Dr Patricia Clugston-A Spirit of Determination.

Dr Patricia Clugston was a British Columbia native who completed her plastic surgery residency training in Vancouver in 1993 before pursuing a fellowship in Nashville with Dr Patrick Maxwell in 1994. When Dr Clugston returned to Vancouver, she helped to establish a comprehensive and renowned breast reconstruction program. She spent her career advocating for and working towards better treatment options for women seeking breast reconstruction. As a determined surgeon and accomplished athlete, Dr Clugston was truly a tour de force in all aspects of her life. Patty, as she was affectionately known by her colleagues, loved her job. Dr Clugston was an avid advocate for medical education and an outstanding clinical researcher and speaker that established her as a shining star in Canadian plastic surgery. Patty had always lived life to the fullest and was determined that scleroderma would not change this. Her sharp wit, intellectual curiosity, and pragmatism masked an incredible courage as she fought bravely against a cruel disease. Dr Clugston died on March 1, 2005, at the age of 46 surrounded by the loving company of her husband, friends, and family at the Vancouver General Hospital. The Dr Patricia Clugston Chair in Breast Reconstruction was established in her name to honour her legacy and continue to improve the care of patients with breast cancer.

Originaire de la Colombie-Britannique, la docteure Patricia Clugston a terminé sa résidence en plasturgie à Vancouver en 1993 avant d'effectuer des études postdoctorales à Nashville avec le docteur Patrick Maxwell en 1994. À son retour à Vancouver, elle a contribué à mettre sur pied un programme de reconstruction mammaire complet et réputé. Elle a consacré sa carrière à préconiser et à rechercher de meilleures possibilités thérapeutiques pour les femmes qui veulent une reconstruction mammaire. Chirurgienne déterminée et athlète accomplie, elle dominait dans tous les aspects de sa vie. Patty, comme l'appelaient affectueusement ses collègues, adorait son travail. Cette défenseure passionnée de l'enseignement de la médecine était une chercheuse clinicienne et une conférencière remarquable, ce qui l'a établie comme une tête d'affiche de la plasturgie au Canada. Elle a toujours vécu sa vie au maximum et était déterminée à ne pas laisser la sclérodermie y changer quelque chose. Sa vivacité d'esprit, sa curiosité intellectuelle et son pragmatisme cachaient un courage incroyable, car elle luttait contre une maladie cruelle. Elle est décédée le 1er mars 2005 au Vancouver General Hospital à l'âge de 46 ans, entourée de l'amour de son mari, de ses amis et de sa famille. La chaire Dre Patricia Clugston en reconstruction mammaire a été créée en son nom pour commémorer sa mémoire et continuer d'améliorer les soins aux patientes atteintes du cancer du sein.

The Vascular Basis of the Pronator Quadratus Muscle Flap and Its Use in Clinical Cases.

Background Pronator quadratus (PQ) is a deeply situated muscle in the forearm which may occasionally be utilized for soft-tissue reconstruction. The purpose of this anatomical and clinical study was to confirm vascular supply of PQ muscle (PQM) in order to optimize its transfer and confirm its utility in clinical situations. Methods In Part A of the anatomical study, fresh human cadavers ( n = 7) were prepared with an intra-arterial injection of lead oxide and gelatin solution, and PQM and neurovascular pedicle were dissected ( n = 14). In the anatomical study Part B, isolated limbs of embalmed human cadavers ( n = 12) were injected with India ink-gelatin mixture and PQ were dissected. Results PQ is a type II muscle flap, with one major pedicle, the anterior interosseous (AI) vessels and two minor pedicles from the radial and ulnar vessels. The mean dimensions of the muscle were 5.5 × 5.0 × 1.0 cm 3 , mean pedicle length was 9.6 cm, and the mean diameter of the artery and the vein was 2.3 mm and 2.8 mm, respectively. The dorsal cutaneous perforating branch (DPB) of the artery supplied the skin over the dorsal forearm and wrist. This branch also anastomosed with the 1, 2 intercompartmental supraretinacular artery (ICSRA). Conclusion This study confirms the potential utility and vascular basis of the PQM flap and its associated cutaneous paddle. In the clinical part, two patients with nonhealing wounds exposing the median nerve and flexor tendons in the distal forearm were treated using the PQM flap with good results.

