Subjects -> MANUFACTURING AND TECHNOLOGY (Total: 363 journals)
    - CERAMICS, GLASS AND POTTERY (31 journals)
    - MACHINERY (34 journals)
    - MANUFACTURING AND TECHNOLOGY (223 journals)
    - METROLOGY AND STANDARDIZATION (6 journals)
    - PACKAGING (19 journals)
    - PAINTS AND PROTECTIVE COATINGS (4 journals)
    - PLASTICS (42 journals)
    - RUBBER (4 journals)

PLASTICS (42 journals)

Showing 1 - 39 of 39 Journals sorted alphabetically
ACS Applied Polymer Materials     Hybrid Journal   (Followers: 8)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Industrial and Engineering Polymer Research     Open Access   (Followers: 4)
Advances in Polymer Technology     Open Access   (Followers: 14)
Chinese Journal of Polymer Science     Hybrid Journal   (Followers: 9)
Cirugia Plastica Ibero-Latinoamericana     Open Access  
European Polymer Journal     Hybrid Journal   (Followers: 42)
High Performance Polymers     Hybrid Journal   (Followers: 1)
International Journal of Biobased Plastics     Open Access   (Followers: 1)
International Journal of Polymeric Materials     Hybrid Journal   (Followers: 6)
International Polymer Processing     Full-text available via subscription   (Followers: 1)
Iranian Journal of Polymer Science and Technology     Open Access   (Followers: 1)
Journal of Applied Polymer Science     Hybrid Journal   (Followers: 107)
Journal of Cellular Plastics     Hybrid Journal  
Journal of Elastomers and Plastics     Hybrid Journal  
Journal of Inorganic and Organometallic Polymers and Materials     Hybrid Journal   (Followers: 8)
Journal of Plastic Film and Sheeting     Hybrid Journal   (Followers: 1)
Journal of Polymer Research     Hybrid Journal   (Followers: 7)
Journal of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
Journal of Polymers and the Environment     Hybrid Journal   (Followers: 1)
Majalah Kulit, Karet, dan Plastik     Open Access  
Microplastics and Nanoplastics     Open Access   (Followers: 1)
Plastic and Polymer Technology     Open Access   (Followers: 40)
Plastic and Reconstructive Surgery     Hybrid Journal   (Followers: 30)
Plastics Engineering     Partially Free  
Polymer     Hybrid Journal   (Followers: 84)
Polymer Bulletin     Hybrid Journal   (Followers: 6)
Polymer Engineering & Science     Hybrid Journal   (Followers: 14)
Polymer Science Series B     Hybrid Journal   (Followers: 4)
Polymer Science Series C     Hybrid Journal   (Followers: 3)
Polymer Science Series D     Hybrid Journal   (Followers: 3)
Polymer Science, Series A     Hybrid Journal   (Followers: 3)
Polymer-Plastics Technology and Materials     Hybrid Journal   (Followers: 5)
Polymers and Polymer Composites     Hybrid Journal  
Polymers from Renewable Resources     Hybrid Journal  
Progress in Rubber, Plastics and Recycling Technology     Hybrid Journal   (Followers: 1)
Reinforced Plastics     Full-text available via subscription   (Followers: 17)
SPE Polymers     Open Access  
Similar Journals
Journal Cover
Plastic and Reconstructive Surgery
Journal Prestige (SJR): 1.731
Citation Impact (citeScore): 2
Number of Followers: 30  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0032-1052 - ISSN (Online) 1529-4242
Published by LWW Wolters Kluwer Homepage  [297 journals]
  • The Art of Questioning

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      Authors: Seyferth; Anne; Ratna, Aarushi; Chung, Kevin C.
      Abstract: imageNo abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • A Comparison of Complications in Therapeutic versus Contralateral
           Prophylactic Mastectomy Reconstruction: A Paired Analysis

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      Authors: Sergesketter; Amanda R.; Marks, Caitlin; Broadwater, Gloria; Shammas, Ronnie L.; Greenup, Rachel A.; Clancy, Sharon; Plichta, Jennifer K.; Hollenbeck, Scott T.; Phillips, Brett T.
      Abstract: imageBackground: Although breast reconstruction after bilateral mastectomies including a contralateral prophylactic mastectomy is known to have a higher overall complication profile, whether reconstructive complication rates differ between the therapeutic mastectomy and contralateral prophylactic mastectomy sides remains unclear.Methods: Women undergoing bilateral mastectomies with autologous or implant-based breast reconstruction for a unilateral breast cancer at a single institution were identified (2009 to 2019). Postoperative complications were stratified by laterality (therapeutic mastectomy versus contralateral prophylactic mastectomy). Paired data were analyzed to compare the risks of complications between prophylactic and therapeutic reconstruction sides in the same patient.Results: A total of 130 patients (260 reconstructions) underwent bilateral autologous or implant-based reconstruction. Although most women underwent a simple mastectomy, a higher proportion of therapeutic mastectomies were modified radical mastectomies including axillary lymph node dissections compared to contralateral prophylactic mastectomies (15.4 percent versus 0 percent). Forty-four percent of women completed postmastectomy radiation therapy of the therapeutic side before definitive reconstruction. Overall, both therapeutic and prophylactic reconstructions had a similar incidence of reconstructive failure (p = 0.57), return to the operating room (p = 0.44), mastectomy skin flap necrosis (p = 0.32), seroma (p = 0.82), fat necrosis (p = 0.16), wound infection (p = 0.56), and cellulitis (p = 0.56). Nearly one-fifth of patients experienced complications limited to the prophylactic side [contralateral prophylactic mastectomy reconstruction complications, n = 26 (20.0 percent); therapeutic mastectomy reconstruction complications, n = 15 (11.5 percent)].Conclusion: Despite a history of local radiation therapy and more extensive oncologic surgery on the therapeutic side, there are no significant differences in the incidence of postsurgical complications on the therapeutic mastectomy and contralateral prophylactic mastectomy sides after bilateral reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Prospective Longitudinal Patient-Reported Satisfaction and Health-Related
           Quality of Life following DIEP Flap Breast Reconstruction: Effects of
           Reconstruction Timing

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      Authors: Ochoa; Oscar; Garza, Ramon III; Pisano, Steven; Chrysopoulo, Minas; Ledoux, Peter; Arishita, Gary; Ketchum, Norma; Michalek, Joel E.; Nastala, Chet
      Abstract: imageBackground: Without reconstruction, mastectomy alone can produce significant detrimental effects on health-related quality of life. The magnitude of quality-of-life benefits following breast reconstruction may be unique based on timing of reconstruction. Facilitated by the BREAST-Q questionnaire, characterization of how reconstruction timing differentially affects patient-reported quality of life is essential for improved evidence-based clinical practice.Methods: Consecutive DIEP flap breast reconstruction patients prospectively completed BREAST-Q questionnaires preoperatively and at two different time intervals postoperatively. The first (postoperative time point A) and second (postoperative time point B) postoperative questionnaires were completed 1 month postoperatively and following breast revision/symmetry procedures, respectively. Postoperative flap and donor-site complications were recorded prospectively. Stratified by timing (immediate versus delayed) of reconstruction, preoperative clinical data, operative morbidity, and BREAST-Q scores were compared at all time points.Results: Between July of 2012 and August of 2016, 73 patients underwent 130 DIEP flap breast reconstructions. Collectively, breast satisfaction, psychosocial well-being, and sexual well-being scores significantly (p < 0.001) increased postoperatively versus baseline. Chest and abdominal physical well-being scores returned to baseline levels by postoperative time point B. Preoperatively, patients undergoing delayed breast reconstruction reported significantly (p < 0.05) lower breast satisfaction, psychosocial well-being, and sexual well-being scores compared to immediate reconstruction patients. Postoperatively, delayed and immediate reconstruction patients reported similar quality-of-life scores. Outcome satisfaction and flap and donor-site morbidity were similar between groups irrespective of timing of reconstruction.Conclusions: In this prospective study, patient-reported outcomes demonstrate significant improvements in breast satisfaction, psychosocial well-being, and sexual well-being among patients following DIEP flap reconstruction. Moreover, preoperative differences in quality-of-life scores among delayed/immediate reconstruction patients were eliminated postoperatively.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Defining Mastectomy Skin Flap Necrosis: A Systematic Review of the
           Literature and a Call for Standardization

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      Authors: Oleck; Nicholas C.; Gu, Cindy; Pyfer, Bryan J.; Phillips, Brett T.
      Abstract: imageBackground: Mastectomy skin flap necrosis following breast reconstruction may lead to wound dehiscence, infection, implant exposure, and reconstructive failure. The absence of a standardized definition for it has led to variation in estimated incidence, from as low as 2 percent to greater than 40 percent. The authors systematically reviewed the literature on mastectomy skin flap necrosis to characterize existing definitions and provide a framework for future classification.Methods: A systematic review of the PubMed and Cochrane databases identified studies reporting a discrete definition of mastectomy skin flap necrosis and corresponding outcomes in breast reconstruction. Provided definitions were extracted, categorized, and comparatively analyzed.Results: Fifty-nine studies met inclusion criteria, with a combined total of 14,368 patients and 18,920 breasts. Thirty-four studies (57.6 percent) reported mastectomy skin flap necrosis solely as a function of total breasts, and 11 (18.6 percent) reported mastectomy skin flap necrosis solely as a function of total patients. Only 14 studies (23.7 percent) provided two separate rates. The overall rate of mastectomy skin flap necrosis was 10.4 percent (range, 2.3 to 41.2 percent) and 15.3 percent (range, 4.7 to 39.0 percent), when reported per breast or per patient, respectively. Studies were categorized by mastectomy skin flap necrosis definition, including intervention (n = 33), depth (n = 20), area (n = 4), and timing (n = 2). Mastectomy skin flap necrosis rates were highest in studies defining necrosis by depth (15.1 percent), followed by intervention (9.6 percent), timing (6.4 percent), and area (6.3 percent). Necrosis rates among studies defining mastectomy skin flap necrosis by intervention, depth, and area were found to be statistically different (p < 0.001)Conclusions: Reported mastectomy skin flap necrosis definitions and outcomes vary significantly in the existing literature. For accurate characterization and quantification, a clear, simplified, consensus definition must be adopted.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Combining Breast and Ovarian Operations Increases Complications

