Johnny I Efanov

• MD, PhD
• Plastic and Reconstructive Surgeon at Centre hospitalier de l'Université de Montréal (CHUM)

Introduction: Additive manufacturing has emerged as a promising solution for improving the accessibility and affordability of upper limb prostheses. Despite the growing need, traditional prosthetic devices remain costly and often inaccessible, particularly in underserved regions. This review examines the current landscape of 3D-printed upper limb p...

Background Centralization to trauma centers is the gold standard for digital revascularization, but avoidable transfers constitute a real challenge to the trauma network. Our transfer center is characterized by a 24/7 call center managed by specialized nurses responsible for data collection, pictures and imagery transmissions and arrangement of sys...

This editorial commentary critically examines the systematic review by Miotti et al , which discusses the evolving trends in upper lid blepharoplasty towards a conservative, volume-preserving approach. The review emphasizes the shift from traditional tissue resection to techniques that maintain anatomical integrity, paralleling broader trends in pa...

Artificial intelligence (AI) is currently utilized across numerous medical disciplines. Nevertheless, despite its promising advancements, AI’s integration in hand surgery remains in its early stages and has not yet been widely implemented, necessitating continued research to validate its efficacy and ensure its safety. Therefore, this review aims t...

This editorial explores the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on postoperative recovery in hand fracture patients, amidst shifting pain management strategies away from opioids due to their adverse effects. With hand fractures being significantly common and postoperative pain management crucial for recovery, the potential of N...

We present a design for a three-dimensional (3D) printed two-point discrimination (2PD) tool that has many of the features of commercially available 2PD tools but can be manufactured for relatively low cost using a 3D printer or laser cutter. Design freely downloadable at: https://www.thingiverse.com/thing:5360547

Objectives: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complicati...

Lymphedema continues to be a widely prevalent condition with no definitive cure. It affects a wide range of patients across different ages and backgrounds. The significant burden of this chronic and debilitating condition necessitates more research and comprehensive healthcare coverage for affected patients. In developed countries, cancer survivors...

Background and Objective Implant-based breast surgery is a common procedure for both reconstructive and aesthetic purposes. Breast implants, like any foreign object, trigger the formation of a capsule around them. While generally harmless, the capsule can undergo fibrotic changes leading to capsular contracture, which can negatively impact surgical...

Background: Appropriate thumb function is critical as it is makes up approximately 40% of the hand's function leading to the greatest influence in activities of daily living (ADLs). Local flaps are the primary option for thumb reconstruction, of which the Moberg flap has been reported to have the added advantage of its advancement capacity relative...

A systematic review was conducted on studies reporting steroid injections with ultrasound for de Quervain. From 10 studies included and 379 wrists, 73.9% reported complete resolution of symptoms, 18.2% with partial and 7.9% without resolution. When compared to the landmark-guided technique, ultrasound guidance showed significantly higher rates of s...

Background: The aim of this study was to determine the feasibility of the chicken foot model for surgical trainees interested in practising the designing, harvesting and inset of locoregional flaps of the hand. Methods: A descriptive study was performed to demonstrate the technical aspects of harvesting four locoregional flaps in a chicken foot mod...

Background:. Breast reconstruction after mastectomy improves patient quality of life. Independently of the type of reconstruction, ancillary procedures are sometimes necessary to improve results. Fat grafting to the breast is a safe procedure with excellent results. We report patient-reported outcomes using the BREAST-Q questionnaire after autologo...

Introduction Abdominoperineal resection (APR) of low rectal and anal tumors are performed for optimal oncological outcome but results in large defects in the perineum. Although vertical rectus abdominus (VRAM) flap is commonly employed for extensive perineal reconstruction, donor site morbidity remains problematic. The fascio-cutaneous “lotus petal...

Background: An amputation of the upper extremity not only is devastating for the patient's physical, emotional, and social well-being but also constitutes a financial stress for both the patient and the health care system. The objective of this study was to determine the utility and quality-adjusted life-years of hand allotransplantation versus my...

Background : Hand vascularized composite allotransplantation (VCA) and myoelectric prostheses have proven their efficacy for treating hand amputation. Despite reported functional outcomes, the lack of consensus on VCA versus myoelectric prostheses brought us to report on their utilities and costs within the Canadian healthcare system. Methods : A...

Peripheral nerve injuries represent a considerable portion of chronic disability that especially affects the younger population. Prerequisites of proper peripheral nerve injury treatment include in-depth knowledge of the anatomy, pathophysiology, and options in surgical reconstruction. Our greater appreciation of nerve healing mechanisms and the de...

Bones comprise a significant percentage of human weight and have important physiologic and structural roles. Bone remodeling occurs when healthy bone is renewed to maintain bone strength and maintain calcium and phosphate homeostasis. It proceeds through four phases: (1) cell activation, (2) resorption, (3) reversal, and (4) bone formation. Bone he...

