Liposuction-Only Breast Reduction: A Systematic Review of Outcomes.

INTRODUCTION: Over the past few decades, there have been multiple reports of liposuction assisted breast reduction. This technique appeals to patients due to the limited scars and complication profile, compared to traditional reduction mammaplasty techniques. We aimed to systematically review the literature, to elucidate the outcomes and safety of liposuction-only breast reduction. METHODS: A systematic review was performed using the Ovid (Medline/PubMed) database, in accordance with the PRISMA checklist. RESULTS: In total 7 articles were included within this systematic review. A total of 652 patients were included. Liposuction-only breast reduction appears to lead to improvements in subjective outcome measures, patient satisfaction, and objective outcomes such as moderate breast volume reduction and reduction in breast ptosis. Overall, the procedure had a low complication profile. Liposuction did not preclude further surgery. No evidence of malignancy or difficulty in future breast cancer screening was noted. CONCLUSION: Macromastia leads to a considerable health burden, especially in health-related costs. From the current evidence base, liposuction-only breast reduction appears to be a safe and effective procedure, especially in patients requiring a mild-moderate breast volume reduction and mild ptosis correction. More research is required, with standardised subjective and objective outcome measures, and longer follow-up periods to confirm the effectiveness and safety of this technique. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Fresh Frozen Cartilage in Rhinoplasty Surgery: A Systematic Review of Outcomes.

INTRODUCTION: Cadaveric fresh frozen cartilage provides an enticing alternative to traditional autologous cartilage grafts. This review provides a systematic analysis of existing literature on the use of fresh frozen rib for in rhinoplasties and focuses on clinical and aesthetic outcomes. METHODS: The methodology was designed and registered in the PROSPERO database (CRD42023447166). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was used to perform this systematic review. RESULTS: Four articles were included, with a total of 554 patients. A total of 477 patients were female (86%). Mean age ranged between 35.8 and 40.6. Mean follow-up ranged from 12.2 to 20.3 months. Only one article had a suitable control (with autologous rib graft). Pooled complications rates were low. Infection occurred in 12 patients (2%), warping in 8 patients (1.4%) and resorption in 3 patients (0.5%). CONCLUSION: Fresh frozen cartilage may be a safe and reliable alternative to autologous rib grafts. Complication rates were comparable to previous systematic reviews of autologous graft and irradiated allograft. Overall, patients reported high satisfaction rates with low rates of revision procedures. Further studies are required to assess both clinical and cost effectiveness against the current gold standard (autologous graft). LEVEL OF EVIDENCE III: Rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessment of finger dexterity through the DIGITS joint tracking web application-An evaluation study with comparison to the nine-hole pegboard test.

BACKGROUND: Hand dexterity is an important clinical marker after hand surgery as it can greatly impact one's ability to perform their day-to-day activities. With the increased focus on remote patient monitoring after hand surgery, new technologies are required to remotely monitor hand dexterity. PURPOSE: The purpose of this study is to identify dexterity outcomes using the web application "DIGITS" and compare these outcomes to the nine-hole-pegboard test (NHPT). STUDY DESIGN: Cross-sectional observational study. METHODS: This was a two-part study with a pilot of our remote dexterity design using DIGITS followed by a validation study comparing DIGITS to a gold-standard metric of dexterity, NHPT. The pilot study recruited 42 healthy subjects between the ages of 18-65 to perform a remote finger tapping exercise using DIGITS. The second part of the study included 50 subjects between the ages of 18-65. Participants completed a demographic questionnaire and then completed three finger tapping sequences for 20 seconds using DIGITS and three trials of the NHPT with each hand. Correlational analyses were done to compare the DIGITS dexterity test with the NHPT. RESULTS: Four outcome measures to assess dexterity were identified, which included (1) total sequences completed in 20 seconds, (2) time to complete 10 sequences, (3) average frequency per sequence, and (3) sequence accuracy. Significant negative correlations were found with the NHPT and total sequences completed in 20 seconds in both dominant and non-dominant hand trials. Additionally, significant negative correlations were found between the NHPT and the time to complete 10 sequences and average frequency in the non-dominant hand trials. CONCLUSIONS: This study shows promising results for the use of DIGITS as a remote measure of hand dexterity. The total number of sequences completed significantly correlates with the NHPT and should be further explored in representative patient populations.