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      Authors: Henn; Dominic; Barrera, Janos A.; Sivaraj, Dharshan; Lin, John Q.; Rizk, Nada M.; Ma, Irene; Gurtner, Geoffrey C.; Lee, Gordon K.; Nazerali, Rahim S.
      Abstract: imageBackground: Breast cancer resulting from a genetic mutations, such as BRCA1 or BRCA2, is seen in 5 to 10 percent of patients. More widespread genetic testing has increased the number of affected women undergoing prophylactic mastectomy and oophorectomy. Recent studies have yielded mixed results regarding complication rates after combined breast and ovarian operations. The authors compared surgical outcomes of breast operations performed in combination with salpingo-oophorectomies or as separate procedures.Methods: The authors retrospectively analyzed surgical complications and length of hospital stay in 145 female patients, from which 87 had undergone combined breast surgery and salpingo-oophorectomy, and 58 had undergone these procedures separately. Multivariate logistic regression models were used to calculate odds ratios and 95 percent confidence intervals.Results: Patients undergoing combined breast and ovarian operations experienced higher rates of overall complications (46.5 percent versus 19 percent; p < 0.001), infections (22.2 percent versus 8.6 percent; p < 0.05), and delayed wound healing (13.2 percent versus 0 percent; p < 0.05) related to the breast surgery, when compared with patients undergoing separate procedures. Multivariate logistic regression analysis confirmed a significant association between combined surgery and overall postoperative complications (OR, 5.87; 95 percent CI, 2.03 to 16.91; p = 0.02). Patients undergoing tissue expander–based breast reconstruction combined with ovarian surgery had significantly longer hospital stays compared to patients undergoing separate procedures (3.5 days versus 1.8 days; p < 0.001).Conclusions: The authors’ data indicate that combining breast and ovarian operations is associated with a higher risk of postoperative complications related to the breast procedure and increases the duration of hospital stay in patients with tissue expander–based reconstructions. The authors’ study provides valuable information for preoperative counseling of patients considering both breast and ovarian surgery.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • The Impact Oncoplastic Reduction Has on Long-Term Recurrence in Breast
           Conservation Therapy

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      Authors: Losken; Albert; Smearman, Erica L.; Hart, Alexandra M.; Broecker, Justine S.; Carlson, Grant W.; Styblo, Toncred M.
      Abstract: imageBackground: The use of oncoplastic reduction techniques have many proven benefits over lumpectomy alone in the management of women with breast cancer. The impact it has on tumor recurrence is unclear. The purpose of this review was to evaluate the incidence of recurrence in patients who underwent oncoplastic reduction techniques compared to lumpectomy alone.Methods: A prospectively maintained database of patients at Emory Hospital who underwent oncoplastic reduction techniques at the time of tumor resection was queried. These patients were compared to a series of patients who had lumpectomy alone over a similar period. For inclusion in the study, patients were at least 10 years since the time of the tumor resection. The main outcome of interest was tumor recurrence.Results: There were 97 patients in the lumpectomy-only group and 95 patients in the oncoplastic reduction group, with an average follow-up of 7.8 years and 8.5 years, respectively. Patients in the oncoplastic group were younger (lumpectomy only, 61.4 years; oncoplastic reduction, 51.6 years; p < 0.001) and had larger tumors (lumpectomy only, 1.1 cm; oncoplastic reduction, 1.6 cm; p < 0.001). Local recurrence was 13 percent in the lumpectomy-only group and 9 percent in the oncoplastic reduction group (p = 0.34), and overall recurrence rates were similar (lumpectomy only, 15 percent; oncoplastic reduction, 24 percent; p = 0.13). Overall, surgical intervention (lumpectomy alone versus oncoplastic reduction) was not associated with local recurrence or any recurrence on univariate and multivariate analyses.Conclusion: Despite the oncoplastic reduction patients having a higher risk of recurrence and a more generous tumor resection, the long-term recurrence rates were equivalent when compared to breast-conserving therapy alone.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Reverse Lymphatic Mapping and Immediate Microsurgical Lymphatic
           Reconstruction Reduces Early Risk of Breast Cancer–Related Lymphedema

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      Authors: Weinstein; Brielle; Le, Nicole K.; Robertson, Ellen; Zimmerman, Amanda; Tavares, Tina; Tran, Thanh; Laronga, Christine; Panetta, Nicholas J.
      Abstract: imageBackground: Breast cancer–related lymphedema is a progressive disease that poses tremendous physical, psychosocial, and financial burden on patients. Immediate lymphaticovenular anastomosis at the time of axillary lymph node dissection is emerging as a potential therapeutic paradigm to decrease the incidence of breast cancer–related lymphedema in high-risk patients.Methods: Eighty-one consecutive patients underwent reverse lymphatic mapping and, when feasible, supermicrosurgical immediate lymphaticovenular anastomosis at the time of axillary lymph node dissection at a tertiary care cancer center. Patients were followed prospectively in a multidisciplinary lymphedema clinic (plastic surgery, certified lymphatic therapy, dietary, case management) at 3-month intervals with clinical examination, circumferential limb girth measurements, and bioimpedance spectroscopy. An institutional control cohort was assessed for the presence of objectively diagnosed and treated breast cancer–related lymphedema. Data were analyzed by a university statistician.Results: Seventy-eight patients met inclusion, and 66 underwent immediate lymphaticovenular anastomosis. Mean follow-up was 250 days. When compared to a retrospective control group, the rate of lymphedema in patients who underwent immediate lymphaticovenular anastomosis was significantly lower (6 percent versus 44 percent; p < 0.0001). Patients with 6-month follow-up treated with combined adjuvant radiation therapy and chemotherapy had significantly greater risk of developing breast cancer–related lymphedema (p = 0.04) compared to those without combined adjuvant therapy. Arborized anastomotic technique had a statistically shorter operative time than end-to-end anastomosis (p = 0.005).Conclusions: This series of consecutive patients demonstrate a 6 percent incidence of early-onset breast cancer–related lymphedema with immediate lymphaticovenular anastomosis and an increased risk in those undergoing combined adjuvant treatment. These early data represent an encouraging and substantial decrease of breast cancer–related lymphedema in high-risk patients.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Discussion: Reverse Lymphatic Mapping and Immediate Microsurgical
           Lymphatic Reconstruction Reduces Early Risk of Breast Cancer–Related
           Lymphedema

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      Authors: Liu; Daniel Z.
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Effective Treatment of Chronic Mastectomy Pain with Intercostal Sensory
           Neurectomy

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      Authors: Hart; Sarah E.; Agarwal, Shailesh; Hamill, Jennifer B.; Brown, David L.
      Abstract: imageSummary: Chronic postmastectomy pain affects up to 40 percent of patients and leads to diminished quality of life and increased risk of opioid dependence. The cause of this pain is incompletely understood; however, one hypothesis is that direct injury to cutaneous intercostal nerves at the time of mastectomy and/or reconstruction leads to chronic pain. As a result, proximal neurectomy of the involved sensory nerve(s) has been suggested to be effective for these patients. The purpose of this study was to determine whether chronic pain in postmastectomy patients can be diagnosed reliably in an office setting and pain reduced by intercostal sensory neurectomy. The authors performed a retrospective review of seven patients with a history of breast surgery and chronic pain who underwent intercostal neurectomy combined with muscle or dermal wrapping of the proximal end of the resected nerve. All patients were diagnosed by history and physical examination, and suspected nerves were further identified with local anesthetic nerve blocks. An average of 3.14 neurectomies were performed per patient (range, one to six). There was a significant reduction in visual analogue scale pain scores following surgery, from 9 preoperatively to 1 postoperatively (p = 0.02). Eighty-six percent of patients were pain-free or “considerably improved” at their latest follow-up appointment (average, 6.14 months). It is concluded that intercostal sensory nerve injury at the time of mastectomy and/or reconstruction can lead to chronic mastectomy pain, which can be easily diagnosed and effectively treated with intercostal neurectomy.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Robotic Harvest of the Deep Inferior Epigastric Perforator Flap for Breast
           Reconstruction: A Case Series

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      Authors: Bishop; Sarah N.; Asaad, Malke; Liu, Jun; Chu, Carrie K.; Clemens, Mark W.; Kapur, Sahil S.; Largo, Rene D.; Selber, Jesse C.
      Abstract: imageBackground: Robotic surgery is emerging as a viable tool in reconstructive surgery. Harvesting of the deep inferior epigastric perforator flap is typically performed through an anterior approach, which involves a long fascial incision. A robotic approach allows the deep inferior epigastric pedicle to be harvested from the posterior surface. This approach reduces the length of the fascial incision and should decrease the abdominal morbidity associated with large fascial dissections.Methods: A case series study of 21 patients who underwent a robotic deep inferior epigastric perforator or during a 12-month period for breast reconstruction was performed. Patient demographics, surgical characteristics, and complications were assessed.Results: Mean patient age was 54.6 ± 7.6 years, and mean body mass index was 30.4 ± 3.9 kg/m2. Mean fascial incision and pedicle length were 3.6 ± 1.6 cm and 13.3 ± 1 cm, respectively. None of the patients required conversion to open harvest. Mean length of hospital stay was 3.8 ± 0.9 days. Surgical site occurrences were identified in five patients (31.3 percent). One patient had delayed wound healing at the donor site. None of the patients developed hernia or bulge. The mean benefit (B = C − A), defined as length of fascial incision spared and measured as the difference between pedicle length and intramuscular course, was 9.83 ± 2.28 cm. The precision of computed tomography angiography in identifying the intraoperative fascial incision was 86 percent.Conclusion: The robotic deep inferior epigastric perforator flap is a safe and reliable technique that decreases the length of fascial incision and short-term complications associated with the open approach.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Tear Trough Filler Techniques Utilizing Hyaluronic Acid: A Systematic
           Review

