Avinash Islur

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 specialtys 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.

Analgesic Consumption Following Outpatient Carpal Tunnel Release

PURPOSE Few studies have examined the consumption of prescribed opioid medications after elective outpatient surgery. A better understanding of opioid consumption after elective upper-extremity surgery may lead to improved prescribing practices, decreased costs, and less leftover medication available for potential misuse. The goal of this study was to evaluate pain control and quantify the amount of leftover pain medication after outpatient carpal tunnel release. METHODS We performed a prospective study of patients scheduled for outpatient carpal tunnel surgery. All patients had failed nonsurgical treatment and had an electromyelogram/nerve conduction study confirming the clinical diagnosis. All patients were encouraged to remove the dressing on the first postoperative day. A total of 56 patients were initially enrolled in the study; 7 did not meet the inclusion criteria, which left 49 patients who completed the study. Average age was 57 years; 66% of patients were female. Information collected included analgesic prescribed, number of tablets consumed, and number of tablets remaining. Use of postoperative orthoses, complications, use of other analgesic medications, and reasons for not taking the prescribed analgesics were recorded. RESULTS Paracetamol with codeine and paracetamol with tramadol accounted for all prescriptions. Patients most frequently were given a prescription for 40 tablets. Average number of tablets consumed was 10 (range, 0-40 tablets). More than half of patients consumed fewer than 2 tablets. The average number of postoperative days of analgesic consumption was 2 (range, 0-7 days). Overall 1,531 tablets were leftover from the entire cohort. CONCLUSIONS This study demonstrates that excess prescription analgesics are being prescribed after carpal tunnel surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Canadian Plastic Surgery Resident Work Hour Restrictions: Practices and Perceptions of Residents and Program Directors

Background: The impact of resident work hour restrictions on training and patient care remains a highly controversial topic, and to date, there lacks a formal assessment as it pertains to Canadian plastic surgery residents. Objective: To characterize the work hour profile of Canadian plastic surgery residents and assess the perspectives of residents and program directors regarding work hour restrictions related to surgical competency, resident wellness, and patient safety. Methods: An anonymous online survey developed by the authors was sent to all Canadian plastic surgery residents and program directors. Basic summary statistics were calculated. Results: Eighty (53%) residents and 10 (77%) program directors responded. Residents reported working an average of 73 hours in hospital per week with 8 call shifts per month and sleep 4.7 hours/night while on call. Most residents (88%) reported averaging 0 post-call days off per month and 61% will work post-call without any sleep. The majority want the option of working post-call (63%) and oppose an 80-hour weekly maximum (77%). Surgical and medical errors attributed to post-call fatigue were self-reported by 26% and 49% of residents, respectively. Residents and program directors expressed concern about the ability to master surgical skills without working post-call. Conclusions: The majority of respondents oppose duty hour restrictions. The reason is likely multifactorial, including the desire of residents to meet perceived expectations and to master their surgical skills while supervised. If duty hour restrictions are aggressively implemented, many respondents feel that an increased duration of training may be necessary.

USE of arterialized saphenous vein venous flow-through flaps as a temporizing measure for hand salvage in contaminated wounds presenting with limb ischemia: A case series

Vascular injuries resulting in limb ischemia are traditionally treated acutely with autologous or prosthetic bypass grafts. Traumatic contaminated injuries with soft tissue and vascular segmental loss are challenging as prosthetic bypasses are at risk of erosion, infection, and occlusion; and autologous bypasses are at risk of desiccation, blow‐out, infection, and clotting. We propose a novel approach to these injuries by using arterialized saphenous vein venous flow‐through free flaps (S‐VFTF) as an autologous bypass, and present the results of its application in a series of cases.

Anastomosis to the common and proper digital vessels in free flap soft tissue reconstruction of the hand.

This study seeks to demonstrate the safety of anastomosing free flaps to the common or proper digital artery, and to the volar or dorsal digital vein in soft tissue reconstruction of the hand; as well, as to discuss the advantages of this technique.

The Complications of Polyacrylamide Hydrogel Augmentation Mammoplasty: A Case Report and Review of the Literature

The use of polyacrylamide hydrogel (PAAG) as an injectable filler for breast augmentation has fallen out of popularity since its first use in the 1980s but has produced an increasing patient population presenting with complications related to PAAG injections. Polyacrylamide hydrogel use was popularized most notably in China, Russia, and Iran. However, given immigration trends and medical tourism, PAAG-related complications have become increasingly more common in North America. These complications can be difficult to treat, often necessitating complex surgery that includes gel removal, debridement procedures, and often breast reconstruction. Approaches to surgical treatment and subsequent breast reconstruction are not universally defined primarily because of the limited knowledge about this group of patients. This article presents the option of autologous free flap reconstruction for a patient with extensive muscular involvement and aims to summarize complications and risks associated with PAAG through case report and a review of the literature.

The proximal superficial femoral artery perforator flap: Anatomic study and clinical cases

The upper thigh has provided multiple new soft tissue free flaps in recent decades, including the anterolateral thigh, anteromedial thigh, transverse upper gracilis, the profunda artery perforator, and superficial circumflex iliac perforator flaps. The purpose of this study is to describe a new, reliable free flap option in the upper thigh: the proximal superficial femoral artery perforator (p‐SFAP) flap.

Necrotizing fasciitis after scalpel injury sustained during postmortem examination

A 44-year-old pathologist presented to the emergency department after sustaining a scalpel injury during a postmortem examination 16 hours previously. He had stabbed the dorsum of his left thumb overlying the interphalangeal joint and immediately irrigated the wound with water. At the time of

Treatment of Chronic Stern Type III Proximal Interphalangeal (PIP) Joint Contractures with Arterialized Venous Flaps: A Novel Approach

CONCLUSION: We demonstrate that knotless flexor tendon repair with barbed suture has equivalent strength with reduced repair site cross-sectional area compared to traditional techniques. A knotless flexor tendon repair offers many potential advantages over traditional repairs. Smaller tendon profile may decrease gliding resistance, thus reducing the risk for postsurgical tendon rupture during rehabilitation.