activities of daily living in patients who have had CTRS.

Patients in the present cross-sectional study were evaluated with two standardized questionnaires at least two months postoperatively following CTRS. The questionnaires consisted of the Multidimensional Scale of Perceived Social Support, which evaluated social support, and QuickDASH, which evaluated hand function. A correlation analysis was then performed to identify any relationships between the two questionnaires.

In a sample of 20 patients, correlation analyses revealed that perceived social support was significantly associated with hand function scores postoperatively (r=−0.73, P<0.01). In addition, a statistically significant relationship existed between social support and the preoperative self-rating pain scores (r=−0.51, P<0.05). These results indicate that there is a strong association between the degree of social support and the ability to perform hand activities of daily living following CTRS.

The overprojected nasal tip presents a significant challenge to the surgeon performing rhinoplasty. Full transfixion incision as a means of dealing with this deformity has been studied only in combination with other surgical methods.

To determine whether transfixion incision alone would result in significant nasal tip deprojection, and if skin thickness had an effect on the extent of deprojection the procedure yielded.

Seventy-two consecutive patients with an aesthetic goal of nasal tip deprojection were enrolled. The sole surgical means of deprojection used was transfixion incision. Subjects were categorized as thin-, medium- or thick-skinned based on the surgeon's analysis. These groups were compared in terms of their postprocedural nasal tip deprojection.

Using transfixion incision as the sole means of correcting this deformity resulted in a mean nasal tip deprojection of 1.6 mm (ranging from 0 mm to 3 mm). Patients in the thin skin group had a mean deprojection of 2.12 mm. This was significantly greater than for both the medium- and thick-skinned groups. There was no significant difference between the medium- and thick-skinned groups.

Surgeons may use skin thickness when planning interventions for correcting nasal tip overprojection. When used alone, transfixion incision resulted in tip deprojection comparable with that achieved when combined with other methods, particularly for thin-skinned patients. Surgeons can thus use a graduated approach in which transfixion incision, the least destructive method, is used before proceeding with other interventions.