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 by number of followers
Journal of Applied Polymer Science     Hybrid Journal   (Followers: 134)
Polymer     Hybrid Journal   (Followers: 88)
European Polymer Journal     Hybrid Journal   (Followers: 42)
Plastic and Polymer Technology     Open Access   (Followers: 40)
Plastic and Reconstructive Surgery     Hybrid Journal   (Followers: 31)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Reinforced Plastics     Full-text available via subscription   (Followers: 17)
Polymer Engineering & Science     Hybrid Journal   (Followers: 14)
Advances in Polymer Technology     Open Access   (Followers: 13)
ACS Applied Polymer Materials     Hybrid Journal   (Followers: 11)
Chinese Journal of Polymer Science     Hybrid Journal   (Followers: 9)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Journal of Inorganic and Organometallic Polymers and Materials     Hybrid Journal   (Followers: 8)
Polymer Bulletin     Hybrid Journal   (Followers: 6)
Journal of Polymer Research     Hybrid Journal   (Followers: 6)
International Journal of Polymeric Materials     Hybrid Journal   (Followers: 6)
Journal of Polymer Science Part C : Polymer Letters     Hybrid Journal   (Followers: 5)
Polymer-Plastics Technology and Materials     Hybrid Journal   (Followers: 5)
Advanced Industrial and Engineering Polymer Research     Open Access   (Followers: 5)
Polymer Science Series B     Hybrid Journal   (Followers: 4)
Polymer Science, Series A     Hybrid Journal   (Followers: 3)
Polymer Science Series C     Hybrid Journal   (Followers: 3)
Polymer Science Series D     Hybrid Journal   (Followers: 3)
Iranian Journal of Polymer Science and Technology     Open Access   (Followers: 1)
Progress in Rubber, Plastics and Recycling Technology     Hybrid Journal   (Followers: 1)
Microplastics and Nanoplastics     Open Access   (Followers: 1)
High Performance Polymers     Hybrid Journal   (Followers: 1)
Journal of Polymers and the Environment     Hybrid Journal   (Followers: 1)
International Polymer Processing     Full-text available via subscription   (Followers: 1)
Journal of Plastic Film and Sheeting     Hybrid Journal   (Followers: 1)
Plastics Engineering     Partially Free   (Followers: 1)
Polymers from Renewable Resources     Hybrid Journal  
International Journal of Biobased Plastics     Open Access  
Polymers and Polymer Composites     Hybrid Journal  
SPE Polymers     Open Access  
Majalah Kulit, Karet, dan Plastik     Open Access  
Cirugia Plastica Ibero-Latinoamericana     Open Access  
Journal of Elastomers and Plastics     Hybrid Journal  
Journal of Cellular Plastics     Hybrid Journal  
Similar Journals
Journal Cover
Plastic and Reconstructive Surgery
Journal Prestige (SJR): 1.731
Citation Impact (citeScore): 2
Number of Followers: 31  
 
  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]
  • Branding in Health Care

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      Authors: Seyferth; Anne V.; Egan, Jennifer M.; Chung, Kevin C.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • The Batwing Mastopexy in Immediate Implant-Based Breast Reconstruction: An
           Aesthetic Enhancement for Patients with Cancer

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      Authors: Kadakia; Nikita; Kubiak, Jeremy W.; Landau, Mark J.; Mohiuddin, Waseem; Lewis, Priya G.; Kim, Hahns Y.
      Abstract: imageBackground: Historically, many patients with breast ptosis have been excluded from nipple-sparing mastectomies. By performing mastopexy at the time of immediate reconstruction, more patients with breast ptosis can be considered for nipple-sparing mastectomies. The authors review their experience of simultaneous batwing mastopexy performed at the time of immediate implant-based reconstruction.Methods: Using retrospective chart review, the authors identified patients who underwent immediate implant-based breast reconstruction from 2015 through 2020 at a single institution. The patients were divided into two cohorts—batwing mastopexy and standard reconstruction (no mastopexy)—and compared.Results: A total of 324 breast operations in 188 patients were included (80 concurrent batwing and 244 standard implant-based reconstructions). Patient characteristics were similar between the groups, except that patients in the batwing group had greater ptosis and more patients in the standard group underwent adjuvant chemotherapy. Mean follow-up was 15.9 months (range, 3.19 to 55.20 months). Complication rates were comparable in the batwing and standard groups, with no statistically significant differences in rates of hematoma (1.3 versus 3.3 percent; = 0.34), seroma (5.0 versus 8.2 percent; p = 0.34), major infection (8.8 versus 9.0 percent; p = 0.94), skin or nipple necrosis (6.3 versus 11.5 percent; p = 0.18), or explantation (11.3 versus 14.8 percent; p = 0.43). The rate of minor infections was higher in the group with concurrent batwing mastopexy (10.0 versus 3.7 percent; p = 0.03).Conclusions: The authors demonstrate that simultaneous batwing mastopexy can be performed safely at the time of immediate breast reconstruction. This technique provides comparable complication rates, improves aesthetic outcomes in patients with significant ptosis or macromastia, and allows nipple-sparing mastectomy to be an option for those who would otherwise be excluded.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Defining the Relationship between Pocket and Breast Implant Surface Area
           as the Basis for a New Classification System for Capsular Contracture

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      Authors: Hammond; Dennis C.; Chaudhry, Arif
      Abstract: imageBackground: The precise cause of and treatment for capsular contracture remains uncertain, at least partially because there is no reliable quantitative measurement tool. To address this, it is postulated that the surface area of an implant as defined by the surrounding pocket may provide a quantifiable variable that can be measured to evaluate the degree of capsular contracture.Methods: A bench model for capsular contracture was developed. The surface area of a series of spherical test objects and noncontracted and contracted breast implants was measured using a wax-coating technique and three-dimensional reconstructions created from computed tomographic scan images.Results: Comparison of the mathematically calculated surface areas to the wax and computed tomographic scan results for spheres of known dimension provided nearly identical values, documenting the accuracy of the two experimental methods. Comparison of the surface area measurements between the test groups showed that the average decrease in surface area for all implants was 20 percent, ranging from a high of 30.9 percent for a low-profile implant to a low of 14.1 percent for a high-profile implant. The anatomically shaped devices demonstrated nearly uniform degrees of surface area change over three different heights with volume and projection held relatively constant.Conclusions: The described bench model provides a useful tool for the study of capsular contracture. Surface area is a descriptive variable that can assess the degree of capsular contracture that is present. A classification system based on surface area is presented.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Discussion: Defining the Relationship between Pocket and Breast Implant
           Surface Area as the Basis for a New Classification System for Capsular
           Contracture

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      Authors: Hall-Findlay; Elizabeth J.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Surgical Outcome Measures in a Cohort of Patients at High Risk of Breast
           Cancer Treated by Bilateral Risk-Reducing Mastectomy and Breast
           Reconstruction