Complications associated with operative versus nonsurgical treatment of distal radius fractures in patients aged 65 years and older.

PURPOSE: To compare complication rates for distal radius fractures treated operatively versus nonsurgical in patients older than 65 years. We hypothesized that surgical intervention would improve fracture alignment, but it would be associated with more complications and equivalent functional outcomes when compared with the nonsurgical group. METHODS: Patients (operative, n = 129) and controls (nonsurgical, n = 129) were identified from a prospective clinical and operating room database. They were matched on fracture severity (AO-A/B/C1 vs AO-C2/C3), sex, age, and energy of injury. Data on complications were extracted from medical charts using a validated complications checklist, and radiologic data were collected for all patients. Functional outcomes (Patient-Related Wrist Evaluation) at 1 year were available in only a subset of patients. We determined differences in complication and reoperation rates using a chi-square test. RESULTS: A significant number of patients experienced complications in the operative group (operative = 37 of 129; nonsurgical = 22 of 129). The most common complication was median neuropathy (n = 8 operative; n = 14 nonsurgical), followed by surgical site infections (n = 16 operative; 12 of 16 were pin site infections) and complex regional pain syndrome (n = 4 operative; 3 nonsurgical). The complication rate in patients treated with volar plate was 22% (16 of 74), for dorsal plate it was 50% (2 of 4), for external fixation it was 42% (16 of 38), and for percutaneous pinning it was 23% (3 of 13). The number of patients requiring reoperations was similar in both groups (11 [9%] operative; 7 [5%] nonsurgical). Our secondary radiologic and functional outcomes demonstrate that despite a higher incidence of malunion in nonsurgical patients (nonsurgical: 69% vs operative: 29%), a subset of patients from both groups (n = 140) had minimal pain and disability at 1 year (Patient-Related Wrist Evaluation operative: 16.9 ± 23.2; nonsurgical: 15.7 ± 17.5). CONCLUSIONS: In a study matching fracture severity, sex, age, and energy of injury, we found that elderly patients with distal radius fractures who underwent surgery had higher complication rates than those treated nonsurgically. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

A Canadian National Survey Study of Harassment in Surgery-Still a Long Way to Go.

OBJECTIVES: Previous literature has consistently documented harassment and discrimination in surgery. These experiences may contribute to the continuing gender inequity in surgical fields. The objective of our study was to survey Canadian surgeons and surgical trainees to gain a greater understanding of the experience of harassment across genders, career stage, and specialty. METHODS: A cross-sectional, online survey was distributed to Canadian residents, fellows, and practicing surgeons in general surgery, plastic surgery, and neurosurgery through their national society email lists and via social media posts. RESULTS: There were 194 included survey respondents (60 residents, 11 fellows, and 123 staff) from general surgery (44.8%), plastic surgery (42.7%), and neurosurgery (12.5%). 59.8% of women reported having experienced harassment compared to only 26.0% of men. Women were significantly more likely to be harassed by colleagues and patients/families compared to men. Residents (62.5%) were two times more likely to report being harassed compared to fellows/staff (38.3%). Residents were significantly more likely to be harassed by patients/families while fellows/staff were more likely to be harassed by colleagues. There were no significant differences in self-reported harassment across the three surgical specialties. There was no significant difference in rates of reported harassment between current residents (62.5%), and fellow/staff recollections of their experiences of harassment during residency (59.2%). CONCLUSIONS: The prevalence of gender-based discrimination remains high and harassment prevalence remains largely unchanged from when current staff were in residency. Our findings highlight a need to implement systemic changes to support the increasing number of women entering surgery, and to improve surgical culture to continue to attract the best and brightest to the field.

Telerehabilitation Technology Used for Remote Wrist/Finger Range of Motion Evaluation: A Scoping Review.

