Use of a Barbed Suture Tie-Over Technique for Skin Graft Dressings: A Case Series

Joyce, Kenneth M.,Joyce, Cormac W.,Mahon, Nicola,Kelly, Jack L. Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.3

Background A tie-over dressing is the accepted method to secure skin grafts in order to prevent haematoma or seroma formation. We describe the novel application of a barbed suture tie-over for skin graft dressing. The barbs act as anchors in the skin so constant tensioning of the suture is not required. Methods From January 2014 to August 2014 we used the technique in 30 patients with skin defects requiring split-thickness or full-thickness grafts. Patient demographics, clinicopathological details and graft outcome were collected prospectively. Results The majority of cases were carried out for split-thickness skin grafts (n=19) used on the lower limb (n=20). The results of this novel technique were excellent with complete (100%) graft take in all patients. Conclusions Our results demonstrate the clinical application of a barbed device for securing skin grafts with excellent results. We find the technique quick to perform and the barbed device easy to handle, which can be applied without the need for an assistant.

Levels of Evidence in the Plastic Surgery Literature: A Citation Analysis of the Top 50 ‘Classic’ Papers

Kenneth M Joyce,Cormac W Joyce,John C Kelly,Jack L Kelly,Sean M Carroll 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.4

Background The plastic surgery literature is vast, consisting of a plethora of diverse articles written by a myriad of illustrious authors. Despite this considerable archive of published material, it remains nebulous as to which precise papers have had the greatest impact on our specialty. The aim of this study was to identify the most cited papers in the plastic surgery literature and perform a citation analysis paying particular attention to the evidence levels of the clinical studies. Methods We identified the 50 most cited papers published in the 20 highest impact plastic surgery journals through the Web of Science. The articles were ranked in order of number of citations acquired and level of evidence assessed. Results The top 50 cited papers were published in six different journals between the years 1957 and 2007. Forty-two of the papers in the top 50 were considered as level IV or V evidence. No level I or II evidence was present in the top 50 list. The average level of evidence of the top 50 papers was 4.28. Conclusions In the plastic surgery literature, no positive correlation exists between a high number of citations and a high level of evidence. Anatomical reconstructive challenges tend to be the main focus of plastic surgery rather than pathologic diseases and consequently, papers with lower levels of evidence are relatively more valuable in plastic surgery than many other specialties.

Use of a Barbed Suture Tie-Over Technique for Skin Graft Dressings: A Case Series

Kenneth M Joyce,Cormac W Joyce,Nicola Mahon,Jack L Kelly 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.3

Background A tie-over dressing is the accepted method to secure skin grafts in order to prevent haematoma or seroma formation. We describe the novel application of a barbed suture tie-over for skin graft dressing. The barbs act as anchors in the skin so constant tensioning of the suture is not required. Methods From January 2014 to August 2014 we used the technique in 30 patients with skin defects requiring split-thickness or full-thickness grafts. Patient demographics, clinicopathological details and graft outcome were collected prospectively. Results The majority of cases were carried out for split-thickness skin grafts (n=19) used on the lower limb (n=20). The results of this novel technique were excellent with complete (100%) graft take in all patients. Conclusions Our results demonstrate the clinical application of a barbed device for securing skin grafts with excellent results. We find the technique quick to perform and the barbed device easy to handle, which can be applied without the need for an assistant.

Proximal Interphalangeal Joint Dislocations and Treatment: An Evolutionary Process

Kenneth Michael Joyce,Cormac Weekes Joyce,Frank Conroy,Jeff Chan,Emily Buckley,Sean Michael Carroll 대한성형외과학회 2014 Archives of Plastic Surgery Vol.41 No.4