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      Authors: Rao; Babar K.; Berger, Lauren E.; Reilly, Catherine; Alamgir, Mahin; Galadari, Hassan
      Abstract: imageBackground: Hyaluronic acid soft-tissue augmentation fillers are commonly injected into multiple areas of the face, including the tear trough. Despite well-documented risks, there is no standardized, evidence-based approach to inject filler in this area, be it using a hypodermic needle or a microcannula. The authors, therefore, sought to establish a preference between the two methods to facilitate progression toward standardization and prevention of adverse events.Methods: This is a systematic review of articles discussing hyaluronic acid tear trough injection techniques performed in vivo and related outcomes. Searches were conducted across The Cochrane Library, PubMed, Scopus, Web of Science, and Embase to yield relevant articles published before February of 2020. All selected articles incorporated discrete patient cases and were analyzed by a variety of variables assessing evidence strength, outcomes, technique, and patient safety.Results: After appraisal, 42 articles met eligibility criteria: 20 using needles, 12 using cannulas, and 10 focusing on adverse events. Level III was the most commonly awarded evidence grade, corresponding to retrospective, nonexperimental descriptive studies. There were no statistically significant differences in reported aesthetic results, patient satisfaction, or incidence of adverse events across the needle-based and cannula-based articles. Some technique trends, such as targeted anatomical plane and needle position, emerged in subsequent articles.Conclusion: Given that there were no statistically significant differences in patient safety or outcomes, an evidence-based preference for needle or cannula injection into the tear trough cannot be made at this time. Current inconsistencies make tear trough injection procedures difficult to replicate, making standardization based on avoidance of adverse events not feasible.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Current Practices in Dorsal Augmentation Rhinoplasty

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      Authors: Fisher; Mark; Alba, Brandon; Ahmad, Jamil; Robotti, Enrico; Cerkes, Nazim; Gruber, Ronald P.; Rohrich, Rod J.; Bradley, James P.; Tanna, Neil
      Abstract: imageBackground: Dorsal augmentation rhinoplasty addresses the aesthetic and functional impairments caused by a deficient nasal dorsum. Augmentation rhinoplasty can be performed using a variety of different surgical techniques and grafting materials that all have distinct advantages and disadvantages.Methods: Grafting materials have unique characteristics, uses, and safety profiles. A detailed overview of various grafting materials and their uses, risks, and benefits is provided.Results: Autologous grafting materials include septal cartilage, auricular cartilage, and costal cartilage. These donor sites can provide various amounts of en bloc or diced cartilage. Alternatively, bone may be used when strong structural stability is required, and soft tissue may be used to fill mild to moderate defects. Homologous grafts (e.g., irradiated and nonirradiated rib) and acellular dermal matrices are alternatives to autologous graft with many similar advantages and no need for an additional surgical site. Lastly, alloplastic implants may be successfully used for dorsal augmentation if both patient and surgeon understand their associated risks.Conclusion: To perform successful dorsal augmentation, surgeons should be familiar with the wide variety of operative approaches and augmentation materials that are currently available and understand their risks, benefits, and uses.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Outcomes of Combined Liposuction/Laser Skin Tightening versus Open
           Suction-Assisted Brachioplasty in Moderate Arm Ptosis

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      Authors: Fayek; Mina; Rizk, Ibrahem N.; Hashem, Ahmed M.; El Sharkawy, Omar A.
      Abstract: imageBackground: Only a few studies have directly compared outcomes of different arm contouring techniques across matched cohorts of patients. In this study, the authors present preliminary data comparing outcomes of conventional open suction-assisted brachioplasty (using the Pascal and Le Louarn procedure) versus combined liposuction/laser skin tightening in (grade 2b arm ptosis per El Khatib classification).Methods: Thirty patients (60 arms) (28 women, two men) with moderate brachial ptosis (severe upper arm adiposity and a moderate degree of skin laxity) (grade 2b arm ptosis per El Khatib classification) were included. Objective and subjective measures were used in the assessment of results.Results: There were no statistically significant differences in objective measurements (arm circumference reduction ratio and percentage of ptosis elimination) between the groups. Patient satisfaction scores were higher with liposuction/laser skin tightening and found to be statistically significant (p < 0.05). Patients in this latter cohort reported less pain and earlier return to work (mean less than a week) (p < 0.05). Four patients complained of residual ptosis in each group.Conclusions: Liposuction/laser skin tightening is a safe and effective alternative to open suction-assisted brachioplasty (using the Pascal and Le Louarn technique) in patients with severe arm adiposity and moderate brachial ptosis (grade 2b arm ptosis as described by El Khatib classification). Proper patient selection remains critical for the success of this treatment strategy and requires precise clinical analysis as described.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Radiofrequency Heating and High-Intensity Focused Electromagnetic
           Treatment Delivered Simultaneously: The First Sham-Controlled Randomized
           Trial

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      Authors: Samuels; Julene B.; Katz, Bruce; Weiss, Robert A.
      Abstract: imageBackground: Radiofrequency-based and high-intensity focused electromagnetic (HIFEM)-based devices have proved effective and safe for abdominal body shaping. Radiofrequency is known to reduce adipose tissue, whereas HIFEM treatment is effective for muscle definition. The authors investigated the efficacy of a novel device delivering synchronized radiofrequency and HIFEM treatment simultaneously for abdominal toning and fat reduction.Methods: Seventy-two patients were enrolled and randomly divided into active (n = 48; age, 45.5 ± 13.0 years) and sham groups (n = 24; age, 44.6 ± 12.3 years). Both groups received three treatments on the abdomen once a week. The intensity in the active group was set to maximum tolerable level; in the sham group, the intensities were set to 5 percent. Ultrasound images were taken before treatment and at 1, 3, and 6 months after treatment to examine changes in subcutaneous fat and rectus abdominis muscle thickness. Digital photographs were taken, and satisfaction and therapy comfort were assessed.Results: Ultrasound images of the active group at 1 month showed significant (p < 0.05) reduction in adipose tissue thickness by 20.5 percent (4.8 ± 2.6 mm), whereas rectus abdominis muscle thickness increased by 21.5 percent (2.0 ± 0.8 mm). Results at 3 months improved to 28.3 percent (7.6 ± 3.7 mm) and 24.2 percent (2.3 ± 0.9 mm), respectively. Improvements were maintained at 6 months after treatment in the active group, whereas the sham group showed no significant changes. Treatments were found to be comfortable. The active group showed higher satisfaction with outcomes.Conclusion: Active treatment utilizing simultaneous application of radiofrequency and HIFEM therapy resulted in a significant increase in rectus abdominis thickness and subcutaneous fat reduction, exceeding previously published results for separate HIFEM and radiofrequency treatments.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Structural Preservation Rhinoplasty: A Hybrid Approach

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      Authors: Toriumi; Dean M.; Kovacevic, Milos; Kosins, Aaron M.
      Abstract: imageSummary: Structural preservation rhinoplasty merges two popular philosophies of rhinoplasty—structure rhinoplasty and preservation rhinoplasty—in an effort to maximize patient outcomes, aesthetics, and function. This allows the surgeon to both preserve the favorable attributes of the nose, and also to structure the nasal tip and dorsum with grafts to maximize contour and support. The concept of dorsal preservation is to preserve favorable dorsal aesthetic lines without the creation of an “open roof.” However, the addition of some structure concepts can expand the utility of dorsal preservation in primary rhinoplasty patients. The authors discuss these structure concepts and their applicability to dorsal preservation.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Ferreira-Ishida Technique: Spare Roof Technique B. Step-by-Step Guide to
           Preserving the Bony Cap While Dehumping

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      Authors: Gonçalves Ferreira; Miguel; Ishida, Luiz Carlos; Ishida, Luiz Henrique; Santos, Mariline
      Abstract: imageSummary: For V-shaped nasal bones, the authors consider that ostectomy of the dorsal keystone area can be avoided, and this has led to the development of a new preservation technique: the spare roof technique B (or Ferreira-Ishida technique), where the bony cap is preserved. It includes six main steps, as follows. Step 1, draw on the surface of the skin the desired dorsal brow-tip aesthetic lines, the pyriform aperture, the rhinion, and the amount of triangular bone that has to be taken out to allow pushing-down the bony cap, and the transversal line in the beginning of the nasal hump. Step 2, release the upper lateral cartilages from the dorsal septum (“high septal strip”). Step 3, take out the amount of dorsal septum necessary to dehump. Step 4, perform the paramedian high parallel osteotomies exactly below the marked brow-tip dorsal aesthetic lines. Then, perform the second group of lower osteotomies, until the E-point, to achieve a triangular shape of bone in each side of the bony cap. Perform the ostectomy of the mentioned triangular areas. Release the lateral keystone area. Perform partial ultrasonic ostectomy endonasally, below the nasal bones, to promote the weakening of the transverse fracture line, in the sagittal plane just above the E-point. Push-down gently the rectangular bony cap with a Luc nasal forceps (19 cm) in a greenstick fashion. Perform lateral traditional osteotomies from high to low to high to narrow the bony bridge as much as is needed. Step 5, perform a regular L-shape Cottle septoplasty (if necessary). Step 6, suture the cartilaginous middle vault (upper lateral cartilages) to the dorsal aspect of the remaining septum.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Autologous Conditioned Serum Increases Fat Graft Viability More than
           Platelet-Rich Plasma in a Controlled Rat Model

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      Authors: Baykara; Gokay; Sungur, Nezih; Ozer, Kadri; Atan, Oguz; Caydere, Muzaffer; Kosar, Pinar Nercis; Kocer, Ugur
      Abstract: imageBackground: Platelet-rich plasma has been used to support fat graft retention, but it may include inflammatory mediators such as interleukin-1β. Autologous conditioned serum also contains high levels of various anti-inflammatory cytokines. The authors hypothesized that combining autologous conditioned serum with fat graft would increase fat graft survival more than platelet-rich plasma.Methods: Twenty-seven adult, male, Sprague-Dawley rats were divided into three groups of nine. Ten nonstudy rats were used to prepare platelet-rich plasma, autologous conditioned serum, and fat grafts. Next, 0.7-ml fat graft with a combination of 0.2 ml of autologous conditioned serum, platelet-rich plasma, or phosphate-buffered saline was applied to their dorsa. Fat graft volume was assessed on postoperative day 2 and on the day of euthanization at 1, 3, and 5 months postoperatively. Histopathologic analysis was performed to measure integrity, inflammation, fibrosis, and vascularization.Results: The median volume percentages and interquartile ranges at 1 month postoperatively were 97.3 percent (77.3 to 119.6 percent), 40.4 percent (30.9 to 46.9 percent), and 72.1 percent (53.6 to 84.9 percent) in autologous conditioned serum plus fat graft, phosphate-buffered saline plus fat graft, and platelet-rich plasma plus fat graft, respectively (p < 0.05); at 3 months postoperatively, values were 82.3 percent (70.3 to 88.3 percent), 36.6 percent (29.4 to 43.1 percent), and 48.3 percent (31.4 to 57.9 percent) (p < 0.001); and at 5 months postoperatively, values had increased to 83.9 percent (58.3 to 102.4 percent), 40.3 percent (20.1 to 50.6 percent), and 56.3 percent (37.7 to 74.9 percent), respectively (p < 0.05).Conclusions: Autologous conditioned serum and platelet-rich plasma improved fat graft outcomes compared to saline, whereas autologous conditioned serum was associated with less inflammation, greater fat viability, and more integrity.Clinical Relevance Statement: Combining fat graft with autologous conditioned serum may be a better option to minimize resorption rate and improve graft survival.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Intramuscular Stem Cell Injection in Combination with Bioengineered Nerve
           Repair or Nerve Grafting Reduces Muscle Atrophy

