Publications by authors named "Hani Sinno"

48 Publications

Analysis of Utility Assessment Scores to Objectify the Health Burden Caused by Breast Conservation Therapy.

Plast Surg (Oakv) 2020 May 21;28(2):77-82. Epub 2020 May 21.

Department of Surgery, Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Background: Lumpectomy followed by radiation, known as breast conservation therapy (BCT), is a viable surgical treatment option for early-stage breast cancer. However, the current literature suggests that patients prefer mastectomy over BCT, likely due to the wide variety of postmastectomy reconstructive options. Our aim is to investigate the objective health burden of living with BCT to help surgeons gain a better understanding of patient treatment preferences.

Methods: Three validated health state utility tools were used to objectify the burden of living with post-BCT results: visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG). A prospective sample of the general population and medical students were recruited, and their responses analyzed to attain these scores.

Results: Utility scores for living with BCT are VAS 0.81 ± 0.19, TTO 0.93 ± 0.10, and SG 0.92 ± 0.14. The TTO and SG suggest a willingness to trade 2.5 years of life years and an 8% chance of death undergoing reconstructive procedures to correct a BCT defect, respectively. Age, gender, race, education, and income were not statistically significant independent predictors for higher or lower utility scores.

Conclusion: The impact of the health burden of BCT was ascertained using validated objective numeric utility scores. These indices demonstrate a willingness to trade less life years to undergo correction of a BCT defect than reconstruction following unilateral mastectomy. They can provide surgeons with the best objective understanding of patient preferences for shared decision-making in the management of breast cancer.
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http://dx.doi.org/10.1177/2292550320925894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298570PMC
May 2020

Prospective, Double-Blind Evaluation of Umbilicoplasty Techniques Using Conventional and Crowdsourcing Methods.

Plast Reconstr Surg 2017 Dec;140(6):1151-1162

Boston, Mass.; and New Orleans, La.

Background: Umbilical reconstruction is an important component of deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study evaluated the aesthetics of three different umbilical reconstruction techniques during DIEP flap breast reconstruction.

Methods: From January to April of 2013, a total of 29 consecutive patients undergoing DIEP flap breast reconstruction were randomized intraoperatively to receive one of three umbilicoplasty types: a diamond, an oval, or an inverted V incision. Independent plastic surgeons and members of the general public, identified using an online "crowdsourcing" platform, evaluated aesthetic outcomes in a blinded fashion. Reviewers were shown postoperative photographs of the umbilicus of all patients and a four-point Likert scale was used to rate the new umbilicus on the size, scar formation, shape, localization, and overall appearance.

Results: Results for the focus group of independent plastic surgeons and 377 members of the public were retrieved (n = 391). A total of 10 patients (34.5 percent) were randomized into having the diamond incision, 10 (34.5 percent) had the oval incision, and nine (31.0 percent) had the inverted V incision. Patients were well matched in terms of overall characteristics. The general public demonstrated a significant preference for the oval incision in all five parameters. There was no preference identified among surgeons.

Conclusion: This study provides evidence that a sample of the U.S. general public prefers the aesthetics of the oval umbilicoplasty incision, which contrasted with the lack of preference identified within this focus group of plastic surgeons.

Clinical Question/level Of Evidence: Therapeutic, II.
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http://dx.doi.org/10.1097/PRS.0000000000003839DOI Listing
December 2017

Utility outcome assessment of pes planus deformity.

Foot Ankle Surg 2018 Apr 30;24(2):119-123. Epub 2016 Dec 30.

Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 1003, Boulevard Décarie, Montréal, Québec H4A 0A9, Canada. Electronic address:

Background: Despite being a common condition, there are no objective measures in the literature to reflect the burden of pes planus on affected individuals. Our primary objective was to evaluate this burden by recruiting a sample from the general population using validated utility outcome measures.

Methods: Participants were recruited online and filled a questionnaire to help measure the health burden of pes planus. Three recognized utility outcome scores were used to compare the health burden of monocular blindness, binocular blindness, and pes planus. These included the standard gamble (SG), time trade-off (TTO), and visual analogue score (VAS). Paired t test, independent t test, and linear regression were used for statistical analysis.

Results: Ninety-two participants were included in the final analysis. The utility outcome scores (VAS, TTO, SG) for pes planus were 73±17, 0.90±0.08, and 0.88±0.12, respectively. The linear regression analysis showed that age was inversely proportional to the time trade-off. However, race, educational level, and income were not significant predictors of utility outcome score for pes planus.

Conclusions: This study shows that the perceived burden of living with pes planus is comparable to living with some debilitating conditions. Our participants were willing to sacrifice 3.6 years of life, and have a procedure with a theoretical 12% mortality risk to attain perfect health.
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http://dx.doi.org/10.1016/j.fas.2016.12.005DOI Listing
April 2018

Bilateral Hallux Valgus: A Utility Outcome Score Assessment.

J Foot Ankle Surg 2016 Sep-Oct;55(5):944-7. Epub 2016 Jun 8.

Orthopedist, Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, Montreal, Quebec, Canada.

Hallux valgus is the most common forefoot problem in adults. Although it can cause considerable disability and affect the quality of life of those affected, many patients seek medical attention because of cosmetic concerns. Our aim was to objectively measure the perceived health burden of living with bilateral hallux valgus. Previously validated utility outcome measures, including the visual analog scale, time trade-off, and standard gamble tests, were used to quantify the health burden for single-eye blindness, double-eye blindness, and bilateral hallux valgus in 103 healthy subjects using an online survey. The Student t test and linear regression analysis were used for statistical analysis. The mean visual analog scale, time trade-off, and standard gamble scores for bilateral hallux valgus were 0.86 ± 1.6, 0.95 ± 0.5, and 0.95 ± 0.14, respectively. These were significantly greater than the utility scores for single-eye and double-eye blindness (p < .05). Age, gender, race, income, and education were not statistically significant independent predictors of the utility scores for hallux valgus. In conclusion, we have objectively demonstrated the effect of living with bilateral hallux valgus deformities. Our sample population reported being willing to undergo a procedure with a 5% mortality rate and sacrifice 1.8 years of life to attain perfect health and avoid the bilateral hallux valgus health state. Our findings will guide us in counseling our patients and understanding how they perceive their foot deformity.
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http://dx.doi.org/10.1053/j.jfas.2016.04.010DOI Listing
July 2017

Impact of Living With Scoliosis: A utility Outcome Score Assessment.