Fast Organic Vapor Phase Deposition of Thin Films in Light-Emitting Diodes.

Fast deposition of thin films is essential for achieving low-cost, high-throughput phosphorescent organic light-emitting diode (PHOLED) production. In this work, we demonstrate rapid and uniform growth of semiconductor thin films by organic vapor phase deposition (OVPD). A green PHOLED comprising an emission layer (EML) grown at 50 Å/s with bis[2-(2-pyridinyl-N)phenyl-C](acetylacetonato)iridium(III) (Ir(ppy)2(acac)) doped into 4,4'-bis(N-carbazolyl)-1,1'-biphenyl (CBP) exhibits a maximum external quantum efficiency of 20 ± 1%. The morphology, charge transport properties, and radiative efficiency under optical and electrical excitation of the PHOLED EML are investigated as functions of the deposition rate via both experimental and theoretical approaches. The EML shows no evidence for gas phase nucleation of the organic molecules at deposition rates as high as 50 Å/s. However, the roll-off in quantum efficiency at high current progressively increases with deposition rate due to enhanced triplet-polaron annihilation. The roll-off results from accumulation of stress within the PHOLED EML that generates a high density of defect states. The defects, in turn, act as recombination sites for triplets and hole polarons, leading to enhanced triplet-polaron annihilation at high current. We introduce a void nucleation model to describe the film morphology evolution that is observed using electron microscopy.

Shaping Plastic Surgery in British Columbia-The Courtemanche Legacy.

Dr Albert Douglas Courtemanche was born in Gravenhurst, Ontario on November 16, 1929. In 1949, he was accepted to the University of Toronto Medical School, graduating in 1955. After completing his internship at the Toronto General Hospital and at the Hospital for Sick Children, he completed his surgical training in Vancouver and in the United Kingdom. When Dr Courtemanche returned from his training in 1962, he joined Dr Cowan on the surgical staff at the Vancouver General Hospital. He was responsible for establishing a new plastic surgery ward, a dedicated operating room (OR), an integrated burn unit and also starting the UBC plastic surgery training program. Dr Courtemanche became involved in working with the Royal College, first as an examiner and then as the Chairman of the Plastic Surgery Exam Board in 1981. He eventually became the first and only plastic surgeon to ever hold the position as President of the Royal College. Dr Courtemanche emphasized throughout his career the importance of teaching and role modeling. A very proud moment in Dr Courtemanche's career was when his son Douglas became a pediatric plastic surgeon. After retiring Dr Courtemanche became a volunteer at the VanDusen Botanical Garden and completed their Master Gardeners Program.

Le docteur Albert Douglas Courtemanche est né à Gravenhurst, en Ontario, le 16 novembre 1929. En 1949, il est accepté à l'école de médecine de l'Université de Toronto, où il est promu en 1955. Après avoir terminé son internat au Toronto General Hospital et au Hospital for Sick Children, il se spécialise en chirurgie à Vancouver et au Royaume-Uni. À son retour en 1962, il complète l'unité de chirurgie du Vancouver General Hospital avec le docteur Cowan. Il met sur pied un nouveau service de chirurgie plastique, une salle d'opération réservée, une unité intégrée des grands brûlés et le programme de formation en chirurgie plastique de l'université de la Colombie-Britannique. Le docteur Courtemanche s'investit au sein du Collège royal, d'abord comme examinateur, puis comme président du comité d'examen en chirurgie plastique en 1981. Il devient enfin le premier et le seul chirurgien plasticien à occuper la présidence du Collège royal. Tout au long de sa carrière, le docteur Courtemanche a souligné l'importance de l'enseignement et de la formation par l'exemple. Il a d'ailleurs ressenti une grande fierté lorsque son fils Douglas est devenu chirurgien plasticien en pédiatrie. Après avoir pris sa retraite, le docteur Courtemanche est devenu bénévole au jardin botanique VanDusen, où il a suivi le programme de maître jardinier.