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      Authors: Gandhi; Ashu; Duxbury, Paula; Clancy, Tara; Lalloo, Fiona; Wisely, Julie A.; Kirwan, Cliona C.; Foden, Philip; Stocking, Katie; Howell, Anthony; Evans, D. Gareth
      Abstract: imageBackground: Women with breast cancer–related genetic pathogenic variants (e.g., BRCA1, BRCA2) or with a strong family history carry lifetime risks of developing breast cancer of up to 80 to 90 percent. A significant proportion of these women proceed to bilateral risk-reducing mastectomy. The authors aimed to document the surgical morbidity of risk-reducing mastectomy and establish whether a diagnosis of breast cancer at the time of surgery impacted outcomes.Methods: Clinical details of 445 women identified as having a greater than 25 percent lifetime risk of developing breast cancer who underwent risk-reducing mastectomy and breast reconstruction were interrogated for surgical outcomes such as planned, unplanned, and emergency procedures; complication rates; length of stay; and longevity of breast reconstruction. These outcome measures were recorded in women diagnosed with breast cancer perioperatively (cancer group) and those without malignancy (benign group).Results: Median follow-up was similar in both groups (benign group, 70 months; cancer group, 73 months). Patients were older in the cancer group than in the benign group (43 years versus 39 years; p < 0.001). Women in the cancer group required more planned procedures to complete reconstruction than those in the benign group (four versus two; p = 0.002). Emergency procedures, unplanned surgical interventions (e.g., capsulectomy), and postreconstruction complication rates were similar between groups. One in five women overall required revision surgery. Patients with autologous reconstructions had a revision rate of 1.24 per 1000 person-years compared with 2.52 per 1000 person-years in the implant reconstruction group.Conclusions: Women contemplating risk-reducing mastectomy can be reassured that this is a safe and effective procedure but will likely take multiple interventions. This knowledge should be integral to obtaining informed consent.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Oncologic Safety of Staged Prepectoral Implant Reconstruction following
           Nipple-Sparing Mastectomy: A Mean 9-Year Follow-Up

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      Authors: Salibian; Arthur H.; Harness, Jay K.
      Abstract: imageBackground: Prepectoral reconstruction following nipple-sparing mastectomy has recently gained popularity as an alternative to total or partial submuscular reconstruction. In the absence of long-term follow-up, concerns have been raised over the oncologic safety of using mastectomy flaps that preserve the entire thickness of the subcutaneous fat and its circulation. In this article, the authors present their average 9-year oncologic follow-up of patients who underwent nipple-sparing mastectomy and two-stage prepectoral implant reconstruction without acellular dermal matrix.Methods: In this retrospective study, a group of previously reported (151 consecutive) breast cancer patients [246 breasts (160 therapeutic and 86 preventative)] who underwent nipple-sparing mastectomy and staged prepectoral implant reconstruction between 2005 and 2015 were followed up for an average of 109 months (range, 14 to 192 months). Tumor-related data, oncologic markers, staging, neoadjuvant/adjuvant therapy, and radiation therapy were evaluated to determine local recurrence, overall survival, and disease-free survival rates.Results: The local recurrence rate in 151 patients was 2.6 percent. Eleven patients (7.3 percent) died as a result of metastatic disease and three patients died as a result of unrelated causes. The average 109-month overall survival rate was 92.9 percent, and the disease-free survival rate was 87.8 percent. Over the same period, nine patients (6 percent) were alive with distant disease.Conclusion: The authors’ 9-year two-stage prepectoral reconstruction study of nipple-sparing mastectomy shows that the procedure is oncologically safe, having comparable recurrence, overall survival, and disease-free survival rates as total mastectomy.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Discussion: Oncologic Safety of Staged Prepectoral Implant Reconstruction
           following Nipple-Sparing Mastectomy: A Mean 9-Year Follow-Up

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      Authors: Jensen; Jay Arthur
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Comparison of Liposomal Bupivacaine to a Local Analgesic Cocktail for
           Transversus Abdominis Plane Blocks in Abdominally Based Microvascular
           Breast Reconstruction

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      Authors: Lombana; Nicholas F.; Falola, Reuben A.; Zolfaghari, Kiumars; Roth, Clark; Abraham, Jasson T.; Saint-Cyr, Michel H.
      Abstract: imageBackground: Transversus abdominis plane blocks can improve pain control and decrease opioid use within an enhanced recovery after surgery (ERAS) protocol in patients undergoing abdominally based autologous breast reconstruction. The authors have transitioned to using a local analgesic cocktail for transversus abdominis plane blocks. The purpose of this study was to compare postoperative opioid use in patients who received the blocks.Methods: Patients who underwent abdominally based autologous breast reconstruction between November of 2015 and December of 2019 were retrospectively reviewed. The study group received bupivacaine, ketorolac, dexmedetomidine, and dexamethasone; the control group received liposomal bupivacaine with or without bupivacaine, ketorolac, or dexmedetomidine, as a transversus abdominis plane block. The primary outcome of interest was postoperative opioid use and pain scores.Results: One hundred four women met inclusion criteria: 36 in group A (before ERAS, before transversus abdominis plane block), 38 in group B (ERAS, transversus abdominis plane block with liposomal bupivacaine), and 30 in group C (ERAS, transversus abdominis plane block with local anesthetic cocktail). Total daily oral morphine equivalent consumption (group A, 633; group B, 240; group C, 135; p < 0.0001) and average daily oral morphine equivalent consumption (group A, 137; group B, 56; group C, 29; p < 0.0001) were significantly less for group C in the inpatient phase. Patients in group C were prescribed significantly fewer outpatient oral morphine equivalents (group A, 79; group B, 74; group C, 52; p = 0.01).Conclusions: Transversus abdominis plane blocks are a significant component of an ERAS protocol for abdominally based breast reconstruction. Liposomal bupivacaine is a popular option for transversus abdominis plane blocks. The authors’ results demonstrate that a local anesthetic cocktail, composed of economical and readily available medications, can provide excellent patient pain control and decrease postoperative opioid use.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Importance of Incidental Findings in Preoperative Computed Tomography
           Angiography for Abdominally Based Free Flap Breast Reconstruction: A
           Multi-Institutional Study

