The Therapeutic Efficacy of Botulinum Toxin in Treating Scleroderma-Associated Raynaud's Phenomenon: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Objective: To assess the therapeutic efficacy of local injections of botulinum toxin type A (Btx-A) in improving blood flow to the hands of patients with Raynaud's phenomenon (RP) secondary to scleroderma.

Methods: In this randomized, double-blind, placebo-controlled clinical trial, patients with scleroderma-associated RP received Btx-A (50 units in 2.5 ml sterile saline) in one randomly selected hand and sterile saline (2.

Effects of Cleft Width and Veau Type on Incidence of Palatal Fistula and Velopharyngeal Insufficiency After Cleft Palate Repair.

Background: Postoperative fistulae and velopharyngeal insufficiency (VPI) are 2 important complications after cleft palate repair. The effects of preoperative cleft width on outcomes after cleft palate repair have been rarely studied.

Methods: A retrospective review of all patients undergoing primary cleft palatoplasty by a single surgeon between 2004 and 2011 was performed.

Rectal pain of neural origin: resection of sensory rectal branches of pudendal nerve.

Background: A neural origin should be considered in the differential diagnosis of rectal pain if the onset of the pain is in relationship to previous surgery on the anus or rectum.

Study Design: A retrospective cohort was identified by computer search of office files from May 2010 to December 2012. Seven patients, two males, and five females, were identified who have been treated surgically for complaints of isolated rectal pain arising from coloproctectomy in three patients (inflammatory bowel disease) and after hemorrhoidectomy in three patients and one patient with mesh placed for urinary incontinence.

Velopharyngeal Insufficiency Rates After Delayed Cleft Palate Repair: Lessons Learned From Internationally Adopted Patients.

Most surgeons recommend cleft palate repair between 6 and 12 months of age. Internationally adopted patients often undergo delayed repair due to social circumstances. There are few outcomes studies on this population.

Face transplantation surgical options and open problems in cadaveric models: a review article.

Being first conceptualized in 2005-2006, total face transplantation is now a clinical reconstructive option in the treatment of patients with acquired facial deformity. The authors propose a review on the status of total face transplantation based on their clinical experience in dealing with traditional microsurgical head and neck reconstructions and on the basis of their published pre-clinical research investigating technical aspects of the facial allotransplantation procedure in cadaveric models. The authors first discuss the harvesting options and propose two facial flaps which address different reconstructive needs.

Outcome of endoscopic carpal tunnel release in patients with chronic nonhand pain compared with those without chronic pain.

Purpose: This prospective observational study compared the outcomes of single-port endoscopic carpal tunnel release in patients taking narcotic pain medication chronically for back, neck, leg, or other bodily pain for more than 3 months, with patients not taking chronic narcotic pain medication (control group).

Methods: Patients undergoing endoscopic carpal tunnel release completed the Levine-Katz carpal tunnel questionnaire (primary outcome) and the Disabilities of the Arm, Shoulder, and Hand questionnaire preoperatively, at 2, 4, 6, and 12 weeks, and at 1 year after surgery. We measured subjective satisfaction with surgery at each postoperative time point as well.

Internal mammary intercostal perforators instead of the true internal mammary vessels as the recipient vessels for breast reconstruction.

Background: Free tissue transfer has become a mainstay in breast reconstruction, with the internal mammary system frequently used as the recipient vessels. Sacrificing the internal mammary artery, however, eliminates the potential to use this vessel as a coronary artery bypass conduit in the future and potentially increases recipient-site morbidity. The authors' goal was to evaluate the learning curve and effectiveness of their use of the internal mammary intercostal perforators for microsurgical breast reconstruction.

A treatment strategy for postburn neck reconstruction: emphasizing the functional and aesthetic importance of the cervicomental angle.

The authors describe an algorithm for reconstruction of both the soft tissue and skeletal components of severe postburn neck deformities. The critical functional and aesthetic importance of the cervicomental angle is emphasized. The neck is subdivided into 3 anatomic subunits: (1) lower lip/chin subunit, (2) submental subunit, and (3) anterior neck subunit.

Clinical implications of orbital volume change in the management of isolated and zygomaticomaxillary complex-associated orbital floor injuries.

Background: Orbital floor injuries can occur in isolation or in association with zygomaticomaxillary complex fractures. Volumetric computed tomographic measurements of affected orbits are investigated for utility in guiding management in these two groups.

Methods: The medical records of all patients with craniomaxillofacial injuries (2003 to 2005) were reviewed.

The helical arcade: anatomic basis for survival in near-total ear avulsion.

Survival of the ear based on a single vascular pedicle has been previously documented. The anatomic basis for this survival remains incompletely described. In the 3 clinical cases of inferior-to-superior near-total ear avulsion presented herein, the authors have observed that the ear can survive based on a narrow pedicle along the helical root.

Triple chimeric flap based on anterior tibial vessels for reconstruction of severe traumatic injuries of the hand with thumb loss.