Spine (Phila Pa 1976) 2017 Jan;42(2):E93-E97

Department of Surgery, Shriners Hospital for Children, McGill University, Montreal, Quebec, Canada.

Study Design: Survey.

Objective: The aim of this study was to objectify the burden of adolescent idiopathic scoliosis (AIS) to better advocate for scoliosis care in the future.

Summary Of Background Data: AIS is a common spinal deformity that can affect individuals on many levels. Patients with big curves usually seek medical advice for surgical correction of their deformity.

Methods: Participants completed an online questionnaire to help measure the health burden of AIS. Three utility outcome measures were then calculated. These included the visual analog scale, time trade off, and standard gamble. Student t test and linear regression were used for statistical analysis.

Results: One hundred and ten participants were included in the analysis. The mean visual analog scale, time trade off, and standard gamble scores for AIS were 0.77 ± 0.16, 0.90 ± 0.11, and 0.91 ± 0.13, respectively. Factors such as age, sex, income, and level of education were dependent predictors of utility scores for AIS.

Conclusion: Our participants demonstrated a significant perceived burden of AIS. If faced with AIS, participants were willing to sacrifice 3.6 years of their lives and undergo a procedure with 9% mortality rate to gain perfect health. Such findings can guide future allocation of resources for better scoliosis care and management.

Level Of Evidence: 4.
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http://dx.doi.org/10.1097/BRS.0000000000001708DOI Listing
January 2017

Mastopexy for breast ptosis: Utility outcomes of population preferences.

Plast Surg (Oakv) 2015 ;23(2):103-7

Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;

Background: Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states.

Objective: To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics.

Methods: Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant.

Results: Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance.

Discussion: For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to 'perfect health' than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema.

Conclusions: Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459404PMC
http://dx.doi.org/10.4172/plastic-surgery.1000916DOI Listing
June 2015

Nipple-areolar Complex Reconstruction following Postmastectomy Breast Reconstruction: A Comparative Utility Assessment Study.

Plast Reconstr Surg Glob Open 2015 Apr 7;3(4):e380. Epub 2015 May 7.

Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic and Reconstructive Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada; and Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Background: Nipple-areola complex (NAC) reconstruction occurs toward the final stage of breast reconstruction; however, not all women follow through with these procedures. The goal of this study was to determine the impact of the health state burden of living with a reconstructed breast before NAC reconstruction.

Methods: A sample of the population and medical students at McGill University were recruited to establish the utility scores [visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG)] of living with an NAC deformity. Utility scores for monocular and binocular blindness were determined for validation and comparison. Linear regression and Student's t test were used for statistical analysis, and significance was set at P < 0.05.

Results: There were 103 prospective volunteers included. Utility scores (VAS, TTO, and SG) for NAC deformity were 0.84 ± 0.18, 0.92 ± 0.11, and 0.92 ± 0.11, respectively. Age, gender, and ethnicity were not statistically significant independent predictors of utility scores. Income thresholds of <$10,000 and >$10,000 revealed a statistically significant difference for VAS (P = 0.049) and SG (P = 0.015). Linear regression analysis showed that medical education was directly proportional to the SG and TTO scores (P < 0.05).

Conclusions: The absence of NAC in a reconstructed breast can be objectively assessed using utility scores (VAS, 0.84 ± 0.18; TTO, 0.92 ± 0.11; SG, 0.92 ± 0.11). In comparison to prior reported conditions, the quality of life in patients choosing to undergo NAC reconstruction is similar to that of persons living with a nasal deformity or an aging neck requiring rejuvenation.
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http://dx.doi.org/10.1097/GOX.0000000000000133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422211PMC
April 2015

The utility of outcome studies in plastic surgery.

Plast Reconstr Surg Glob Open 2014 Jul 7;2(7):e189. Epub 2014 Aug 7.

Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.; Division of Plastic Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada; and Division of Plastic Surgery, University of Michigan Medical School, Ann Arbor, Mich.

Summary: Outcome studies help provide the evidence-based science rationalizing treatment end results that factor the experience of patients and the impact on society. They improve the recognition of the shortcoming in clinical practice and provide the foundation for the development of gold standard care. With such evidence, health care practitioners can develop evidence-based justification for treatments and offer patients with superior informed consent for their treatment options. Furthermore, health care and insurance agencies can recognize improved cost-benefit options in the purpose of disease prevention and alleviation of its impact on the patient and society. Health care outcomes are ultimately measured by the treatment of disease, the reduction of symptoms, the normalization of laboratory results and physical measures, saving a life, and patient satisfaction. In this review, we outline the tools available to measure outcomes in plastic surgery and subsequently allow the objective measurements of plastic surgical conditions. Six major outcome categories are discussed: (1) functional measures; (2) preference-based measures and utility outcome scores; (3) patient satisfaction; (4) health outcomes and time; (5) other tools: patient-reported outcome measurement information system, BREAST-Q, and Tracking Operations and Outcomes for Plastic Surgeons; and (6) cost-effectiveness analysis. We use breast hypertrophy requiring breast reduction as an example throughout this review as a representative plastic surgical condition with multiple treatments available.
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http://dx.doi.org/10.1097/GOX.0000000000000104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229293PMC
July 2014

Patient selection optimization following combined abdominal procedures: analysis of 4925 patients undergoing panniculectomy/abdominoplasty with or without concurrent hernia repair.