Background: Monitoring finger/wrist range of motion (ROM) is an important component of routine hand therapy after surgery. Telerehabilitation is a field that may potentially address various barriers of in-person hand therapy appointments. Therefore, the purpose of this scoping review is to identify telerehabilitation technologies that can be feasibly used in a patient's home to objectively measure finger/wrist ROM. Methods: Following PRISMA-ScR guidelines for scoping reviews, we systematically searched MEDLINE and Embase electronic databases using alternative word spellings for the following core concepts: "wrist/hand," "rehabilitation," and "telemedicine." Studies were imported into Covidence, and systematic two-level screening was done by two independent reviewers. Patient demographics and telerehabilitation information were extracted from the selected articles, and a narrative synthesis of the findings was done. Results: There were 28 studies included in this review, of which the telerehabilitation strategies included smartphone angle measurement applications, smartphone photography, videoconference, and wearable or external sensors. Most studies measured wrist ROM with the most accurate technologies being wearable and external sensors. For finger ROM, the smartphone angle application and photography had higher accuracy than sensor systems. The telerehabilitation strategies that had the highest level of usability in a remote setting were smartphone photographs and estimation during virtual appointments. Conclusions: Telerehabilitation can be used as a reliable substitute to in-person goniometer measurements, particularly the smartphone photography and motion sensor ROM measurement technologies. Future research should investigate how to improve the accuracy of motion sensor applications that are available on easy-to-access devices.

Next-Generation Remote Hand Assessments: Cross-Platform DIGITS Web Application.

Purpose: We have previously developed DIGITS, a platform for remote evaluation of range of motion, dexterity, and swelling of fingers for reducing barriers to accessing clinical resources. The current study was aimed at evaluating DIGITS across different devices with varied operating systems and camera resolutions using a single person's hands. Methods: Our team has now developed a web application version of the DIGITS platform, which makes it accessible on any device that is equipped with a camera, including computers, tablets, and smartphones. In the present study, we aimed to validate this web application by comparing flexion and extension measurements on the same person's hands using three different devices with cameras of different resolutions. The absolute difference, SD, standard mean error, and intraclass correlation coefficient were calculated. Additionally, equivalency testing was performed using the confidence interval approach. Results: Our findings indicated that the differences in degree measured between the devices ranged from 2° to 3° when digit extension was assessed (all hand landmarks are visible in the camera's direct view) and from 3° to 8° when digit flexion was assessed (some of the hand landmarks are hidden from view). The intraclass correlation coefficient of individual trials ranged from 0.82 to 0.96 for extension and 0.77 to 0.87 for flexion across all devices. Additionally, within a 90% confidence interval, our data showed equivalency with measurements using three different devices. Conclusions: The absolute differences were within an acceptable 9° tolerance for measurements taken between devices for flexion and extension. Equivalency was observed for measurements of finger range of motion taken using DIGITS, regardless of devices, platforms, or camera resolutions. Clinical relevance: In summary, the DIGITS web application has good test-retest reliability to generate data on finger range of motion for hand telerehabilitation. DIGITS can reduce costs to patients, providers, and health care facilities for conducting postoperative follow-up assessments.

Do all hemochromatosis patients have the same origin? An analysis of mitochondrial DNA and Y-DNA.

BACKGROUND: Mitochondrial DNA (mtDNA) and Y-DNA analysis have been widely used to predict ancestral origin. Genetic anthropologists predict that human civilizations may have originated in central Africa one to two million years previously. Primary iron overload is not a common diagnosis among indigenous people of northern Africa, but hereditary hemochromatosis is present in approximately one in 200 people in northern Europe. MtDNA analysis has the potential to determine whether contemporary hemochromatosis patients have an ancient ancestral linkage. METHODS: DNA was obtained from buccal smears for mtDNA and Y-DNA analysis. Y-DNA analysis included examination of 20 short tandem repeat markers on the Y chromosome. Analysis of mtDNA involved sequencing of the HVR-1 genetic sequence (nucleotides 16001 to 16520) and was compared with the Cambridge Reference Sequence. MtDNA ancestral haplotypes were predicted from the analysis of the HVR-1 sequence. RESULTS: Twenty-six male C282Y homozygotes were studied. There were 28 polymorphisms present in the HVR-1 sequence of these participants. The most common polymorphism was present at position 16519 in 15 participants and at position 16311 in eight participants. There were 12 different ancestral haplotypes predicted by mtDNA analysis, with the K haplotype being present in five participants. Y-DNA analysis revealed eight different haplotypes, with R1b being found in 11 of the 26 participants. CONCLUSION: Analysis of mtDNA and Y-DNA in 26 hemochromatosis patients suggested that they did not all originate from the same ancestral tribe in Africa. These findings were consistent with the theory that the original hemochromatosis mutation occurred after migration of these ancestral people to central Europe, possibly 4000 years previously.

