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Bouhadana G, Gornitsky J, Saleh E, El Jalbout R, Borsuk DE, Cugno S. Determination of Novel, Cranium-Based Relationships for Construct Placement in Microtia Reconstruction for Hemifacial Microsomia Patients. Cleft Palate Craniofac J 2024; 61:631-638. [PMID: 36310432 DOI: 10.1177/10556656221135925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Determine if the ideal location of the construct in microtia reconstruction for hemifacial microsomia (HFM) can be more accurately derived from measurements on the cranium. DESIGN High-resolution computerized tomography (CT) images were analyzed through craniometric linear relationships. SETTING Our tertiary care institution from 2000 to 2021. PATIENTS/PARTICIPANTS Patients diagnosed with HFM and microtia, who had high-resolution craniofacial CT scans, yielding 36 patients accounting for 44 CT scans. MAIN OUTCOME MEASURE(S) First, the integrity of the posterior cranial vault among HFM patients was determined. If proven to be unaffected, it could be used as a reference in the placement of the construct. Second, the position of the ear in relation to the cranium was assessed in healthy age-matched controls. Third, if proven to be useful, the concordance of these cranium-based relationships could be validated among our HFM cohort. RESULTS The posterior cranial vault is unaffected in HFM (P > .001). Further, craniometric relationships between the tragus and the Foramen Magnum, as well as between the tragus and the posterior cranium, have been shown to be highly similar and equally precise in predicting tragus position in healthy controls (P > .001). These relationships held true across all age groups (P > .001), and importantly among HFM patients, where the mean absolute difference in predicted tragus position never surpassed 1.5 mm. CONCLUSIONS Relationships between the tragus and the cranium may be used as an alternative to distorted facial anatomy or surgeon's experience to assist in pre-operative planning of construct placement in microtia reconstruction for HFM patients.
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Affiliation(s)
- Gabriel Bouhadana
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Jordan Gornitsky
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Eli Saleh
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Ramy El Jalbout
- Division of Diagnostic Radiology, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel E Borsuk
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
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Chocron Y, Zammit D, Cugno S, Atkinson J, Gilardino MS. Atypical Presentation of a Midline Nasal Dermoid with Intracranial Extension. Plast Surg (Oakv) 2023; 31:417-420. [PMID: 37915355 PMCID: PMC10617456 DOI: 10.1177/22925503211064376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 11/03/2023] Open
Abstract
Although rarer than their lateral orbital counterparts, dermoid cysts are part of any differential diagnosis of a midline nasal mass in the pediatric population. Here we present a case of a nasal dermoid with intracranial extension that presented as a mass appearing at the nasal-cheek junction. This atypical presentation for a nasal dermoid highlights the need for clinicians to remain vigilant and consider midline dermoid cyst as a diagnosis despite an off-midline position on the face.
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Affiliation(s)
- Yehuda Chocron
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Dino Zammit
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Jeffrey Atkinson
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Mirko S. Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
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Bouhadana G, Zammit D, Oiknine N, Cugno S. The Implementation of International Electives for Plastic Surgery Residents: Current State and Future Directions. J Craniofac Surg 2023; 34:2034-2039. [PMID: 37582277 DOI: 10.1097/scs.0000000000009602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/04/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Interest in international surgical missions has been rising exponentially, with the plastic surgery community being a leader in this endeavor. The role of residents in such missions remains a topic of debate. This systematic review aims to consolidate the literature relevant to the inclusion of plastic surgery residents on international surgical missions to devise an algorithm to facilitate resident participation. MATERIALS AND METHODS A comprehensive search of PubMed, Medline, and EMBASE was performed to identify studies relevant to plastic surgery resident involvement in the context of surgical missions. Relevant conclusions were retrieved from each study and compiled according to category. RESULTS Of 418 initial studies, 26 were retained for the qualitative synthesis. These were grouped into 3 categories: surveys (n=12), reflections (n=7), and reviews (n=7). The survey studies addressed the perceived value, educational impact, and long-term effect on participating residents. Three reflection studies were from the perspective of residents and 4 from staff, while all recounted the many benefits gained for participating residents. Review studies addressed the issue of accreditation and the ethics surrounding resident involvement. CONCLUSION This systematic review highlights the overwhelming support from residents and staff, the highly regarded educational value, and the positive global health effects associated with plastic surgery resident participation in international surgical missions. The authors hope this will encourage and facilitate the implementation of formal opportunities for residents within residency training programs.