Background: Reconstruction of severe traumatic injuries of the hand with digit loss may require multiple procedures over a prolonged period. The authors present a clinical series of patients in which these types of injuries were reconstructed in a single operation.

Methods: A chimeric flap based on the anterior tibial vessels is described.

Strategy for reoperative free flaps after failure of a first flap.

Background: Free vascularized tissue transfer is generally associated with high success rates, but failures do occur. After a flap failure, the decision is often made to perform a second, reoperative free flap.

Methods: A retrospective review of all microsurgical free tissue transfers performed at the authors' institution identified 13 patients who underwent a second, reoperative free flap after a failed primary flap.

Metabolic and functional characterization of human adipose-derived stem cells in tissue engineering.

Background: The use of adipose-derived stem cells for tissue engineering involves exposing them to metabolically adverse conditions. This study examines the metabolism, proliferation, and differentiation of adipose-derived stem cells under various conditions.

Methods: Adipose-derived stem cells were cultured in 16 media conditions containing 0.

Extended applications of vascularized preauricular and helical rim flaps in reconstruction of nasal defects.

Background: Composite auricular chondrocutaneous grafting is a well-established technique for reconstructing alar defects. It can provide excellent results because it matches nasal tissue well in terms of color, texture, and contour. However, the size of composite graft that can be transferred is limited by its lack of blood supply.

Treatment of metronidazole-refractory Clostridium difficile enteritis with vancomycin.

Background: Clostridium difficile infection of the colon is a common and well-described clinical entity. Clostridium difficile enteritis of the small bowel is believed to be less common and has been described sparsely in the literature.

Methods: Case report and literature review.

A retrospective analysis of facial fracture etiologies.

The medical records of 437 patients with 929 facial fractures were retrospectively analyzed. Fracture patterns were classified based on the presence or absence of fractures in each of 4 anatomic subunits (frontal, upper midface, lower midface, and mandible). The most common etiology of trauma was assault (36%), followed by motor vehicle collision (MVC, 32%), fall (18%), sports (11%), occupational (3%), and gunshot wound (GSW, 2%).

A financial analysis of operative facial fracture management.

Background: The financial impact of operative facial fracture management has not been systematically investigated. This study aims to provide a descriptive financial analysis of patients undergoing operative facial fracture management at a single academic medical center and the financial impact on the health system.

Methods: The records of 202 patients who underwent operative facial fracture management over a 3-year period (2003 to 2005) were analyzed.

Osteocutaneous face transplantation.

Background: Facial transplantation has the potential to become a viable option in the treatment of acquired and congenital facial deformities. Transplantation of the bony maxillofacial skeleton with the soft tissues (osteocutaneous face transplantation) has not been performed clinically nor has it been described experimentally in a human cadaver model.

Methods: A mock osteocutaneous face transplant procedure was carried out on a cadaver model.

[Facial allograft transplantation: fiction or reality? Surgical techniques in a fresh human cadaver model].

Background: The aim of this study was to describe two methods of face-harvesting techniques -- a skin and soft tissue flap and a combined osteocutaneous flap -- and to demonstrate the compatibility between donor and recipient in a human fresh cadaver model.

Methods: In fresh human cadavers the skin and soft tissue of the face (type 1) and a combined osteocutaneous flap (including a le Fort III segment, type 2) were harvested. The faces were subsequently exchanged among the donor crania, simulating full-face transplantation.

Concomitant injuries in patients with panfacial fractures.

Background: Patients with panfacial fractures comprise a small portion of the overall facial fracture patient population. Because of the forces necessary to cause panfacial injury, these patients often have other concomitant injuries. The timing of operative facial fracture management remains controversial.

Efficacy of ethyl nitrite in reversing surgical vasospasm.

Vasospasm leading to thrombosis is a major cause of free flap failure. Flap blood flow may improve by application of vasodilating agents to the pedicle. The purpose of this study is to evaluate the effect of a novel S-nitrosylating agent, O-ethyl nitrite, on flap blood flow and pedicle vessels diameter in a rat model, after induction of vasospasm.

Free vascularized tissue transfer to preserve upper extremity amputation levels.

Background: Free vascularized tissue transfer to preserve upper extremity amputation level is an uncommon procedure. The authors investigate the role of free tissue transfer in preserving both morphology and function of the amputated upper extremity, with the goal of facilitating prosthetic rehabilitation.

Methods: Thirteen patients who underwent microsurgical free tissue transfer to preserve upper extremity amputation level were reviewed retrospectively.

Effects of glutamine, glucose, and oxygen concentration on the metabolism and proliferation of rabbit adipose-derived stem cells.

The use of adipose-derived stem cells (ASCs) for tissue engineering involves exposing them to metabolically adverse conditions. This study examined the metabolism, proliferation, and viability of ASCs under various oxygen, glucose, and glutamine concentrations to determine how these cells respond to such environments. ASCs were cultured in each of 8 media preparations containing 4.