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      Authors: Schaakxs; Dominique; Wiberg, Mikael; Kingham, Paul J.; Kalbermatten, Daniel F.
      Abstract: imageBackground: Peripheral nerve injuries represent a clinical challenge, especially when they are accompanied by loss of neural tissue. In this study, the authors attempted to attain a better outcome after a peripheral nerve injury by both repairing the nerve lesion and treating the denervated muscle at the same time.Methods: Rat sciatic nerves were transected to create 10-mm gaps. Repair was performed in five groups (n = 5 rats for each), as follows: group 1, nerve repair using poly-3-hydroxybutyrate strips to connect the proximal and distal stumps, in combination with control growth medium injection in the gastrocnemius muscle; group 2, nerve repair with poly-3-hydroxybutyrate strip seeded with Schwann cell-like differentiated adipose stem cells (differentiated adipose stem cell strip) in combination with growth medium intramuscular injection; group 3, differentiated adipose stem cell strip in combination with intramuscular injection of differentiated adipose stem cells; group 4, repair using autograft (reverse sciatic nerve graft) in combination with intramuscular injection of growth medium; and group 5, autograft in combination with intramuscular injection of differentiated adipose stem cells. Six weeks after nerve injury, the effects of the stem cells on muscle atrophy were assessed.Results: Poly-3-hydroxybutyrate strips seeded with differentiated adipose stem cells showed a high number of βIII-tubulin–positive axons entering the distal stump and abundant endothelial cells. Group 1 animals exhibited more muscle atrophy than all the other groups, and group 5 animals had the greatest muscle weights and muscle fibers size.Conclusion: Bioengineering nerve repair in combination with intramuscular stem cell injection is a promising technique to treat nerve lesions and associated muscle atrophy.Clinical Relevance Statement: Nerve injuries and resulting muscle atrophy are a clinical challenge. To optimize functional recovery after a nerve lesion, the authors treated the nerve and muscle at the same time by using regenerative medicine with adipose stem cells and obtained encouraging results for future clinical applications.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Lipofilling in Osteoarthritis of the Finger Joints: Initial Prospective
           Long-Term Results

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      Authors: Meyer-Marcotty; Max; Batsilas, Ioannis; Sanders, Agnes; Dahmann, Sonja; Happe, Caroline; Herold, Christian
      Abstract: imageBackground: There is considerable interest in the possibility of offering an alternative and less invasive method of treatment for osteoarthritis that will preserve the joint. This article presents for the first time the long-term results of a prospective study following autologous fat transfer to arthritic finger joints.Methods: The authors report on 28 finger joints with osteoarthritis that they treated by injecting fatty tissue into the joints. The degree of pain, force of pinch grip, and fist closure were assessed and hand function was determined using the German version of the Disabilities of the Arm, Shoulder and Hand questionnaire.Results: The average follow-up period during the study was 44 months. The median force of pinch grip rose highly significantly from 2.00 kg (range, 0.00 to 11.00 kg) to 4.30 kg (range, 2.00 to 12.00 kg) (p < 0.001). The median force of fist closure rose from 15.00 kg (range, 2.00 to 44.00 kg) to 18.00 kg (range, 3.78 to 42.00 kg) (p = 0.082). The median Disabilities of the Arm, Shoulder and Hand value improved nonsignificantly from 50 (range, 3 to 72) to 25 (range, 0 to 85) (p = 0.129). The median level of pain experienced showed a highly significant improvement from 6.0 (range, 1.0 to 10.0) to 0.5 (range, 0.0 to 6.5) (p < 0.001).Conclusions: Even over a long-term study period, the transfer of fatty tissue to arthritic finger joints has shown itself to be a minimally invasive, safe and promising alternative treatment to conventional surgical procedures that offers significant improvements in terms of osteoarthritis symptoms. Because this method preserves the joint, conventional resection surgery still remains a later option.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • The Effect of Anticoagulation on the Treatment of Dupuytren Contracture
           with Collagenase

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      Authors: Noland; Shelley S.; Paul, Aaron W.; Pflibsen, Lacey R.; Rizzo, Marco
      Abstract: imageBackground: There have been no formal studies of the use of collagenase clostridium histolyticum (Xiaflex; Endo Pharmaceuticals, Malvern, Pa.) in the anticoagulated patient. Previous study on its use excluded patients receiving anticoagulation therapy. This study reviewed the effects of anticoagulation use in patients undergoing collagenase clostridium histolyticum injection and cord rupture to determine safety and efficacy.Methods: The authors retrospectively reviewed patients receiving collagenase clostridium histolyticum injections for Dupuytren contracture between 2010 and 2017. Outcomes included type of anticoagulation, skin tear, tendon rupture, lymphadenopathy, sensory abnormality, hematoma, and bleeding.Results: A total of 388 injections were performed in 197 patients. The average clinical follow-up was 311 days. Fifty-two percent of patients (n = 201) were anticoagulated. The vast majority were taking aspirin (acetylsalicylic acid) (n = 182), followed by warfarin (n = 27), clopidogrel (n = 9), apixaban (n = 8), rivaroxaban (n = 4), and dabigatran (n = 2). There were 42 skin tears, 21 in the anticoagulated group. One tendon rupture occurred in the anticoagulated group (acetylsalicylic acid) and none occurred in the nonanticoagulated group (p = 0.34). No patients experienced sensory abnormalities, a hematoma requiring intervention, or uncontrollable bleeding.Conclusions: Anticoagulation is commonly encountered by hand surgeons treating Dupuytren contracture. There is no significant difference in complications in the anticoagulated patient versus the nonanticoagulated patient. It is safe to perform collagenase clostridium histolyticum injections for Dupuytren contracture in the anticoagulated patient, regardless of the type of anticoagulation.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Anatomical Analysis of the Lateral Femoral Cutaneous Nerve and Its Passage
           beneath the Inguinal Ligament

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      Authors: Mandal; Patrick; Russe, Elisabeth; Schwaiger, Karl; Wechselberger, Gottfried; Feigl, Georg
      Abstract: imageBackground: Meralgia paraesthetica is a mononeuropathy of the lateral femoral cutaneous nerve. According to the literature, the nerve travels beneath the inguinal ligament 1.3 to 5.1 cm medial to the anterior superior iliac spine. Compression at this site may cause pain and paresthesia. The aim of this study was to provide more accurate measurements to improve the diagnostic and surgical management of meralgia paraesthetica.Methods: The lateral femoral cutaneous nerve was dissected bilaterally in 50 Thiel-embalmed human cadavers. Measurements were performed with a standard caliper at the superior and inferior margins of the inguinal ligament. The distance from the inner lamina of the anterior superior iliac spine to the medial margin of the lateral femoral cutaneous nerve was measured. Data were collected and statistical analysis was performed with R.Results: Ninety-three lateral femoral cutaneous nerves of 50 cadavers were dissected. In 6 percent of cadavers, the lateral femoral cutaneous nerve could not be found. The mean distance from the inner lamina of the anterior superior iliac spine to the lateral femoral cutaneous nerve’s medial border was 2.1 ± 1.3 cm (range, 0.2 to 6.4 cm; 95 percent CI, 1.8 to 2.4 cm) at the superior margin of the inguinal ligament and 1.9 ± 1.4 cm (range, 0.2 to 3.0 cm; 95 percent CI, 1.6 to 2.2 cm) at the inferior border of the inguinal ligament.Conclusion: This anatomical study shows that the majority of the lateral femoral cutaneous nerve passes beneath the inguinal ligament in a very narrow area of 0.6 cm.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Discussion: Anatomical Analysis of the Lateral Femoral Cutaneous Nerve and
           Its Passage beneath the Inguinal Ligament

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      Authors: Dellon; A. Lee
      Abstract: imageNo abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Factors Impacting the Success of Free Functioning Gracilis Muscle Transfer
           for Elbow Flexion in Brachial Plexus Reconstruction

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      Authors: Hinchcliff; Katharine M.; Kircher, Michelle F.; Bishop, Allen T.; Spinner, Robert J.; Shin, Alexander Y.
      Abstract: imageBackground: Free functioning muscle transfer is a reconstructive option to restore elbow flexion in brachial plexus injuries. The authors determined the impact of body mass index, age, and location of distal tendon attachment on elbow flexion strength after free functioning muscle transfer in traumatic brachial plexus injury patients.Methods: A retrospective review of patients who underwent free functioning muscle transfer for elbow flexion as part of their brachial plexus injury reconstruction with a minimum 2-year follow-up were evaluated. Outcomes assessed included elbow flexion strength (British Medical Research Council grade) and change in Disabilities of the Arm, Shoulder and Hand questionnaire and visual analogue scale pain scores.Results: One hundred six patients met inclusion criteria. The average age was 32 years, and the average body mass index was 27.1 kg/m2; 56.5 percent of patients achieved M3 or greater muscle grade using the authors’ strict modification of the British Medical Research Council scale. Disabilities of the Arm, Shoulder and Hand questionnaire scores improved from 45.7 to 38.8 (p < 0.05). Visual analogue scale pain scores decreased, but this trend did not obtain significance. Age and body mass index both had a significant negative impact on final free functioning muscle transfer grade (p < 0.05). Use of a distal tendon insertion led to improved muscle grade outcomes, with targeting of wrist extension being superior to finger flexion (p < 0.05). Simultaneous musculocutaneous nerve grafting did not significantly alter final elbow flexion strength.Conclusions: Increasing age and body mass index both imparted a deleterious effect on free functioning muscle transfer muscle grade. Distal muscle targets had better strength outcomes than when the biceps tendon was used.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Genetic Influence on Neurodevelopment in Nonsyndromic Craniosynostosis

