Postoperative Prophylactic Antibiotic Use in Breast Reduction Mammoplasty: A Single Centre Retrospective Cohort Study.

Introduction: Breast reduction mammoplasty (BRM) is a common procedure performed by plastic surgeons treating patients with hypermastia. It is customary to give preoperative prophylactic intravenous antibiotics for BRM, followed by several days of postoperative prophylactic oral antibiotics, despite the lack of evidence of their effectiveness in preventing surgical site infections (SSIs). The purpose of this study is to determine if the addition of prophylactic postoperative antibiotics is more effective in preventing SSIs in comparison to a single dose of preoperative prophylactic antibiotics in BRM. Methods: A retrospective analysis of 124 elective BRM cases by a single senior plastic surgeon was completed. Two study groups were formed based on the location of surgery and each group was assigned a different antibiotic regimen. The first antibiotic regimen consisted of a single preoperative intravenous dose of antibiotics (group 1), while the second regimen consisted of a preoperative intravenous dose followed by a 5-day course of oral antibiotics (group 2). Results: Overall SSI rate was 5.6%. Infection rate in group 1 was 8.1% in comparison to 3.2% for group 2 (P value .44). Overall, the incidence of complications was 29.0%; 38.7% in group 1 and 19.4% in group 2 (P value .03). Complications consisted of 35 cases of delayed wound healing, 7 SSIs and 2 hematomas requiring evacuation. Conclusion: Study results demonstrated that the use of postoperative prophylactic antibiotics for BRM had no significant effect on the rate of SSIs.

Introduction: La mammoplastie de réduction mammaire (MRM) est une procédure couramment pratiquée par les chirurgiens plastiques traitant des patientes ayant une hypertrophie mammaire. Il est habituel d'administrer une prophylaxie intraveineuse préopératoire pour la MRM puis plusieurs jours d'antibiothérapie prophylactique postopératoire par voie orale en dépit de l'absence de données probantes de leur efficacité à prévenir les infections du site chirurgical. L'objectif de cette étude était de déterminer si l'ajout d'antibiotiques postopératoires à visée prophylactique est plus efficace pour la prévention des infections de la cicatrice opératoire que la seule administration préopératoire d'une dose unique d'antibiotiques à visée prophylactique dans la MRM. Méthodes: Une analyse rétrospective a été réalisée par un seul chirurgien plastique expérimenté de 124 cas de MRM planifiés. Deux groupes d'étude ont été constitués en fonction du lieu de la chirurgie parmi deux centres chirurgicaux et chaque groupe ayant reçu l'un des deux protocoles d'antibiothérapie suivants : le premier schéma thérapeutique était constitué d'une seule dose préopératoire administrée par voie intraveineuse (groupe 1) et le deuxième consistait en l'administration de la dose préopératoire par voie intraveineuse suivie de 5 jours d'antibiotiques par voie orale (groupe 2). Résultats: Le taux global d'infections de la cicatrice opératoire était de 5,6%. Le taux d'infections dans le groupe 1 a été de 8,1%, comparativement à 3,2% dans le groupe 2 (P = 0,44). L'incidence globale des complications a été de 29,0%; 38,7% dans le groupe 1 et 19,4% dans le groupe 2 (P = 0,03). Les complications ont été 35 cas de retard de cicatrisation, 7 cas d'infection du site chirurgical et 2 hématomes nécessitant leur évacuation. Conclusion: Les résultats de l'étude ont montré que l'utilisation postopératoire d'antibiotiques à visée prophylactique pour la mammoplastie de réduction mammaire n'avait pas d'effet significatif sur le taux d'infections du site chirurgical.

Morphologic Analysis of the Carpal Tunnel and Median Nerve Following Open and Endoscopic Carpal Tunnel Release.

Background: Endoscopic carpal tunnel release (ECTR) has purported advantages over open release such as reduced intraoperative dissection and trauma and more rapid recovery. Endoscopic carpal tunnel release has been shown to have comparable outcomes to open release, but open release is considered easier and safer to perform. Previous studies have demonstrated an increase in carpal tunnel volume, regardless of the technique used. However, the mechanism by which this volumetric increase occurs has been debated. Our study will determine through magnetic resonance imaging (MRI) analysis the morphologic changes that occur in both open carpal tunnel release (OCTR) and ECTR, thereby clarifying any morphologic differences that occur as a result of the 2 operative techniques. We hypothesize that there will be no morphologic differences between the 2 techniques. Methods: This was a prospective study to compare the postoperative anatomy of both techniques with MRI. Nineteen patients with clinical and nerve conduction study-confirmed carpal tunnel syndrome underwent either open or endoscopic release. Magnetic resonance imaging was performed preoperatively and 6 months postoperatively in all patients to examine the volume of the carpal tunnel, transverse distance, anteroposterior (AP) distance, divergence of tendons, and Guyon's canal transverse and AP distance. Results: There was no significant difference in the postoperative morphology of the carpal tunnel and median nerve between OCTR and ECTR at 6-month follow-up on MRI. Conclusion: We conclude that there are no morphologic differences in OCTR and ECTR. It is an increase in the AP dimension that appears to be responsible for the increase in the volume of the carpal tunnel.

