Logan Carr

Opioid Sparing in Cleft Palate Surgery

Objective: This study aimed to determine whether intraoperative acetaminophen was able to decrease opioid consumption, pain scores, and length of stay while increasing oral intake in cleft palate surgery. Design/Setting/Patients: One hundred consecutive patients with cleft palate who underwent a von Langenbeck or 2-flap palatoplasty and intravelar veloplasty at a tertiary medical center by the 2 senior authors from 2010 to 2015 were reviewed. Interventions: Three intraoperative treatment groups were analyzed: intravenous (IV) acetaminophen, per rectal (PR) acetaminophen, and no acetaminophen. All patients received long-acting local anesthesia infiltration before incision. Additionally, all patients were admitted overnight and given weight-based per oral (PO) acetaminophen and oxycodone and IV morphine as needed based on pain scores. Outcomes Measured: The study outcomes included pain scores, opioid requirement, length of stay, and oral intake. Results: The treatment groups were comprised of 40 patients who received IV acetaminophen, 22 PR acetaminophen, and 35 none. Concerning demographic data, there was no statistical difference between treatment groups. There was no statistically significant difference for opioid intake, although both IV and PR acetaminophen groups had decreased pain scores (P = .029). There was no difference in oral intake (P = .13) or length of stay (P = .31) between treatment groups. Conclusion: In this study, intraoperative administration of acetaminophen was associated with decreased pain scores, but no opioid-sparing effect. As other studies have shown an opioid-sparing effect with postoperative acetaminophen, we recommend withholding the intraoperative dose and beginning therapy in the immediate postoperative period.

Direct Cost Comparison of Open Carpal Tunnel Release in Different Venues

Background: The increased efficiency and cost savings have led many surgeons to move their practice away from the traditional operating room (OR) or outpatient surgery center (OSC) and into the clinic setting. With the cost of health care continuing to rise, the venue with the lowest cost should be utilized. We performed a direct cost analysis of a single surgeon performing an open carpal tunnel release in the OR, OSC, and clinic. Methods: Four treatment groups were prospectively studied: the hospital OR with monitored anesthesia care (OR-MAC), OSC with MAC (OSC-MAC), OSC with local anesthesia (OSC-local), and clinic with local anesthesia (clinic). To determine direct costs, a detailed inventory was recorded including the weight and disposal of medical waste. Indirect costs were not included. Results: Five cases in each treatment group were prospectively recorded. Average direct costs were OR (

Dupuytren Disease Management Trends: A Survey of Hand Surgeons

213.75), OSC-MAC (

Abstract 31. Extensor Pollicis Brevis Subcompartment Characteristics in the 1st Dorsal Extensor Compartment: An Anatomic and Radiographic Study

102.79), OSC-local (

Salve and burdock: A safe, effective Amish remedy for treatment of traumatic wounds?

55.66), and clinic (

Abstract: Extensor Pollicis Brevis Subcompartment Characteristics in the 1st Dorsal Extensor Compartment: An Anatomic Study

31.71). The average weight of surgical waste, in descending order, was the OR (4.78 kg), OSC-MAC (2.78 kg), OSC-local (2.6 kg), and the clinic (0.65 kg). Using analysis of variance, the clinic’s direct costs and surgical waste were significantly less than any other setting (P < .005). Conclusions: The direct costs of an open carpal tunnel release were nearly 2 times more expensive in the OSC compared with the clinic and almost 7 times more expensive in the OR. Open carpal tunnel release is more cost-effective and generates less medical waste when performed in the clinic versus all other surgical venues.

Medically Managed Gout Precipitating Acute Carpal Tunnel Syndrome

Background: Indication for intervention in Dupuytren disease is influenced by many factors, including location and extent of disease, surgeon preference, and comfort level with different treatment techniques. The aim of this study was to determine current Dupuytren disease management trends. Methods: A questionnaire was sent through the American Society for Surgery of the Hand to all members. In addition to demographic data, questions focused on indications for different procedural interventions based on location of disease, age, and activity level of the patient. Results: Approximately 24% of respondents completed the survey. Respondents were mostly orthopedic surgeons in private practice who do not work with residents or fellows. Respondents preferred collagenase over needle aponeurotomy and limited fasciectomy for primary Dupuytren disease involving only the metacarpophalangeal (MCP) joint. Limited fasciectomy was the preferred treatment for primary Dupuytren disease involving the MCP and proximal interphalangeal joints. For a patient amenable to any treatment option, the majority would use collagenase, although 87.1% felt that fasciectomy offered the longest disease-free interval. Furthermore, given the option of a young, working patient, 42.7% would use collagenase, while plastic and general surgeons were more likely to treat this patient with limited fasciectomy. More plastic surgeons (vs orthopedic) believe that limited fasciectomy yields the longest disease-free interval. For a patient amenable to any surgical option, orthopedic surgeons prefer collagenase, whereas plastic hand surgeons prefer a limited fasciectomy. Conclusion: There are several procedural options for the treatment of Dupuytren disease. This study details current practice patterns among hand surgeons and reveals the increasingly prevalent use of collagenase.

Scedosporium: an unlikely cause of fungal necrotizing fasciitis.

RESULTS: Three-dimensional curvature and cluster analyses were performed in 43 patients. The difference in average mean curvature between patients who underwent operation and conservative treatment was 11.3 m and -16.1m for mid-forehead strip and right/left lateral orbit, respectively. The average mean curvatures of three regions of interest were significantly different (p<0.0001). In addition, K-means clustering classified patients into two different severity groups, and there was 96% agreement between the algorithm classification and surgeons’ decisions except two patients.

Reexploring the Anatomy of the Distal Humerus for its Role in Providing Vascularized Bone

BACKGROUND: Amish patients show a demonstrated preference for traditional, herbal remedies over modern medical interventions such as skin grafting. One such remedy is a mixture of Burn & Wound Ointment (B & W Ointment; Holistic Acres, LLC; Newcomerstown, Ohio) and steeped burdock leaves. Although both have demonstrated some antimicrobial and wound healing properties, burdock and/or the combination of B & W Ointment and burdock has never been studied to determine its purported ability to reduce pain, prevent infection, and accelerate wound healing. METHODS: A retrospective chart review was performed on 6 Amish patients treated with salve and burdock leaves instead of skin grafting following complex traumatic wounds to determine whether the traditional treatment incurred any patient harm. RESULTS: The time of wound epithelialization and healing complications were noted, among other data points. Time to full epithelialization ranged from 1 to 7 months. Time to full wound healing was proportional to wound size. CONCLUSIONS: Although the treatment presented here is unconventional, it did not cause harm to the patients studied.

Plastic Surgery Management of Intravenous Infiltration and Extravasation Injuries

INTRODUCTION: DeQuervain’s tenosynovitis is a common condition often satisfactorily treated with steroid injections alone. Certain patients, however, ultimately require surgical release of the 1st dorsal extensor compartment. We hypothesize that patients with an EPB subcompartment are more likely to require surgery. The purpose of this study was to better characterize the 1st dorsal compartment anatomy, determine the incidence of EPB subcompartments, and explore potential radiographic correlations related to these findings.