Plast Reconstr Surg 2014 Oct;134(4):539e-550e

Boston, Mass.; and Montreal, Quebec, Canada From the Division of Plastic Surgery and the Division of Bariatric Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Division of Plastic Surgery, Jewish General Hospital, McGill University.

Background: Massive weight loss following bariatric surgery causes unwanted excess skin and subcutaneous tissue. Intraoperative abdominal wall exposure during abdominal contouring surgery provides the possibility for concurrent ventral, umbilical, or inguinal hernia repair. The authors evaluated the incidence of postoperative complications following abdominal contouring surgery with or without concurrent hernia repair and the impact of surgical specialty.

Methods: Analysis of patients undergoing abdominal contouring surgery with or without concurrent hernia repair was performed using the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2011. The incidence of postoperative complications was determined. Logistic regression assessed influence of demographics and comorbidities on postoperative outcomes. Control group (body mass index > 27.5) and high-risk group (body mass index > 40) undergoing a hernia repair were also included for comparison.

Results: Among 4925 patients, 63.7 percent underwent abdominoplasty and/or panniculectomy only; 36.3 percent underwent a simultaneous hernia repair. The abdominal contouring surgery with simultaneous hernia repair group had a higher complication rate than the abdominal contouring surgery group (18.3 percent versus 9.8 percent, p < 0.001). Body mass index was associated with increased wound complications and major complications in both groups. Diabetes, smoking, chronic steroid use, and hypertension increased wound complications in the abdominal contouring surgery/hernia repair group.

Conclusions: Patients undergoing hernia repair with abdominal contouring surgery may have higher postoperative complication rates than after abdominal contouring surgery alone. Hypertension, smoking, and chronic steroid use were predictors for negative outcomes. Furthermore, surgical specialty is associated with significantly different complication rates.

Clinical Question/level Of Evidence: Therapeutic, III.
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http://dx.doi.org/10.1097/PRS.0000000000000519DOI Listing
October 2014

The ideal nasolabial angle in rhinoplasty: a preference analysis of the general population.

Plast Reconstr Surg 2014 Aug;134(2):201-210

Montreal, Quebec, Canada; and Boston, Mass. From the Division of Plastic Surgery, McGill University; and the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.

Background: In aesthetic rhinoplasty, the described ideal nasolabial angle ranges from 90 to 120 degrees, with variable anthropologic differences. The authors sought to verify the most aesthetic nasolabial angle as specifically perceived by a random prospective sample of the general population and determine whether age, sex, race, and education were independent associated predictors.

Methods: The authors prospectively recruited 98 random volunteers from the general population. They were asked to rank three different nasolabial angles for the female nose (100, 105, and 110 degrees) and the male nose (90, 100, and 105 degrees) as "most," "moderately," and "least aesthetic." Demographic data were used to determine correlations between aesthetic preferences. Pearson chi-square test and t test were used to determine statistical significance

Results: The most aesthetic female nasolabial angle was 104.9±4.0 degrees. The most aesthetic male nasolabial angle was 97.0±6.3 degrees. Male subjects, younger volunteers, Native Americans, and African Americans preferred more acute male nasolabial angles (90 degrees). Female subjects, volunteers older than 50 years, college graduates, those with a previous rhinoplasty, and Caucasian and Asian subjects preferred more obtuse male nasolabial angles.

Conclusions: In the authors' sample of the general population, the ideal and most aesthetic nasolabial angle ranged from 100.9 to 108.9 degrees in the female nose and 90.7 to 103.3 degrees in the male nose. Age, sex, race, education, and having undergone a previous rhinoplasty were predictors of differences in the ideal male nasolabial angle but did not change preference of the female nasolabial angle.
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http://dx.doi.org/10.1097/PRS.0000000000000385DOI Listing
August 2014

Population preferences of undergoing brachioplasty for arm laxity.

Ann Plast Surg 2014 Dec;73 Suppl 2:S149-52

From the *Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and †Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada.

Background: The number of patients requesting surgical procedures performed for brachioplasty and massive weight loss is increasing. The authors set out to quantify the health state utility outcome assessment of living with arm deformity requiring brachioplasty.

Methods: Utility assessments using the visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) were used to obtain utilities scores for arm deformity, monocular blindness, and binocular blindness from a sample of the general population and medical students. Linear regression and Student t test were used for statistical analysis. A P value less than 0.05 was deemed statistically significant.

Results: All the measures for arm deformity of the 107 volunteers (VAS, 0.80 ± 0.14; TTO, 0.91 ± 0.12; SG, 0.94 ± 0.10) were significantly different (P < 0.001) from the corresponding measures for monocular blindness and binocular blindness. When compared to the sample of the general population, having a medical education demonstrated a statistical significance of being less likely to trade years of life and less likely to gamble risk of death for a procedure such as a brachioplasty. Race and sex were not statistically significant independent predictors of risk acceptance.

Conclusions: We have objectified the health state of living with upper arm deformity requiring brachioplasty. Utility outcome scores (VAS, 0.80 ± 0.14; TTO, 0.91 ± 0.12; SG, 0.94 ± 0.10) were comparable to living with health states such as aging neck needing rejuvenation, excess skin in the thighs necessitating thigh lift, and massive weight loss requiring panniculectomy based on previously reported studies.
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http://dx.doi.org/10.1097/SAP.0000000000000131DOI Listing
December 2014

Living with a unilateral mastectomy defect: a utility assessment and outcomes study.

J Reconstr Microsurg 2014 Jun 17;30(5):313-8. Epub 2014 Feb 17.

Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Background: The gold standard for the treatment of breast cancer includes mastectomy surgery. Our goal was to quantify the health state utility assessment of living with unilateral mastectomy.

Methods: The visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG) were used to obtain utilities for unilateral mastectomy, monocular blindness and binocular blindness from a prospective sample of the general population and medical students.