Dr Henry Shimizu: The Journey of a Canadian Plastic Surgeon, Advocate, and Artist.

Dr Henry Shimizu was a dedicated Canadian plastic surgeon with Japanese roots who spent his career practicing in Edmonton at the University of Alberta Hospital. He relished the opportunity to share his expertise by training residents and medical students. Dr Shimizu completed his plastic surgery training in the United States and was central to establishing the plastic surgery training program in Edmonton. Beyond clinical practice, Dr Shimizu was a prominent advocate in his community, serving as the Chairman of the Redress committee for Japanese internment. As a talented painter, he had produced magnificent oil paintings based on childhood recollections as an internee in the Slocan Valley. Dr Shimizu has made significant contributions to Canadian plastic surgery serving as president of the Canadian Society of Plastic Surgeons in 1978. His clinic work and dedication to the community at large were recognized with the Order of Canada in 2004 and more recently an honorary degree from the University of Victoria. Dr Shimizu continues to golf, paint, and travel in his retirement. He is happily married to his wife Joan and is the proud father of 4 children and 6 grandchildren.

Le docteur Henry Shimizu, un plasticien canadien dévoué d'origine japonaise, a exercé pendant toute sa carrière à l'University of Alberta Hospital d'Edmonton. Il adorait partager ses compétences par l'enseignement aux résidents et aux étudiants en médecine. Il a terminé sa formation en chirurgie plastique aux États-Unis et a joué un rôle essentiel dans la création du programme de chirurgie plastique à Edmonton. Au-delà de la pratique clinique, le docteur Shimizu était un militant réputé dans sa communauté : il a présidé le comité de redressement pour l'internement des Japonais. Peintre talentueux, il a produit de magnifiques peintures à l'huile sur ses souvenirs d'enfance alors qu'il était interné dans la vallée de Slocan. Le docteur Shimizu a contribué largement à la chirurgie plastique au Canada et a présidé la Société canadienne des chirurgiens plasticiens en 1978. Il a été nommé membre de l'Ordre du Canada en 2004 pour son travail clinique et son dévouement envers l'ensemble de la communauté, et plus récemment, a reçu un doctorat honorifique de l'université de Victoria. Maintenant à la retraite, le docteur Shimizu continue de jouer au golf, de peindre et de voyager. Il vit un mariage heureux avec sa femme, Joan, et est le fier père de quatre enfants et de six petits-enfants.

Dr Michael Bell: A Surgeon With Boundless Ingenuity.

Dr Michael Bell was born in Kingston, Ontario, on October 14, 1944. He was always a curious child who exhibited a tendency toward innovation and experimentation. Dr Bell was accepted into the MD program at the University of Toronto graduating in 1969 before completing his plastic surgery residency there. Dr Bell accepted a position bringing hand and microsurgery expertise to the University of Ottawa in 1976. He pioneered the widespread use of local anesthetic for surgery and developed an innovative relationship with Leonard Lee of Lee Valley tools. Canica Design created several surgical products, including an enhanced design on the traditional scalpel handle and wound closure devices. Dr Bell had a passion for making improvements to enable surgeons to advance patient care. He encourages a philosophy of critical thinking that contributes to continued design in plastic surgery. Dr Bell continues to design and craft new devices with alumni of the Lee Valley Tools team.

Le docteur Michael Bell est né le 14 octobre 1944 à Kingston, en Ontario. Il a toujours été un enfant curieux, qui affichait une tendance vers l'innovation et l'expérimentation. Accepté au programme de médecine à l'université de Toronto, il a obtenu son diplôme en 1969 avant d'y effectuer sa résidence en chirurgie plastique. Il a accepté un poste à l'Université d'Ottawa en 1976, où il a mis en valeur ses compétences en chirurgie de la main et en microchirurgie. Ce pionnier de l'utilisation généralisée des anesthésiques locaux pour la chirurgie, a noué une relation novatrice avec Leonard Lee de Lee Valley Tools. Canica Design® a créé plusieurs produits chirurgicaux, y compris la conception améliorée du manche habituel de scalpel et des dispositifs de fermeture des plaies. Le docteur Bell se passionnait pour les améliorations afin que les chirurgiens puissent faire progresser les soins aux patients. Il favorise une philosophie de pensée critique qui contribue à poursuivre les concepts en chirurgie plastique et continue de concevoir et d'inventer de nouveaux dispositifs avec les anciens de l'équipe de Lee Valley Tools.

