Cost-benefit analysis of 3D-printed vascular models in abdominal free flap breast reconstruction.

3D-printed vascular models can enhance flap harvesting efficiency in abdominal free flap breast reconstruction, reducing the use of operating room time. However, no economic analyses with respect to model use in this context have been conducted to date. As such, this study examines model cost-benefit tradeoffs for use in abdominal free flap breast reconstruction.

Alternative Nerve Coaptations: End-To-Side and Beyond.

Modern end-to-side (ETS) nerve transfers have undergone several permutations since the early 1990's. Preclinical data have revealed important mechanisms and patterns of donor axon outgrowth into the recipient nerves and target reinnervation. The versatility of ETS nerve transfers can also potentially address several processes that limit functional recovery after nerve injury by babysitting motor end-plates and/or supporting the regenerative environment within the denervated nerve.

Outcomes of Nerve Transfers in Peroneal Nerve Palsy.

The objective of this work is to: (i) evaluate the postoperative outcomes after lower extremity nerve transfer (LENT) in patients with peroneal nerve palsy, and (ii) evaluate the patient and surgical factors that best predict successful restoration of ankle dorsiflexion following nerve transfer. A retrospective cohort of prospectively collected data included all patients who underwent LENT (2010-2018). Two independent reviewers performed data collection.

Impact of Body Mass Index and Comorbidities on Outcomes in Upper Extremity Nerve Transfers.

Background:  There is a paucity of research investigating the impact of patient comorbidities, such as obesity and smoking, on nerve transfer outcomes. The objective of this retrospective cohort study was to evaluate the impact of body mass index (BMI) and comorbidities on the clinical outcomes of upper extremity nerve transfers.

Methods:  A retrospective cohort study was executed.

National Multidisciplinary Survey of Regional Anesthesia Preferences in Breast Reconstruction.

Background: The purpose of this work was to determine the regional anesthesia preferences of plastic surgeons (PS) and anesthesiologists (A) involved in breast reconstruction in Canada.

Methods: Online surveys were sent to members of the Canadian Society of Plastic Surgeons (CSPS) and the Canadian Anesthesiologists Society (CAS). The primary outcome was regional anesthesia preferences in breast reconstruction (delayed, immediate, alloplastic, autologous).

Evaluation of Intrinsic Hand Musculature Reinnervation following Supercharge End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer.

Supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer is commonly performed in the authors' institution to augment intrinsic hand function. Following observations of recovery patterns, the authors hypothesized that despite its more distal innervation, the first dorsal interosseous muscle recovers to a greater extent than the abductor digiti minimi muscle. The objective of this work was to evaluate the clinical and electrodiagnostic pattern of reinnervation of intrinsic hand musculature following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer.

The rule of thirds: Determining the ideal areolar proportions.

Background: Breast surgery often requires changing the diameter of the areola. Recommended areolar size is commonly based on population averages, or surgical judgement. An ideal areola size has not been previously been described.

Economics of Lymphovenous Bypass.

Background: The objective of this study was to compare the economic impact of complete decongestive therapy and lymphovenous bypass in the management of upper extremity lymphedema.

Methods: Economics were modeled for a patient with breast cancer-related lymphedema undergoing three different clinical pathways: (1) complete decongestive therapy alone; (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy; or (3) lymphovenous bypass requiring ongoing complete decongestive therapy. Activity-based cost analysis identified costs incurred with complete decongestive therapy and lymphovenous bypass.

Harvesting the 'SEAD': Long-Term Follow-Up of the Surgical Exploration and Discovery Program.

Objective: The Surgical Exploration and Discovery (SEAD) program was established to facilitate career decision-making by providing preclerkship students with comprehensive exposure to surgical specialties. Our short-term findings demonstrated that, compared to a control group, SEAD participants showed significantly greater career-related learning. The purpose of this study was to understand the long-term impact of the SEAD program.

Reinnervation of Extrinsic Finger Flexors and Brachioradialis 22 and 36 Months Following Traumatic Pan-Brachial Plexopathy: A Case Report.

A 25-year-old man sustained a right-sided brachial plexus injury from a high-velocity motocross accident. Physical examination and electromyography were consistent with a pan-brachial plexopathy with no evidence of axonal continuity. The patient underwent a spinal accessory to suprascapular nerve transfer and an intercostal to musculocutaneous nerve transfer with interpositional sural nerve grafts.

Branches From the "SEAD": Sustained and Feasible Expansion of the Surgical Exploration and Discovery Program.

Problem: A predicted shortage of surgeons and attrition among surgical residents has highlighted the need to attract well-suited medical students to surgical specialties. Literature suggests that early exposure may increase interest by addressing misconceptions and allowing students more time to make an informed career decision.