Results: All measures (VAS, TTO, SG) for unilateral mastectomy (0.75 SD 0.17, 0.87 SD 0.14, and 0.86 SD 0.18, respectively) of the 140 volunteers were significantly different from the corresponding scores for monocular (0.61 SD 0.18, 0.84 SD 0.17, and 0.84 SD 0.18, respectively) and binocular blindness (0.38 SD 0.17, 0.67 SD 0.24, and 0.69 SD 0.23, respectively). Age, gender, race, education, and income were not statistically significant independent predictors of utility scores.

Conclusion: In a sample of the general population and medical students, utility assessments for living with unilateral mastectomy were comparable with those of living with bilateral mastectomy and severe breast hypertrophy. Our sample population, if faced living with unilateral mastectomy was willing to gamble a theoretical 14% chance of death and willing to trade 4.2 years of existing life-years.
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http://dx.doi.org/10.1055/s-0033-1361842DOI Listing
June 2014

Analysis of the National Surgical Quality Improvement Program database in 19,100 patients undergoing implant-based breast reconstruction: complication rates with acellular dermal matrix.

Plast Reconstr Surg 2013 Nov;132(5):1057-1066

Boston, Mass. From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.

Background: The use of acellular dermal matrices has become increasingly popular in immediate and delayed tissue expander/implant-based breast reconstruction. However, it is unclear whether their use is associated with increased postoperative complication rates. Using the American College of Surgeons National Surgical Quality Improvement Program database, the authors assessed baseline differences in demographics and comorbidities with and without acellular dermal matrix and determined whether postoperative complication rates varied.

Methods: Using the national surgical database (2005 to 2011), tissue expander/implant-based breast reconstruction cases were extracted using Current Procedural Terminology codes. Differences in preoperative demographics and comorbidities were assessed using chi-square and t test analysis using SPSS. The authors analyzed variations in complication rates and determined whether demographics and comorbidities affected outcomes using multivariate logistical analysis. A post hoc power study was calculated.

Results: Of 19,100 cases, 3301 involved acellular dermal matrix use. Overall complication rates were not statistically significant (acellular dermal matrix, 5.3 percent; non-acellular dermal matrix, 4.9 percent; p=0.396). Several risk factors were statistically significant associated factors of complications. Higher body mass index was associated with wound complications in both cohorts. In the non-acellular dermal matrix group, body mass index, smoking, and diabetes were associated with major complications, and radiotherapy and steroid use with minor complications.

Conclusions: Acellular dermal matrix use did not appear to increase complication rates in tissue expander/implant-based breast reconstruction in this survey of a national surgical database. There was no significant difference in complication rates between the acellular dermal matrix and non-acellular dermal matrix groups.

Clinical Question/level Of Evidence: Therapeutic, III.
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http://dx.doi.org/10.1097/PRS.0b013e3182a3beecDOI Listing
November 2013

The effects of Moufarrege total posterior pedicle reduction mammaplasty on breastfeeding: a review of 931 cases.

Aesthet Surg J 2013 Sep;33(7):1002-7

Dr Sinno is the Aesthetic & Reconstructive Clinical Fellow at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Background: Since its original description in 1979, the Moufarrege total posterior pedicle reduction mammaplasty technique has proven to be a safe and reliable procedure providing aesthetic and functional enhancement.

Objectives: To determine if the Moufarrege total posterior pedicle reduction mammaplasty affects successful breastfeeding.

Method: Retrospective chart review was performed for patients operated on between 1981 and 1997, and a written questionnaire was given. Patients were asked about their ability to lactate and successfully breastfeed preoperatively and postoperatively. The t test and χ(2) test were used to compare means and categorical variables, respectively. Values were also compared with a sample of women (n = 2223) from the Quebec general population as collected by the Longitudinal Study of Child Development in Quebec (ELDEQ, 1998-2002).

Results: A total of 931 patients (all women) underwent reduction mammaplasty during the study period at Jewish General Hospital, Montreal, Quebec, Canada (H.S.) or Hopital Hotel-Dieu, Montreal, Quebec, Canada (E.B. and R.M). There was a 62% response rate to the questionnaire. There were no statistically significant differences in the percentage of women able to lactate postoperatively vs preoperatively (98% vs 100%, respectively; P = .2). The percentage of women able to successfully breastfeed for 4 and 6 months was also not statistically different when comparing postoperative vs preoperative ability (4 months: 33% vs 44 %, P = .13; 6 months: 29% vs 28%, P = .77). The sample of women from the Quebec population did not differ statistically from those undergoing the Moufarrege breast reduction in terms of successful breastfeeding for 1, 2, 3, and 4 months (59% vs 67%, 52% vs 47%, 42% vs 41%, and 40% vs 33%, respectively).

Conclusions: The Moufarrege breast reduction technique is a reliable and safe procedure that does not seem to negatively affect the success of breastfeeding based on the results of our retrospective chart review and patient questionnaire.

Level Of Evidence: 4.
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http://dx.doi.org/10.1177/1090820X13501857DOI Listing
September 2013

Reporting disclosures to the reader in plastic surgery journal publications.

Can J Plast Surg 2012 ;20(3):e35-6

Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec.

Background: With the associations between investigators and funding sources becoming increasingly complicated, conflicts of interest may arise that could potentially cause biases in the reporting of results.

Objective: To determine the number of published plastic surgery articles that lack reporting of disclosures.

Methods: An online review of four major North American plastic surgery journal publications from January 1, 2007 to December 31, 2007, was performed. For identification and to provide anonymity, journals were assigned a letter from A to D.

Results: Of the 1759 articles reviewed, 726 (41%) were included. Disclosure was not reported in 368 (51%) articles: Journal A (n=10, 3%), Journal B (n=153, 85%), Journal C (n=193, 93%) and Journal D (n=12, 32%). Journals differed significantly in their reporting of disclosure (P<0.01).

Conclusion: In the plastic surgery journals reviewed, the lack of documentation of disclosures was frequent. To ensure identification of bias in plastic surgery publications, a section dedicated to disclosure statements is recommended for each published article.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433824PMC
September 2013

The effects of topical collagen treatment on wound breaking strength and scar cosmesis in rats.