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Affiliation(s)
| | - Dino Zammit
- Division of Plastic and Reconstructive Surgery, McGill University
| | - Noah Oiknine
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, McGill University
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Iyer H, Bouhadana G, Cugno S. Local Versus General Anesthesia in Pediatric Otoplasty: A Cost and Efficiency Analysis. Cleft Palate Craniofac J 2023:10556656231186268. [PMID: 37394834 DOI: 10.1177/10556656231186268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE Quantify the cost benefits of otoplasty under local as opposed to general anaesthesia. DESIGN A cost analysis of all components of otoplasty surgery under local anaesthesia (LA) in a minor operating room (OR) and general anaesthesia in a main OR was performed. SETTING Our institution, compared to provincial/federal data, with costs converted into 2022 Canadian dollars. PATIENTS, PARTICIPANTS Patients undergoing otoplasty under LA in the last year. INTERVENTIONS An efficiency analysis was performed by means of an opportunity cost, and the cost of failure was added to the overall LA costs. MAIN OUTCOME MEASURE Expenses for infrastructure, surgical and anaesthetic material, salaries, and personnel costs were derived from the literature, our hospital OR catalog and federal/provincial salary data, respectively. The cost of failure to tolerate local anaesthesia for such cases was also tabulated. RESULTS The true cost of LA otoplasty was computed as the absolute cost ($611.73) added to the cost of failure ($10.80), resulting in a total of $622.53/procedure. The true cost of GA otoplasty was calculated as the absolute cost ($2033.05) added to the opportunity cost ($1108.94), representing 3141.99$/procedure. The total savings when performing LA otoplasty to GA otoplasty are thus 2519.44$/case, with 1 GA otoplasty costing 5.05 LA otoplasties. CONCLUSION Otoplasty under local anaesthesia offers significant cost savings when compared with the same procedure under general anaesthesia. Economic considerations must be given particular attention given the elective nature of this procedure, which is often publicly funded.
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Affiliation(s)
- Hari Iyer
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Gabriel Bouhadana
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
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Abstract
Hypertrophic scars and keloids are caused by excessive tissue response to dermal injury due to local fibroblast proliferation and collagen overproduction. This response occurs because of pathologic wound healing due to dysregulation in the inflammatory, proliferative, and/or remodeling phase. Patients with hypertrophic scars or keloids report reduced quality of life, physical status, and psychological health. Hypertrophic scars or keloids will develop in 30 to 90% of individuals, and despite their prevalence, treatment remains a challenge. Of the treatments currently available for hypertrophic scars and keloids few have been adequately supported by studies with appropriate experimental design. Here, we aim to review the available literature to provide up-to-date information on the etiology, epidemiology, histology, pathophysiology, prevention, and management options available for the treatment of hypertrophic scars and keloids and highlight areas where further research is required.
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Affiliation(s)
- Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Tyler Safran
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Peter G. Davison
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | - Amanda M. Murphy
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
- Division of Plastic and Reconstructive Surgery, Jewish General Hospital, Montreal, Canada
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Meng F, Zuo KJ, Amar-Zifkin A, Baird R, Cugno S, Poenaru D. Pediatric burn contractures in low- and lower middle-income countries: A systematic review of causes and factors affecting outcome. Burns 2019; 46:993-1004. [PMID: 31813620 DOI: 10.1016/j.burns.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/16/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
Abstract
In low- and lower middle-income countries (LMICs), timely access to primary care following thermal injury is challenging. Children with deep burns often fail to receive specialized burn care until months or years post-injury, thus suffering impairments from hypertrophic scarring or joint and soft tissue contractures. We aimed to examine the correlation between limited access to care following burn injury and long-term disability in children in LMICs and to identify specific factors affecting the occurrence of late burn complications. A systematic literature search was conducted to retrieve articles on pediatric burns in LMICs using Medline, Embase, the Cochrane Library, LILACS, Global Health, African Index Medicus, and others. Articles were assessed by two reviewers and reported in accordance with PRISMA guidelines. Of 2896 articles initially identified, 103 underwent full-text review and 14 met inclusion criteria. A total of 991 children who developed long-term burn sequelae were included. Time from injury to consultation ranged from a few months to 17 years. Factors associated with late complications included total body surface area burned, burn depth, low socio-economic status, limited infrastructure, perceived inability to pay, lack of awareness of surgical treatment, low level of maternal education, and time elapsed between burn injury and reconstructive surgery.
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Affiliation(s)
- Fanyi Meng
- Division of Plastic and Reconstructive Surgery, Montreal Children's Hospital, Montreal, QC, Canada
| | - Kevin J Zuo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Robert Baird
- Division of Pediatric General Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, Montreal Children's Hospital, Montreal, QC, Canada
| | - Dan Poenaru
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, Montreal, QC, Canada.