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      Authors: Timberlake; Andrew T.; Junn, Alexandra; Flores, Roberto; Staffenberg, David A.; Lifton, Richard P.; Persing, John A.
      Abstract: imageBackground: Nonsyndromic craniosynostosis is one of the most common anomalies treated by craniofacial surgeons. Despite optimal surgical management, nearly half of affected children have subtle neurocognitive deficits. Whereas timing and type of surgical intervention have been studied, the possibility of genetic influence on neurodevelopment in nonsyndromic craniosynostosis patients remains unexplored.Methods: The authors performed whole-exome sequencing for 404 case-parent trios with sporadic nonsyndromic craniosynostosis. Statistical analyses were performed to assess the burden of de novo mutations in cases compared to both expectation and 1789 healthy control trios. Individuals with and without each mutation class were analyzed, and the presence or absence of various types of neurodevelopmental delay were recorded alongside demographic information.Results: The authors identified a highly significant burden of damaging de novo mutations in mutation-intolerant [probability of loss of function intolerance (pLI)>0.9] genes in nonsyndromic craniosynostosis probands (p = 5.9 × 10−6). Children with these mutations had a two-fold higher incidence of neurodevelopmental delay (p = 0.001) and a more than 20-fold greater incidence of intellectual disability (p = 7.2 × 10−7), and were 3.6-fold more likely to have delays that persisted past 5 years of age (p = 4.4 × 10−4) in comparison with children with nonsyndromic craniosynostosis without these mutations. Transmitted loss of function mutations in high-pLI genes also conferred a 1.9-fold greater risk of neurodevelopmental delay (p = 4.5 ×10−4).Conclusions: These findings implicate genetic lesions concurrently impacting neurodevelopment and cranial morphogenesis in the pathoetiology of nonsyndromic craniosynostosis and identify a strong genetic influence on neurodevelopmental outcomes in affected children. These findings may eventually prove useful in determining which children with nonsyndromic craniosynostosis are most likely to benefit from surgical intervention.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Discussion: Genetic Influence on Neurodevelopment in Nonsyndromic
           Craniosynostosis

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      Authors: Bargiela; Marie; Liao, Eric C.
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Influence of Nonsyndromic Bicoronal Synostosis and Syndromic Influences on
           Orbit and Periorbital Malformation

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      Authors: Lu; Xiaona; Forte, Antonio Jorge; Dinis, Jacob; Junn, Alexandra; Alperovich, Michael; Alonso, Nivaldo; Persing, John A.
      Abstract: imageBackground: Oculoorbital disproportion in patients with craniosynostosis has similarities and dissimilarities between syndromic and nonsyndromic cases. The authors hypothesized that these two conditions have specific individual influences as they relate to development of the orbital and periorbital skeletons.Methods: A total of 133 preoperative computed tomography scans (nonsyndromic bicoronal synostosis, n = 38; Apert syndrome bicoronal synostosis subtype, n = 33; Crouzon syndrome bicoronal synostosis subtype, n = 10; controls, n = 52) were included. Craniometric and volumetric analyses related to the orbit and periorbital anatomy were performed.Results: Orbital cavity volume was mildly restricted in nonsyndromic bicoronal synostosis (7 percent, p = 0.147), but more so in Apert and Crouzon syndromes [17 percent (p = 0.002) and 21 percent (p = 0.005), respectively]. The sphenoid side angle in Apert syndrome was wider than when compared to Crouzon syndrome (p = 0.043). The ethmoid side angle in Apert patients, however, was narrower (p = 0.066) than that in Crouzon patients. Maxilla anteroposterior length was more restricted in Apert syndrome than Crouzon syndrome (21 percent, p = 0.003) and nonsyndromic cases (26 percent, p < 0.001). The posterior nasal spine position was retruded in Crouzon syndrome (39 percent, p < 0.001), yet the anterior nasal spine position was similar in Apert and Crouzon syndromes.Conclusions: Orbit and periorbital malformation in syndromic craniosynostosis is likely the combined influence of syndromic influences and premature suture fusion. Apert syndrome expanded the anteriorly contoured lateral orbital wall associated with bicoronal synostosis, whereas Crouzon syndrome had more infraorbital rim retrusion, resulting in more severe exorbitism. Apert syndrome developed maxillary hypoplasia, in addition to the maxillary retrusion, observed in Crouzon syndrome and nonsyndromic bicoronal synostosis patients.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Safety of Mandibular Osteotomies in Infants with Pierre Robin Sequence:
           Computer-Aided Modeling to Characterize the Risks of Various Techniques

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      Authors: Siska; Robert C.; Prabhu, Shamit S.; Lor, Lyfong S.; Emmerich, Veronica; Massary, Dominic; Pan, Brian S.; Flores, Roberto L.; Runyan, Christopher M.
      Abstract: imageBackground: Mandibular distraction osteogenesis is effective for the correction of severe tongue-based airway obstruction in infants with Pierre Robin sequence. Involved osteotomies may damage developing tooth buds and/or the inferior alveolar nerve. The authors evaluated the theoretical safety of various osteotomy techniques to better define infantile mandibular anatomy using computer-aided modeling.Methods: Seven mandibular osteotomy techniques (oblique, inverted-L, multiangular, walking stick, high oblique, vertical/high inverted-L, and horizontal) were simulated using computed tomography studies from infants with Pierre Robin sequence and without other associated conditions. Software was used to manually segment the mandibular bone, inferior alveolar nerve, and tooth buds.Results: Sixty-five computed tomography scans were included, yielding 130 hemimandibles. The horizontal osteotomy pattern had significantly lower theoretical risk of tooth bud (p < 0.001) and inferior alveolar nerve involvement (p < 0.001) than all other patterns. Osteotomies with high vertical components (i.e., vertical, walking stick, and multiangular) had lower theoretical tooth bud involvement than the more proximal oblique and inverted-L osteotomies (p < 0.001). Average lingula location was measured at a point 65 percent of the mandibular width from anterior mandibular border and 63 percent of the mandibular height from the inferior mandibular border.Conclusions: Surgical planning with computed tomography scans can help evaluate an infant’s mandibular anatomy to select an osteotomy that reduces morbidity risks. Regardless of technique, tooth buds and the inferior alveolar nerve are often included in osteotomies. The lingula location in this study demonstrates a position more superior and posterior than that previously described.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Less Operating and More Overtriage: National Trends in Interfacility
           Transfer of Facial Fracture Patients

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      Authors: Wasicek; Philip J.; Kantar, Rami S.; Gebran, Selim; Yoon, Joshua; Kalsi, Richa; Morrison, Jonathan J.; Nam, Arthur J.
      Abstract: imageBackground: The purpose of this study was to characterize demographics, injury patterns, and initial management trends of facial fracture patients who were subject to interfacility transfer.Methods: Using the National Trauma Data Bank from 2007 to 2015, facial fracture patients arriving by interfacility transfer were included in the study.Results: Over 9 years, 171,618 patients were included, with 37.5 percent having an isolated facial injury. Isolated facial injury patients tended to be younger, less frequently white, more frequently assaulted, and more frequently underwent facial fracture operative repair during the index admission (all, p < 0.001). From 2007 to 2015, insurance coverage increased from 54.6 to 79.0 percent (R2 = 0.90, p < 0.001). In addition, there was a 45 percent proportional increase in patients 50 to 89 years of age compared to a 20 percent decrease in patients 0 to 39 years of age (both, R2 = 0.99, p < 0.001). The proportion of transfer patients with isolated facial injury increased over the study period (32.0 to 39.4 percent, R2 = 0.90, p < 0.001); however, there was a decline in operative intervention (29.5 to 22.1 percent, R2 = 0.94, p < 0.001) and a 151 percent increase in the proportion discharged from the emergency department upon transfer arrival (R2 = 0.99, p < 0.001).Conclusions: Facial fracture patients subject to interfacility transfer comprise a wide array of demographics and injury patterns, with most having concomitant injuries and only a minority undergoing immediate operative intervention. Over time, this demographic has become older, sustained more isolated facial injury, and undergone fewer immediate operative interventions and is more frequently insured and more frequently discharged from the emergency department upon transfer arrival, reflecting increasing rates of secondary overtriage.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Hypertelorbitism Corrected by Facial Bipartition Improves Exotropia

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      Authors: Chen; Kevin; Duvvuri, Priya; Gibstein, Alex; Nakfoor, Bruce; Fisher, Mark; Kawamoto, Henry; Bradley, James P.
      Abstract: imageBackground: The purpose of this study was to detail perioperative ophthalmologic evaluations to characterize functional ocular outcomes after facial bipartition surgery.Methods: Patients with hypertelorbitism who underwent facial bipartition surgery were studied specifically for eye motility disorders by separating patients into rare craniofacial clefts (midline and paramedian) (n = 34) and craniofacial dysostosis (Apert, Crouzon, and Pfeiffer) (n = 74). Preoperative and postoperative (12 months) ophthalmologic examinations (with depth perception tests), computed tomography scans, and magnetic resonance imaging scans were analyzed.Results: Among craniofacial cleft patients, mean interdacryon distance was reduced from 39 ± 4 mm to 17 ± 2 mm, with strabismus improved from 88 percent (exotropia 82 percent) preoperatively to only 29 percent postoperatively. Depth perception improved to a lesser degree, with abnormal tests at a rate of 79 percent preoperatively to 56 percent postoperatively. Wider hypertelorbitism had a higher degree of strabismus. Among craniofacial dysostotic patients, mean interdacryon distance was reduced from 37 ± 3 mm to 17 ± 2 mm, and strabismus improved from 55 percent to only 14 percent. Depth perception improved to a lesser degree, with 68 percent abnormal tests preoperatively and 46 percent postoperatively. Apert patients had more V-pattern strabismus and exotropia (79 percent) than did other craniofacial dysostosis patients (42 percent).Conclusions: The authors’ data indicate that facial bipartition for hypertelorbitism—known to improve periorbital aesthetics—also improves eye motility disturbances. Thus, vision problems related to exotropia should be considered a functional indication for facial bipartition surgery in patients with hypertelorbitism.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Buccal Fat Pad: Adjunctive Procedure for Lateral Defect Coverage following
           Primary Palatoplasty