Can J Plast Surg 2012 ;20(3):181-5

Division of Plastic and Reconstructive Surgery, Department of Surgery; ; Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine;

Background: Topical application of collagen has been suggested to enhance wound healing; however, its long-term effect on wounds has not been studied in a rat model.

Hypothesis: Topical application of collagen type I will not facilitate incision healing or cosmesis in rats up to 28 days postwounding.

Methods: The effects of bovine collagen type I (6 mg/mL) on the rat surgical paired skin incision model were examined. Each rat served as its own control in which topical collagen was applied to one incision while normal saline (0.9%) was applied to the other incision. Rats were euthanized three (n=6), seven (n=6) and 28 (n=5) days after wounding. Tissue harvested from each time point was examined for maximal breaking strength, and for biochemical and histological analysis.

Results: There were no statistically significant differences (ie, P<0.05) in maximum wound breaking strength between the collagen- and saline-treated wounds at all time points. Histological analysis revealed a similar infiltration of inflammatory cells and fibroblasts in the wound edges of all incisions when matched with time of wounding. Western blot analysis revealed no differences in fibronectin or collagen I content in all wounds in each rat.

Conclusions: The topical application of collagen did not facilitate wound healing from three to 28 days in the rat wound model.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433816PMC
http://dx.doi.org/10.1177/229255031202000318DOI Listing
September 2013

Complements and the wound healing cascade: an updated review.

Plast Surg Int 2013 24;2013:146764. Epub 2013 Jul 24.

Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, QC, H3A 2B4, Canada.

Wound healing is a complex pathway of regulated reactions and cellular infiltrates. The mechanisms at play have been thoroughly studied but there is much still to learn. The health care system in the USA alone spends on average 9 billion dollars annually on treating of wounds. To help reduce patient morbidity and mortality related to abnormal or prolonged skin healing, an updated review and understanding of wound healing is essential. Recent works have helped shape the multistep process in wound healing and introduced various growth factors that can augment this process. The complement cascade has been shown to have a role in inflammation and has only recently been shown to augment wound healing. In this review, we have outlined the biology of wound healing and discussed the use of growth factors and the role of complements in this intricate pathway.
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http://dx.doi.org/10.1155/2013/146764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741993PMC
August 2013

Open reduction internal fixation poststernotomy mediastinitis.

Plast Surg Int 2013 17;2013:571685. Epub 2013 Jul 17.

Division of Plastic Surgery, Department of Surgery, Jewish General Hospital, 3755 Côte-Sainte-Catherine Road, A500, Montreal, QC, Canada H3T 1E2.

Introduction. Mediastinitis has been reported to complicate 5% of sternotomy surgery. We have adopted an open reduction and rigid internal fixation (ORIF) approach during the conventional rescue surgery in the treatment of mediastinitis. Methods. A retrospective review was performed to compare the outcomes of patients that had an ORIF to correct postoperative mediastinitis following median sternotomy. These were compared with the outcome of the patients that did not undergo ORIF. Results. In the 5-year study period, we reviewed 35 mediastinitis patient charts. Postoperatively, the ORIF patient group remained in the Intensive Care Unit (ICU) and on a ventilator for a mean of 1.5 and 0.75 days, respectively. Patients treated without ORIF spent significantly more days in the ICU (mean of 7.5 days, P < 0.05) and on a ventilator (mean of 2.15 days, P = 0.1). Furthermore, it was found that none of the patients (0%) who underwent ORIF complained of any postoperative sternal instability or pain. Preoperatively, however, these rates were as high as 72%. Conclusions. In the select patient, ORIF can be a safe option in the management of mediastinitis, which we have shown to significantly decrease morbidity and mortality by providing anatomic reduction as well as physiologic stabilization. We have shown that ORIF will improve the quality of life of the patient by minimizing abnormal sternal mobility and pain and will also decrease inpatient costs by decreasing days spent in the ICU and ventilator dependence.
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http://dx.doi.org/10.1155/2013/571685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730391PMC
August 2013

Thigh laxity after massive weight loss: a utilities outcomes assessment.

Ann Plast Surg 2013 Sep;71(3):304-7

Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada.

Background: The presence of excess skin after massive weight loss, particularly in the thighs, not only contributes to a negative body image but can also lead to functional deficits in mobility. In the present study, we quantified the health state utility of living with excess skin in the thighs in an attempt to objectively establish the burden on the quality of life in patients living with excess thigh skin laxity.

Method: Using visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG), we compared the utility outcome scores for thigh skin excess with monocular and binocular blindness from a prospective sample of medical students and the general population. Utility scores were compared using paired t test. Linear regression was performed using age, race, and education as independent predictors of each of the utility scores.

Results: One hundred thirty-four prospective participants were enrolled during a 6-month period, and 112 participants met our inclusion criteria. The utility outcome scores for thigh lift (VAS, TTO, and SG, 0.77 ± 0.15, 0.90 ± 0.11, and 0.89 ± 0.14, respectively) were statistically different from binocular blindness (VAS, TTO, and SG, 0.37 ± 0.18, 0.70 ± 0.23, and 0.70 ± 0.26; P < 0.001), but other than VAS (0.67 ± 0.15, P < 0.001), similar to monocular blindness (TTO and SG, 0.89 ± 0.13 and 0.81 ± 0.14, respectively; P > 0.05). SG (0.89 ± 0.14 vs 0.97 ± 0.02, P = 0.003) and TTO (0.89 ± 0.11 vs 0.95 ± 0.03, P = 0.038) were different between general population and medical students, respectively, corresponding to 3.96 versus 1.80 potential years willing to be traded (P < 0.05). Additionally, SG was higher in whites versus nonwhites who were willing to take a potential 8% chance of mortality compared to 15%, respectively (P = 0.001), to achieve "perfect" health.

