Plastic Surgery Commons^™

Development Of An On-Call Assessment Tool For Competency-Based Surgical Training, Eric C. Mitchell

Electronic Thesis and Dissertation Repository

Introduction: A central tenet of competency-based medical education is formative assessment of trainees. There are no assessments examining resident competence on-call, despite this being a significant component of resident training and characterized by less supervision compared to daytime.

Methods: A national survey was conducted to evaluate the state of assessment in Canadian Plastic and Reconstructive Surgery programs. An on-call assessment tool was developed based on a consensus group and was piloted over six months. Validity of the tool was examined through qualitative and quantitative methods.

Results: There were 63 tools completed across ten residents and seven staff physicians. Tool reliability …

Severe Lower Extremity Trauma In Ontario: A Linked Population-Based Analysis, Stephanie M. Kim

Electronic Thesis and Dissertation Repository

Open tibia fractures (OTF) are a management challenge. Admission to a trauma center (TC) and a coordinated approach to bony fixation and soft-tissue reconstruction (STR) have been shown to improve outcomes. The objective of this study was to describe patients who had OTF in Ontario and analyze their outcomes. Linked population data pertaining to patients who had OTF between the years 2009-2020 were examined. Demographic information, admission location, and management course were collected. 4240 patients were found. The mean age was 47, and majority were males. Patients admitted to TC had greater proportion of having Injury Severity Score >15, and …

Breast Augmentation: The Current Landscape, Khalifa Sh. Al-Ghanim

Electronic Thesis and Dissertation Repository

Primary breast augmentation is one of the most common surgeries performed by plastic surgeons. Breast augmentation, since its inception in 1895, has become a multimillion-dollar industry. Today, the two most common methods include implant-based and fat graft augmentation. Implant-based augmentation includes the use of silicone or saline prosthesis to enhance breast volume or shape. With fat grafting, a patient’s fat is harvested, processed, and injected into the breast to achieve the desired result. This thesis aims to outline the current literature on both methods of breast augmentation, review patient reported outcomes, as well as a proposed clinical trial to gain …

Development Of A Novel Rodent Model Of Radiation-Induced Implant Capsular Contracture, Tanya Delyzer

Electronic Thesis and Dissertation Repository

Radiation-induced implant capsular contracture is a challenging complication of post-mastectomy breast reconstruction. The objective of this thesis was to establish a novel rodent model that replicates the critical properties of this complication. Retired breeder female Sprague-Dawley rats underwent surgery with custom smooth silicone implants placed under the right 4^th mammary fat pad. Half these rats received 26Gy of ionizing radiation to the implant and fat pad. Radiated implants had both higher Baker grades of capsular contracture and Kumar scores denoting radiation-induced fibrosis. Irradiated capsules showed increased Masson’s trichrome staining and significantly higher hydroxyproline to total protein ratio compared to …

4dct Analysis Of In-Vivo Carpal Kinematics During Fem, Manisha R. Mistry

Electronic Thesis and Dissertation Repository

A consensus, detailed understanding of carpal kinematics remains elusive. 4-dimensional CT (4DCT) is a validated modality capable of accurately studying in-vivokinematic motion. The objective of this work is to quantify normal, in-vivo kinematic motion of the carpus through a flexion-extension arc of motion using 4DCT. Ten healthy, un-injured volunteers underwent a 4DCT scanning protocol through a complete arc of flexion-extension motion. Kinematic changes in motion were quantified using helical axis motion data for each carpal bone. Helical axes were compared between bones and statistical analysis performed using repeated-measures ANOVA to identify difference in kinematic motion between bones (p<0.05). The carpus can be divided into four main kinematic blocks: the distal carpal block, the proximal carpal block and individual scaphoid and trapezial blocks. This work supports an additional segmentation of the trapezium from the distal carpal row, which suggests some modulation between the scaphoid and distal carpal row.

An Exploration Of Facial Skin Scarring, Its Impact And Contemporary Evaluation, Michael G. Brandt

Electronic Thesis and Dissertation Repository

Facial skin cancer secondary to surgical treatment may be distressing due to the malignancy itself and from the consequences of its treatment. A visible postsurgical scar is an obvious reminder of the condition. This investigation sought to broaden our understanding of facial scarring and develop a novel tool for its objective evaluation. To this end, skin cancer as the most common etiology of facial scarring was reviewed. The scar scale literature was evaluated in the context of assessing scars through a biopsychosocial lens. Finally, the development of a novel scar scale was presented. Thirty-four individuals completed 13,056 ratings using a …

Comparing Motion Outcomes In Salvage Procedures For Wrist Arthritis, Stacy Fan

Electronic Thesis and Dissertation Repository

Scaphoidectomy and four corner fusion (4CF), and proximal row carpectomy (PRC) are salvage procedures that may be offered in advanced wrist arthritis. The optimal clinical treatment remains unclear. Biomechanical studies comparing outcomes of these procedures often only report uniplanar motion, rather than multiplanar motion which is more representative of functional wrist motion. Further, the impact of altering the relationship of the proximal and distal carpal rows in the coronal plane during 4CF has not been well-studied.

The purpose of this in-vitro biomechanical study was to quantify changes in wrist kinematics during wrist flexion-extension, radial-ulnar deviation, and circumduction in “anatomic 4CF”, …

Choice Of Implant Filler In Breast Reconstruction: A Study Of The Cost-Effectiveness Of Saline And Silicone Implants, Kathleen Nelligan

Electronic Thesis and Dissertation Repository

Breast reconstruction following mastectomy is increasing and implant-based breast reconstruction is the most common surgical approach. Saline and silicone implants have different cost and complication profiles and it is unclear which is the more cost-effective option. A systematic review of the literature was undertaken to summarize the quality of life data in breast reconstruction, specifically, previously published health state utility values relevant to breast reconstruction. In addition, a cost-utility analysis was undertaken from the perspective of the third-party payer, accounting for the most common complications associated with saline and silicone implants. This demonstrated that despite the increased initial cost of …

The Promotion Of Adipogenesis In A Rat Model Of Radiation-Induced Mammary Fat Pad Fibrosis, Jessica Truong

Electronic Thesis and Dissertation Repository

Radiofibrosis of the breast makes satisfactory breast tissue reconstruction challenging and is associated with complications. Autologous fat grafting can improve surgical outcomes but fat retention is variable. We developed RHAMM peptide mimetics (NPI-110) that decrease tissue fibrosis and increase mammary fat pad adipogenesis by promoting the differentiation of mesenchymal progenitor cells into adipocytes. We tested the efficacy of NPI-110 in a rat model of radiation-induced mammary fat pad fibrosis. Effects of radiation and NPI-110 were quantified by visible skin changes, fat pad volume estimates using high frequency ultrasound, mRNA expression of genes involved in fibrosis (Collagen-1:Collagen-1, TGFß1) and adipogenesis (PPARγ, …