Cosmetic surgery training in Canadian plastic surgery residencies: are we training competent surgeons?

BACKGROUND: With the demand for cosmetic surgery continuing to rise, it is necessary to reevaluate the current state of cosmetic surgery training during plastic surgery residency. An evaluation of cosmetic surgery training in US plastic surgery residency programs in 2006 identified several areas for improvement, resulting in changes to both the duration and content of training. OBJECTIVES: The authors assess the current state of cosmetic surgery training in Canadian plastic surgery residency programs. METHODS: A paper survey of all graduating Canadian plastic surgery residents eligible to complete the 2009 Royal College of Physicians and Surgeons of Canada fellowship examinations was performed (N = 29). The survey was conducted primarily at the Canadian Plastic Surgery Review Course in February 2009, with surveys collected from absent residents by e-mail within 1 month after the course. The survey covered 2 broad areas: (1) specifics regarding resident cosmetic surgery training and (2) confidence and satisfaction associated with this experience. RESULTS: Of the 29 residents surveyed, 28 responded (96%). The majority of Canadian plastic surgery residency programs (75%) have a designated cosmetic surgery rotation, but 90% of respondents felt it has become increasingly difficult to gain exposure to cosmetic procedures as most are performed at private surgery centers. Elective rotations at cosmetic surgery practices and resident cosmetic clinics were considered the most beneficial for cosmetic surgery education. Residents considered cosmetic surgery procedures of the face (such as rhinoplasty and facelift) more challenging, but they had more confidence with breast and body contouring procedures. CONCLUSIONS: Canadian plastic surgery residency programs need to ensure that residents continue to receive comprehensive exposure to both surgical and nonsurgical cosmetic procedures to ensure our specialty's continued leadership in this evolving and highly competitive field. A multidimensional approach utilizing a variety of readily available resources will ensure that the current and future cosmetic surgery educational needs of Canadian plastic surgery residents are met.

Time-resolved small-angle X-ray scattering studies of polymer-silica nanocomposite particles: initial formation and subsequent silica redistribution.

Small angle X-ray scattering (SAXS) is a powerful characterization technique for the analysis of polymer-silica nanocomposite particles due to their relatively narrow particle size distributions and high electron density contrast between the polymer core and the silica shell. Time-resolved SAXS is used to follow the kinetics of both nanocomposite particle formation (via silica nanoparticle adsorption onto sterically stabilized poly(2-vinylpyridine) (P2VP) latex in dilute aqueous solution) and also the spontaneous redistribution of silica that occurs when such P2VP-silica nanocomposite particles are challenged by the addition of sterically stabilized P2VP latex. Silica adsorption is complete within a few seconds at 20 °C and the rate of adsorption strongly dependent on the extent of silica surface coverage. Similar very short time scales for silica redistribution are consistent with facile silica exchange occurring as a result of rapid interparticle collisions due to Brownian motion; this interpretation is consistent with a zeroth-order Smoluchowski-type calculation.

When does silica exchange occur between vinyl polymer-silica nanocomposite particles and sterically stabilized latexes?

The redistribution of silica nanoparticles between "core-shell" polymer-silica nanocomposites and sterically stabilized latexes is investigated using a combination of electron microscopy, disk centrifuge photosedimentometry (DCP), and X-ray photoelectron spectroscopy (XPS). Facile exchange of silica nanoparticles occurs on addition of sterically-stabilized polystyrene (or poly(2-vinylpyridine)) latex to polystyrene-silica (or poly(2-vinylpyridine)-silica) nanocomposite particles previously prepared by heteroflocculation. In contrast, no silica exchange occurs after such a latex "challenge" if similar polymer/silica nanocomposite particles are prepared via in situ polymerization. Silica redistribution can be confirmed by post mortem electron microscopy studies, which are facilitated if the original nanocomposite and latex particles differ sufficiently in their mean diameters. Ideally, XPS requires a unique elemental marker for the nanocomposite particle cores, which become progressively more exposed if silica exchange occurs. DCP is a particularly convenient in situ technique for assessing whether or not silica exchange has occurred. If no silica exchange occurs, there is little or no change in the nanocomposite and latex size distributions. On the other hand, silica redistribution always results in a larger mean particle diameter for the (partially) silica-coated latex particles relative to the original bare latex. In addition, incipient flocculation is typically observed after silica exchange. Like electron microscopy, DCP studies are aided if there is a significant difference in particle diameter between the original polymer-silica nanocomposite particles and the added latex. Moreover, silica redistribution can be prevented for heteroflocculated polymer-silica nanocomposite particles under certain conditions. For example, although silica exchange is observed at pH 10 when adding sterically-stabilized polystyrene (or poly(2-vinylpyridine)) latex to heteroflocculated poly(2-vinylpyridine)-silica particles, it does not occur at pH 5. Presumably, this is due to greater electrostatic attraction between the cationic P2VP cores and the anionic silica nanoparticles at this lower pH.