Tendon stores, releases, and dissipates energy to efficiently transmit contractile forces from muscle to bone. Tendon injury is exceedingly common, with the spectrum ranging from chronic tendinopathy to acute tendon rupture. Tendon generally develops according to three main steps: collagen fibrillogenesis, linear growth, and lateral growth. In the...

Dupuytren's disease (DD) remains a common fibroproliferative condition with significant sequelae and impact on patient's lives. The etiology of DD is poorly understood, and genetic predisposition is thought to be a strongly associated factor. Despite remarkable strides in improving our molecular understanding of DD, clinical treatment options have...

Background Fifth metacarpal neck fractures account for 20% of all hand fractures, yet there remains debate with respect to management, particularly when conservative treatment is initiated. The objective of this study is to compare functional and patient-reported outcomes (PROs) in patients treated with early protected movement or splint immobiliza...

Arterialized venous flow-through flaps are solely vascularized through the venous plexus. The flaps were first described 40 years ago; however, reports of venous congestion and ischemia discouraged surgeons from adopting them into their armamentarium. Nevertheless, recent studies have demonstrated a resurgence of venous flow-through flaps for recon...

Our objective was to determine the potential impact of the surgical treatment of ameloblastoma in children through validated health state utility outcome measures. Methods: A survey-based preference health utility assessment using the visual analog scale, time trade-off, and standard gamble methods was undertaken among a general population sample...

Background Simulation models are increasingly important for skill acquisition during microsurgery training. Prosthetics, living and non-living biological models have been proposed in the literature in the optics of recreating real-life scenarios in a controlled environment. This study aims to validate and prove the reusability of a novel non-living...

Small surgical residency programs like plastic surgery can be challenging environments to accommodate parental leave. This study aimed to report the experiences, attitudes and perceived support of Canadian plastic surgery residents, recent graduates and staff surgeons with respect to pregnancy and parenting during training. Residents and staff surg...

Acellular dermal matrices have become a mandatory tool in reconstructive breast surgery. Since their introduction, they have been considered to be nonreactive and nonimmunogenic scaffolds. However, some patients who undergo implant-based breast reconstruction with acellular dermal matrices develop postoperative cutaneous erythema overlying their ma...

Purpose: Reconstruction of peripheral nerve gaps represents a considerable challenge for surgeons, despite traditional microsurgical technique of nerve autografts and recent advances in biological substitutes for nerve regeneration. Nerve allografts have emerged as viable alternatives for selected indications, although sparse literature has investi...

Purpose Trapeziometacarpal joint osteoarthritis can illicit a significant burden for afflicted patients. Amongst different treatment options, trapeziectomy with ligament reconstruction and tendon interposition (LRTI) has been shown to produce positive outcomes in terms of pain relief and function. Although considered safe by most surgeons, postope...

Pedicled latissimus dorsi musculocutaneous flaps are reliable options for reconstruction of torso and head and neck defects. After ensuring that no kink or external compression occurs on the pedicle, the survival rate exceeds 99%. However, we experienced a complete necrosis of the flap after insertion of a peripherally inserted central catheter lin...

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal joint osteoarthritis may have both postoperative benefits and complications. This study sought to determine the health state utility outcome measures of trapeziectomy with LRTI. Patients who underwent trapeziectomy with LRTI were invited to complete th...

Introduction: Despite positive outcomes reported in the literature, some surgeons remain reluctant to the systematic use of venous couplers in free flap tissue transfer. In our institution, the use of the coupler devices for venous anastomosis in free flap breast reconstruction has yet to be adopted by all surgeons. The purpose of the study was to...

Negative pressure wound therapy (NPWT) represents one of the many solutions for complex wounds of the upper extremity. The goal of this study was to investigate the most common indications for definitive treatment of wound defects in the upper extremity with NPWT and to report revision surgery outcomes after its use. A systematic review of the lite...

Biofilm forms when bacteria surrounded by an extracellular matrix aggregate on a surface. It can develop on many surfaces, including wound dressings; this can be particularly nefarious for burn patients undergoing skin grafting (autograft) for burn wound coverage as they often suffer from compromised immune system function. Autograft donor sites ar...

PURPOSE: The rise in alloplastic breast reconstruction has revealed a rare but serious associated malignancy, breast-implant associated anaplastic large cell lymphoma (BIA-ALCL). The first case of BIA-ALCL was diagnosed in 1997, but due to the novelty and low prevalence of this condition, many unknown characteristics remain. The aim of this study w...

Background Although increasingly reported in the literature, most plastic surgeons cannot define the etiology of double capsules. Often an incidental finding at implant exchange, double capsules are frequently associated with macrotextured devices. Several mechanisms have been proposed, including at the forefront that shearing causes a delamination...