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      Authors: Thanapaisal; Chantaramon; Punyavong, Pattama; Jenwitheesuk, Kamonwan; Surakunprapha, Palakorn; Winaikosol, Kengkart
      Abstract: imageBackground: The buccal fat flap is an encapsulated mass originating from a specific fat tissue that is easily accessed and richly vascularized. The aim of this study was to report the effect of using the buccal fat flap on the oronasal fistula rate in primary palatoplasty.Methods: A case-controlled study of 94 patients who underwent primary cleft palate repair. Patients were divided into two groups: (1) two-flap palatoplasty with buccal fat flap for coverage of lateral hard palate defect and (2) conventional two-flap palatoplasty. The incidence of oronasal fistula and postoperative complications were compared between groups. Multivariate analysis was performed to determine the risk factors of oronasal fistula development.Result: Forty-seven patients in each group demonstrated the same baseline characteristics. The buccal fat group showed a significant lower postoperative oronasal fistula rate (2.13 percent versus 21.28 percent, p = 0.008) and smaller fistula size (2 mm versus 4 mm, p = 0.049). A cleft width wider than 11.5 mm increased the odds ratio of fistula formation by 8.44-fold (p = 0.047), and the use of buccal fat protected against postoperative palatal fistula formation (OR, 0.08, p = 0.019).Conclusion: The use of buccal fat flaps for lateral hard palatal defect coverage in primary palatoplasty can reduce the rate of postoperative palatal fistula, especially in cases of wide palatal cleft.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Mandibular Distraction Osteogenesis in Robin Sequence Using
           Three-Dimensional Analysis and Planning

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      Authors: Pourtaheri; Navid; Maniskas, Seija; Chandler, Ludmila; Steinbacher, Derek M.
      Abstract: imageSummary: The optimal management of patients with Robin sequence may include neonatal mandibular distraction osteogenesis, which has been used to achieve excellent functional and aesthetic outcomes in appropriate patients. This article and video vignette depict the treatment of micrognathia and airway obstruction secondary to Robin sequence, demonstrating the planning and surgical approach of the senior author (D.M.S.) using mandibular distraction osteogenesis.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • A Markov Analysis of Surgical versus Medical Management of Chronic
           Migraines

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      Authors: Yesantharao; Pooja S.; Lee, Erica; Klifto, Kevin M.; Colakoglu, Salih; Dellon, A. Lee; Reddy, Sashank K.
      Abstract: imageBackground: Refractory chronic migraine is a common and debilitating neurologic condition, affecting over 8 million people in the United States. It is associated with billions of dollars in lost productivity annually. Novel medical (anti–calcitonin gene-related peptide antibodies) and surgical treatment modalities have emerged for chronic migraine in recent years. The current study investigated the cost-utility of surgical versus medical management of refractory chronic migraine.Methods: A Markov cohort analysis using hybrid Monte Carlo patient simulation was performed to compare surgical decompression versus erenumab for the treatment of refractory chronic migraine in adults. Both societal and payer perspectives were considered. Primary model outcomes included incremental cost-effectiveness ratio, or cost per quality-adjusted life-year gained.Results: Over a 5-year period, migraine surgery was associated with an increase of 0.2 quality-adjusted life-year per patient when compared to erenumab. In terms of costs, the results demonstrated a $19,337 decrease in direct medical costs and a $491 decrease in indirect costs (productivity lost) for the surgery cohort compared to erenumab. Because surgery improved quality of life and decreased costs compared to erenumab, even when considering revision surgery needs, surgery was the overall dominant treatment in terms of cost-effectiveness. Sensitivity analyses demonstrated that surgery was cost-effective compared to erenumab when patients required therapy for at least 1 year.Conclusions: Surgical deactivation of migraine trigger sites may pose a cost-effective approach to treating refractory chronic migraine in adults. This is especially the case when patients are anticipated to require therapy for more than 1 year.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Body Feminization Combining Large-Volume Fat Grafting and Gluteal Implants

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      Authors: del Vecchio; Daniel; Bravo, Miguel G.; Mandlik, Veronika; Aslani, Alexander
      Abstract: imageBackground: With the increase in popularity of fat transfer to the buttocks in body contouring surgery, new patient subsets are emerging. The gender confirmation patient has specific characteristics that must be addressed to achieve the best outcomes.Methods: The authors performed an observational prospective study including 36 consecutive patients who underwent body feminization as a gender affirming operation using large-volume fat transplantation with or without gluteal implants.Results: Thirty-six consecutive male-to-female transgender patients have undergone large-volume fat transplantation to the buttocks performed by the authors, between July of 2016 and January of 2019. In 12 of these 36 cases, large-volume fat grafting was supplemented by intramuscular placement of silicone implants. The mean waist-to-hip ratio before surgery was 1.11, and this improved to 0.81 after surgery (fat transfer–only group, 0.88; fat transfer plus implants group, 0.75).Conclusions: The transgender patient is a unique patient requiring a specific set of surgeon’s skills and intraoperative strategies to achieve good outcomes. Composite solutions with both implants and lipofilling lead to better outcomes in terms of waist-to-hip ratio in these patients.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Comparative Effectiveness Analysis of Resorbable Synthetic Onlay and
           Biologic Intraperitoneal Mesh for Abdominal Wall Reconstruction: A 2-Year
           Match-Paired Analysis

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      Authors: Othman; Sammy; Christopher, Adrienne; Patel, Viren; Jia, Hanna; Mellia, Joseph A.; Kovach, Stephen J.; Fischer, John P.
      Abstract: imageBackground: Abdominal wall reconstruction persists as a challenging surgical issue with a multitude of management strategies available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay plane against biologic mesh in the intraperitoneal plane.Methods: A single-center, two-surgeon, 5-year retrospective review (2014 to 2019) was performed examining subjects who underwent abdominal wall reconstruction in the onlay plane with resorbable synthetic mesh or in the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, postoperative outcomes, and costs were analyzed.Results: Eighty-eight subjects (44 per group) were identified (median follow-up, 24.5 months). The mean age was 57.7 years, with a mean body mass index of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9 percent) and 55 percent having failed prior repair. Resorbable synthetic mesh onlay subjects were significantly less likely (4.5 percent) to experience recurrence compared to biologic intraperitoneal mesh subjects (22.7 percent; p < 0.026). In addition, mesh onlay suffered fewer postoperative surgical-site occurrences (18.2 percent versus 40.9 percent; p < 0.019) and required fewer procedural interventions (11.4 percent versus 36.4 percent; p < 0.011), and was also associated with significantly lower total costs ($16,658 ± $14,930) compared to biologic intraperitoneal mesh ($27,645 ± $16,864; p < 0.001).Conclusions: Abdominal wall reconstruction remains an evolving field, with various techniques available for treatment. When faced with hernia repair, resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh placed in the intraperitoneal plane because of lower long-term recurrence rates, surgical-site complications, and costs.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Objective Comparison of Donor-Site Morbidity following Full and
           Thoracodorsal Nerve-Preserving Split Latissimus Dorsi Flaps

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      Authors: Oberhofer; Haley M.; Samant, Sonja S.; Swan, Courtney C.; Wolfe, Erin M.; Satteson, Ellen S.; Leyngold, Mark M.; Chim, Harvey
      Abstract: imageBackground: The latissimus dorsi flap is a workhorse for reconstruction. However, flap harvest has been variably reported to result in donor-site morbidity. The aim of this study was to compare donor-site morbidity following harvest of a split latissimus dorsi flap, preserving the anterior branch of the thoracodorsal nerve, and a traditional nerve-sacrificing full latissimus dorsi flap.Methods: Patients who underwent split or full latissimus dorsi flaps between July of 2017 and August of 2020 at a single center were recalled for assessment. Donor-site morbidity in the shoulder was evaluated through the Disabilities of the Arm, Shoulder and Hand questionnaire; the Shoulder Pain and Disability Index; and the American Shoulder and Elbow Surgeons questionnaire. Medical Research Council strength grading was also performed.Results: A total of 22 patients in the split latissimus dorsi cohort and 22 patients in the full latissimus dorsi cohort were recalled. Patient-reported outcomes as assessed through the Disabilities of the Arm, Shoulder and Hand questionnaire; Shoulder Pain and Disability Index; and American Shoulder and Elbow Surgeons questionnaire scores revealed statistically greater (p < 0.05) donor-site morbidity associated with the traditional compared to split latissimus dorsi flap. Seven patients in the full latissimus dorsi cohort had less than Medical Research Council grade 5 power at the shoulder, whereas all patients in the split latissimus dorsi cohort demonstrated full power at the shoulder.Conclusions: Traditional full latissimus dorsi flaps were found to result in greater donor-site morbidity compared to thoracodorsal nerve-preserving split latissimus dorsi flaps. Split latissimus dorsi flaps may be beneficial in preserving donor-site function and strength.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Closed-Incision Negative-Pressure Wound Therapy after Resection of
           Soft-Tissue Tumors Reduces Wound Complications: Results of a Randomized
           Trial

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      Authors: Dadras; Mehran; Ufton, Dominic; Sogorski, Alexander; Wallner, Christoph; Wagner, Johannes M.; Lehnhardt, Marcus; Harati, Kamran; Behr, Björn
      Abstract: imageBackground: Wound healing after resection of large soft-tissue tumors is often impaired by large dead space and fluid collection. Recently, the authors were able to show an association of wound complications with worse oncologic outcome in soft-tissue sarcomas. The aim of the study was to examine the value of closed-incision negative pressure wound therapy on postoperative wound drainage and wound complications after soft-tissue tumor resection.Methods: Patients for whom resection is planned of a soft-tissue tumor larger than 10 cm in diameter of the extremities or the trunk were allocated randomly to one of two groups. After wound closure, patients in the study group received closed-incision negative-pressure wound therapy for a duration of 5 days, whereas those in the control group received regular dressings. The amount of drainage fluid, course of wound healing, length of hospital stay, and wound edge perfusion at postoperative day 5 measured by white-light infrared spectroscopy were compared.Results: Sixty patients could be included in the study with even distribution to both study arms, meeting the goal. The postoperative course of wound drainage volume was significantly lower in the study group, and hospital stay was significantly shorter, with 9.1 ± 3.8 days versus 13.9 ± 11.8 days. The occurrence of wound complications was significantly lower in the study group on time-to-event analysis (one versus six). Tissue spectroscopy revealed a significantly higher oxygen saturation increase in the wound edge for the study group versus the control group.Conclusion: Closed-incision negative-pressure wound therapy should be considered for patients undergoing resection of large soft-tissue tumors.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Hidradenitis Suppurativa: A Comparison of Institutional Experience and the
           Tracking Operations and Outcomes for Plastic Surgeons Registry