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Tsangaris E, Riff KWYW, Berenguer B, Bulstrode NW, Celerier C, Cugno S, Fanous A, Mazeed AS, Marchac A, Stotland MA, Klassen AF. Translation and cultural adaptation of the EAR-Q into Arabic, Chinese, French and Spanish for use in an international field-test study. Eur J Plast Surg 2019. [DOI: 10.1007/s00238-019-01585-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Background: Cystic lesions of the carpal bones are rare entities that are infrequently reported in the literature. Scaphoid intraosseous cystic lesions represent a rare subset of carpal bone cysts. This review aims to summarize the available evidence on the evaluation and treatment of scaphoid cystic lesions to help guide clinical management. Methods: Systematic electronic searches were performed using PubMed, Ovid, and Embase databases. Studies included were graded for their risk of bias. Pooled descriptive statistics were performed on incidence, etiology, physical exam findings, treatment, and follow-up. Results: A total of 38 patients representing 41 scaphoid cystic lesions were pooled from 27 articles. Patients presented with wrist pain without fracture (n = 27), pathological fracture (n = 9), swelling only (n = 1), or were asymptomatic (n = 4). Cystic lesions of the scaphoid were initially revealed on imaging with radiographs alone (n = 22), radiographs in combination with computed tomography (CT) (n = 10) or magnetic resonance imaging (n = 6), CT alone (n = 1), or using all 3 modalities (n = 2). Intraosseous ganglia were identified most frequently (n = 31), followed by "bone cyst-like pathological change" (n = 3), unicameral bone cysts (n = 2), aneurysmal bone cysts (n = 2), primary hydatid cysts (n = 2), and cystic like changes post fall (n = 1). Treatment modalities included curettage and bone graft (n = 39) or below-elbow cast (n = 2). On follow-up (average of 21.3 months; n = 40), all patients improved clinically after treatment and were found to have full wrist range of motion without pain (n = 31), slightly reduced grip strength (n = 3), limited range of motion (n = 2), or persistent mild discomfort (n = 2). Conclusions: Scaphoid cystic lesions are most commonly intraosseous ganglia, but can include other etiologies as well. The main presenting symptom is radial wrist pain that usually resolves after treatment. The presence of intracarpal cystic lesions should be considered in the differential diagnosis of wrist pain.
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Affiliation(s)
| | | | - Becher Al-Halabi
- Division of Plastic and Reconstructive
Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Hassan Al-Naeem
- Division of Plastic and Reconstructive
Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive
Surgery, McGill University Health Center, Montreal, Quebec, Canada
- Sabrina Cugno, Department of Plastic and
Reconstructive Surgery, McGill University Health Center, 1001 Decarie Boulevard
B05.3029, Montreal, Québec, Canada H4A 3J1.
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Cugno S, Bulstrode NW. Cartilage exposure following autologous microtia reconstruction: An algorithmic treatment approach ✰. J Plast Reconstr Aesthet Surg 2018; 72:498-504. [PMID: 30528282 DOI: 10.1016/j.bjps.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 11/04/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Successful reconstruction of microtia involves fabrication of a cartilaginous framework and provision of thin, durable, soft tissue cover. Vascular compromise of this skin envelope can lead to exposure of the underlying cartilage, resulting in cartilage resorption and distortion of the final form of the ear construct. We describe our algorithm for management of this complication. METHODS All patients who underwent autologous ear reconstruction by a single surgeon (NWB) from April 2006 to September 2012 were retrospectively reviewed to identify any that developed exposure of the underlying cartilage framework. Details related to timing, location, size and management of the cartilage exposure were collected. RESULTS From a total of 230 autologous auricular reconstructions (median age at first stage, 11.4 years), 15 exposures of the cartilage framework were identified. All exposures occurred following the first stage of reconstruction (mean of post-operative day 29, range, 7-86 days). Large areas of exposure (> 10 mm2) required surgical management, with debridement and coverage with either a cutaneous or fascial flap, depending on the location. Areas < 10 mm2 were managed conservatively. All exposures were successfully treated with no adverse effects on the final aesthetic outcome. CONCLUSION Cartilage exposure following autologous microtia reconstruction can be a devastating complication if not addressed in a prompt and effective manner. The management strategy we propose provides a concise algorithm to guide the treatment of cartilage exposure. LEVEL OF EVIDENCE Therapeutic, grade III.