Conclusions: We have objectified the utility of living with thigh deformity after massive weight loss. Our sample population if faced with the condition was willing to sacrifice a potential 3.6 years of life and potentially undergo a procedure with 11% chance of mortality to address excess thigh laxity.
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http://dx.doi.org/10.1097/SAP.0b013e3182834b88DOI Listing
September 2013

Complements c3 and c5 individually and in combination increase early wound strength in a rat model of experimental wound healing.

Plast Surg Int 2013 23;2013:243853. Epub 2013 May 23.

Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, QC, Canada H3G 1A4 ; Biomedical Technology and CellTherapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine, McGill University, 3775 Rue University, Room 311, Lyman Duff Medical Building, Montreal, QC, Canada H3A 2B4.

Background. Complements C3 and C5 have independently been shown to augment and increase wound healing and strength. Our goal was to investigate the combinatorial effect of complements C3 and C5 on wound healing. Methods. Each rat served as its own control where topical collagen was applied to one incision and 100 nM of C3 and C5 in collagen vehicle was applied to the other incision (n = 6). To compare between systemic effects, a sham group of rats (n = 6) was treated with collagen alone on one wound and saline on the other. At day 3, the tissue was examined for maximal breaking strength (MBS) and sectioned for histological examination. Results. There was a statistically significant 88% increase in MBS with the topical application of C3C5 when compared to sham wounds (n < 0.05). This was correlated with increased fibroblast and collagen deposition in the treated wounds. Furthermore, there appeared to be an additive hemostatic effect with the C3C5 combination. Conclusions. The combination of complements C3 and C5 as a topical application drug to skin wounds significantly increased wound healing maximum breaking strength as early as 3 days.
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http://dx.doi.org/10.1155/2013/243853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676956PMC
June 2013

Diagnosis and management of eosinophilic cellulitis (Wells' syndrome): A case series and literature review.

Can J Plast Surg 2012 ;20(2):91-7

McGill University, Montreal, Quebec.

Introduction: Eosinophilic cellulitis (Wells' syndrome) is an inflammatory dermatitis that is often misdiagnosed as infectious cellulitis due to its similarity in presentation. Misdiagnosis leads to delay of correct treatment and inappropriate use of antibiotics.

Methods: A case series of eosinophilic cellulitis and a literature review are presented.

Results: Patients with Wells' syndrome may present with a variety of nonspecific symptoms, such as fever, arthralgia and malaise, as well as myriad cutaneous lesions with associated erythema, presenting as blisters, bullae, papules and/or nodules. Several treatment modalities have been used to treat eosinophilic cellulitis and have been met with variable success rates; these include systemic corticosteroids, topical corticosteroids and antihistamines, with success rates of 91.7%, 50% and 25%, respectively.

Conclusions: A high degree of clinical suspicion must be exercised to diagnose this rare condition. Cellulitis with an atypical presentation or not responding to appropriate antibiotic treatment should trigger suspicion of Wells' syndrome. To date, the most successful treatment method is a short course of systemic corticosteroids.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383552PMC
http://dx.doi.org/10.1177/229255031202000204DOI Listing
June 2013

The impact of living with severe lower extremity lymphedema: a utility outcomes score assessment.

Ann Plast Surg 2014 Aug;73(2):210-4

From the *Division of Plastic and Reconstructive Surgery, Montreal General Hospital, †Faculty of Medicine, McGill University, Montreal, Quebec, Canada; and ‡Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Background: Debilitating lower extremity lymphedema can be either congenital or acquired. Utility scores are an objective measure used in medicine to quantify degrees of impact on an individual's life. Using standardized utility outcome measures, we aimed to quantify the health state of living with severe unilateral lower extremity lymphedema.

Methods: A utility outcomes assessment using visual analog scale, time trade-off, and standard gamble was used for lower extremity lymphedema, monocular blindness, and binocular blindness from a sample of the general population and medical students. Average utility scores were compared using a paired t test. Linear regression was performed using age, race, and education as independent predictors.

Results: A total of 144 prospective participants were included. All measures [visual analog scale, time trade-off, and standard gamble; expressed as mean (SD)] for unilateral lower extremity lymphedema (0.50 ± 0.18, 0.76 ± 0.22, and 0.76 ± 0.21, respectively) were significantly different (P < 0.001) from the corresponding scores for monocular blindness (0.64 ± 0.18, 0.84 ± 0.16, and 0.83 ± 0.17, respectively) and binocular blindness (0.35 ± 0.17, 0.61 ± 0.28, and 0.62 ± 0.26, respectively).

Conclusions: We found that a sample of the general population and medical students, if faced with severe lymphedema, is willing to theoretically trade 8.64 life-years and undergo a procedure with a 24% risk of mortality to restore limb appearance and function to normal. These findings provide a frame of reference regarding the meaning of a diagnosis of severe lower extremity lymphedema to a patient and will allow objective comparison with other health states.
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http://dx.doi.org/10.1097/SAP.0b013e3182713ce0DOI Listing
August 2014

An atypical growth of a giant fibroadenoma after trauma.

J Pediatr Adolesc Gynecol 2012 Oct;25(5):e115-7

Division of Plastic and Reconstructive Surgery, McGill University, McGill University Health Centre, Montreal, Quebec, Canada.

Background: Fibroadenomas are the most common benign breast lesion in female adolescents. However, it is important to recognize that a small percentage have been shown to progress to giant fibroadenomas. Giant fibroadenomas can spontaneously infarct leading to significant morbidity and are also difficult to distinguish from the more aggressive phyllodes tumors.

Case: We describe the first case, to the best of our knowledge, of a 12-year-old girl who presented with a giant fibroadenoma complicated by a central infarct and an intra-lesional hemorrhage from a trauma to the breast.

Summary And Conclusion: The complicated giant fibroadenoma with an intra-lesional hemorrhage has characteristics of both benign and malignant lesions, and is difficult to distinguish by history and physical alone. Ultrasonography is a valuable tool yet the core needle biopsy remains the gold standard to confirm the diagnosis.
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http://dx.doi.org/10.1016/j.jpag.2012.06.004DOI Listing
October 2012

The impact of living with a functional and aesthetic nasal deformity after primary rhinoplasty: a utility outcomes score assessment.