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      Authors: Colakoglu; Salih; Yang, Jerry; French, Mackenzie M.; Winocour, Julian; Um, Grace T.; Blumenauer, Brian; Siddikoglu, Duygu; Mureau, Marc A. M.; Chong, Tae; Higdon, Kent; Perdikis, Galen; Inchauste, Suzanne M.; Kaoutzanis, Christodoulos; Mathes, David W.
      Abstract: imageBackground: In addition to its intended purpose of perforator mapping, computed tomography angiography can also identify incidental findings that may require further evaluation. In this multi-institutional study, the authors evaluated the frequency of incidental findings and their significance and effects on treatment course and aimed to identify risk factors for detecting such findings.Methods: A retrospective review of patients who underwent perforator mapping with computed tomography angiography was performed over a 5-year period from three academic institutions. Relevant sociodemographic and clinicopathologic information, computed tomography angiography reports, follow-up visits, and treatment outcomes were reviewed. Univariate and multivariate analyses were performed to assess the relationship between risk factors and incidental findings.Results: From January of 2015 to July of 2020, a total of 656 patients were identified who met inclusion criteria. Overall, 342 incidental findings were found, 76 of which required additional imaging or consultation. Ultimately, 10 patients (1.5 percent) had findings that altered reconstructive management, including five patients (0.8 percent) having severe disease that resulted in the cancellation of their reconstruction. Advanced age and immediate reconstruction timing were independent risk factors for incidental findings.Conclusions: Incidental findings are commonly identified on preoperative computed tomography angiography for deep inferior epigastric perforator flap breast reconstruction. Suspicious findings should be investigated thoroughly because they can alter the reconstructive course. Understanding of high-risk groups for incidental findings can further advance patient education during initial consultation.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Current Practices in the Pathologic Assessment of Breast Tissue in
           Transmasculine Chest Surgery

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      Authors: Goodwin; Isak A.; Luo, Jessica; Magno-Pardon, David A.; Veith, Jacob; Willcockson, James; Carter, Gentry; Matsen, Cindy; Kwok, Alvin C.; Agarwal, Cori A.
      Abstract: imageBackground: No guidelines exist regarding management of breast tissue for transmasculine and gender-nonconforming individuals. This study aims to investigate the experiences and practices regarding perioperative breast cancer risk management among the American Society of Plastic Surgeons members performing chest masculinization surgery.Methods: An anonymous, online, 19-question survey was sent to 2517 U.S.-based American Society of Plastic Surgeons members in October of 2019.Results: A total of 69 responses were analyzed. High-volume surgeons were more likely from academic centers (OR, 4.88; 95 percent CI, 1.67 to 15.22; p = 0.005). Age older than 40 years [n = 59 (85.5 percent)] and family history of breast cancer in first-degree relatives [n = 47 (68.1 percent)] or family with a diagnosis before age 40 [n = 49 (71.0 percent)] were the most common indications for preoperative imaging. Nineteen of the respondents (27.5 percent) routinely excise all macroscopic breast tissue, with 21 (30.4 percent) routinely leaving breast tissue. Fifty-one respondents (73.9 percent) routinely send specimens for pathologic analysis. There was no significant correlation between surgical volume or type of practice and odds of sending specimens for pathologic analysis. High patient costs and patient reluctance [n = 27 (39.1 percent) and n = 24 (35.3 percent), respectively] were the most often cited barriers for sending specimens for pathologic analysis. Six respondents (8.7 percent) have found malignant or premalignant lesions in masculinizing breast specimens.Conclusions: Large variation was found among surgeons’ perioperative management of chest masculinizing surgery patients regarding preoperative cancer screening, pathologic assessment of resected tissue, and postoperative cancer surveillance. Standardization of care and further studies are needed to document risk, incidence, and prevalence of breast cancer in the transmasculine population before and after surgery.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Best Practices for BREAST-Q Research: A Systematic Review of Study
           Methodology

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      Authors: Gallo; Lucas; Chu, Jacqueline J.; Shamsunder, Meghana G.; Hatchell, Alexandra; Patel, Aadit R.; Godwin, Kendra; Hernandez, Marisol; Pusic, Andrea L.; Nelson, Jonas A.; Voineskos, Sophocles H.
      Abstract: imageBackground: Data heterogeneity and methodologic errors hinder the ability to draw clinically meaningful conclusions from studies using the BREAST-Q Reconstruction Module patient-reported outcome measure. In this systematic review, the authors evaluate the quality of BREAST-Q Reconstruction Module administration in relation to the BREAST-Q version 2.0 user’s guide and the reporting of key methodology characteristics. The authors also describe a framework for improving the quality of BREAST-Q data analysis and reporting.Methods: The authors conducted a systematic search of PubMed, Embase, Cochrane CENTRAL, and Ovid HAPI databases to identify articles on the BREAST-Q Reconstruction Module to assess postmastectomy breast reconstruction outcomes. The authors registered the protocol before study implementation on Open Science Framework (https://osf.io/c5236) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on mode of BREAST-Q administration, time horizon justification, and sample size calculation were collected.Results: The authors included 185 studies in the analysis. Errors in BREAST-Q administration were identified in 36 studies (19.5 percent). Appropriate administration of the BREAST-Q could not be determined in 63 studies (34.1 percent) because of insufficient reporting. Time horizon for the primary outcome was reported in 71 studies (38.4 percent), with only 17 (9.2 percent) reporting a sample size calculation.Conclusions: The authors identified important yet actionable shortcomings in the BREAST-Q literature. Researchers are encouraged to review the BREAST-Q user’s guide in the study design phase to mitigate errors in patient-reported outcome measure administration and reporting for future trials using the BREAST-Q Reconstruction Module. Adhering to these guidelines will allow for greater clinical utility and generalizability of BREAST-Q research.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Impact of Surgical Rejuvenation on Visual Processing and Character
           Attribution of Periorbital Aging

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      Authors: Boonipat; Thanapoom; Abu-Ghname, Amjed; Lin, Jason; Garcia-Gonzalo, Esperanza; Bite, Uldis; Stotland, Mitchell A.
      Abstract: imageBackground: The perceptual response to aging changes in the periorbital region and the effects of surgical rejuvenation on that response have not been elucidated. The authors examined the reflexive visual response to periorbital aging before and after brow lift and upper blepharoplasty surgery and investigated how observers’ character attributions of the images were affected by the rejuvenative intervention.Methods: Preoperative and postoperative photographs were obtained of patients with brow ptosis and dermatochalasis who underwent brow lift and blepharoplasty. Forty observers examined each image while an infrared eye-tracking camera continuously recorded their eye movements. The observers rated the images with respect to character attributes (attractiveness, trustworthiness, sociability, healthiness, and capability) on a scale of one to seven.Results: Fourteen patients who underwent brow lift and blepharoplasty were identified and studied. The surgical intervention was found to increase observers’ attention to the eye and brow region, while decreasing relative attention to the forehead and lower eyelid areas; increase the two-dimensional surface area of the forehead and eye and brow zones in a manner directly associated with the measured changes in visual attention; and significantly increase the ratings for all five positively valanced character attributes compared with preoperative controls.Conclusions: The authors provide an important combination of explicit and implicit data illustrating how surgical rejuvenation unveils the periorbital region to the observer. This change in pattern of inspection was associated with an improvement in the perception of character.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Orbital Aging: A Computed Tomography–Based Study of 240 Orbits