Three-Dimensional Vascular Anatomical Study of the Tensor Fasciae Latae Muscle and Perforators.

BACKGROUND: To harvest any flap on the lateral circumflex femoral artery (LCFA) including tensor fasciae latae (TFL) muscle, a precise description of the vascular anatomy is required. There have been conflicting reports of the vascular supply of TFL and its overlying skin. The objective of this study was to evaluate the anatomy of the TFL muscle according to the location, origin, type, caliber, and length of vessels that supply the muscle. METHODS: This study was performed on human cadavers (n = 16 thighs) that were injected with a mixture of lead oxide and gelatin through the femoral artery. Whole body computed tomography scans were performed. Three-dimensional images of the arterial anatomy were created using Materialise Interactive Medical Image Control Software (MIMICS). Anatomical dissection of all cadaver thighs was performed to visualize the arterial blood supply of the muscle and its regional perforators. RESULTS: Sixteen thighs were included in the study. The main arterial supply of the TFL muscle was in all cases, the ascending branch of the LCFA (LCFA-asc) artery. The mean external diameter of the LCFA-asc artery was 2.7 mm ± 0.4 and the mean length was 3.6 cm ± 0.6. The distance from the anterior superior iliac spine to point where the vascular pedicle reaches the muscle ranged from 6.7 to 10.2 cm. The average number of cutaneous perforators was 10.9 ± 4. There were musculocutaneous perforators in all of our dissections (n = 16) and 14 of our specimens had septocutaneous perforators. CONCLUSION: The main vascular supply to the TFL muscle is the ascending branch of the LCFA, which also gives rise to septocutaneous and musculocutaneous perforators. MIMICS provides excellent three-dimensional anatomical information about the vascular supply of the TFL.

Future of 3D printing: How 3D bioprinting technology can revolutionize healthcare?

Currently there are more than 2,000 children on the transplant waiting list-and more than 100,000 Americans nationwide-awaiting a matching organ. Most children aged one through 10 are awaiting a kidney, liver, or heart. As with any transplant, there are two ways to find an organ-someone can donate or someone can die. Unfortunately, the supply falls far short of the demand, leaving people to die every day waiting for a second chance at life. Scientific and medical experts, however, continue to develop promising technology like 3D bioprinting that could save thousands of lives without the need of a donor.

Computed Tomographic Angiography Used for Localization of the Cutaneous Perforators and Selection of Anterolateral Thigh Flap "Bail-Out" Branches.

BACKGROUND: The purpose of this study was to evaluate the territory supplied by the lateral circumflex femoral artery for the consistency of a proximal perforator that could be used as an alternative pedicle for the anterolateral thigh flap if a tedious intramuscular course is encountered during elevation of the perforator used to develop the initial surgical plan. It is hypothesized that a consistent "bail-out" perforator supplying the proximal thigh would facilitate a simpler anterolateral thigh flap harvest, with minimal modification to flap design. METHODS: Computed tomographic images of 9 fresh cadavers were imported using Materialize's Interactive Medical Imaging Control System software to create surface-rendered 3-dimensional reconstructions of 15 lower limbs. Perforators emerging proximally and laterally to a 3-cm radius circle drawn at the midpoint of the anterior superior iliac spine and superolateral patella were considered potential bail-out perforators and evaluated for their number emerging diameter, length, course, and location relative to the anterior superior iliac spine. RESULTS: An average of 2.9 ± 1.8 perforators per limb were identified. Mean pedicle length was 111 ± 20 mm, measured from the origin in the lateral circumflex femoral artery to where the perforators emerged through the deep fascia directly overlying the thigh muscles. Average diameter at origin in the lateral circumflex femoral artery was 2.8 ± 0.8 mm, and that at emergence through the deep fascia was 1.1 ± 0.3 mm. Vessel course was predominantly musculocutaneous (90%). CONCLUSIONS: A significant bail-out perforator routinely supplies the proximal anterolateral thigh and may be used as an alternative vascular pedicle for an anterolateral thigh flap if a tedious intramuscular course is encountered during elevation of a perforator identified within the conventional landmarks (3-cm radius circle at the midpoint of the anterior superior iliac spine and superolateral patella).