Muscle strength and fatigue in patients with generalized myasthenia gravis.

Myasthenia gravis (MG) is characterized by fatigue and fluctuating muscle weakness resulting from impaired neuromuscular transmission (NMT). The objective of this study was to quantify, by direct measurement of muscle force, the strength and fatigue of patients with MG. A maximal voluntary isometric contraction protocol of shoulder abductors was used in conjunction with conventional fatigue and disease-severity instruments. Results from patients with (D-MG) and without (ND-MG) decrement on repetitive nerve stimulation (RNS) of the spinal accessory and axillary nerves were compared with healthy controls. Patients with MG reported greater fatigue than controls. Muscle strength was lowest in the D-MG group, followed by the ND-MG group and controls. Normalized shoulder abduction fatigue and recovery values did not differ between the D-MG and ND-MG groups or controls. The RNS decrement appears to relate best to disease severity and muscle weakness but not to objective measures of fatigue in this population.

Regional Wait Times for Patients With Nonmelanoma Skin Cancer in Southwestern Ontario.

BACKGROUND: Nonmelanoma skin cancer (NMSC) affects many Canadians. Although morbidity and mortality are rare, the burden to patients and the health-care system is significant. This study aims to evaluate current plastic surgery wait times and care pathways for patients with NMSC in Southwestern Ontario. METHODS: A retrospective chart review of 225 patients treated in Ontario from 2015 to 2018 was conducted. Inclusion criteria included patients with an NMSC managed with surgical excision. Referral information was compared. Primary outcomes were wait times: from referral to consultation, referral to excision, and consultation to excision. Data were analyzed using Student t test with equal variance. RESULTS: One-hundred forty-three patients were included from the academic cohort and 82 from the community cohort. Referrals to academic and community surgeons included lesion location (90% and 97.6%, respectively), but less frequently included size (18% and 29.2%, respectively). Most referrals to academic surgeons included biopsy results (78.6%), as opposed to community referrals (25.6%). Patients in the academic cohort waited 15.3 ± 12.7 weeks from referral to consultation, and 15.7 ± 13 weeks from referral to excision. Patients from the community cohort waited significantly shorter periods of 4.9 ± 3.1 (P < .001) and 11.7 ± 9.9 weeks (P = .016), respectively. However, patients of the academic cohort waited 2.4 ± 7.1 weeks from consultation to excision, while patients in the community cohort waited 6.7 ± 9.6 weeks (P < .001). Rates of negative peripheral margins on pathology were similar between groups, at 89.5% of the academic cohort and 88.9% of the community cohort. Deep margins were positive 5.7% of the time at the academic sites and 6.2% of the time in the community. CONCLUSIONS: Patients referred to academic centres waited significantly longer periods of time in several parameters compared to those referred to a community surgeon. However, academic surgeons often had expedited consultation-to-excision time frame. This study provides important data for future quality improvement initiatives in NMSC care.