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      Authors: Ugradar; Shoaib; Manoukian, Narek; Azhdam, Ariel; Le, Alan; Chen, Jessica; Rootman, Daniel; Goldberg, Robert A.; Lambros, Val
      Abstract: imageBackground: Previous studies have attempted to explain age-related changes to the orbit in isolation, often producing conflicting results. The authors used highly accurate imaging software to analyze computed tomographic scans to characterize changes related to age objectively.Methods: In this case-control study, patients seen in an ear, nose, and throat clinic were screened for study entry. Male and female participants were divided into two age groups (20 to 30 years and 60 to 75 years). Primary outcomes included measurement of bony orbital dimensions, volume of soft tissues (muscle and fat volume), and anterior globe position. Three-dimensional reconstructions were created of each orbit allowing these measurements. The generalized estimating equation was used so that both orbits from each patient could be included without any bias.Results: The final sample included 240 orbits from 120 patients. There were 30 patients in each age group. Among female participants, the bony orbital volume (p < 0.05), fat volume (p < 0.01), and central width (p < 0.001) of the bony orbit increased with age. The anterior globe position was significantly greater in older female participants (p < 0.01). For male participants, the fat volume (p < 0.0001) and central height (p < 0.03) increased with age; the lateral rim moved posteriorly with age (p < 0.007). The anterior globe position was not different between the age groups in male participants (p = 0.56).Conclusion: The female bony orbit expands with age and is associated with a more anterior position of the globe; the male bony orbital volume remains the same and the lateral rim moves posteriorly.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Vertical V-Y Advancement Lifting Based on Fat Compartments: A New Approach
           for Lower Eyelid and Midcheek Rejuvenation

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      Authors: Sun; Xiaoming; Chen, Xiangling; Zhang, Lu; Zhang, Ying; Jin, Rong; Mao, Xiyuan; Cheng, Liying; Bian, Weiwei; Zhang, Yuguang
      Abstract: imageBackground: Lower blepharoplasty techniques continue to improve over time. With discovery of the numerous fat compartments of the face, surgeons noticed that the appearance of the lower eyelid area through aging could be improved through midface lifting. This article introduces a vertical V-Y advancement lifting technique using the concept of fat compartments for lower lid and midcheek rejuvenation.Methods: Eighty female patients were categorized into four age groups at 20 patients each from 20 to 59 years old. The average measurement for the lower lid length in each group was recorded. An additional 318 patients who underwent lower eyelid blepharoplasty combined with fat compartments advancement lifting for lid-cheek junction rejuvenation from April of 2015 to May of 2018 were included in this study. The postoperative effect was evaluated based on preoperative and postoperative photographs, lower lid length measurements, and three-dimensional facial analyses.Results: Lower lid lengths gradually increased with age, with the greatest increase occurring in the 30- to 39-year-old group. A total of 318 Asian female patients (age range, 35 to 58 years) underwent the surgical procedure. Measurements of lower lid length showed an average reduction of 0.31 cm 6 months after surgery. Three-dimensional facial analysis indicated that midcheek volume increased at varying degrees after surgery.Conclusions: Lower eyelid blepharoplasty combined with vertical V-Y advancement lifting makes it possible to restore facial fat compartments. This procedure improves projection in the midcheek without fillers, thus achieving a more youthful appearance of the lower lid and lid-cheek contour in middle-aged women.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Development and Initial Validation of a Novel Professional Aesthetic Scale
           for the Female Abdomen

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      Authors: Sood; Rachita; Muhammad, Lutfiyya N.; Sasson, Daniel C.; Shah, Nikita; Yeh, Chen; Nahas, Fabio X.; Dumanian, Gregory A.
      Abstract: imageBackground: A growing body of literature describes abdominal aesthetic goals to tailor surgical and nonsurgical treatment options to meet patient goals. The authors aimed to integrate layperson perceptions into the design of a novel professional aesthetic scale for the abdomen.Methods: An iterative process of expert consensus was used to choose five domains: abdominal muscle lines, abdominal shape, scar, skin, and umbilicus. A survey was developed to measure global and domain-specific aesthetic preferences on five abdomens. This was distributed through Amazon Mechanical Turk to 340 respondents. Principal component analysis was used to integrate survey data into weights for each of the scale’s subquestions. Attending plastic surgeons then rated abdomens using the final scale, and reliability and validity were calculated.Results: The final scale included 11 subquestions—hourglass shape, bulges, hernia, infraumbilical skin, supraumbilical skin, umbilicus shape, umbilicus medialization position, umbilicus height position, semilunar lines, central midline depression, and scar—within the five domains. Central midline depression held the highest weight (16.1 percent) when correlated with global aesthetic rating, followed by semilunar lines (15.8 percent) and infraumbilical skin (11.8 percent). The final scale demonstrated strong validity (Pearson r = 0.99) and was rated as easy to use by seven attending plastic surgeons.Conclusions: The final scale is the first published professional aesthetic scale for the abdomen that aims to integrate layperson opinion. This analysis and survey data provide insights into the importance of 11 components in overall aesthetic appeal of the abdomen.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Microneedling Outcomes in Early Postsurgical Scars

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      Authors: Claytor; R. Brannon; Sheck, Casey Gene; Chopra, Vinod
      Abstract: imageBackground: Scars are a vexing sequela of surgery. Microneedling, also known as minimally invasive percutaneous collagen induction, has demonstrated impressive improvements in chronic acne scars; however, no evidence exists for treating postsurgical scars during active wound healing. The purpose of this study was to demonstrate the utility and safe use of minimally invasive percutaneous collagen induction in acute postsurgical scars.Methods: Twenty-five patients who underwent surgery had scars treated with three treatments of minimally invasive percutaneous collagen induction in the postoperative period. Scar assessment was measured by Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, and Global Aesthetic Improvement Scale after each of the three treatments and at final 2-month follow-up.Results: Patients had positive improvement in Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, and Global Aesthetic Improvement Scale scores at 16-week posttreatment initiation evaluation compared to initial measurement (p < 0.001). No statistically significant differences were noted when comparing the age of the patient, location of scars, or Fitzpatrick phototype scales among patients. When comparing patients who began treatment early (6 to 7 weeks postoperatively) to those who began treatment late (13 to 16 weeks postoperatively), there was a statistically significant difference in the Patient and Observer Scar Assessment Scale group (p < 0.04).Conclusions: Postsurgical scars treated with minimally invasive percutaneous collagen induction in the maturation and remodeling phase had no adverse outcomes. Interestingly, the data show treatment initiated early in the maturation phase (6 to 7 weeks postoperatively), while natural collagen formation was tapering off, demonstrated improved aesthetic outcomes compared to treatments initiated late in the maturation phase (13 to 16 weeks postoperatively).CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Mentoplasty with Cancellous Bone Chip Scaffolding: An Innovative Technique
           for Chin Aesthetics

