Le Forum, Vol. 40 No. 4

https://digitalcommons.library.umaine.edu/francoamericain_forum/1089/thumbnail.jp

LaserGauge : development of a device for automatic measurement of bore depth in bone during surgery

Purpose: This thesis comprised two main phases. Initial work focused on clarifying the need and use case for a novel device to measure drilled bore depth in bone during osteosynthesis surgery. Next, I demonstrated the feasibility and reliability of an optical sensing device for automatic measurement of drilled bore depth in bone during surgery compared with conventional methods. Methods: I completed a structured Needs Assessment followed by an Engineering Design process to develop a series of prototypes using laser displacement sensors mounted on a surgical drill to determine drilled bore depth in bone. In all versions of the prototypes bore depth was computed based on a characteristic pattern of drilling velocity in bicortical bone. Prototypes consisted of one or more laser displacement sensors sending displacement and time data to a microprocessor and then a personal computer. After data filtering with a second order Butterworth filter velocity and acceleration were calculated using differentiation and double differentiation. Characteristic spikes in velocity and acceleration indicated cortical breach and allowed identification of bore depth. Exploratory experiments were done with multiple sensor arrangement concepts in porcine long bones, and more rigorous final evaluation experiments were done with the lead designs in pig hind limbs with comparison to CT scan as ‘gold standard’. Results: In exploratory experiments a design involving two laser displacement sensors angled towards the drilling axis measuring distance from a mock drill guide performed better than alternative designs. This design in final evaluation experiments showed superior performance to the conventional depth gauge under three clinically relevant drilling conditions (standard deviation 0.70 mm vs. 1.38 mm, 0.86 mm vs. 3.79 mm, 0.80 mm vs. 3.19 mm). A positive bias was present in all drilling conditions. Conclusions: An optical sensing device can be used to measure bore depth in bone during surgery.Applied Science, Faculty ofBiomedical Engineering, School ofGraduat

Citation Analysis in Breast Reconstruction Publications Between 2000 and 2010

Introduction and Purpose: Breast reconstruction is an active area of plastic surgery research. Citation analysis allows for quantitative analysis of publications, with more citations presumed to indicate greater influence. We performed citation analysis to evaluate the most cited papers on breast reconstruction between 2000 to 2010 to identify contemporary research trends. Methods: The SCI-EXPANDED database was used to identify the 50 most cited papers. Data points included authorship, publication year, publication journal, study design, level of evidence, number of surgeons/institutions, center of surgery, primary outcome assessed, implant/flap/acellular dermal matrix/fat graft, acellular dermal matrix brand and use with implants/flaps, fat graft use with implants/flaps, unilateral/bilateral, one-/two-stage, immediate/delayed, number of patients/procedures, complications. Descriptive analysis of trends was performed based on results. Results: 20% of papers were published in 2006, 16% in 2007 and 12% in both 2004/2009. 66% were published in Plastic and Reconstructive Surgery. The majority were retrospective or case series, and of Level III or IV evidence. The one Level I study was a prospective multicenter trial. 21 and 7 papers discussed procedures by single/multiple surgeons, respectively. Results from single/multiple centers were discussed in 18 and 6 papers, respectively. 30 papers discussed implant-based reconstruction, 22 papers flap-based (19 microsurgical), 15 papers acellular dermal matrix, and five papers fat grafting. The primary focus in the majority was complications or outcomes. Conclusion: Our analysis demonstrates continually evolving techniques in breast reconstruction. However, there is notable lack of high quality evidence to guide surgical decision-making in the face of increasing surgical options. </jats:p

Resident Behaviours to Prioritize According to Canadian Plastic Surgeons

Introduction: Many articles have been published outlining the resident selection process for plastic surgery training programs. However, which qualities Canadian plastic surgeons value most in their current residents remains unclear. A national survey study was conducted to identify which attributes surgeons associate with the highest resident performance and which behaviours trainees should prioritize during their training. Methods: A literature review was performed to identify studies that documented attributes valued in plastic surgery applicants and characteristics of high-performing surgical residents. These qualities were extracted to construct a survey consisting of both ranking and open-ended questions. After an iterative review process, the survey was disseminated nationally to consultants and trainees of Canadian plastic surgery training programs. Results: Survey responses were obtained from 120 invitees and a weighted rank was calculated for each evaluated attribute. The terms integrity, professional, and work ethic were viewed as the most important attributes prized by surgeons. Dishonesty, lack of dependability, and unprofessionalism were viewed as the most concerning behaviours. Additionally, disinterest and arrogance were identified by the open-ended questions as behaviours surgeons would like to see less frequently in their trainees. When compared to surgeons, trainees undervalued the importance of knowledge and the impact of unprofessional behaviour. Conclusions: With the multiple roles that a resident must fulfill, understanding which attributes are of the most importance will help focus self-directed learning and development within residency programs. Ultimately, instilling the importance of integrity and professionalism is most highly valued by members of the Canadian plastic surgery community. </jats:sec

Feasibility of Using Optical Sensing to Measure Bore Depth in Surgical Bone Drilling

The depth gauge is used in many osteosynthesis surgeries to measure drilled bore depth for screw selection, and has significant limitations. Its use has been shown to contribute to placement of incorrectly sized screws, which can lead to adverse outcomes in patients.We have developed an automatic depth gauge prototype which mounts on an existing surgical drill and makes use of an optical sensor. This builds off previous work in our lab which showed that drilled bore depth could be computed from continuous measurement of drill displacement relative to the bone. We tested our device in animal models and compared it with digital calipers as a gold standard. In a simple porcine model the prototype showed potentially superior performance (mean error 2.05mm, SD 0.67mm) compared with the conventional depth gauge (mean error 0.83 mm, SD 1.55 mm). However, this could not be reproduced in a more realistic porcine model.An automated depth gauge mounted on a conventional surgical drill shows potential as a replacement for the existing depth gauge, but the design needs to be refined for use in an operating room setting.</jats:p

Supplemental_1 - Resident Behaviours to Prioritize According to Canadian Plastic Surgeons

Supplemental_1 for Resident Behaviours to Prioritize According to Canadian Plastic Surgeons by Peter Mankowski, Daniel Demsey, Erin Brown and Aaron Knox in Plastic Surgery</p