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Spotlight in Plastic Surgery

2018; Lippincott Williams & Wilkins; Volume: 142; Issue: 1 Linguagem: Inglês

10.1097/prs.0000000000004538

1529-4242

Brett T. Phillips, Justin M. Broyles, Erez Dayan, Rajiv P. Parikh, Navid Pourtaheri, Ara A. Salibian, Kyle Sanniec, Camilla J. Stewart, Arun K. Gosain,

Digital Imaging in Medicine

We are excited to introduce a new initiative, “Spotlight in Plastic Surgery,” intended to provide a synopsis of key articles from major journals that plastic surgeons may overlook, and Plastic and Reconstructive Surgery – Global Open. We believe this will serve to increase knowledge and awareness of articles of high relevance to plastic surgeons that are not printed in Plastic and Reconstructive Surgery. The Resident Ambassadors to Plastic and Reconstructive Surgery have shown overwhelming support for this project, reviewing key articles published from December of 2017 through March of 2018. One such article published in JAMA Oncology has already had a significant impact on awareness of breast implant–associated anaplastic large cell lymphoma (ALCL) by the medical community, highlighting the importance of this literature review in assisting our readers to improve knowledge and patient care. “Spotlight in Plastic Surgery” demonstrates that each of you as a reader of Plastic and Reconstructive Surgery can help shape the Journal, as the idea for this column was provided by an aspiring leader, Brett Phillips, who made the Editorial Board aware of this unmet need and has served to spearhead the initiative going forward. Should you have further suggestions as to articles to be reviewed or the format of Spotlight, please contact us through e-mail at [email protected] Contemporary Hormonal Contraception and the Risk of Breast Cancer. By Mørch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard Ø. Published in the New England Journal of Medicine, December 2017.1 A prospectively collected cohort study based on a national Denmark database assessed the effect of hormonal contraception use on breast cancer incidence in premenopausal women (aged 15 to 49 years; 1,797,132 patients). The results indicated that although hormonal contraception increases the relative risk of developing breast cancer, absolute risk increases were low: one additional case per year for every 7690 women on hormonal contraception. For plastic surgeons performing reduction mammaplasty or transgender mastectomy, the likelihood of having occult cancer is considered in the decision to send breast tissue for analysis. Hormonal contraception use is unlikely to affect the recommendation to send specimens for patients aged 30 years and older. Navid Pourtaheri, M.D., Ph.D. Case Western Reserve University School of Medicine Cleveland, Ohio Trial of Contralateral Seventh Cervical Nerve Transfer for Spastic Arm Paralysis. By Zeng MX, Hua XY, Feng JT, et al. Published in the New England Journal of Medicine, January 2018.2 This study investigated the effect of grafting the contralateral C7 nerve from the nonparalyzed side to the paralyzed side in patients with more than 5 years of spastic arm paralysis caused by chronic cerebral injury. The group included 36 patients randomly assigned into rehabilitation alone (n = 18) and C7 nerve transfer plus rehabilitation (n = 18). The investigators concluded that this transfer was associated with greater improvement in power, function, and reduced spasticity compared with the control group over the 12-month period. Spastic limb paralysis is a major cause of long-term disability caused by stroke, traumatic brain injury, or cerebral palsy. For plastic and hand surgeons who treat these patients, this article demonstrates the value of contralateral C7 nerve transfers. Erez Dayan, M.D. Massachusetts General Hospital Boston, Mass. Rescuing the Clinical Breast Examination: Advances in Classifying Technique and Assessing Physician Competence. By Laufer S, D’Angelo AD, Kwan C, et al. Published in the Annals of Surgery, December 2017.3 This study aims to develop new performance evaluation standards for the clinical breast examination following recent evidence that palpation force significantly affects clinical breast examination accuracy. Four validated breast models were used to assess 553 physicians attending three clinical meetings (2013 to 2014), with regression analysis showing that different finger movements independently and significantly affect clinical breast examination accuracy. Despite an emphasis on early detection and treatment, breast cancer remains a major public health problem in a demographic of patients with growing expectations of aesthetic breast surgery. Awareness of accurate clinical breast examination technique places plastic surgeons in a position to improve rates of preoperative screening. Camilla J. Stewart, M.B.Ch.B.Hons. St. Georges Hospital London, United Kingdom Complications in Postmastectomy Breast Reconstruction: One-Year Outcomes of the Mastectomy Reconstruction Outcomes Consortium (MROC) Study. By Wilkins EG, Hamill JB, Kim HM, et al. Published in the Annals of Surgery, January 2018.4 In this study from the National Cancer Institute–funded Mastectomy Reconstruction Outcomes Consortium, the authors evaluated 1-year complication rates in postmastectomy breast reconstruction. In 2224 patients across 11 centers in North America, autologous reconstructions (deep inferior epigastric perforator, free transverse rectus abdominis musculocutaneous, pedicled transverse rectus abdominis musculocutaneous, and latissimus dorsi) were associated with higher risks of complications compared with prosthetic reconstructions. Furthermore, on multivariate analyses, older age, high body mass index, immediate reconstruction, bilateral reconstruction, and radiation therapy were independent predictors of complications. This multicenter study with a large sample size represents an important step forward in patient-centered care by further enabling patients and providers to make high-quality, informed decisions regarding breast reconstruction. Rajiv P. Parikh, M.D., M.P.H.S. Washington University Hospital St. Louis, Mo. Prevalence of Work-Related Musculoskeletal Disorders among Surgeons and Interventionalists: A Systematic Review and Meta-Analysis. By Epstein S, Sparer EH, Tran BN, et al. Published online in JAMA Surgery, February 2018.5 Physicians, particularly surgeons, are at high risk for work-related musculoskeletal disorders. However, to date, there is no aggregate body of literature that examines the incidence of related musculoskeletal disorders that procedure-based physicians encounter. Dr. Bernard Lee and colleagues seek to identify the prevalence of work-related musculoskeletal disorders within this subset of physicians by using a meta-analysis of 21 articles. Not surprisingly, up to 60 percent reported pain and 12 percent reported absence, work modification, or early retirement within 12 months. It is clear from this analysis that rates of work-related musculoskeletal disorders are high among surgeons and that preventative measures should be taken to ensure a healthy, productive career. Justin M. Broyles, M.D. The Johns Hopkins University School of Medicine Baltimore, Md. Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast. By de Boer M, van Leeuwen FE, Hauptmann M, et al. Published in JAMA Oncology, March 2018.6 In this study aimed at better understanding the risk of developing breast implant–associated ALCL, de Boer et al. use a nationwide Dutch pathology registry to calculate the risk of breast implant–associated ALCL in women with and without breast implants. The authors confirm the high relative risk and low absolute risk (one in 35,000 at age 50; one in 7000 at age 75) of breast implant–associated ALCL in women with implants. Their findings also support breast implant–associated ALCL association with macrotextured implants (72 percent of cases), and reinforce the known favorable prognosis of the disease. This valuable information can further aid plastic surgeons in counseling patients undergoing implant-based procedures. Ara A. Salibian, M.D. NYU Langone Health New York, N.Y. Intraoperative Clonidine for Prevention of Postoperative Agitation in Children Anaesthetised with Sevoflurane (PREVENT AGITATION): A Randomised, Placebo-Controlled, Double-Blind Trial. By Ydemann M, Nielsen BN, Henneberg S, et al. Published in The Lancet: Child & Adolescent Health, January 2018.7 This multisite, double-blind, randomized controlled trial found that intravenous clonidine given 20 minutes before the conclusion of surgery reduced postoperative agitation and opioid consumption, prolonged the time to first analgesic administration, and decreased postoperative nausea and vomiting. They did note slightly longer recovery times in the clonidine group but ultimately found clonidine to have an acceptable safety profile and be cost-effective. Discussion on the use of intravenous clonidine should be had between the plastic surgeon and anesthesia team when treating healthy pediatric patients to decrease agitation and opioid consumption following plastic surgery intervention. Kyle Sanniec, M.D., M.H.A. University of Texas Southwestern Medical Center Dallas, Texas Long-Term Outcomes for Neoadjuvant versus Adjuvant Chemotherapy in Early Breast Cancer: Meta-Analysis of Individual Patient Data from Ten Randomized Trials. By the Early Breast Cancer Trialists’ Collaborative Group. Published in The Lancet: Oncology, January 2018.8 This meta-analysis evaluated 4756 patients with early breast cancer from randomized trials with adjuvant versus neoadjuvant chemotherapy. Neoadjuvant chemotherapy had 1.37 times greater local recurrence rates than similar sized tumors with adjuvant chemotherapy. Tumors downsized with neoadjuvant chemotherapy had higher local recurrence rates after breast conserving therapy than tumors of similar size in patients who only had adjuvant chemotherapy. When performing reconstruction of patients who have undergone breast conserving therapy after their tumors have been downsized by neoadjuvant chemotherapy, the tumor size does not equate to decreased local recurrence rates. Vigilance and collaboration with our surgical oncologists to mitigate local recurrence risks is paramount. Kyle Sanniec, M.D., M.H.A. University of Texas Southwestern Medical Center Dallas, Texas Craniofacial Reconstruction by a Cost-Efficient Template-Based Process Using 3D Printing. By Msallem B, Beiglboeck F, Honigmann P, Jaquiéry C, Thieringer F. Published in Plastic and Reconstructive Surgery Global Open, November 2017.9 In this Special Topic article from Switzerland, the authors describe the potential use of cost-efficient three-dimensional printing in craniofacial reconstruction. Increased use of computer-aided design/computer-aided manufacturing technology in our field has driven down costs and improved anatomical accuracy in these difficult reconstructive cases but remains relatively time-consuming and expensive. The authors claim that after acquiring fixed costs of a three-dimensional printer and anatomical software, individual implants using poly(methyl methacrylate) can be created within hours at a cost of only $250. Comparatively, custom polyetheretherketone implants can take several weeks to create, at a cost of several thousand dollars. Brett T. Phillips, M.D., M.B.A. The University of Texas M. D. Anderson Cancer Center Houston, Texas Liposomal Bupivacaine in Implant-Based Breast Reconstruction. By Motakef S, Wong WW, Ingargiola MJ, et al. Published online in Plastic and Reconstructive Surgery Global Open, November 2017.10 In this prospective, randomized, single-blind clinical trial, implant-based breast reconstruction patients were provided intraoperative liposomal bupivacaine or standard bupivacaine as a field block to help postoperative pain control. All patients received the same standardized postoperative pain control management. In the small sample size of 12 patients per group, the liposomal bupivacaine group was found to have decreased opioid and benzodiazepine consumption along with decreased hospital length of stay and hospital charges. No difference was seen in pain score, nausea/vomiting, or antiemetic consumption. A limitation of this study is that it is underpowered and would benefit from a much larger multicenter study. Brett T. Phillips, M.D., M.B.A. The University of Texas M. D. Anderson Cancer Center Houston, Texas Brett T. Phillips, M.D., M.B.A. Justin M. Broyles, M.D. Erez Dayan, M.D. Rajiv P. Parikh, M.D., M.P.H.S. Navid Pourtaheri, M.D., Ph.D. Ara A. Salibian, M.D. Kyle Sanniec, M.D., M.H.A. Camilla J. Stewart, M.B.Ch.B.Hons. Arun K. Gosain, M.D.