Background: Projecting the demand for plastic surgeons has become increasingly important in a climate of scarce public resource within a single payer health-care system. The goal of this study is to provide a comprehensive workforce update and describe the perceptions of the workforce among Canadian Plastic Surgery residents and surgeons. Methods...

Background: Areas of surgical care in which, traditionally, plastic surgeons were exclusively involved are now routinely offered by other surgical specialists. Whether this shift in clinical responsibilities influenced publication rates of plastic surgeons remains unknown. The current article investigates the proportion of contributions in plastic...

Clinical approach to surgical patients has evolved to include previous patients as part of the treating team in the role of “patient–advisors”. Knowing that compliance to rehabilitation protocols is significant for a successful functional hand replantation, we set out to quantify functional patient–reported outcomes in individuals enrolled in a Pat...

Background After thumb amputations, restoration of function and aesthetic can be accomplished with microvascular free toe flaps. However, many patients in clinical practice do not choose this reconstruction despite positive reported outcomes. This study aims to determine patients' perceptions with respect to free toe flaps to improve areas of infor...

Background: Skin coverage remains a significant hurdle in large-sized burns. Recent advances have allowed to grow Bilaminar Cultured Skin Autografts (BCSGs) from patients' own donor sites. The aim of this study was to report long-term outcomes in patients with large-sized burns having received BCSGs. Methods: Nine patients received BCSGs from Ja...

Patient-Reported Outcome Measures (PROMs) are important clinical devices for evaluating injuries and surgeries of the hand. However, some of the most widely used questionnaires, such as the MHQ and bMHQ, are currently unavailable in French, which prevents them from being used in the French Canadian province of Quebec as well as in other French-spea...

Objective:. Over the past few years, virtual surgical planning (VSP) has evolved into a useful tool for the craniofacial surgeon. Virtual planning and computer-aided design and manufacturing (CAD/CAM) may assist in orthognathic, cranio-orbital, traumatic, and microsurgery of the craniofacial skeleton. Despite its increasing popularity, little empha...

Background: Despite benefits in reducing capsular contractures, textured implants have been associated with significant pitfalls such a propensity for biofilm formation. Few studies have investigated whether the use of acellular dermal matrix (ADM) on textured implants produces similar findings. This study aims to characterize biofilm formation at...

Background: Aging leads to a panoply of changes of facial morphology. The present study was conducted to analyze modifications of the facial skeleton with aging, using high-resolution imaging and comparing the same individuals at two time points. Methods: The electronic medical record system was reviewed since its inception in 2001 for patients...

Background: To prevent postoperative thrombosis, indications for anticoagulation in finger replantation have been described, but no consensus has yet been found for cessation protocols. The aim of this study is to investigate cessation methods of intravenous anticoagulation after finger replantation. Methods: A retrospective review of all patien...

Objective: Research sets the foundation for developing plastic surgeons who think critically and approach clinical practice with an inquisitive mind. The objective of this study was to characterize current attitudes and perceived barriers towards conducting research during residency. Design: A validated 36-item questionnaire was developed by a n...

Background: As opposed to upper and lower extremity amputations representing a considerable volume of admissions, the prowess of microsurgeons is seldom solicited in complex cases of head and neck replantation. Our aim was to determine the rate of successful replantation of craniofacial parts in a systematic review of the literature. Methods: We...

Background: Macro-texturing of breast implants was developed with the double goal of improving implant stabilization within the breast cavity and decreasing the rate of capsular contractures. However, recent evidence suggests that double capsular formation, a potentially worrisome phenomenon associated with late seromas and biofilms, occurs with p...

Craniomaxillofacial reconstruction using virtual surgical planning, computer-aided manufacturing, and new microsurgical techniques optimizes patient-specific and defect-directed reconstruction. A 3D customized free deep circumflex iliac artery (DCIA) flap with intraoral anastomoses was performed on a 23-year-old man with a posttraumatic right zygom...

Background: Venous congestion/insufficiency plays a major role in failure of finger replantation. Despite acceptable salvage rates with postoperative anticoagulation or leeching, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of anastomosing single versus mult...

Objective: Surgical repair of digital flexion deformities can result in vascular injuries threatening the viability of the affected digit. While uncommon, these injuries are reported to have a rate as high as 0.8% following palmo-digital fasciectomy for Dupuytren's disease. Late presentation of such vascular events pose a challenge, since taking t...

To investigate the effect of the therapeutic hypothermia (TH), used in infants with moderate or severe HIE, on fluid balance and incidence of hyponatremia. Retrospective cohort study of moderate and severe HIE infants before (pre) and after (post) TH implementation. Daily fluid and electrolytes intake/output was collected from the medical records o...

Retrospective review investigating serum calcium and magnesium levels in neonates with moderate or severe hypoxic-ischemic encephalopathy