Faculty Bibliography

Ichthyosis is a broad and loosely defined group of hereditary and acquired disorders characterized by filaggrin dysfunction and impaired epidermal homeostasis that results in dry, scaly and thickened skin. Individuals with truncation mutations in the profilaggrin gene coding for filaggrin are strongly predisposed to severe forms of ichthyosis. The phenotypical expression of ichthyosis caused by the same genotypical mutation can vary considerably in severity and in regards to how much constricting scar tissue develops. Here, we report a case of digital ichthyosis threatening the neurovascular integrity to the small finger to discuss the importance of early diagnosis and role of Z-plasty flaps in the surgical treatment of constriction band formation.

PURPOSE:To examine the effect of mechanical fatigue on the bond strength of resin composite cemented to silica-coated yttria-tetragonal zirconia polycrystal ceramic (Y-TZP). MATERIALS AND METHODS:Ten Y-TZP blocks were polished down to 600-grit silicon carbide paper. Specimens were silica coated by airborne-particle abrasion with 30-μm silica-modified Al2O3 particles. Blocks were cleaned in an ultrasonic bath, and a dental adhesive was applied and light cured for 20 s. Pre-cured composite blocks were luted to treated Y-TZP surfaces with a dual-curing resin cement. Half of the samples (n = 5) were subjected to mechanical fatigue before trimming (fatigue group) and the other half tested 24 h after bonding procedures (control group). Forty-five beam-shaped samples with an approximately 1 mm2 cross-sectional area were prepared for each group and tested in microtensile mode at 0.5 mm/min. Fractographic analysis was performed by optical and scanning electron microscopy. Only specimens that failed at the interface area were considered for statistical analysis. Weibull distribution (95% confidence bounds) was used to determine the characteristic strength (σ0 in MPa) and Weibull modulus (m) for each group. Probability of survival was calculated over the range of loads until specimens failed. RESULTS:The control group showed σ0 = 45.91 MPa and m = 7.98, and the fatigue group σ0 = 43.94 MPa and m = 6.44 (p > 0.05). The probability of survival did not differ significantly between groups. CONCLUSIONS:Fatigue did not affect the bond strength between silica-treated Y-TZP intaglio surfaces and composite cement under these experimental conditions.

During a 1-year hospital-based residency, dental residents are required to rotate through many departments including surgery, medicine, and emergency medicine. It became apparent that there was a gap between clinical skills knowledge taught in dental school curriculum and skills required for hospital-based patient care. In response, a simulation-based intensive clinical skill "boot camp" was created. The boot camp provided an intensive, interactive 3-day session for the dental residents. During the 3 days, residents were introduced to medical knowledge and skills that were necessary for their inpatient hospital rotations but were lacking in traditional dental school curriculum. Effectiveness of the boot camp was assessed in terms of knowledge base and comfort through presession and postsession surveys. According to resident feedback, this intensive introduction for the dental residents improved their readiness for their inpatient hospital-based residency.

[This corrects the article DOI: 10.1055/s-0036-1597138.].

BACKGROUND:Patients who are seriously ill and have run out of available treatment options may seek access to investigational agents that have not yet been fully vetted by regulatory agencies for safety and efficacy and approved for use in human subjects. Over time, a variety of terms have evolved internationally to denote mechanisms for providing access to such unapproved investigational agents. The lack of consistency in terminology used to describe this process is confusing at best and, at worst, possibly even detrimental to patients. METHODS:To highlight variation around the globe in terminology denoting pre-approval access to investigational agents, we conducted extensive Internet searches to locate specific legislation, guidance, or policy documents describing access mechanisms in numerous countries. We created a table of results intended to convey a sampling of international terminological diversity. RESULTS:The profusion of terms used internationally to indicate pre-approval access to investigational agents is evident. We recommend a shift toward the use of "pre-approval access" as an umbrella term encompassing all forms of access to unapproved agents. We also recommend use of the phrases "individual/named patient regulatory routes for pre-approval access" and "group/cohort regulatory routes for pre-approval access" to differentiate between pre-approval access programs designed for single patients, versus those designed for groups of patients. CONCLUSIONS:There is a pressing need to revisit and better align pre-approval access terminology at the international level. Adopting the umbrella term "pre-approval access" may be a useful strategy for initiating and promoting harmonization of terms to reduce potential confusion by patients and health care decision makers regarding experimental treatment options.

Fingertip amputation is the most common amputation encountered by hand surgeons. Treatment decisions are multifactorial, based on mechanism, level of injury, tissue loss, associated injuries, and patient preference, among others. In this article, we present use of the thenar flap in combination with bone graft and split-thickness nail bed graft to address the tripartite loss of distal phalanx, soft tissue, and nail bed. This method allows for a full-length and functional reconstructed fingertip that is aesthetically satisfactory and does not require microsurgical techniques.

BACKGROUND:Surgical site infections (SSIs) represent one of the most common postoperative complications in patients undergoing aesthetic surgery. OBJECTIVES/OBJECTIVE:This study reports the incidence and risk factors of major SSIs following aesthetic surgery. METHODS:A prospective cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of a major SSI requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for SSIs including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. RESULTS:, P < .01) were higher in patients with SSIs. Patients with a SSI were more likely to be smokers (10.5% vs 8.2%, P = .04) and diabetic (4.5% vs 1.8%, P < .01). Females suffered more SSI than males (0.5% vs 0.3%, P = .02). Trunk/extremity procedures had a higher incidence of SSI compared to breast or face procedures (0.9% vs 0.2%, P < .01). On multivariate analysis, independent predictors of SSI included age (Relative Risk [RR] 1.01), female gender (RR 1.86), BMI (RR 1.07), smoking (RR 1.61), diabetes (RR 1.58), hospital or ambulatory surgery center procedures (RR 1.39), trunk/extremity procedures (RR 2.42), and combined procedures (RR 1.88). CONCLUSIONS:SSIs following cosmetic surgical procedures are associated with numerous independent predictors, which should be taken into consideration when counseling patients undergoing aesthetic surgery. LEVEL OF EVIDENCE/METHODS:2 Risk.

Background:Venous thromboembolism (VTE) is one of the most feared postoperative complications in cosmetic surgery. The true rate of VTE in this patient population remains largely unknown with current American Society of Plastic Surgeons (ASPS) prophylaxis recommendations partially extrapolated from other surgical specialties. Objectives:This study analyzed the risk factors for VTE in cosmetic surgical procedures. Methods:A prospective cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of a clinically significant VTE within 30 days of surgery. Risk factors analyzed included age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Results:A total of 129,007 patients were identified, of which 116 (0.09%) had a confirmed VTE. Combined procedures had a significantly higher overall rate of VTE compared to solitary procedures (0.20% vs 0.04%, P < .01). On multivariate logistic regression, significant risk factors for VTE (P < .05) included body procedures (RR 13.47), combined procedures (RR 2.4), increasing BMI (RR 1.06), and age (RR 1.02). Gender, smoking, diabetes, and type of surgical facility were not found to be significant risk factors. Face procedures (0.01%) and breast procedures (0.01%) had the lowest VTE rates, followed by combined face/body (0.16%), body procedures (0.21%), and combined body/breast procedures (0.28%). Conclusions:The incidence of VTE after cosmetic procedures is relatively low. However, the risk increases with combined procedures as well as with particular body areas, most notably trunk and extremities. Equally, significant patient risk factors exist, including BMI and age.