Morphology and phylogeny of Prorocentrum caipirignum sp. nov. (Dinophyceae), a new tropical toxic benthic dinoflagellate.

A new species of toxic benthic dinoflagellate is described based on laboratory cultures isolated from two locations from Brazil, Rio de Janeiro and Bahia. The morphology was studied with SEM and LM. Cells are elliptical in right thecal view and flat. They are 37-44µm long and 29-36µm wide. The right thecal plate has a V shaped indentation where six platelets can be identified. The thecal surface of both thecal plates is smooth and has round or kidney shaped and uniformly distributed pores except in the central area of the cell, and a line of marginal pores. Some cells present an elongated depression on the central area of the apical part of the right thecal plate. Prorocentrum caipirignum is similar to Prorocentrum lima in its morphology, but can be differentiated by the general cell shape, being elliptical while P. lima is ovoid. In the phylogenetic trees based on ITS and LSU rDNA sequences, the P. caipirignum clade appears close to the clades of P. lima and Prorocentrum hoffmannianum. The Brazilian strains of P. caipirignum formed a clade with strains from Cuba, Hainan Island and Malaysia and it is therefore likely that this new species has a broad tropical distribution. Prorocentrum caipirignum is a toxic species that produces okadaic acid and the fast acting toxin prorocentrolide.

The Superficial Femoral Artery Flap: A 3-Dimensional Anatomical Study.

BACKGROUND: The superficial femoral artery perforator (SFAP) flap offers advantages for pedicled transfer including consistent perforators and vascular territory, well-hidden donor site scar, and hairless flap skin. This article provides a historical overview of the SFAP flap and describes the vascular anatomy of the SFAP by 3-dimensional analysis and angiography. METHODS: Ten fresh cadavers were injected using the lead oxide technique through the femoral artery. Spiral computed tomographic scanning and 3-dimensional evaluation were used to describe the SFAP number, diameter, length, type, and location. RESULTS: A total of 288 perforators in 15 cadaver limbs were identified; 19 ± 8 perforators per thigh ≥0.5 mm in diameter, with an average diameter of 0.8 ± 0.3 mm and a range of 0.5 to 2.1 mm; the mean length of each perforator was 68 ± 31 mm; 45% were septocutaneous and 55% were musculocutaneous. The medial thigh region was divided into 6 areas (anterior and posterior halves, then the proximal third, middle third, and distal third of each). The majority of the perforators were located in the middle and distal thirds of the anteromedial thigh (33% each). CONCLUSIONS: Using 3-dimensional vascular anatomical analysis, the number, location, length, type, and diameter of the SFAP were documented. In the literature, relatively few reports of the use of the SFAP flap are available, however, this is a valid donor site with consistent cutaneous perforators suitable for harvest as a local or regional flap transfer. This is the first 3-dimensional vascular anatomical study to comprehensively document the vascular anatomy of the SFAP flap.