Background: Proximal interphalangeal joint (PIPJ) dislocations represent a significantproportion of hand clinic visits and typically require frequent follow-ups for clinical assessment,orthotic adjustments, and physiotherapy. There are a large number of treatmentoptions available for PIPJ dislocations, yet no prospective or controlled studies have beencarried out, largely due to the diversity of the various types of injuries. Methods: We retrospectively reviewed all the PIPJ dislocations in our institution over a fiveyearperiod and directly compared the different splinting techniques that we have used overthis time frame. Results: There were a total of 77 dislocations of the PIPJ (57 men and 20 women) that wereincluded in our study. We found that our management has shifted gradually from completeimmobilisation to controlled early mobilisation with figure-of-eight splints. Followingtreatment, the range of motion of the PIPJ in the figure-of-eight group was significantlygreater than that in the other three methods (P<0.05) used. There were significantly fewerhospital visits in the figure-of-eight splint group than in the other treatment groups. Conclusions: The treatment of PIPJ dislocations has undergone a significant evolution in ourexperience. Early controlled mobilisation has become increasingly important, and therefore,splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellentresults in our experience. It should be considered for all PIPJ dislocations, but careful patientselection is required to achieve optimum results.

Levels of Evidence in the Plastic Surgery Literature: A Citation Analysis of the Top 50 'Classic' Papers

Joyce, Kenneth M,Joyce, Cormac W,Kelly, John C,Kelly, Jack L,Carroll, Sean M Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.4

Background The plastic surgery literature is vast, consisting of a plethora of diverse articles written by a myriad of illustrious authors. Despite this considerable archive of published material, it remains nebulous as to which precise papers have had the greatest impact on our specialty. The aim of this study was to identify the most cited papers in the plastic surgery literature and perform a citation analysis paying particular attention to the evidence levels of the clinical studies. Methods We identified the 50 most cited papers published in the 20 highest impact plastic surgery journals through the Web of Science. The articles were ranked in order of number of citations acquired and level of evidence assessed. Results The top 50 cited papers were published in six different journals between the years 1957 and 2007. Forty-two of the papers in the top 50 were considered as level IV or V evidence. No level I or II evidence was present in the top 50 list. The average level of evidence of the top 50 papers was 4.28. Conclusions In the plastic surgery literature, no positive correlation exists between a high number of citations and a high level of evidence. Anatomical reconstructive challenges tend to be the main focus of plastic surgery rather than pathologic diseases and consequently, papers with lower levels of evidence are relatively more valuable in plastic surgery than many other specialties.

Proximal Interphalangeal Joint Dislocations and Treatment: An Evolutionary Process

Joyce, Kenneth Michael,Joyce, Cormac Weekes,Conroy, Frank,Chan, Jeff,Buckley, Emily,Carroll, Sean Michael Korean Society of Plastic and Reconstructive Surge 2014 Archives of Plastic Surgery Vol.41 No.4

Background Proximal interphalangeal joint (PIPJ) dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries. Methods We retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame. Results There were a total of 77 dislocations of the PIPJ (57 men and 20 women) that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (P<0.05) used. There were significantly fewer hospital visits in the figure-of-eight splint group than in the other treatment groups. Conclusions The treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.

Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi breast reconstruction: A review of patient satisfaction

Ciaran M Hurley,Adrian McArdle,Kenneth M Joyce,Eoin O’Broin 대한성형외과학회 2018 Archives of Plastic Surgery Vol.45 No.6

Background Nipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction. The aim of this study was to evaluate the surgical outcomes and patient satisfaction with immediate breast and nipple reconstruction performed in a single stage after skin-sparing mastectomy. Methods All patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included. Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy. Results During the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. The majority of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy. Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast (62±4), nipple reconstruction (61±4.8), overall outcome (74.3±5), and psychosocial well-being (77.7±3.2). Conclusions Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single- stage procedure promotes psychosocial well-being involving issues that are intrinsically linked with breast cancer surgery.

Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi breast reconstruction: A review of patient satisfaction

Hurley, Ciaran M,McArdle, Adrian,Joyce, Kenneth M,O'Broin, Eoin Korean Society of Plastic and Reconstructive Surge 2018 Archives of Plastic Surgery Vol.45 No.6

Background Nipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction. The aim of this study was to evaluate the surgical outcomes and patient satisfaction with immediate breast and nipple reconstruction performed in a single stage after skin-sparing mastectomy. Methods All patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included. Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy. Results During the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. The majority of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy. Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast ($62{\pm}4$), nipple reconstruction ($61{\pm}4.8$), overall outcome ($74.3{\pm}5$), and psychosocial well-being ($77.7{\pm}3.2$). Conclusions Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked with breast cancer surgery.