Ann Plast Surg 2012 Oct;69(4):431-4

Division of Plastic and Reconstructive Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.

Background: Revision rhinoplasty for functional deformities can be both an aesthetic and reconstructive surgical challenge. We set out to quantify the health state utility assessment of living with the physical appearance of nasal asymmetry along with having nasal obstruction. The use of utility scores has helped to establish the health burden of living with various medical conditions. We sought to quantify living with a health state of nasal asymmetry with nasal obstruction after primary rhinoplasty using utility outcome scores.

Methods: We used previously validated utility outcome measures to quantify the health burden of this clinical scenario in 128 prospective subjects. These subjects were from a sample of the population and medical students recruited to complete a survey to determine the utility outcome score of revision rhinoplasty using visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) tests to obtain utility scores for revision rhinoplasty. Linear regression and Student t test were used for statistical analysis.

Results: All measures (VAS, TTO, and SG) for functional nasal deformity (0.80±0.13, 0.90±0.12, and 0.91±0.13, respectively) of the 128 prospective subjects participating in this online study were significantly different (P<0.005) from the corresponding scores for monocular blindness (0.63±0.15, 0.85±0.16, and 0.85±0.19, respectively) and binocular blindness (0.38±0.18, 0.66±0.25, and 0.69±0.24, respectively). Being white was inversely related to the VAS utility scores for rhinoplasty (P<0.05). Additionally, female sex was positively correlated to the TTO score. Age, income, and education were not predictors of utility scores.

Conclusions: In a sample of the population and medical students, VAS, TTO, and SG utility scores for revision rhinoplasty were determined and can be compared objectively with other health states and diseases with known utility scores. In a preoperative setting, women were objectively willing to potentially "trade" more years of life to treat a functional nasal deformity. If faced with a deformed nose after primary rhinoplasty, our sample population would consent to undergo a revision rhinoplasty procedure with a theoretical 9% chance of mortality and were willing to trade 3.6 years of their remaining life.
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http://dx.doi.org/10.1097/SAP.0b013e3182480384DOI Listing
October 2012

Utility outcome scores for unilateral facial paralysis.

Ann Plast Surg 2012 Oct;69(4):435-8

Division of Plastic and Reconstructive Surgery, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.

Background: Facial paralysis is a debilitating condition. Dynamic and static facial reanimation remains a challenge for plastic surgeons and requires important resources. Our objective was to quantify the health state utility assessment (ie, utility score outcomes) of living with unilateral facial paralysis.

Methods: Utility assessments using visual analog scale, time trade-off, and standard gamble were used to obtain utility outcome scores for unilateral facial paralysis from a prospective sample of the general population and medical students.

Results: A total number of 123 individuals prospectively participated in the study. All measures (visual analog scale, time trade-off, and standard gamble) for unilateral facial paralysis [0.56±0.18, 0.78±0.21, and 0.79±0.21 respectively] were significantly different (P<0.0001) from the corresponding outcome scores for monocular blindness [0.61±0.21, 0.83±0.21, and 0.85±0.18, respectively] and binocular blindness [0.33±0.18, 0.65±0.28, and 0.65±0.29, respectively]. Linear regression analysis using age, race, income, and education as predictors of each of the utility scores for facial paralysis showed no statistical significance.

Conclusions: In samples of the general population and medical students, all utility score outcome measures for facial paralysis were lower than those for monocular blindness. Our sample population, if faced with unilateral facial paralysis, would theoretically undergo facial reanimation procedures with a willingness to sacrifice 8 years of life and be willing to undergo a procedure with a 21% chance of mortality to attain perfect health, respectively.
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http://dx.doi.org/10.1097/SAP.0b013e318246e698DOI Listing
October 2012

Accelerated wound healing with topical application of complement C5.

Plast Reconstr Surg 2012 Sep;130(3):523-529

Montreal, Quebec, Canada From the Divisions of Plastic Surgery, Department of Surgery, and the Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering, Faculty of Medicine, the Department of Pathology, and the Orthopedic Research Laboratory, McGill University.

Background: Delayed-healing traumatic, surgical, and chronic wounds can be detrimental to patients and the health care system. The authors set out to investigate the effects of complement C5, a naturally occurring chemotactic cytokine, on wounds.

Methods: The authors examined the effects of complement C5 on the rat paired skin incision model. Each rat served as its own control where topical collagen was applied to one incision and 100 nM of C5 in collagen vehicle was applied to the other incision. Rats were killed on days 3 (n = 6), 7 (n = 6), and 28 (n = 5) after wounding.

Results: There was a statistically significant, 65 percent increase in maximum wound breaking strength with the topical application of C5 at day 3 (p < 0.01). The increase persisted to 14 percent at 7 days after wounding (p < 0.05). When compared with the sham group, the C5-treated wound strength increased by 83 percent at day 3 and 64 percent at day 7. There was no change in breaking strength at 28 days. Western blot analysis demonstrated a significant increase in collagen and fibronectin content in the C5-treated wounds.

Conclusions: Topical application of C5 to skin wounds significantly increases wound healing maximum breaking strength as early as 3 days and up to 7 days after wounding. C5 accelerated wound healing by at least 4 days in the first week of wounding. This was correlated with an increase in vascular permeability, increased inflammatory cell recruitment, subsequent fibroblast migration, and increased collagen deposition.
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September 2012

An objective assessment of the perceived quality of life of living with bilateral mastectomy defect.

Breast 2013 Apr 31;22(2):168-172. Epub 2012 Jul 31.

Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada. Electronic address:

Background: Mastectomy is a common treatment for breast cancer. We set out to quantify the health state utility assessment of living with bilateral mastectomy using previously described validated methods.