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      Authors: Steele; Andrew W.; Miller, Nathan F.; Wallace, Sean J.; Hume, Keith M.; Sommers, Catherine A.; Simmons, Christopher J.; Murphy, Robert X. Jr
      Abstract: imageBackground: Hidradenitis suppurativa is a chronic inflammatory dermatologic condition occurring most commonly in areas with large numbers of apocrine sweat glands. Surgical excision and wound reconstruction are indicated for severe or refractory disease. This study aims to explore institutional reconstructive outcomes following hidradenitis suppurativa excision and compare these to the nationally recognized Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database to determine best-practice guidelines.Methods: A retrospective chart review of all patients with surgically treated hidradenitis suppurativa from January of 2004 to January of 2016 was performed. Data on patient characteristics, reconstructive methods, and outcomes were collected. Outcomes for each reconstructive method were analyzed and associations between reconstruction and complications were determined. These results were compared to TOPS data.Results: A total of 382 operative sites for 101 individual patients were reviewed. Overall complication rates were 80, 68.3, and 59.6 percent for simple, intermediate, and complex closure, respectively; 68.3 percent for adjacent soft-tissue rearrangement; and 100 percent for split-thickness skin grafts and perforator flaps. Statistical significance was identified between superficial wound dehiscence and adjacent tissue rearrangement compared to intermediate and complex closure (p = 0.0132). TOPS data revealed similar wound breakdown rates for primary closure methods but much lower rates with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps.Conclusions: Primary closure techniques for hidradenitis suppurativa wound reconstruction possess high complication rates, whereas improved outcomes are observed with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps. The correlation in outcomes between our experience and that reported in the TOPS database provides a level of validation to this national database.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • The Multiple-U Technique: A Novel Microvascular Anastomosis Technique That
           Guarantees Everted Anastomosis Sites with Solid Intima-to-Intima Contact

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      Authors: Kuo; Spencer Chia-Hao; Tsai, Yueh-Ju; Kuo, Pao-Jen; Huang, Faye; Lin, Tsan-Shiun; Hsieh, Ching-Hua
      Abstract: imageSummary: The key to successful microvascular anastomosis is achieving intima-to-intima contact, which is not always easy. In this article, the authors propose the multiple-U technique, which is a novel microvascular anastomosis technique that characterizes easy and reliable intima-to-intima contact. The technique was performed on patients who underwent free flap reconstruction for head and neck defects at the Kaohsiung Chang Gung Memorial Hospital from September 1, 2020, to November 30, 2020. The immediate patency test results for all vessel anastomoses were positive, and the postoperative recovery courses of the patients were without any vascular complications. In conclusion, the multiple-U technique is a widely available technique that guarantees everted anastomosis sites and solid intima-to-intima contact. This technique can be performed on both arterial and venous anastomoses regardless of vessel size and wall thickness.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Adjunctive Nonpharmacologic Interventions for the Management of Burn Pain:
           A Systematic Review

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      Authors: Gasteratos; Konstantinos; Papakonstantinou, Menelaos; Man, Angela; Babatsikos, Emmanouil; Tamalonis, Albina; Goverman, Jeremy
      Abstract: imageBackground: The conventional way of treating burn victims with mainstream pain control modalities is costly and has many negative side effects. In this study, the authors aim to present the findings from the major clinical trials on three nonpharmacologic interventions—hypnosis, virtual/augmented reality, and yoga—as supplements to conventional pain regimens for burn management.Methods: A computerized literature search was conducted of the PubMed and ClinicalTrials.gov databases in April of 2020. The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research.Results: The search yielded 254 articles from 1955 to 2020. Fifty-eight studies met the authors’ inclusion criteria. Yoga reduced cognitive and somatic anxiety in burn survivors, and improved body image. Virtual reality is effective in pain reduction in both the pediatric and the adult burn population, and in faster burn wound reepithelialization. Hypnosis has similar results regarding reducing pain quality and anxiety in burn patients undergoing burn wound care and dressing changes but was not found to significantly accelerate the healing process.Conclusions: Nonpharmacologic interventions are not a substitute for conventional analgesics; however, they could help patients have better control over their pain, greater self-esteem, and less postburn traumatic experiences. Burn care centers should consider nonpharmacologic interventions to improve patient satisfaction and their participation in the treatment and rehabilitation process.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Use of Microscope-Integrated Near-Infrared Fluorescence for Enhancing Deep
           Lymphatic Vessel Detection during Supermicrosurgical Lymphaticovenous
           Anastomosis: A Longitudinal Cohort Study

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      Authors: Mito; Daisuke; Wang, Yu-Ming; Wu, Shao-Chun; Lin, Wei-Che; Tsai, Pei-Yu; Hsieh, Ching-Hua; Yang, Johnson Chia-Shen
      Abstract: imageBackground: The default setting of microscope-integrated near-infrared fluorescence (MINIRF) using indocyanine green for locating superficial lymphatic vessels during lymphaticovenous anastomosis was limited to less than or equal to 70 percent intensity. The authors investigated whether maximizing the MINIRF intensity setting could increase the number of deep lymphatic vessels being found, thereby increasing the total number of lymphatic vessels for lymphaticovenous anastomosis.Methods: This longitudinal cohort study enrolled 94 patients (86 female and eight male patients) with lower limb lymphedema. Superficial lymphatic vessels were identified with the MINIRF default setting, before maximal intensity was used for deep lymphatic vessel detection. Primary/secondary endpoints included the number of superficial and deep lymphatic vessels identified. No control was used. Demographic data, intraoperative findings [including superficial and deep (indocyanine green–enhanced and non–indocyanine green–enhanced) lymphatic vessels], and severity of lymphosclerosis were recorded. Data in three regions of the lower limb (i.e., foot/above ankle, below knee, and thigh) were compared.Results: A total of 481 lymphatic vessels were identified, comprising 260 superficial and 221 deep lymphatic vessels. The median number of lymphatic vessels found per patient was five (interquartile range, four to six), and the median lymphatic vessel size was 0.63 mm (interquartile range, 0.5 to 0.8 mm). No difference was found in number (p = 0.360), size (p = 0.215), or severity of lymphosclerosis (p = 0.226) between the overall superficial and deep lymphatic vessels in the three lower limb regions.Conclusions: Deep lymphatic vessel detection can be aided by maximizing MINIRF intensity. These deep lymphatic vessels are comparable to superficial lymphatic vessels in number, size, and functionality, making them potentially valuable for lymphedema improvement.CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • The Use and Technique of Sentinel Node Biopsy for Skin Cancer

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      Authors: Upadhyaya; Siddhi N.; Knackstedt, Rebecca W.; Ko, Jennifer S.; Gastman, Brian R.
      Abstract: imageLearning Objectives: After studying this article, the participant should be able to: 1. Understand the indications for and prognostic value of sentinel lymph node biopsy in skin cancer. 2. Learn the advantages and disadvantages of various modalities used alone or in combination when performing sentinel lymph node biopsy. 3. Understand how to perform sentinel lymph node biopsy in skin cancer patients.Summary: Advances in technique used to perform sentinel lymph node biopsy to assess lymph node status have led to increased accuracy of the procedure and improved patient outcomes.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Representation of Ethics in COVID-19 Research: A Systematic Review

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      Authors: Seyferth; Anne V.; Wood, Shannon M.; Kane, Robert L.; Chung, Kevin C.
      Abstract: imageBackground: Ethical discourse in the scientific community facilitates the humane conduct of research. The urgent response to COVID-19 has rapidly generated a large body of literature to help policymakers and physicians address novel pandemic challenges. Plastic surgeons, in particular, have to manage the postponement of elective procedures and safely provide care for non–COVID-19 patients. Although COVID-19 research may provide guidance on these challenges, the extent to which ethical discussions are present in these publications remains unknown.Methods: Articles were identified systematically by searching the PubMed, Embase, Central, and Scopus databases using search terms related to ethics and COVID-19. The search included articles published during the first 9 months of the COVID-19 pandemic. The following data were extracted: presence of an ethical discussion, date of publication, topic of ethical discussion, and scientific discipline of the article.Results: One thousand seven hundred fifty-three articles were included, of which seven were related to plastic surgery. The ethical principle with the greatest representation was nonmaleficence, whereas autonomy had the least representation. Equity and access to care was the most common topic of ethical discussion; the mental health effects of COVID-19 were the least common. The principle of justice had the greatest variation in representation.Conclusions: In a systematic review of COVID-19–related articles that were published during the first 9 months of the pandemic, the ethical principles of autonomy and justice are neglected in ethical discussions. As ethical dilemmas related to COVID-19 remain prevalent in plastic surgery, attention to ethical discourse should remain a top priority for leaders in the field.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Discussion: Representation of Ethics in COVID-19 Research: A Systematic
           Review

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      Authors: Hetzler; Peter T. III; Song, David H.
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Sharing the Operating Room: A Descriptive Study of Combined and
           Collaborative Plastic Surgery Cases

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      Authors: Davis; Matthew J.; Lopez, Joseph P.; Turner, Acara; Abu-Ghname, Amjed; Davies, Lesley W.; Buchanan, Edward P.
      Abstract: imageBackground: Plastic surgeons are often asked for intraoperative assistance by other surgical services. Improvement of a plastic surgery service has been shown to improve patient outcomes, decrease length of stay, and increase hospital revenue, yet plastic surgery’s contribution to a hospital tends to be undervalued. The purpose of this study was to quantify the multidisciplinary role the plastic surgery service plays within a single, large pediatric institution.Methods: Surgical cases involving both plastic surgery and at least one other team were identified from 2016 to 2019. Each case was categorized as either “combined” or “collaborative” based on whether the two teams worked separately on separate problems or together on the same problem, respectively. Data points collected included combined and collaborative cases, operating room hours, and total hospital charges billed.Results: Of the 7564 total plastic surgery cases performed, multidisciplinary cases made up a minority of total cases (16 percent) but required 32 percent of the operating room hours and provided 49 percent of the total charges billed. Collaborative cases alone accounted for 20 percent of the service’s operating room hours and 39 percent of total charges billed, while making up only 8 percent of total cases.Conclusions: Relative to cases where plastic surgery operates alone, combined and collaborative cases account for a disproportionately high number of operating room hours and provide a disproportionately high amount of charges billed.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Quality Improvement: A Primer for Plastic Surgeons

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      Authors: Drinane; James J.; Desemone, James; Patel, Ash
      Abstract: imageSummary: It is the duty of all health care workers to improve the quality of care and patient outcomes. Quality improvement is a component of health policy required by residency accrediting bodies and is a mandatory component of postgraduate medical education. It is imperative for plastic surgeons to develop skills in quality improvement to ensure that they can cope with increased patient volumes while ensuring that their patients have access to care that is safe, equitable, effective, efficient, timely, and patient-centered. This article discusses techniques and tools often used in quality improvement. Challenges encountered with quality improvement initiatives are discussed, and recommendations on how to handle them as they occur are offered. This primer provides a foundation for plastic surgeons and their staff to guide their quality improvement efforts. A hypothetical quality improvement project is used as an example to illustrate the concepts of quality improvement in this primer.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • The Price of Publishing: An Investigation of the Open Access Landscape in
           Plastic Surgery