HISTORIQUE: De nombreux Canadiens ont un cancer cutané non mélanome (CCNM). Bien que la morbidité et la mortalité soient rares, le fardeau est important pour les patients et le système de santé. La présente étude a été conçue pour évaluer les temps d'attente et les trajectoires de soins en chirurgie plastique pour les patients du sud-ouest de l'Ontario ayant un CCNM. MÉTHODOLOGIE: Les chercheurs ont réalisé une analyse rétrospective des dossiers de 225 patients traités de 2015 à 2018 en Ontario. Un CCNM traité par excision chirurgicale faisait partie des critères d'inclusion. Les chercheurs ont comparé les données d'adressage vers la chirurgie. Les résultats cliniques primaires étaient les temps d'attente entre l'adressage et la consultation, entre l'adressage et l'excision ainsi qu'entre la consultation et l'excision. Les chercheurs ont analysé les données au moyen du test de Student de variance égale. RÉSULTATS: Au total, 143 patients ont fait partie de la cohorte universitaire et 82, de la cohorte communautaire. L'adressage vers des chirurgiens universitaires ou communautaires découlait du siège de la lésion (90 % et 97,6 %, respectivement) et, à une moindre fréquence, de sa dimension (18,6 % et 29,2 %, respectivement). La plupart des adressages vers des chirurgiens universitaires incluaient les résultats de biopsies (78,6 %), contrairement à celui vers des chirurgiens communautaires (25,6 %). Les patients de la cohorte universitaire ont attendu 15,3 ± 12,7 semaines entre l'adressage et la consultation, et 15,7 ± 13 semaines entre l'adressage et l'excision. Les patients de la cohorte communautaire ont attendu beaucoup moins longtemps, soit 4,9 ± 3,1 (P < 0,001) et 11,7 ± 9,9 semaines (P = 0,016), respectivement. Cependant, les patients de la cohorte universitaire ont attendu 2,4 ± 7,1 semaines entre la consultation et l'excision, et ceux de la cohorte communautaire, 6,7 ± 9,6 semaines (P < 0,001). À la pathologie, le taux de marges périphériques négatives était semblable entre les groupes, se situant à 89,5 % dans la cohorte universitaire et à 88,9 % dans la cohorte communautaire. Les marges profondes étaient positives dans 5,7 % des cas en milieu universitaire et dans 6,2 % des cas dans la communauté. CONCLUSIONS: Les patients adressés à des centres universitaires attendaient considérablement plus longtemps à l'égard de plusieurs paramètres par rapport à ceux adressés à un chirurgien communautaire. Cependant, les chirurgiens universitaires réduisaient souvent la période entre la consultation et l'excision. La présente étude fournit des données importantes en vue de prochaines initiatives d'amélioration de la qualité des soins du CCNM.

Variation of Grip Strength and Wrist Range of Motion with Forearm Rotation in Healthy Young Volunteers Aged 23 to 30.

Background Grip strength and wrist range of motion (ROM) are important metrics used to evaluate hand rehabilitation and outcomes of wrist interventions. Published normative data on these metrics do not recognize the contribution of forearm rotation. This study aims to identify and quantify variations in grip strength and wrist ROM with forearm rotation in healthy young individuals. Materials and Methods Wrist ROM and grip strength were measured in 30 healthy volunteers aged 23 to 30. Participant demographics, grip strength, and wrist ROM (wrist flexion and extension, ulnar and radial deviation) at three forearm positions (full supination, neutral, and full pronation) were measured using a digital dynamometer and standard goniometers. Data analysis was conducted using a one-way repeated measure ANOVA. Forearm position values were compared using post hoc analysis. Results Grip strength in males was greatest in neutral position (males: nondominant 51.4 kg, dominant 56.1 kg) followed by supination (males: nondominant 46.6 kg, dominant 51.7 kg) and weakest in pronation (males: nondominant 40.1 kg, dominant 42.9 kg). Grip strength in females was similar between supination (nondominant: 26.1 kg, dominant: 28.5 kg) and neutral (nondominant: 27.4 kg, dominant: 29.1 kg) positions, but both were greater than in pronation (nondominant: 22.3 kg, dominant: 24.1 kg). Wrist flexion in males was significantly reduced in supination compared with neutral and pronated positions (nondominant: supination 63.1°, neutral 72.6°, pronation 73.3°; dominant: supination 62.4°, neutral 70.2°, pronation 70.3°), whereas not significant wrist flexion in females was also weaker in supination (supination 74.4°, neutral 79.9°). Wrist extension in males was greater in pronation (supination 64.6°, pronation 69.5°) whereas females showed no significant difference in any of the forearm positions. Ulnar deviation in males did not differ with forearm position, but females demonstrated greater ulnar deviation in supination on the nondominant hand (supination 44.6°, pronation 33.2°). Whereas there was no difference in radial deviation with forearm position in females, it was markedly greater in pronation versus supination on both sides in males (nondominant: supination 16.3°, pronation 24.6°; dominant: supination 15.4°, pronation 23.9°). Conclusion This study characterizes variations in grip strength and wrist ROM in three forearm positions in healthy young individuals. All measurements differed with forearm rotation and were not influenced by hand dominance. These results suggest that wrist ROM and grip strength should be evaluated in different positions of forearm rotation, rather than a fixed position. This has functional implications particularly in patients involved with specialized activities such as sports, instrument-playing, or work-related activities.

