A Prospective Randomized Controlled Trial of Aspiration and Fibrin Sealant Use Versus Aspiration Alone in the Treatment of Dorsal Wrist Ganglia.

PURPOSE: Multiple treatments for dorsal wrist ganglia (DWG) exist but have high recurrence rates. We investigated whether aspiration followed by injection of Tisseel is more effective at reducing the DWG recurrence rate than aspiration alone. METHODS: Adults with untreated DWG were randomly assigned to aspiration alone (A) or aspiration followed by Tisseel injection (AT). Patients were measured at baseline, 1, 6, and 12 months. Primary outcome was the rate of recurrence. Secondary outcomes included recurrent ganglion size and maximum pain experienced from the ganglion. Continuous data were compared with Student t tests and Mann-Whitney U tests. Categorical data were compared with χ2 tests and Fisher exact tests. Treatment effect was reported as relative risk or mean differences (MD) with 95% confidence intervals. RESULTS: Seventy-nine patients were randomized to the A (n = 39) or AT (n = 40) group. Twenty-five patients were lost to follow-up. There were no differences in recurrence risk between groups at 1, 6, or 12 months (P > .05). Ganglia were significantly smaller for both groups at 1 month versus baseline (P < .001). The A group demonstrated a significantly larger decrease in size at 1 month versus the AT group (MD = 0.75 cm2, 95% confidence interval: 0.07-1.43, P = .03). Both groups experienced significantly less pain at 1, 6, and 12 months (P < .03), but this was not significantly different between groups. CONCLUSION: Aspiration and Tisseel injection does not decrease DWG recurrence versus aspiration alone. Both interventions produced a significant decrease in pain. Although aspiration alone carries a high recurrence risk, it may provide sufficient symptomatic relief for patients with DWG.

OBJECTIF: Malgré les nombreux traitements des ganglions de la face dorsale du poignet (GFDP), les taux de récurrence sont élevés. Les auteurs ont évalué si la ponction suivie d'une injection de Tisseel réduisait le taux de récurrence de GFDP avec plus d'efficacité que la ponction seule. MÉTHODOLOGIE: Les adultes présentant un GFDP non traité ont été répartis au hasard entre la ponction seule (P) et la ponction suivie par une injection de Tisseel (PT). Les chercheurs les ont mesurés au départ, puis au bout de un, six et 12 mois. Le taux de récurrence représentait le résultat clinique primaire, et la taille des ganglions récurrents et la douleur maximale provoquée par le ganglion, les résultats cliniques secondaires. Les chercheurs ont comparé les données continues avec les tests de Student et les tests Mann-Whitney et les données catégorielles avec les tests du chi carré et les tests exacts de Fisher. Ils ont déclaré l'effet du traitement sous forme de risque relatif (RR) ou de différences moyennes (DM), selon des intervalles de confiance à 95 %. RÉSULTATS: Au total, les chercheurs ont réparti 79 patients au hasard entre le groupe P (n = 39) ou PT (n = 40). Ils ont perdu 25 patients au suivi. Ils n'ont constaté aucune différence quant au risque de récurrence entre les groupes au bout de un, six ou 12 mois (P > .05). Les ganglions étaient beaucoup plus petits dans les deux groupes au bout d'un mois qu'au départ (P < .001). La taille du ganglion avait diminué davantage dans le groupe P que dans le groupe PT au bout d'un mois (DM = 0.75 cm2, IC à 95 %: 0,07 à 1,43, P = .03). Les deux groupes ressentaient beaucoup moins de douleur au bout de un, six et 12 mois (P < .03), mais cette différence n'était pas significative entre les groupes. CONCLUSIONS: La ponction et l'injection de Tisseel ne réduisent pas la récurrence de GFDP par rapport à la ponction seule. Les deux interventions entraînaient une diminution significative de la douleur. Même si la ponction seule s'associe à un fort risque de récurrence, elle peut apporter un soulagement symptomatique suffisant pour les patients ayant un GFDP.

Breast reduction scars: a prospective survey of patient preferences.

BACKGROUND: Studies have shown that scarring is a primary reason for patient dissatisfaction with reduction mammaplasty. OBJECTIVES: The authors prospectively evaluated patient preferences for the 3 most common breast reduction scar patterns: horizontal, vertical, and Wise. METHODS: Sixty-six patients were recruited for the study before receiving their reduction mammaplasty consultation. Each patient was shown line drawings and postoperative photographs of the 3 breast reduction techniques and scored the scars on a modified 10-point Likert scale (1 = unacceptable; 10 = acceptable). The survey responses had no impact on the patients' medical care. A nonparametric Friedman test was used to compare the mean scores, and univariate generalized linear regression analysis was performed to adjust for confounding factors. Post hoc analysis was performed using the Bonferroni method. Significance was set at P < .001. RESULTS: Sixty patients completed the study. The mean preference ranking was significantly higher for the horizontal scar pattern versus vertical and Wise (P < .001). The mean score difference between the horizontal and Wise patterns was 2.982. The mean difference between the horizontal and vertical patterns was 2.27. There was no significant difference in preference between the vertical and Wise patterns. Linear regression analysis showed that age, body mass index, and torso/bra size had no significant effect on preference. CONCLUSIONS: To our knowledge, this is the first study designed to prospectively evaluate patient preferences regarding postoperative scars. Results indicate that the horizontal technique is preferable with respect to scar placement.