Methods: Utility assessments using visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG) were used to obtain utilities for mastectomy, monocular blindness and binocular blindness from a prospective sample of the general population and medical students.

Results: All measures (VAS, TTO, SG) for mastectomy (0.70 ± 0.18, 0.85 ± 0.16, and 0.86 ± 0.17, respectively) of the 120 volunteers were significantly different (p < 0.0001) from the corresponding scores for binocular blindness (0.38 ± 0.17, 0.67 ± 0.24, and 0.69 ± 0.23, respectively). Utility scores for mastectomy were not statistically different (p > 0.05) when compared to those for monocular blindness (0.67 ± 0.13, 0.86 ± 0.15, and 0.86 ± 0.15, respectively). Age, gender, race, and income were not statistically significant independent predictors of utility scores. Medical education was associated with statistically significant higher SG compared to general population (0.90 ± 0.11 versus 0.84 ± 0.19; p < 0.05).

Conclusion: In a sample of the general population and medical students, utility assessments for living with bilateral mastectomy were comparable with those of living with the loss of sight from one eye. Our sample population, if faced with living with bilateral mastectomy, would consent to undergo a procedure such as breast reconstruction with a theoretical 14 percent chance of mortality and be willing to trade 5.4 years of existing life-years for such a procedure.
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http://dx.doi.org/10.1016/j.breast.2012.07.001DOI Listing
April 2013

Cleft lip and palate: an objective measure outcome study.

Plast Reconstr Surg 2012 Aug;130(2):408-414

Montreal, Quebec, Canada; and Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Montreal Children's Hospital, McGill University; the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.

Background: Cleft lip and/or palate is a debilitating condition if left unrepaired, resulting in significant speech, hearing, swallowing, feeding, and psychosocial impairments. The authors' objective was to determine the potential impact of being born with cleft lip and/or palate by using previously validated health state utility assessment measures.

Methods: A utility assessment using the visual analogue scale, time trade-off, and standard gamble was used to obtain utilities for cleft lip and/or palate, monocular blindness, and binocular blindness from a prospective sample of the general population and medical students. Average utility scores were compared using paired t test. Linear regression was performed using age, race, and education as independent predictors of each of the utility scores.

Results: Over a 1-year prospective enrollment period, 110 participants were included in our utility analysis. The utility outcome scores for cleft lip and/or palate (visual analogue scale, time trade-off, and standard gamble, 0.69±0.18, 0.85±016, and 0.84±0.18, respectively) were statistically different from those of binocular blindness (visual analogue scale, time trade-off, and standard gamble: 0.38±0.17, 0.70±0.24, and 0.66±0.25, respectively; p<0.001) but not statistically different from those of monocular blindness (visual analogue scale, time trade-off, and standard gamble, 0.67±0.15, 0.86±0.15, and 0.84±0.18, respectively). There was no statistically significant difference in utility scores between male and female participants.

Conclusion: The results of the study demonstrate objectively via health state utility scores that the perceived burden of being born with cleft lip and/or palate is comparable to living with monocular blindness.
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http://dx.doi.org/10.1097/PRS.0b013e3182589d4bDOI Listing
August 2012

Acellular dermal matrix in cleft palate repair: an evidence-based review.

Plast Reconstr Surg 2012 Jul;130(1):177-182

Montreal, Quebec, Canada From the Division of Plastic and Reconstructive Surgery, McGill University Health Center, H. B. Williams Craniofacial and Cleft Surgery Unit, Montreal Children's Hospital.

Background: The repair of wide cleft palates and secondary palatal fistulas remains a challenge for pediatric plastic surgeons. To reduce the incidence of fistulization, use of acellular dermal matrix to facilitate closure has been reported in the literature. A review of the literature was performed to assess whether sufficient evidence exists to recommend the routine use of acellular dermal matrix for either primary palatoplasty or secondary palatal fistula repair.

Methods: A literature search for the period between 1970 and 2011 was performed. All articles with clinical application of acellular dermal matrix in primary palatoplasty or palatal fistula repair were included. Data were analyzed using weighted averages to compare fistula rates between repairs performed with and without acellular dermal matrix (historical controls) for each repair type (primary versus secondary fistula repairs).

Results: Four studies examined the use of acellular dermal matrix in primary palatoplasty (n = 92) with a mean cleft width of 14.2 mm. The overall fistula rate was 5.4 percent compared with 10.6 percent in the non-acellular dermal matrix historical control group. Five studies used acellular dermal matrix in palatal fistula repair (n = 74). The overall recurrent fistula rate was 8.1 percent compared with 12.9 percent in the historical control group.

Conclusions: Based on the available data, the results imply that acellular dermal matrix may have a potential benefit in reducing fistula formation/persistence in palate surgery. However, the authors did not find sufficient prospective randomized (level II or better) evidence to recommend the routine use of acellular dermal matrix for cleft palate repair.
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http://dx.doi.org/10.1097/PRS.0b013e318254b2dcDOI Listing
July 2012

Salter-harris type 2 fracture of the proximal phalanx of the thumb with a rotational deformity: a case report and review.

Pediatr Emerg Care 2012 Mar;28(3):288-91

McGill University Healthcare Center, Montreal, Quebec, Canada.

Hand fractures are the most common site of injury in the pediatric population. They commonly involve the epiphyseal growth plates, and their standard classification is that of Salter-Harris (SH). Rotational deformities after SH fractures are rarely reported in literature. However, only 5 degrees of angulation can cause evident rotational deformity. This could be seen clinically and reconfirmed with radiologic evaluation. Up to this date, there are only a few cases of SH fractures with rotational deformity that have been described. We present 2 cases of SH type 2 with evidence of rotational deformity, which were reduced under local anesthesia in the emergency department. A review of literature is performed. Thus, examination for rotational deformities in SH fractures should be kept in mind. A satisfactory closed reduction under local anesthesia can be obtained.
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http://dx.doi.org/10.1097/PEC.0b013e31823606daDOI Listing
March 2012