Nicole Z. Sommer

The prediction of breast reduction weight.

&NA; Reimbursement for reduction mammaplasty has become more stringent because many insurers require specific documentation of patient symptoms and estimated weight of planned breast resection. The purpose of this study was to develop a simple, clinically useful method for predicting weight of breast tissue to be removed, using routine, easily obtained predictors (i.e., height, weight, age, measurements from sternal notch to nipple, and measurements from sternal notch to inframammary crease). Data were available from a retrospective review of 263 women undergoing reduction mammaplasty. Analyses were performed to predict resected weights obtained both in the operating room and by a pathologist for left and right breasts separately. Regression analyses showed that the sternal notch‐to‐nipple measurement accounted for nearly all of the explained variance in the resected weights, with correlations around 0.80 between sternal notch to nipple and resected weight. For sternal notchto‐nipple measurements ≥28.5 cm, predicted resected weights were approximately 600 g or more, and in general, 80 percent or more patients had specimen weights >500 grams. From 25.5 to 28 cm, the predicted weights ranged from about 400 to 600 g and the prediction rate of weights >500 g was 50 percent. The senior author predicted the resected breast weight to be >500 g 94 percent of the time. The equation alone did not produce an accurate prediction in the critical range, 400 to 600 g. The experienced surgeon more accurately predicted resected weights with use of practiced spatial relationship skills. (Plast. Reconstr. Surg. 109: 506, 2002.)

Tumors of the perionychium.

Tumors of the perionychium are often subtle and difficult to diagnose. Because they are somewhat uncommon, the early symptoms of these tumors, which may include vague pain, local swelling, nail discoloration, nail deformity, or drainage, may be mistaken for signs of infection and/or trauma and therefore treated with topical or oral antibiotics for some time. Functionally important in enhancing fingertip sensation, protection, and manipulating fine objects, the perionychium is continuously subject to day-to-day trauma and injury that can alter the natural contours and growth patterns of the nail plate. Bacterial, viral, or fungal infections can incite swelling, pain, and distortion of the perionychium as well. Both infection and trauma, then, can mask underlying tumors or growths that would delay their diagnosis. A delay in treatment can be devastating if the growth of the perionychium happens to be malignant. Therefore, a general understanding of the signs and symptoms of the perionychium tumors is needed by all physicians and surgeons treating nail problems.

Dapsone for the treatment of doxorubicin extravasation injury in the rat

Doxorubicin is the most common antitumor drug implicated in serious extravasation injuries. Progressive tissue necrosis may lead to intense pain, chronic ulceration, and disfiguring tissue loss. This progressive necrosis is analogous to that seen with brown recluse spider bites, where dapsone is an established mode of therapy, minimizing the area of tissue loss by a proposed antiinflammatory mechanism. The backs of 50 Lewis rats were injected intradermally with 1 mg of doxorubicin in 1 cc of saline to simulate an extravasation injury. The rats were divided into five groups for treatment with oral dapsone 50 mg/kg/day: 10 were controls (no treatment), 10 were started the day before injury, 10 were started the day of injury, 10 were started the day after injury, and 10 were started 1 week after injury. The area of ulceration was calculated by planimetry. The data suggest that dapsone has little positive effect on healing extravasation ulcers.

Cocaine-induced full-thickness tissue necrosis: a case series.

DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. Fig. 1. A 60-year-old woman who underwent resection of a liposarcoma on the right shoulder. (Left) The location of the perforating branches of the tenth intercostal artery in the lateral part of the latissimus dorsi muscle was detected by color Doppler sonography. The divided latissimus dorsi flap was designed to include the perforator in the distal flap. (Right) Three months after primary closure of the donor site.

Establishing Validity Evidence for an Operative Performance Rating System for Plastic Surgery Residents

OBJECTIVE The aim of this study was to describe an operative performance rating system for plastic surgery residents and provide validity evidence for the instrument. METHODS Three plastic surgery residents (PGY levels 1, 5, and 6) from Southern Illinois University School of Medicine (SIUSOM) performed a carpal tunnel release with audio video recording. The 3 videos were reviewed by 8 expert hand surgeons and 3 SIUSOM faculty using the operative performance rating system instrument to assess resident operative performance. Validity evidence including content, internal structure, and relationship to other variables was collected. RESULTS Inter-rater reliability was consistently fair to moderate (weighted Cohens Kappa 0.44-0.84 for experts, 0.24-0.55 for SIUSOM raters), and all assessment items were highly correlated (Cronbachs alpha of 0.9867). Local SIUSOM faculty routinely demonstrated higher overall scores for PGY 1 and PGY 6 residents compared to expert raters. CONCLUSIONS Although limited by small numbers, this pilot study suggests that potential bias based upon PGY year, identity, and performance history may exist and independent assessment by unbiased raters or comparison to national operative norms may be valuable. Our study provides baseline validity evidence for a resident operative performance assessment tool that can be integrated into practice in plastic surgery training programs.

Abstract: Targeted Stretching and Strength Trainingt to Improve Postural Ergonomics and Surgical Endurance in the Operating Room

Plastic surgeons report amongst the highest prevalence of chronic musculoskeletal pain and fatigue in surgeons, which impacts daily life and career longevity.1 Hospital acquired occupational injuries are common, leading to some of the highest economic burdens in the industry. Poor postural awareness and ergonomic set up in the operating room represent the underlying culprit in the majority of situations.2 While a wealth of research documents the physical detriments, there remains a paucity of literature representing solutions to this problem.3–5 In this paper, we review anatomy, surgical equipment, and postural pitfalls in the operating room that lead to neck, back and shoulder pain. This paper provides an individualized template for home strengthening and conditioning exercises to target problematic muscle groups. The goal is to improve postural awareness, core strength, and surgical stamina. Self-motivated and prophylactic conditioning is a must for maintaining physical wellbeing in a surgical field which stresses mental and physical toughness. Future focus should be aimed at implementing dedicated ergonomic education and physical wellness programs early in surgical resident training.

Cocaine-Induced Full Thickness Skin Necrosis

reSultS: Four patients (age 37-50) with cocaine-induced skin necrosis were identified between December 2010 and June 2011. All patients were cocaine users who suffered a prodrome of purpura which progressed to eschars and full-thickness necrosis within 4-6 weeks (Figure 1). Wounds involved the extremities, trunk and face. One patient eviscerated through abdominal necrosis overlying a ventral hernia. All patients demonstrated auto-antibodies including ANA, P-ANCA, lupus anticoagulant and rheumatoid factor. Histopathology revealed thromboses of dermal vessels with few inflammatory cells. Management included serial debridements, xenografting, and split-thickness skin grafting (Figure 2).