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      Authors: Hayes; Danielle S.; Miranda, Suzette G.; Peters, Mary Lee
      Abstract: imageSummary: The facial skeleton is foundational for facial aesthetics. The authors describe an alternative technique for cosmetic chin augmentation that does not require alloplastic implants, osseous genioplasty, or autologous bone harvesting. In this new and innovative technique for chin augmentation, tissue bank allograft cancellous bone chips serve as a scaffold for bony ingrowth. The use of bone chips allows for aesthetic contouring with small adjustments in the facial skeleton. The objective of this article is to provide further information on this novel technique and demonstrate the efficacy and safety of tissue bank allograft cancellous bone chips as an alternative graft material for cosmetic chin augmentation. Retrospective review of patients who underwent chin augmentation with cancellous bone chips from July of 2015 to March of 2019 was performed. Photographic results from several patients are included. No patients developed infections, required reoperation, or went on to have explantation of the graft material. Initial results suggest cancellous bone chips are a safe, efficacious alternative graft material for cosmetic chin augmentation.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Guidelines for Botulinum Neurotoxin Injection for Facial Contouring

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      Authors: Yi; Kyu-Ho; Lee, Hyung-Jin; Hur, Hye-Won; Seo, Kyle K.; Kim, Hee-Jin
      Abstract: imageSummary: The hypertrophied temporalis and masseter muscles give a muscular shaped and bulky contour to the face. Botulinum neurotoxin injection methods are commonly used for facial contouring; however, adverse effects have been reported owing to a lack of delicate anatomical information. The anatomical considerations when injecting botulinum neurotoxin into the temporalis and masseter muscles were reviewed in the present study. Current knowledge on the localization of the botulinum neurotoxin injection point with more recent anatomical dissection and modified Sihler staining procedures was assessed. The authors found that, for the muscles, the injection point can be more precisely demarcated. Optimal injection sites are presented for the temporalis and masseter muscles, and the injection technique is suggested. The authors propose the optimal injection sites in relation to external anatomical landmarks for the frequently injected muscles of the face to facilitate the efficiency of botulinum neurotoxin injections. In addition, these guidelines would aid in more precise practice without the adverse effects of botulinum neurotoxin.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • The Alar Equalization Suture for Nasal Tip Refinement

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      Authors: Savetsky; Ira L.; Hamilton, Kristy L.; Avashia, Yash J.; Rohrich, Rod J.
      Abstract: imageSummary: Anatomic subtleties of the nasal tip have a dramatic impact on the overall appearance of the nose. Creation of the ideal nasal tip in rhinoplasty requires straight lower lateral cartilages, everted lateral crura, a higher caudal edge of the lower lateral cartilages relative to the cephalic margin, and a diamond-shaped tip. In this article, the authors describe the alar equalization suture, a suture technique that further refines nasal tip shaping after traditional maneuvers have been performed.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Use of Tranexamic Acid in Liposculpture: A Double-Blind, Multicenter,
           Randomized Clinical Trial

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      Authors: Hoyos; Alfredo E.; Duran, Héctor; Cardenas-Camarena, Lazaro; Bayter, Jorge E.; Cala, Laura; Perez, Mauricio; Lopez, Alejandro; Talleri, Giancarlo; Domínguez-Millan, Rodrigo; Mogollon, Ivan R.
      Abstract: imageBackground: Intraoperative hemostasis should be performed with great caution because bleeding is a huge enemy of patient safety during surgery. Tranexamic acid is a lysine synthetic derivate that inhibits fibrinolysis and diminishes the bleeding by blocking the five lysine-binding sites for plasminogen. The authors compare the efficacy of tranexamic acid versus placebo as a hemostatic agent in liposculpture procedures.Methods: The authors conducted a multicenter, double-blind, randomized, controlled clinical trial in patients who were scheduled for liposculpture in three plastic surgery centers (Colombia and Mexico) between January of 2019 and February of 2020. One hundred forty-one patients were randomly assigned into three groups: intravenous (1 g of tranexamic acid), subcutaneous (1 g of tranexamic acid), and placebo (normal saline). Forty-seven patients were assigned to each group. There were 30 male patients and 111 female patients. The main outcome was to evaluate the amount of postoperative bleeding between groups. The primary outcome was measured by the hemoglobin point loss at day 1 (preoperative hemoglobin minus hemoglobin at day 1 postoperatively) and the hemoglobin (in milligrams per deciliter) point loss at day 5 (preoperative hemoglobin minus hemoglobin at day 5 postoperatively).Results: The authors found the intravenous intervention group to have a greater hemoglobin level than the other two groups on both the first postoperative day (p = 0.0001) and the fifth postoperative day (p = 0.001). There were no statistical differences in hemoglobin values between the placebo and the subcutaneous intervention groups.Conclusion: Intravenous tranexamic acid is a good therapeutic choice to implement on liposculpture procedures to decrease postoperative bleeding.Clinical Relevance Statement: The preoperative use of intravenous tranexamic acid not only decreases the bleeding rate after liposuction procedures, but also allows greater lipoaspirate volumes when performing high-definition liposculpture. Further studies are required to support the effectiveness of tranexamic acid within the infiltration solution.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Adipose-Derived Stem Cell–Enriched Lipotransfer Reverses Skin Sclerosis
           by Suppressing Dermal Inflammation