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      Authors: Yesantharao; Pooja S.; Long, Chao; Sacks, Justin M.; Lee, Gordon K.; Nazerali, Rahim S.
      Abstract: imageBackground: Open access publishing in plastic surgery has rapidly gained traction in the past decade. This study investigated the digital landscape of plastic surgery open access publishing.Methods: This was a cross-sectional bibliometric investigation of plastic surgery–focused journals. Three publication models were investigated: subscription-only journals, hybrid journals offering both paywalled and open access publishing, and open access–only journals.Results: Eighty-two journals were investigated. In 2010, open access journals comprised 18 percent of all plastic surgery journals online, subscription journals comprised 79 percent, and hybrid journals comprised 3 percent. Conversely, in 2020, open access journals comprised 55 percent of all journals, hybrid journals comprised 45 percent, and there were no subscription-only journals. Multivariable linear regression adjusting for article type/content demonstrated that open access articles from hybrid journals [beta coefficient, 1.3; F(4, 18) = 790; p = 0.05] and high-quality open access journals [beta coefficient, 0.9; F(4, 19) = 738; p = 0.04] were significantly positively associated with number of full-text views. Although impact factor and article processing charges were positively correlated [Pearson correlation coefficient: r(25) = 0.39, p = 0.04] for open access publishing, some high-quality open access journals were found to offer fee waivers/free publishing. Lastly, level of evidence offered by articles from open access versus hybrid journals differed.Conclusions: Overall, this study highlighted important distinctions between trustworthy and predatory journals offering open access publishing in plastic surgery. Open access publishing in trustworthy sources offers greater visibility and is not necessarily cost-prohibitive, but some open access journals can be limited in scope (i.e., less coverage of subspecialty topics) and quality of content. Study findings were used to generate recommendations for navigating open access publishing in plastic surgery.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Standardized Letters of Recommendation in Plastic Surgery: The Impact of
           Gender and Race

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      Authors: Reghunathan; Meera; Carbullido, Mary Kristine; Blum, Jessica; Wong, Serena; Gosman, Amanda A.
      Abstract: imageBackground: In the last few decades, standardized letters of recommendation have seen increasing popularity among various medical specialties and have been shown to demonstrate score inflation and gender bias in some select specialties. Through analysis of standardized letter of recommendation scoring patterns, this study evaluated the impact of race and gender on performance in standardized letters of recommendation and provides suggestions for programs to optimally interpret standardized letters of recommendation and minimize bias when writing letters of recommendation.Methods: Available standardized letters of recommendation were those from interviewed applicants to the integrated plastic surgery program between 2015 and 2018 (82 total applicants) and all applicants in the year of 2019 (241 total applicants). Various standardized letters of recommendation component scores were analyzed by demographics of both applicants and letter writers, including descriptive statistics, analysis of variance, t testing, and Fleiss kappa for interrater reliability using SPSS software (IBM, Armonk, N.Y.).Results: No scoring category had an average score below the eighty-fifth percentile. Male letter writers scored male applicants significantly higher in Overall, Conscientiousness, Self-Initiative, and Academic Performance components, whereas female letter writers scored female applicants higher in Communication and Overall components. In the 2019 cohort, applicants of a minority race received lower scores on average in nine out of 10 categories, a difference that was significant in the Team Player category.Conclusions: Score inflation pervades standardized letters of recommendation scoring in plastic surgery. Work must be done by letter writers to help mitigate racial and gender biases that influence recommendations for resident selection in plastic surgery.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Virtual Surgical Subinternships: Course Objectives and a Proposed
           Curriculum

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      Authors: Reghunathan; Meera; Dean, Riley A.; Hauch, Adam; Reid, Christopher M.; Gosman, Amanda A.; Lance, Samuel H.
      Abstract: imageBackground: Due to the recent COVID-19 pandemic, patient care and medical education have faced many significant changes. The Association of American Medical Colleges and the American Council of Academic Plastic Surgery officially recommended halting all student rotations and interviews for the year. This change has unfortunately fallen squarely at the onset of a vital season for education and recruitment of plastic surgery subinterns. This article presents a curriculum for a single institution’s virtual surgical subinternship to help inspire ideas and inspiration for programs developing their own virtual subinternships.Methods: The goals for the virtual surgical subinternship are focused on student preparation for residency and remain similar to those outlined by the core competencies for in-person rotations. The first virtual subinternship in plastic surgery modeled after the curriculum presented was offered as a 2-week course starting May of 2020.Results: The components of the curriculum include a self-study syllabus, virtual case reviews, virtual suture laboratory, educational teleconferences, participation in research, and mentorship meetings. The 2-week course has approximately 25 hours of conferences and teaching, involving direct interaction with residents and faculty, and approximately 15 hours of self-directed learning.Conclusions: To the authors’ knowledge, this was the first virtual subinternship offered for rising fourth-year medical students. They strongly encourage other residency training programs to offer similar virtual learning opportunities for medical students, particularly for those without access to a home plastic surgery training program. The curriculum presented in this article is simply to provide ideas, inspiration, and a potential framework for programs wishing to create similar virtual learning opportunities.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Characteristics of International Medical Graduates in Academic Plastic
           Surgery

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      Authors: Egro; Francesco M.; Lai, Julia; Muthiah, Nallammai; Smith, Brandon T.; Nguyen, Vu T.
      Abstract: imageBackground: International medical graduates play a significant role in meeting U.S. health care needs, and contribute to a more diverse provider workforce. This study aimed to determine the prevalence, characteristics, and academic productivity of plastic surgery international medical graduate faculty.Methods: A cross-sectional study was conducted to compare characteristics of international medical graduates against domestic medical graduates including demographics, trainings, academic ranks, leadership positions, number of publications and citations, and Hirsch index.Results: International medical graduates represent 10.3 percent of all 918 academic plastic surgeons in the United States, with the majority having graduated from India (16.8 percent), Brazil (8.4 percent), and the United Kingdom (8.4 percent). International medical graduates were more likely to have graduated from independent programs (OR, 5.7; p < 0.0001) and to have completed research fellowship (OR, 2.1; p = 0.0001) and burn fellowship (OR, 6.5; p < 0.0001). Programs led by international medical graduate chairs employed more international medical graduate faculty (21 percent versus 9 percent; p < 0.0001). International medical graduates had comparable Hirsch indices, number of publications, and citations, but received less National Institutes of Health funding ($32,020 versus $223,365). International medical graduates also had comparable rates of attaining leadership positions such as fellowship director and chair but required fewer years of experience to become residency director (8.3 years versus 17.3 years).Conclusions: The contribution of international medical graduates in academic plastic surgery was evident based on research productivity, academic ranks, and leadership positions. International medical graduates are more likely to be employed in programs led by international medical graduate chairs. This study may help guide aspiring international medical graduate academics and aid in hiring decisions at academic institutions.
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Discussion: Characteristics of International Medical Graduates in Academic
           Plastic Surgery

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      Authors: Kokosis; George; Dorafshar, Amir H.
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Change

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      Authors: Colwell; Amy S.; Weinstein, Aaron; Chung, Kevin C.
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Meshach Haskell (Hack) Newman, M.S., M.D., 1937 to 2021

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      Authors: Cederna; Paul S.; Kuzon, William M. Jr
      Abstract: imageNo abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Uncaring: How the Culture of Medicine Kills Doctors & Patients

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      Authors: Wahrman; Aron D.
      Abstract: imageNo abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Supercharge End-to-Side Anterior Interosseous–to–Ulnar Motor Nerve
           Transfer Restores Intrinsic Function in Cubital Tunnel Syndrome

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      Authors: Mukit; Muntazim; Uygur, Safak; Konofaos, Petros
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Reply: Supercharge End-to-Side Anterior Interosseous–to–Ulnar Motor
           Nerve Transfer Restores Intrinsic Function in Cubital Tunnel Syndrome

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      Authors: Dengler; Jana; Dolen, Utku; Patterson, Jennifer M. M.; Davidge, Kristen M.; Yee, Andrew; Mackinnon, Susan E.
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • An Analgesic Regimen for Opioid Reduction in Elective Plastic Surgery: A
           Randomized Prospective Study

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      Authors: Moyano Acevedo; Jairo R.; Matute, Ednna; Triana S, Carlos
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Reply: An Analgesic Regimen for Opioid Reduction in Elective Plastic
           Surgery: A Randomized Prospective Study

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      Authors: Newman; Ashley; Davison, Steven
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • COVID-19: Perspectives from Students Pursuing Plastic Surgery

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      Authors: Reynolds; Allie; Hamidian Jahromi, Alireza; Akin, Jennifer; Stoehr, Jenna Rose
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Reply: COVID-19: Perspectives from Students Pursuing Plastic Surgery

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      Authors: Shah; Nikhil D.; Sasson, Daniel C.; Gosain, Arun K.
      Abstract: No abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Averaged Body Contours: Redefining the Breast Surgery Outcomes
           Presentation

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      Authors: Pietruski; Piotr; Majak, Marcin
      Abstract: imageNo abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Plastic Surgeon Familiarity with Female Genital Mutilation and Cutting in
           the United States

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      Authors: Chappell; Ava G.; Ascha, Mona; Sood, Rachita; Fay, Kathryn; Simon, Melissa; Kim, John Y.; Post, Lori A.; Jordan, Sumanas W.
      Abstract: imageNo abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • Limb Elevation by Transcalcaneal Steinmann Pin in Lower Extremity Free
           Flap Reconstruction

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      Authors: Thione; Alessandro; Vicente-Pardo, Andrea; Pérez-García, Alberto; Balaguer-Cambra, Jorge; Sánchez-García, Alberto
      Abstract: imageNo abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
  • The “Home Effect”: The Impact of Virtual Interviews on the 2021
           Integrated Plastic Surgery Residency Match

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      Authors: Reategui; Alvaro; Khetpal, Sumun; Lopez, Joseph; Steinbacher, Derek M.
      Abstract: imageNo abstract available
      PubDate: Sun, 01 May 2022 00:00:00 GMT-
       
 
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