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Affiliation(s)
- Sabrina Cugno
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, Level 7, Paul O'Gorman Building, Great Ormond Street, London WC1N 3JH, United Kingdom; Department of Plastic and Reconstructive Surgery, Montreal Children's Hospital, 1001 boul. Décarie, Montreal, QC H4A 3J1, Canada; Department of Plastic and Reconstructive Surgery, CHU Sainte-Justine, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC H3T 1C5, Canada.
| | - Neil W Bulstrode
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, Level 7, Paul O'Gorman Building, Great Ormond Street, London WC1N 3JH, United Kingdom
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Mankowski PJ, Kanevsky J, Bakirtzian P, Cugno S. Cellular phone collateral damage: A review of burns associated with lithium battery powered mobile devices. Burns 2016; 42:e61-4. [DOI: 10.1016/j.burns.2015.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
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Cugno S, Kinsler V, Bulstrode NW. Congenital melanocytic naevi. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pearl R, Tahiri Y, Cugno S, Farhadieh RD. Plastic surgery fellowship and board exams. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cugno S, Barnacle A, Harper J, Bulstrode NW. Vascular anomalies. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cugno S, Farhadieh RD, Bulstrode NW. Autologous microtia reconstruction combined with ancillary procedures: a comprehensive reconstructive approach. J Plast Reconstr Aesthet Surg 2013; 66:1487-93. [PMID: 23938195 DOI: 10.1016/j.bjps.2013.06.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/14/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Autologous microtia reconstruction is generally performed in two stages. The second stage presents a unique opportunity to carry out other complementary procedures. The present study describes our approach to microtia reconstruction, wherein the second stage of reconstruction is combined with final refinements to the ear construct and/or additional procedures to enhance facial contour and symmetry. METHODS Retrospective analysis of patients who underwent two-stage microtia reconstruction by a single surgeon (NWB) was conducted in order to ascertain those that had ancillary procedures at the time of the second stage. Patient and operative details were collected. RESULTS Thirty-four patients (male, 15, median age and age range at second stage, 11 and 10-18 years, respectively) who had complementary procedures executed during the second stage of auricular reconstruction were identified. Collectively, these included centralizing genioplasty (n = 1), fat transfer (n = 22), ear piercing (n = 7), and contralateral prominauris correction (n = 7). Six patients had correction for unilateral isolated microtia and in the remaining 28 patients, auricular reconstruction for microtia associated with a named syndrome. All patients reported a high rate of satisfaction with the result achieved and the majority (85%) reported no perceived need for additional surgical refinements to the ear or procedure(s) to achieve further facial symmetry. No peri- or post-operative complications were noted. CONCLUSION Combining the final stage of autologous microtia reconstruction with other ancillary procedures affords a superior aesthetic outcome and decreased patient morbidity.
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Affiliation(s)
- S Cugno
- Department of Plastic Surgery, Great Ormond Street Hospital for Children NHS Trust, Level 7, Paul O'Gorman Building, Great Ormond Street, London WC1N 3JH, United Kingdom.
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Abstract
Despite significant improvements in surgical technique and perioperative care, the management of patients requiring chest wall resection and reconstruction is an ongoing challenge for thoracic surgeons. A successful approach includes a thorough assessment of the patient and the lesion, an adequate biopsy to confirm tissue diagnosis, and a well-established treatment plan. In the case of a primary tumor of the chest wall, the extent of the resection should not be limited by the size of the resulting defect. Following resection, chest wall reconstruction mandates an appreciation for restoration of functional and structural components. An algorithmic approach to chest wall reconstruction begins with the assessment of the nature of the defect, taking into consideration factors such as infection, tumor location, previous radiation therapy, and surgical intervention. The latter factors bear influence on the type of tissue required as well as whether reconstruction can be performed in a single stage or whether it is better delayed. Finally, patient factors including lifestyle and work, as well as prognosis, are considered to determine the best reconstructive option.
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Affiliation(s)
- Pasquale Ferraro
- Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montreal, Université de Montreal, 1560 Sherbrooke Street East, Montreal, Quebec H2L 4M1, Canada.
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Cugno S, Rizis D. Beyond the borders of keloid formation: A case report. Plast Surg (Oakv) 2011. [DOI: 10.4172/plastic-surgery.1000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Cugno S, Rizis D, Cordoba C. Beyond the borders of keloid formation: A case report. Can J Plast Surg 2011; 19:e10-e11. [PMID: 22379373 PMCID: PMC3086507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The keloid scar is a cutaneous mass characterized by nodular fibroblastic proliferation of dermis and a predilection for distinctive anatomical locations. However, keloid extension to neighbouring tissue as a nonsyndromic entity has not been described. In the present report, a case involving a 48-year-old woman with extensive bilateral keloids of the ear lobules and neck following ear piercing is presented.