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      Authors: Jiang; Wenqing; Wang, Jing; Lin, Jiayan; Jiang, Shenglu; Quan, Yuping; Liao, Yunjun; Gao, Jianhua; Cai, Junrong
      Abstract: imageBackground: Scleroderma is a chronic autoimmune disease with an incidence of 2.7 per 100,000 people. Traditional lipotransfer has been used to treat atrophic sclerotic skin. Enzymatically processed cell-assisted lipotransfer and mechanically processed stromal vascular fraction gel are fat products with abundant adipose-derived stem cells. This study assessed whether adipose-derived stem cell–enriched lipotransfer elicits superior therapeutic effects on scleroderma.Methods: Scleroderma was induced in nude mice by injections of bleomycin for 4 weeks. Human-derived Coleman fat, cell-assisted lipotransfer, or stromal vascular fraction gel (0.1 ml) was injected into sclerotic lesions. Histologic examinations, terminal deoxynucleotidyl transferase dUTP nick end labeling, and expression analyses of inflammatory factors in skin lesions and transferred fat were performed at 4 weeks after implantation.Results: Dermal thickness was lower in the groups injected with Coleman fat (339.0 ± 19.66 µm), cell-assisted lipotransfer (271.0 ± 16.15 µm), and stromal vascular fraction gel (197.8 ± 12.99 µm) than in the group injected with phosphate-buffered saline (493.3 ± 28.13 µm) (p < 0.05). The numbers of terminal deoxynucleotidyl transferase dUTP nick end labeling+ and Mac2+ cells in fat tissue were significantly higher in the group injected with Coleman fat than in those injected with stromal vascular fraction gel and cell-assisted lipotransfer. Expression of monocyte chemotactic protein-1 and interleukin-6 was significantly lower in the adipose-derived stem cell–enriched groups than in the Coleman fat group. Histologic analysis showed there were far fewer macrophages and myofibroblasts in skin lesions in the adipose-derived stem cell–enriched groups than in the Coleman fat group.Conclusions: Transplantation of stromal vascular fraction gel and cell-assisted lipotransfer, which contain abundant adipose-derived stem cells, reduces the levels of apoptotic cells and inflammation, significantly reverses skin sclerosis, and elicits superior anti-inflammatory and antifibrotic effects on scleroderma.Clinical Relevance Statement: This study provided an alternative adipose-based therapy, adipose-derived stem cell–enriched fat, for sclerotic lesions and showed its validity for interfering with the inflammation and fibrosis.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • An Agonistic Monoclonal Antibody Targeting cMet Attenuates Inflammation
           and Up-Regulates Collagen Synthesis and Angiogenesis in Type 2 Diabetic
           Mice Wounds

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      Authors: Choi; Min-Ha; Jang, Tae-Sik; Kim, Hyeonwoo; Ku, Inhoe; Lee, Junghun; Jeong, Jae-Gyun; Kim, Sunyoung; Park, Ji-Ung
      Abstract: imageBackground: Diabetic wounds account for 25 to 50 percent of total diabetic health care costs annually, and present overall healing rates of less than 50 percent. Because delayed diabetic wound healing is associated with impaired fibroblast function, the authors hypothesize that tyrosine kinase Met (cMet) agonistic monoclonal antibody will promote diabetic wound healing by means of stable activation of hepatocyte growth factor/cMet signaling.Methods: Two 6-mm dorsal wounds were created in each mouse (6-week-old, male BKS.Cg-Dock7m+/+Leprdb/J; n = 5). After subcutaneous injections of agonist (20 mg/kg) at 0 and 72 hours, the wound sizes were measured at days 0, 1, 3, 6, and 10. Histologic and immunohistochemical analyses were performed at day 10 (cMet, α-smooth muscle actin, CD68, and transforming growth factor-β). In vitro cytotoxicity and migration tests with diabetic fibroblasts were performed with or without agonist treatment (1 or 10 nM). cMet pathway activation of fibroblasts was confirmed through p-p44/42 mitogen-activated protein kinase, p-mTOR, p-cMet, and ROCK-1 expression.Results: The cMet agonistic monoclonal antibody–treated group showed 1.60-fold lower wound area (p = 0.027), 1.54-fold higher collagen synthesis (p = 0.001), and 1.79-fold lower inflammatory cell infiltration (p = 0.032) than the saline-treated control. The agonist increased cMet (1.86-fold; p = 0.029), α-smooth muscle actin (1.20-fold; p = 0.018), and vascular endothelial growth factor (1.68-fold, p = 0.029) expression but suppressed CD68 (1.25-fold; p = 0.043), transforming growth factor-β (1.25-fold; p = 0.022), and matrix metalloproteinase-2 (2.59-fold; p = 0.029) expression. In vitro agonist treatment (10 nM) of diabetic fibroblasts increased their migration by 8.98-fold (p = 0.029) and activated the hepatocyte growth factor/cMet pathway.Conclusions: Tyrosine kinase Met agonistic monoclonal antibody treatment improved diabetic wound healing in mice and reduced wound-site inflammatory cell infiltration. These results need to be validated in large animals before piloting human trials.Clinical Relevance Statement: Although further clinical studies are necessary to evaluate its therapeutic efficacy, our study suggested that cMet agonistic monoclonal antibody can be the alternative modality in order to improve wound healing cascade in diabetic foot patients.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Primary Targeted Muscle Reinnervation after Below-Knee Amputation Is Not
           Associated with an Increased Risk of Major or Minor Surgical
           

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      Authors: Shammas; Ronnie L.; Azoury, Said C.; Sergesketter, Amanda R.; Lee, Hui-Jie; Poehlein, Emily; Othman, Sammy E.; Cason, Roger W.; Levinson, Howard; Kovach, Stephen J.; Mithani, Suhail K.
      Abstract: imageBackground: Targeted muscle reinnervation has emerged as a technique to reduce neuroma and phantom limb pain after below-knee amputation; however, the incidence of postoperative complications remains unknown. This multi-institutional study assessed the risk of postoperative complications among patients who underwent targeted muscle reinnervation at the time of below-knee amputation.Methods: Patients who underwent below-knee amputation with targeted muscle reinnervation were propensity score–matched 1:3 to patients who underwent below-knee amputation alone. Study outcomes included the incidence of major or minor complications within 60 days. Regression models were used to estimate the relative risk of major and minor complications.Results: Overall, 96 patients were matched, including 31 patients who had below-knee amputation with targeted muscle reinnervation and 65 who had below-knee amputation alone. In the matched sample, a higher incidence of major complications (29 percent versus 24.6 percent), readmission (25.8 percent versus 18.5 percent), and reoperation (19.4 percent versus 10.8 percent) was seen after both procedures compared with below-knee amputation alone. Patients who underwent both procedures displayed a higher incidence of minor complications (25.8 percent versus 20.0 percent), blood transfusion (22.6 percent versus 18.5 percent), and wound healing complications (45.2 percent versus 33.8 percent) and longer operative time (mean ± SD, 188.5 ± 63.6 minutes versus 88 ± 28.2 minutes). There was no statistically significant difference in the risk of major (relative risk, 1.20; 90 percent CI, 0.68, 2.11) or minor (relative risk, 1.21; 90 percent CI, 0.61, 2.41) complications between the two cohorts.Conclusions: Despite an increased incidence of postoperative complications, undergoing below-knee amputation with targeted muscle reinnervation does not confer a statistically significant increased risk of major or minor complications. Future studies are needed to delineate patient selection criteria when assessing the suitability of targeted muscle reinnervation at the time of major limb amputation.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Sonographic Changes in the Median Nerve Predict Conversion to Surgery
           after Corticosteroid Injection of the Carpal Tunnel