HISTORIQUE: Le lambeau des perforateurs de l'artère fémorale superficielle (PAFS) comporte des avantages lors d'un transfert de lambeau pédiculé, y compris un territoire perforateur et vasculaire uniforme, une cicatrice bien cachée au site du prélèvement et un lambeau glabre. Le présent article fournit un aperçu historique du lambeau PAFS et en décrit l'anatomie vasculaire par analyse et angiographie tridimensionnelles. MÉTHODOLOGIE: Les chercheurs ont fait une injection dans l'artère fémorale de dix cadavres frais à l'aide de la technique d'oxyde de plomb. Ils ont utilisé la tomodensitométrie spiralée et l'évaluation tridimensionnelle pour décrire le nombre, le diamètre, la longueur, le type et l'emplacement des PAFS. RÉSULTATS: Les chercheurs ont repéré 288 perforateurs dans les membres de 15 cadavres : 19 ± 8 perforateurs par cuisse, d'au moins 0,5 mm de diamètre, d'un diamètre moyen de 0,8 ± 0,3 mm et d'une plage de 0,5 mm à 2,1 mm. Chaque perforateur avait une longueur moyenne de 68 ± 31 mm, 45 % étaient septocutanés et 55 %, musculocutanés. Les chercheurs ont séparé la région médiale de la jambe en six sections (moitiés antérieure et postérieure, et tiers proximal, moyen et distal de chaque moitié). La majorité des perforateurs se trouvaient dans le tiers moyen ou distal de la cuisse antéromédiale (33 % chacun). CONCLUSIONS: À l'aide d'une analyse anatomique vasculaire tridimensionnelle, les chercheurs ont consigné le nombre, l'emplacement, la longueur, le type et le diamètre des PAFS. Relativement peu de publications traitent de l'utilisation du lambeau PAFS, mais c'est un site de prélèvement valable doté de perforateurs cutanés constants, qui convient pour exciser un lambeau en vue d'un transfert local ou régional. Il s'agit de la première étude anatomique vasculaire tridimensionnelle à détailler l'anatomie vasculaire du lambeau PAFS.

The Effect of Written Information on Recall of Surgical Risks of Carpal Tunnel Release Surgery: A Randomized Controlled Study.

BACKGROUND: Written information has been thought to help patients recall surgical risks discussed during the informed consent process, but has not been assessed for carpal tunnel release, a procedure with the rare but serious risk of complex regional pain syndrome. The authors' objective was to determine whether providing a pamphlet would improve patients' ability to remember the risks of surgery. METHODS: Sixty patients seen for carpal tunnel release were included in this prospective, single-blind, randomized study. Patients received either a written pamphlet of the risks of surgery or no additional information following a standardized consultation. Two weeks after the initial consultation, patients were contacted to assess their risk recall and whether they had read about the operation from any source. RESULTS: There was no difference in terms of the number of risks recalled between pamphlet (1.33 ± 1.21) or control groups (1.45 ± 1.22; p = 0.73). Recall of infection was better in the pamphlet group (p < 0.05). No patients remembered complex regional pain syndrome. There was no difference in the proportion of people who read additional information about carpal tunnel release surgery between the pamphlet (34.8 percent) and control groups (21.4 percent; p = 0.39), but reading about carpal tunnel release surgery was associated with improved recall (2.45 ± 1.13 versus 0.77 ± 0.91; p < 0.01). CONCLUSIONS: Reading about surgery improved risk recall, but providing this information in the form of a pamphlet did not, nor did it affect patients' ability to recall the risk of complex regional pain syndrome. These results demonstrate that surgeons should implement additional measures to improve comprehension of surgical risks. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Community occupational therapy for people with dementia and family carers (COTiD-UK) versus treatment as usual (Valuing Active Life in Dementia [VALID] programme): study protocol for a randomised controlled trial.

BACKGROUND: A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers (Community Occupational Therapy in Dementia (COTiD)) was found clinically and cost effective in the Netherlands but not in Germany. This highlights the need to adapt and implement complex interventions to specific national contexts. The current trial aims to evaluate the United Kingdom-adapted occupational therapy intervention for people with mild to moderate dementia and their family carers living in the community (COTiD-UK) compared with treatment as usual. METHODS/DESIGN: This study is a multi-centre, parallel-group, pragmatic randomised trial with internal pilot. We aim to allocate 480 pairs, with each pair comprising a person with mild to moderate dementia and a family carer, who provides at least 4 hours of practical support per week, at random between COTiD-UK and treatment as usual. We shall assess participants at baseline, 12 and 26 weeks, and by telephone at 52 and 78 weeks (first 40% of recruits only) after randomisation. The primary outcome measure is the Bristol Activities of Daily Living Scale (BADLS) at 26 weeks. Secondary outcome measures will include quality of life, mood, and resource use. To assess intervention delivery, and client experience, we shall collect qualitative data via audio recordings of COTiD-UK sessions and conduct semi-structured interviews with pairs and occupational therapists. DISCUSSION: COTiD-UK is an evidence-based person-centred intervention that reflects the current priority to enable people with dementia to remain in their own homes by improving their capabilities whilst reducing carer burden. If COTiD-UK is clinically and cost effective, this has major implications for the future delivery of dementia services across the UK. TRIAL REGISTRATION: Current Controlled Trials ISRCTN10748953 Date of registration: 18 September 2014.