Approach: The Surgical Exploration and Discovery (SEAD) program was created in 2012 with the goal of providing medical students with comprehensive and multifaceted exposure to surgical specialties to develop their knowledge and skills, and in turn positively influence their interest in pursuing a surgical career.

Clinical Outcomes of Nerve Transfers in Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.

Background:  Given the unsatisfactory outcomes with traditional treatments, there is growing interest in nerve transfers to reestablish ankle dorsiflexion in peroneal nerve palsy. The objective of this work was to perform a systematic review and meta-analysis of the primary literature to assess the effectiveness of nerve transfer surgery in restoring ankle dorsiflexion in patients with peroneal nerve palsy.

Methods:  Methodology was registered with PROSPERO, and PRISMA guidelines were followed.

Efficacy and safety of bilateral thoracic paravertebral blocks in outpatient breast surgery.

Unilateral thoracic paravertebral blocks (TPVBs) have demonstrated reliable intraoperative analgesia, low postoperative pain scores, and an opioid-sparing effect in breast cancer surgery. However, secondary to the perceived risk of complications, bilateral TPVB have been less well accepted and are less frequently used. The purpose of this study was to evaluate the feasibility of using bilateral TPVBs in outpatient surgery for patients undergoing bilateral mastectomy with immediate implant-based reconstruction.

Anomalous Extratemporal Facial Nerve in Oculoauriculovertebral Spectrum.

Facial nerve dysfunction is common in oculoauriculovertebral spectrum (OAVS). However, the course of the nerve has rarely been described. A 23-year-old woman with OAVS underwent excision of microtic ear remnants in preparation for an osseointegrated prosthesis and suffered iatrogenic transection of the facial nerve-the pes anserinus was within the subcutaneous tissue 15 mm posterior and 15 mm cephalad to the external acoustic meatus.

Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses.

Background:  Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis.

The Risks and Benefits of Cavernous Neurovascular Bundle Sparing during Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Purpose: We summarize published data on associations between cavernous neurovascular bundle preservation (nerve sparing) during prostatectomy and positive surgical margins, erectile function, urinary function and other patient reported outcomes.

Materials And Methods: A systematic literature search of MEDLINE®, Embase® and Cochrane Reviews databases was performed for interventional or observational studies published between 2000 and 2014. English language articles that compared clinical outcomes of patients undergoing nerve sparing and nonnerve sparing radical prostatectomy were included.

Innovative practice model to optimize resource utilization and improve access to care for high-risk and + patients.

Background: Bilateral prophylactic mastectomy (BPM) has demonstrated breast cancer risk reduction in high-risk/+ patients. However, priority of active cancers coupled with inefficient use of operating room (OR) resources presents challenges in offering BPM in a timely manner. To address these challenges, a rapid access prophylactic mastectomy and immediate reconstruction (RAPMIR) program was innovated.

Growing the 'SEAD': Expansion of the Surgical Exploration and Discovery Program.

Background: The declining popularity of surgical specialties among North American medical students has been attributed partially to limited early exposure and minimal involvement of surgeons in preclerkship education; in response, the Surgical Exploration and Discovery (SEAD) program was developed at the University of Toronto in 2012. SEAD is a 2-week curriculum that provides first-year medical students comprehensive exposure to surgical specialties through operating room observerships, simulation workshops, and career discussions. This study is the first to examine implementation of the SEAD program at another site.

Long-term outcomes and patient satisfaction following wrist ganglion aspiration.

Background: There is a strong body of evidence addressing short-term outcomes following wrist ganglion aspiration; however, few studies have investigated long-term outcomes and patient satisfaction.

Objective: To evaluate patient satisfaction and the long-term rate of recurrence following wrist ganglion aspiration.

Methods: Charts of all patients with a wrist ganglion treated by a single surgeon from 2001 to 2011 were reviewed.

Wrist ganglion treatment: systematic review and meta-analysis.

Purpose: To review the clinical outcomes of treatment for adult wrist ganglions and to conduct a meta-analysis comparing the 2 most common options: open surgical excision and aspiration.

Methods: The review methodology was registered with PROSPERO. We performed a systematic search of MEDLINE and EMBASE for articles published between 1990 and 2013.

Surgical exploration and discovery program: inaugural involvement of otolaryngology - head and neck surgery.

Background: There is significant variability in undergraduate Otolaryngology - Head and Neck Surgery (OTOHNS) curricula across Canadian medical schools. As part of an extracurricular program delivered jointly with other surgical specialties, the Surgical Exploration and Discovery (SEAD) program presents an opportunity for medical students to experience OTOHNS. The purpose of this study is to review the participation and outcome of OTOHNS in the SEAD program.