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      Authors: Wessel; Lauren E.; Kerluku, Jona; Nwawka, O. Kenechi; Miller, Theodore T.; Nguyen, Joseph T.; Fufa, Duretti T.
      Abstract: imageBackground: Risk factors for conversion to surgical management of moderate severity carpal tunnel syndrome are poorly understood. The authors hypothesized that sonographic findings along the carpal tunnel could predict failure of conservative management for carpal tunnel syndrome.Methods: The authors report on 96 wrists with moderate clinical signs and symptoms of carpal tunnel syndrome. Sonographic evaluation with measurement of median nerve cross-sectional area was performed at three consistent anatomic locations. The authors recorded median nerve morphology, inlet and outlet dimensions of the carpal tunnel, and maximal thickness of the transverse carpal ligament. Steroid injection was performed. Patients were followed up for a minimum of 1 year after injection and progression to surgical management was recorded.Results: A total of 54 percent (n = 52) of patients converted to surgical management within 1 year after injection. Median nerve cross-sectional area decreased over the course of the carpal tunnel from proximal to distal in 81 of 96 wrists. A greater decrease in cross-sectional area of the median nerve between the pisiform and the hamate was associated with conversion to operative intervention for carpal tunnel syndrome, with the average decrease in median nerve cross-sectional area among those whose conservative treatment failed being 5.01 mm2 compared with 2.97 mm2 among those who did not progress to surgical treatment.Conclusions: This study demonstrates that ultrasound may be an additional tool used by clinicians to better counsel patients about the severity and progression of their disease. Patients who demonstrate a decrease in cross-sectional area of the median nerve along the carpal tunnel demonstrate a higher likelihood of progression to operative management.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Comparative Effectiveness of Physical Therapy and Electrophysiotherapy for
           the Treatment of Lateral Epicondylitis: A Network Meta-Analysis

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      Authors: Wood; Shannon M.; Yoon, Alfred P.; Tseng, Hsiao-Jung; Yang, Lan-Yan; Chung, Kevin C.
      Abstract: imageBackground: Lateral epicondylitis is a common enthesopathy, possibly caused by overuse and repetitive activity. Although nonoperative management is the primary approach for treating lateral epicondylitis, clinical guidelines and the literature fail to identify the most effective nonoperative treatment. Therefore, the authors conducted a network meta-analysis to compare the effectiveness of physical therapy and electrophysiotherapy treatments for the treatment of lateral epicondylitis.Methods: The authors searched MEDLINE, EMBASE, Web of Science, and Scopus for peer-reviewed randomized controlled trials evaluating the effectiveness of physical therapy and electrophysiotherapy treatments. Data related to article characteristics and outcomes (grip strength and pain visual analog scale score) were collected.Results: Twenty-three clinical trials including 1363 participants (mean age ± SD, 47.4 ± 7.5 years; 53.1 percent women) were included in this study. Pain visual analog scale demonstrated significant reductions in scores after treatment with magnetic field [mean difference (95 percent CI), −1.88 (−2.66 to −1.11)], exercise [−0.90 (−1.69 to −0.1)], and acoustic waves [−0.83 (−1.37 to −0.29)] compared with placebo. For grip strength, no treatment modality was found to be significantly effective. A sensitivity analysis that excluded studies with high publication bias and high degrees of heterogeneity produced similar results to the main analysis with the exception of statistically improved grip strength after light therapy [mean difference (95 percent CI), 5.38 (1.71 to 9.04)] and acoustic wave therapy [7.79 (2.44 to 13.15)].Conclusions: Electrophysiotherapy treatments should be prioritized over physical therapy. Magnetic field therapy was associated with pain reduction, whereas acoustic wave and light therapy were associated with increased grip strength.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Suspensionplasty for Revision Thumb Carpometacarpal Osteoarthritis
           Surgery: Comparing Suture Button Suspensionplasty to Ligament
           Reconstruction and Tendon Interposition

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      Authors: Guerrero; Evan M.; Ferlauto, Harrison R.; Grier, A. Jordan; Wahl, Elizabeth P.; Richard, Marc J.; Ruch, David S.
      Abstract: imageSummary: Several surgical procedures have been described to treat thumb carpometacarpal osteoarthritis, including suture button suspensionplasty and ligament reconstruction and tendon interposition. To date, no single procedure has demonstrated clinical superiority. Suture button suspensionplasty has achieved favorable outcomes at 5 years in primary cases, but has not been validated in revision surgery. In this study, it was evaluated for revision of failed thumb carpometacarpal osteoarthritis surgery, and outcomes were compared to ligament reconstruction and tendon interposition outcomes. A retrospective chart review identified patients who underwent suture button suspensionplasty or ligament reconstruction and tendon interposition after failure of previous thumb carpometacarpal osteoarthritis surgery since 2010. Eighteen patients were included, with nine patients in each group. Eighteen patients had mean final follow-up of 35 months. There were two complications in the ligament reconstruction and tendon interposition group and none in the suture button suspensionplasty group. No patients required additional surgery. The suture button suspensionplasty group had an average visual analogue scale pain score improvement of 2.9, compared to 2.4 in the ligament reconstruction and tendon interposition group. Average final Quick Disabilities of the Arms, Shoulder and Hand questionnaire score was 15.1 in the suture button suspensionplasty group, compared to 22.6 in the ligament reconstruction and tendon interposition group. Mean operative time of 86.3 minutes in the suture button suspensionplasty group was significantly shorter than the 121-minute mean in the ligament reconstruction and tendon interposition group. Suture button suspensionplasty is an effective treatment option for revision of previous thumb carpometacarpal osteoarthritis surgery, with outcomes comparable to revision using ligament reconstruction and tendon interposition, and the added benefit of shorter operative times and early mobilization.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Bone Morphogenic Protein-2 Use for the Surgical Treatment of Acute
           Scaphoid Fractures and Scaphoid Nonunions

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      Authors: Clark; DesRaj M.; Piscoya, Andres S.; Dunn, John C.; Nesti, Leon J.
      Abstract: imageBackground: Bone morphogenic protein-2 has demonstrated promise as an adjunct to surgically treating fractures. Its reported use in the upper extremity is limited. This study reports union rates, outcomes, and complications of scaphoid fractures treated with adjunctive bone morphogenic protein-2 to further characterize bone morphogenic protein-2 use in the hand and wrist.Methods: Retrospective review of scaphoid fractures treated surgically in one region of the Military Health System from 2009 to 2019 was conducted to identify cases using bone morphogenic protein-2. Fracture healing was determined by computed tomography. Primary outcomes were union rate, time to union, and complications. Secondary outcomes included union rates for prior nonunions, union rates at 4 and 6 weeks, and functional outcomes.Results: Fourteen patients met inclusion criteria. Nonunions accounted for 50 percent of included fractures. The total union rate was 93 percent. Mean time to union was 6.2 weeks. All acute fractures healed with a mean time to union of 4.8 weeks. Nonunions had a union rate of 86 percent, with a mean time to union of 7.7 weeks. Four patients (29 percent) developed radiographic heterotopic ossification; however, no significant decrease in motion was appreciated. Thirteen patients (93 percent) resumed the push-ups portion of the military fitness test. No major complications were identified during follow-up.Conclusions: Adjunctive use of bone morphogenic protein-2 in operative fixation of scaphoid fractures resulted in desirable union rates without major complications. Larger, prospective studies are needed to assess whether adjunctive bone morphogenic protein-2 use in scaphoid fractures provides significant benefit compared with other treatments.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Soft-Tissue Reconstruction in Progressive Hemifacial Atrophy: Current
           Evidence and Future Directions