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Affiliation(s)
| | | | - C Cordoba
- Correspondence: Dr Carlos Cordoba, Centre Hospitalier de l’Université de Montréal, 1560 Sherbrooke Street East, Montreal, Quebec H2L 4M1. Telephone 514-890-8000 ext 23757, fax 514-412-7575, e-mail
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Cugno S, prince J, Althubaiti G, Lee H, Moses MA. Groupe pour L’Avancement de la Microchirurgie Canada (GAM). Plast Surg (Oakv) 2009. [DOI: 10.4172/plastic-surgery.1000599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
BACKGROUND Facial composite tissue allotransplantation is a potential reconstructive option for severe facial disfigurement. The purpose of the present investigation was to use decision analysis modelling to ascertain the expected quality-adjusted life years (QALYs) gained with face transplantation (versus remaining in a disfigured state) in an effort to assist surgeons with the decision of whether to adopt this procedure. STUDY DESIGN The probabilities of potential complications associated with facial allotransplantation were identified by a comprehensive review of kidney and hand transplant literature. A decision analysis tree illustrating possible health states for face allotransplantation was then constructed. Utilities were obtained from 30 participants, using the standard gamble and time trade-off measures. The utilities were then translated into QALYs, and the expected QALYs gained with transplantation were computed. RESULTS Severe facial deformity was associated with an average of 7.34 QALYs. Allotransplantation of the face imparted an expected gain in QALYs of between 16.2 and 27.3 years. CONCLUSIONS The current debate within the medical community surrounding facial composite tissue allotransplantation has centred on the issue of inducing a state of immunocompromise in a physically healthy individual for a non-life-saving procedure. However, the latter must be weighed against the potential social and psychological benefits that transplantation would confer. As demonstrated by a gain of 26.9 QALYs, participants' valuation of quality of life is notably greater for face transplantation with its side effects of immunosuppression than for a state of uncompromised physical health with severe facial disfigurement.
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Affiliation(s)
- Sabrina Cugno
- Surgical Outcomes Research Centre (SOURCE), McMaster University, Hamilton, Ontario
| | - Sheila Sprague
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St Joseph’s Healthcare, Hamilton, Ontario
| | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Achilleas Thoma
- Surgical Outcomes Research Centre (SOURCE), McMaster University, Hamilton, Ontario
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St Joseph’s Healthcare, Hamilton, Ontario
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
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Thoma A, Cugno S, Sprague S, Duku E. Decision Analysis Model for Facial Composite Tissue Allotransplantation. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-955121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cugno S, Sprague S, Duku E, Thoma A. Measurement of Utility Values and Quality of Life in Facial Disfigurement as a Prelude to Composite Tissue Allotransplantation of the Face. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-955149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Saririan M, Cugno S, Blankenship J, Huynh T, Sedlis S, Starling M, Pilote L, Wilson B, Eisenberg MJ. Routine versus selective functional testing after percutaneous coronary intervention in patients with diabetes mellitus. J Invasive Cardiol 2005; 17:25-9. [PMID: 15640536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Patients with diabetes mellitus who undergo percutaneous coronary intervention (PCI) have higher rates of restenosis and a poorer prognosis than patients without diabetes. The American College of Cardiology/American Heart Association guidelines on exercise testing suggest that patients with diabetes may benefit from routine post-PCI functional testing (FT). To explore this issue, we examined the functional capacity, quality of life, event rates and procedural outcomes among 61 patients with diabetes enrolled in the Aggressive Diagnosis of Restenosis (ADORE) trial. All patients were randomized to either routine FT or selective FT and were followed for a period of 9 months. Patients with diabetes randomized to routine FT had a higher composite clinical event rate than those randomized to the selective FT strategy. Procedural rates did not differ significantly between the two groups. These results suggest that routine post-PCI FT in patients with diabetes is of little clinical value.
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Puri R, Eisenberg MJ, Pilote L, Blankenship JC, Cugno S, Huynh T. Better functional status among U.S. than Non-U.S. patients after percutaneous coronary intervention: An effect of medical care? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82807-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cugno S, Eisenberg MJ, Blankenship J, Huynh T, Azrin M, Sedlis S, Pilote L. Impact of percutaneous coronary intervention on functional status: results from the ADORE trial. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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