The horizontal breast reduction: Surgical tips for maintaining projection.

Reduction mammoplasty is one of the most common procedures performed by plastic surgeons in Canada. The Wise and vertical scar techniques are two of the most commonly published and performed. Although the horizontal breast reduction is a less commonly used technique, it offers added benefits over other procedures. These include elimination of the vertical scar and a consistently round nipple. However, one of the criticisms of the horizontal technique is the loss of projection of the breast mound. The present article outlines several important points that can aid in achieving an optimal aesthetic result when performing a horizontal breast reduction.

La plastie de réduction mammaire est l'une des interventions que les plasticiens du Canada pratiquent le plus. Les incisions verticales et de type Wise font partie des plus exécutées et des plus publiées. La technique de réduction mammaire horizontale est moins utilisée, mais elle a des avantages par rapport aux autres, y compris la disparition de la cicatrice verticale et le maintien d'un mamelon rond. Cependant, elle s'associe à des critiques sur la perte de projection de la protubérance mammaire. Le présent article expose plusieurs points importants qui peuvent contribuer à obtenir un résultat esthétique optimal dans le cadre d'une plastie de réduction mammaire horizontale.

Incidence of capsular contracture in silicone versus saline cosmetic augmentation mammoplasty: A meta-analysis.

INTRODUCTION: Capsular contracture after augmentation mammoplasty occurs at a rate of 15% to 45%. The purpose of the present study was to determine the effect of implant core type (silicone versus saline) on the rate of capsular contracture in augmentation mammoplasty. METHODS: A systematic review was conducted through a search of three electronic databases. Two reviewers independently scanned titles yielded by the search and identified potentially relevant papers. Inter-reviewer variability and the scientific quality of the articles were assessed. Meta-analysis was performed. RESULTS: Eighty-eight titles of potential relevance were selected from the 393 articles yielded by the search. Inter-rater agreement for selection of potentially relevant articles was 84% (kappa=0.54). Four comparative studies were included in the analysis. Scientific quality scores of the included studies ranged from 5 of 14 to 9 of 14. Three of the four studies reported a higher rate of capsular contracture in patients with silicone implants. A combined odds ratio calculated on two of the studies found a 2.25-fold increased risk of capsular contracture in patients who received silicone implants. Eight series of patients who received cohesive gel silicone implants reported rates of capsular contracture from 0% to 13.6%. CONCLUSIONS: Higher rates of capsular contracture were found in patients who received silicone implants when compared with those who received saline implants. However, the scientific quality of the comparative studies to date on this subject is poor. Recent series evaluating cohesive gel implants report relatively low rates of capsular contracture. A randomized controlled trial comparing rates of capsular contracture in cohesive gel and saline implants is recommended.

Through and through defects of the lower face.

This article considers the particular demands of reconstruction of this complex region of the head and neck in terms of its functional and aesthetic requirements. It presents a classification system that may assist in the selection of the appropriate reconstruction. Finally, the authors discuss some of the more common techniques and flaps that should be considered when planning microsurgical management, and they review the outcomes they have seen in terms of speech, diet tolerance, oral continence, and survival.

Posterior interosseous nerve compression secondary to a parosteal lipoma: Case report and literature review.

An unusual case of limited radial nerve palsy secondary to a parosteal lipoma is presented, along with a thorough review of the literature. Palsy of the posterior interosseous nerve secondary to compression by a lipoma is a rare occurrence. Most cases tend to occur in the fifth to eighth decades of life. The pattern of physical symptoms may be quite variable. A high degree of suspicion must be maintained in the setting of unexplained symptoms. The literature review revealed the presence of a diagnostic proximal forearm radiolucent mass in 13 of 15 patients. Although they are used as diagnostic aids, computed tomography and magnetic resonance imaging have not been shown to alter management. Though benign tumours constitute a minority of such cases, a plain radiograph is recommended in addition to electromyographic and nerve conduction studies.

Voici la description d'un cas plutôt rare de paralysie partielle du nerf radial, secondaire à un lipome parostéal, suivie d'un examen exhaustif de la documentation. La compression du nerf interosseux postérieur par un lipome donne rarement lieu à la paralysie. La plupart des cas se rencontrent chez les personnes âgées entre 50 et 80 ans. Les symptômes physiques peuvent varier considérablement. Il faut entretenir des doutes importants devant des symptômes inexpliqués. L'examen de la documentation a révélé la présence diagnostique d'une masse radiotransparente dans l'avant-bras proximal chez 13 patients sur 15. Bien qu'elles servent d'outils d'aide au diagnostic, la tomodensitométrie et l'imagerie par résonance magnétique ne modifient pas pour autant la prise en charge. Même si les tumeurs bénignes sont rares en pareils cas, il est recommandé de procéder à une radiographie simple, outre l'électromyographie et l'exploration de la conduction nerveuse.