Implementation of an Acute Care Surgery Service Facilitates Modern Clinical Practice Guidelines for Gallstone Pancreatitis.

BACKGROUND: Current practice guidelines for management of gallstone pancreatitis (GSP) recommend early cholecystectomy for patient stabilization and bile duct clearance, preferably at index admission. Historically, this has been difficult to achieve due to lack of emergency surgical resources. We investigated whether implementation of an acute care surgery (ACS) model would allow better adherence to current practice guidelines for GSP. STUDY DESIGN: A retrospective review was conducted of all patients admitted with the diagnosis of GSP to 2 tertiary care university teaching hospitals from January 2002 to October 2013. Diagnosis was confirmed on review of clinical, biochemical, and radiographic criteria. Patients were divided into pre-ACS (2002 to 2009) and post-ACS (2010 to 2013) eras. Only 1 of the 2 hospitals implemented an ACS service in the latter era. Data were collected on demographics, admissions, cholecystectomy timing, and emergency department visits. RESULTS: Before implementation of an ACS service, the rate of index cholecystectomy was 3% at both hospital sites. The rate of index cholecystectomy increased significantly with the addition of ACS, from 2.4% to 67% (p < 0.001). The presence of an ACS team was highly predictive of index cholecystectomy (odds ratio = 10.4; 95% CI 2.0 to 55.1). Patients who did not undergo cholecystectomy during the index admission had an overall readmission rate of 24.9% at both sites. In the ACS hospital, repeat emergency department visits decreased from 24.8% to 8.3% (p < 0.001) and readmission rate decreased from 16.8% to 7.3% (p = 0.04) in the pre-and post-ACS eras, respectively. CONCLUSIONS: Implementation of an ACS service resulted in a higher rate of index cholecystectomy and decreased emergency department visits and readmissions for biliary disease, and allowed for increased adherence to clinical practice guidelines for GSP.

Hyaluronan-phosphatidylethanolamine polymers form pericellular coats on keratinocytes and promote basal keratinocyte proliferation.

Aged keratinocytes have diminished proliferative capacity and hyaluronan (HA) cell coats, which are losses that contribute to atrophic skin characterized by reduced barrier and repair functions. We formulated HA-phospholipid (phosphatidylethanolamine, HA-PE) polymers that form pericellular coats around cultured dermal fibroblasts independently of CD44 or RHAMM display. We investigated the ability of these HA-PE polymers to penetrate into aged mouse skin and restore epidermal function in vivo. Topically applied Alexa(647)-HA-PE penetrated into the epidermis and dermis, where it associated with both keratinocytes and fibroblasts. In contrast, Alexa(647)-HA was largely retained in the outer cornified layer of the epidermis and quantification of fluorescence confirmed that significantly more Alexa(647)-HA-PE penetrated into and was retained within the epidermis than Alexa(647)-HA. Multiple topical applications of HA-PE to shaved mouse skin significantly stimulated basal keratinocyte proliferation and epidermal thickness compared to HA or vehicle cream alone. HA-PE had no detectable effect on keratinocyte differentiation and did not promote local or systemic inflammation. These effects of HA-PE polymers are similar to those reported for endogenous epidermal HA in youthful skin and show that topical application of HA-PE polymers can restore some of the impaired functions of aged epidermis.