Unexpected facile redistribution of adsorbed silica nanoparticles between latexes.

Addition of excess sterically stabilized P2VP latex to a colloidal dispersion of P2VP-silica nanocomposite particles (with silica shells at full monolayer coverage) leads to the facile redistribution of the silica nanoparticles such that partial coverage of all the P2VP latex particles is achieved. This silica exchange, which is complete within 1 h at 20 degrees C as judged by small-angle x-ray scattering, is observed for nanocomposite particles prepared by heteroflocculation, but not for nanocomposite particles prepared by in situ copolymerization. These observations are expected to have important implications for the optimization of nanocomposite formulations in the coatings industry.

Packing efficiency of small silica particles on large latex particles: a facile route to colloidal nanocomposites.

The adsorption of small silica particles onto large sterically stabilized poly(2-vinylpyridine) [P2VP] latex particles in aqueous solution is assessed as a potential route to nanocomposite particles with a "core-shell" morphology. Geometric considerations allow the packing efficiency, P, to be related to the number of adsorbed silica particles per latex particle, N. Making no assumptions about the packing structure, this approach leads to a theoretical estimate for P of 86 +/- 4%. Experimentally, dynamic light scattering is used to obtain a plot of hydrodynamic diameter against N, which indicates the conditions required for monolayer coverage of the latex by the silica particles. Transmission electron microscopy confirmed that, at approximately monolayer coverage, calcination of these nanocomposite particles led to the formation of well-defined hollow silica shells. This is interpreted as strong evidence for a contiguous monolayer of silica particles surrounding the latex cores. On this basis, an experimental value for P of 69 +/- 4% was estimated for nanocomposite particles prepared by the heteroflocculation of a 20 nm silica sol with near-monodisperse P2VP latexes of either 463 or 616 nm diameter at approximately pH 10. X-ray photoelectron spectroscopy was used to quantify the extent of latex surface coverage by the silica particles. This technique gave good agreement with the silica packing efficiencies estimated from calcination studies.

Axillary hyperhidrosis: a 5-year review of treatment efficacy and recurrence rates using a new arthroscopic shaver technique.

BACKGROUND: Axillary hyperhidrosis is a chronic condition characterized by excess axillary perspiration. This results in considerable patient morbidity, with no consistently efficacious medical or surgical treatment method described in the literature. METHODS: All cases of axillary hyperhidrosis over a 5-year period were reviewed retrospectively. Data were gathered by a chart review and telephone interview. Inclusion criteria included primary hyperhidrosis, failed conservative therapy, no prior surgical therapy, surgical management using a new arthroscopic shaver technique (R.L.B.-S.), and 6 months of postoperative follow-up. The technique used was consistent between surgeons. Sweating severity was assessed using a subjective numerical rating scale ranging from 1 to 10. Patient demographics, symptom history, results, and complications were analyzed. RESULTS: Average follow-up for 50 patients meeting the inclusion criteria was 28 months. The subjective severity scale demonstrated severity of 9.8 of 10 preoperatively and 2.3 of 10 postoperatively. Three patients (6 percent) reported mild recurrence of symptoms (4.6 of 10), which was not severe enough to seek further treatment. The average follow-up of those patients was 18.5 months. An overall subjective satisfaction of 96 percent was found, with a treatment success rate of 94 percent. Complications were minimal and self-limiting. The average time away from employment was 3.9 days and the average surgical operating room time was 46 minutes. CONCLUSIONS: The authors' new arthroscopic shaver technique is efficacious, with no significant morbidity, a 96 percent satisfaction rate, a subjectively measured 75 percent reduction of sweat, and a recurrence rate of only 6 percent. For cases of primary hyperhidrosis affecting the axilla not amenable to conservative treatment, the authors recommend an arthroscopic shaver technique as the first-line treatment of choice.

Cutaneous myiasis due to Dermatobium hominis in Winnipeg.

Cutaneous myiasis is an uncommon infestation in North America, with most cases arising in travelers who have recently returned from Central and South America. The majority of cases are due to Dermatobium hominis and present with a furunculoid nodule with local inflammation. The case reported is of a 57-year-old woman with cutaneous myiasis contracted in Winnipeg, Manitoba.

La myiase cutanée est une affection rare en Amérique du Nord et elle se rencontre surtout chez les voyageurs revenus depuis peu de l'Amérique centrale et de l'Amérique du Sud. La plupart des cas sont dus à Dermatobium hominis et ils se manifestent par un nodule furonculoïde et de l'inflammation locale. Voici le cas d'une femme de 57 ans, atteinte de myiase cutanée contractée à Winnipeg.