The Lumbar Artery Perforator Flap: 3-Dimensional Anatomical Study and Clinical Applications.

BACKGROUND: The lumbar region is a potential donor site for perforator-based rotational or free flaps or as a recipient site for free flaps to obtain coverage for deficits in the sacral region. Because of the lack of consensus regarding the microvascular anatomy of this potential flap site, a robust investigation of the anatomy of this region is required. METHODS: Three-dimensional reconstructions (n = 6) of the microvasculature of the lumbar region were generated using MIMICS software (Materialise, Belgium) for each of the four paired lumbar vessels. Diameter, course, and pedicle length were recorded for all lumbar artery (LA) perforators. Statistical analysis was performed using SigmaStat 4.0 and graphs were generated using GraphPad Prism 6 Software. RESULTS: Perforators arising from the first pair of LAs are reliably detected along the inferior margin of the 12th rib, extending inferiorly and laterally from the midline while perforators arising from the fourth pair of LA perforate the fascia along a horizontal plane connecting the posterior iliac crests. There are significantly more cutaneous perforators arising from the first (L1) and fourth (L4) pairs of LA than from the second (L2) and third (L3) (mean ± SD: L1, 5.5 ± 1.2; L2, 1.4 ± 0.7; L3, 1.3 ± 0.7; L4, 4.8 ± 1.0; P < 0.05). The average perforator diameter arising from L1 is greater than those arising from L4 (diameter ± SD: L1, 1.2 mm ± 0.2 >L4, 0.8 mm ± 0.2; P < 0.0001). L1 and L4 perforators have longer pedicle lengths than those arising from L2 and L3 (length ± SD: L1, 98.2 mm ± 57.8; L4, 106.1 mm ± 23.3 >L2, 67.5 mm ± 27.4; L3, 78.5 mm ± 30.3; P < 0.05). CONCLUSIONS: Perforators arising from the first and fourth LAs arise in a predictable fashion, have adequate pedicle lengths, and are of suitable diameter to support a perforator flap. We present a case to support the potential use of this flap for microvascular breast reconstruction.

Anatomical Study of the Princeps Pollicis Artery Perforator Flap.

BACKGROUND: The volar aspect of the thumb often requires local flaps for reconstruction. This study characterizes perforators of the princeps pollicis artery (PPA) and evaluates the potential of a local propeller-type flap raised using these perforators for reconstruction of these defects. METHODS: Cadavers underwent whole-body lead-oxide injection and were then imaged using a 64-slice spiral computed tomographic scanner. The DICOM images were imported into Materialise's Interactive Medical Imaging Control System (Materialise, Belgium) for 3-dimensional reconstruction of the microvasculature. The number, length, caliber, and location of perforators arising from the PPA were determined and a plot was generated illustrating the relative distribution of perforators. RESULTS: A total of 16 PPA perforators were identified in the 8 specimen hands. Perforators had a mean (SD) diameter of 1.2 (0.4) mm and mean (SD) length of 8.9 (4.8) mm. The PPA perforators were consistently identified along the radial aspect of the thenar region. Seventy percent of all PPA perforators can be found over the distal 50% of the MC [20%-54%; mean (1SD)]. CONCLUSIONS: Perforators of the PPA were found in all hands and the average caliber and length of the perforators identified is sufficient for the creation of a local perforator flap. This, coupled with the mean location of these perforators, arising near the base of the thumb, confirms that a cutaneous flap from the thenar region can be raised based on this perforator as a propeller flap to obtain coverage of distal cutaneous defects of the thumb.