Computed tomography-based preoperative vascular imaging in autologous breast reconstruction: A Canadian perspective.

There appears to be increased use of computed tomography angiography (CTA) in the preoperative planning of autologous perforator flap breast reconstruction. Despite the advantages of providing superior anatomical detail, concerns regarding cost and radiation exposure of this technique remain. In the current study, a paper-based survey was distributed to 44 plastic surgeons with a special interest in breast reconstruction at 19 different centres across Canada to collect their perspectives and practice characteristics with respect to the use of CTA as a preoperative imaging modality in breast reconstruction. The response rate of the survey was 75%. The majority of respondents commonly use perforator flap breast reconstruction and CTA in their breast reconstruction practice. Surgeons identified particular benefits of CTA in patients who had previously undergone abdominal surgery. However, more than one-half of the overall cohort was concerned about radiation exposure associated with CTA. A review of the literature suggests that it may be worthwhile to reduce the unnecessary risks of additional radiation exposure to the breast cancer population. A prospective study may help to better define the group of patients in whom CTA will provide optimal benefits in terms of reducing perioperative microvascular morbidity.

On semble utiliser davantage l'angiographie par tomodensitométrie (ATD) lors de la planification préopératoire d'une reconstruction mammaire au moyen d'un lambeau perforant autologue. Malgré les avantages associés à une meilleure précision anatomique, on s'inquiète du coût de cette technique et de l'exposition aux radiations qu'elle entraîne. Dans la présente étude, 44 chirurgiens plasticiens ayant un intérêt pour la reconstruction mammaire provenant de 19 centres du Canada ont reçu un sondage papier afin de colliger leurs points de vue et les caractéristiques de leur pratique à l'égard de l'utilisation de l'ATD comme modalité d'imagerie en prévision d'une reconstruction mammaire. Le sondage a obtenu un taux de réponse de 75 %. La majorité des répondants utilisent souvent la reconstruction mammaire par lambeau perforant et l'ATD dans le cadre de leur pratique de reconstruction mammaire. Les chirurgiens ont souligné les avantages particuliers de l'ATD chez les patients qui avaient déjà subi une opération abdominale. Cependant, plus de la moitié de l'ensemble de la cohorte s'inquiétait de l'exposition aux radiations associée à l'ATD. D'après l'analyse bibliographique, il pourrait être avantageux de réduire les risques inutiles liés à une exposition supplémentaire aux radiations de la population atteinte d'un cancer du sein. Une étude prospective pourrait contribuer à mieux définir le groupe de patients chez qui l'ATD réduit de manière optimale la morbidité microvasculaire périopératoire.

Social Support Contributes to Outcomes following Distal Radius Fractures.

Background. Distal radius fractures are the most common fracture of the upper extremity and cause variable disability. This study examined the role of social support in patient-reported pain and disability at one year following distal radius fracture. Methods. The Medical Outcomes Study Social Support Survey was administered to a prospective cohort of 291 subjects with distal radius fractures at their baseline visit. Pearson correlations and stepwise linear regression models (F-to-remove 0.10) were used to identify whether social support contributes to wrist fracture outcomes. The primary outcome of pain and disability at one year was measured using the Patient Rated Wrist Evaluation. Results. Most injuries were low energy (67.5%) and were treated nonoperatively (71.9%). Pearson correlation analysis revealed that higher reported social support correlated with improved Patient Rated Wrist Evaluation scores at 1 year, r(n = 181) = -0.22, P < 0.05. Of the subscales within the Social Support Survey, emotional/informational support explained a significant proportion of the variance in 1-year Patient Rated Wrist Evaluation scores, R (2) = 4.7%, F (1, 181) = 9.98, P < 0.05. Conclusion. Lower emotional/informational social support at the time of distal radius fracture contributes a small but significant percentage to patient-reported pain and disability outcomes.