Reverse Radial Artery Flap Perforator Anatomy and Clinical Applications.

The pedicled reverse radial forearm flap is a well-known option for the treatment of a variety of soft tissue wounds including dorsal hand wounds. We document the number, emerging diameter, length from origin, course, and location of all perforators of the radial artery in a series of 6 fresh human cadavers after whole body lead oxide and gelatin injection to confirm and comprehensively document the anatomy of the radial artery perforators. This data provide an anatomic basis for a modification to the reversed radial forearm flap used to decrease venous congestion in the postoperative period. Two case reports are presented to provide clinical demonstration of the importance of this modification.

Prorocentrum lima from the South Atlantic: Morphological, molecular and toxicological characterization.

Morphological descriptions using light and scanning electron microscopy and molecular characterization of two Prorocentrum lima strains (UNR-01 and UNR-09) isolated from Armação dos Búzios, Rio de Janeiro, Brazil are provided. Okadaic acid (OA), dinophysistoxin-1 (DTX1) and DTX2 production by strain UNR-01 was investigated using liquid chromatography with mass spectrometry. Toxins were extracted from heat-treated (boiled) and non-boiled cell pellets to obtain respective quantities of free and total OA and DTX1. Growth parameters (growth rate and mean generation time) were determined for strain UNR-01. Prorocentrum lima cells were oblong-to-ovate in shape, broad in the middle region, and narrow at the anterior end. The periflagellar area was triangular, set into a V-shaped depression and was composed of eight periflagellar platelets of different sizes. The morphology fits well the characterization of the species isolated from elsewhere. Phylogenetic analysis based on internal transcribed spacer - ITS - and D1-D3 large subunit - LSU - of ribosomal RNA gene sequences revealed that both strains were identical and closely related to P. lima isolates from the Caribbean Sea and USA. The growth rate of strain UNR-01 was 0.24divday-1. OA concentrations were on average 15.2 and 38.5pg[OA]cell-1 for heat-treated and non-treated cells respectively, while DTX1 mean concentration was 0.5pg[DTX1]cell-1 for both heat-treated and non-treated cells. DTX2 was not detected. To date, these are the first strains of P. lima from the south Atlantic that have been characterized.

Confirmatory factor analysis of the Michigan Hand Questionnaire.

BACKGROUND: When the Michigan Hand Questionnaire (MHQ) was originally developed, an exploratory factor analysis (EFA) was used to reduce the originally large number of generated items to the 63 items currently present on the questionnaire. Confirmation of the implied factor model of the existing MHQ has never been performed. The objective of this study was to confirm the factor model used to create the existing MHQ, and to possibly shorten the existing MHQ using factor analysis. METHODS: Patients attending the Plastic Surgery Clinic at the QEII Health Sciences Centre with a hand complaint were asked to complete the MHQ. Confirmatory factor analysis was performed to explore the implied factor structure of the original EFA and to examine the interplay between the MHQ subscales. Further item-reduction was performed using clinically guided decisions as well as factor analysis-guided statistics. RESULTS: Initial confirmatory factor analysis showed that original EFA model does not optimally explain the relationships between items in the existing MHQ and their corresponding factors. Our abbreviated model of the MHQ consists of 23 items, and performed more favorably in all goodness-of-fit parameters than the original 63-item questionnaire. CONCLUSIONS: The factor model of the existing MHQ does not fully take advantage of the relationship between items in the MHQ and the proposed factors. This study proposes a shortened version of the MHQ that more accurately reflects hand health as well as a factor-based interpretation of the subscales that takes interdependent relationships into account.

Anatomy and physiology of perforator flaps of the upper limb.

Perforator flaps are an excellent reconstructive option for a functional upper limb reconstruction. This article explores the physiology and general principles of perforator flaps and their indications for use in reconstruction of the upper extremity. Workhorse perforator flaps of the upper extremity, such as the radial artery perforator, ulnar artery perforator, lateral arm perforator, posterior interosseous artery, first dorsal metacarpal artery perforator and perforator-based propeller flaps, are discussed in greater detail.