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      Authors: Abi-Rafeh; Jad; Jaberi, Mehrad; Cattelan, Leila; Aljerian, Albaraa; Gilardino, Mirko S.
      Abstract: imageBackground: Progressive hemifacial atrophy is a rare disorder characterized by gradual unilateral soft-tissue atrophy in the face, which may also include clinically significant degeneration of underlying muscle and bone. In recent years, there has been a growing body of evidence regarding different soft-tissue reconstructive strategies in progressive hemifacial atrophy and the impact of intervention timing on disease progression. This article provides a comprehensive synthesis of the latest evidence to guide optimal management.Methods: A comprehensive multidatabase search was performed through April of 2020 using relevant search terms to identify clinical studies. Outcomes, complications, and disease- and patient-related indications pertaining to different soft-tissue reconstructive strategies in progressive hemifacial atrophy were collected and critically appraised.Results: Thirty-five articles reporting on a total of 824 progressive hemifacial atrophy patients were evaluated; 503 patients (61 percent) were managed by microvascular free flaps, 302 patients (37 percent) were managed by autologous fat grafts, and 19 patients (2 percent) were managed by pedicled flaps. A detailed synthesis of outcomes is presented in this article, as is a comparative evaluation of different microvascular free flap options.Conclusions: Soft-tissue reconstruction in progressive hemifacial atrophy remains an evolving field. Operative decision-making is often multifaceted, and guided by specific volumetric, aesthetic, and functional deficiencies. Serial fat grafting is the primary modality used for patients with mild soft-tissue atrophy, whereas microvascular free flaps widely remain the treatment of choice for reconstruction of large-volume defects. There exists a growing role of graft supplementation to improve fat graft survival, whereas recent evidence demonstrates that early intervention may help curb disease progression.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Discussion: Soft-Tissue Reconstruction in Progressive Hemifacial Atrophy:
           Current Evidence and Future Directions

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      Authors: Gishen; Kriya E.; Lee, Justine C.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Discussion: Soft-Tissue Reconstruction in Progressive Hemifacial Atrophy:
           Current Evidence and Future Directions

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      Authors: Lyon; Sarah M.; Siebert, John W.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Impact of Orthodontic Gap Closure versus Prosthetic Replacement of Missing
           Maxillary Lateral Incisor on Dental Arch Relationships and Symmetry in 212
           Patients with Cleft Palate: Retrospective Study

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      Authors: Quenel; Léonie; Keribin, Pierre; Durand, Thomas; Salagnac, Jean-Michel; Perrin, Jean-Philippe; Delaire, Jean; Mercier, Jacques; Talmant, Jean-Claude; Corre, Pierre; Bertin, Helios
      Abstract: imageBackground: Maxillary lateral incisors are frequently missing in patients with cleft lip and/or palate. The aim of this study was to assess how orthodontic gap closure or prosthetic rehabilitation of the missing maxillary lateral incisor affected dental arch relationships and symmetry at the end of treatment. The authors also aimed to determine the effect of the level of oral hygiene on the decision made to manage the missing maxillary lateral incisor gap.Methods: A descriptive, retrospective cohort study including all patients with cleft lip and/or palate born between 1980 and 1999 and treated at Nantes Cleft Center was performed. Patients presenting unilateral or bilateral missing maxillary lateral incisors were reviewed. Data on management of the missing incisor gap, dental arch relationships, symmetry, and level of oral hygiene were collected.Results: A total of 486 patients with cleft lip and/or palate were reviewed, including 212 patients with unilateral or bilateral missing maxillary lateral incisors. When compared with orthodontic gap closure, prosthetic replacement of the gap was associated with better final dental arch relationships (59.8 percent versus 10.3 percent; p < 0.01) and better dental arch symmetry (88.1 percent versus 44.0 percent; p < 0.01) for patients with unilateral missing incisors but not for patients with bilateral missing incisors. A higher level of oral hygiene was associated with more cases of prosthetic replacement for patients with unilateral missing incisors (p = 0.03) but had no effect for patients with bilateral missing incisors.Conclusion: Prosthetic replacement of the missing maxillary lateral incisor gap provided better functional and aesthetic results for patients with cleft lip and/or palate presenting with unilateral missing maxillary lateral incisor.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Efficacy of Postsurgical Nostril Retainer in Patients with Unilateral
           Cleft Lip and Palate Treated with Presurgical Nasoalveolar Molding and
           Primary Cheiloplasty–Rhinoplasty

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      Authors: Al-Qatami; Fawzi; Avinoam, Shayna P.; Cutting, Court B.; Grayson, Barry H.; Shetye, Pradip R.
      Abstract: imageBackground: The aim of this investigation was to determine whether the nasal form of patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding therapy, primary lip-nose surgery, and postsurgical nostril retainer was different from that of patients treated with presurgical nasoalveolar molding and primary lip and nose surgery alone.Methods: This cross-sectional, retrospective review focused on 50 consecutive patients with nonsyndromic unilateral cleft lip and palate: 24 treated with nasoalveolar molding and primary lip and nose surgery followed by postsurgical nostril retainer (group 1) compared with 26 patients treated with nasoalveolar molding and primary lip and nose surgery without postsurgical nostril retainer (group 2). Polyvinyl siloxane nasal impressions were performed at an average age of 12 months and 6 days. Bilateral measurements of alar width at maximum convexity, total alar base width, nasal tip projection, columella length, and nostril aperture width and height were recorded. Statistical comparisons of cleft-side versus noncleft side nasal measurements were performed within group 1 and group 2, as well as comparisons of differences between the two groups.Results: Cleft-side nasal dimension was statistically significantly better in group 1 than in group 2 across all measures except nasal projection (p < 0.05). Group 1 showed less difference between the cleft side and noncleft side in all six measurements than did group 2 (p < 0.05).Conclusions: There was a significant difference in the nasal shape of patients who used a postsurgical nostril retainer compared with those who did not. Patients who used a postsurgical nostril retainer showed better nasal shape at an average age of 12 months compared with the control group.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Orbital Index: A Novel Comprehensive Quantitative Tool for Prediction of
           Delayed Enophthalmos in Orbital Floor Fracture Management

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      Authors: De Ruiter; Brandon J.; Kotha, Vikas S.; Lalezar, Frank D.; Swanson, Marco A.; Kumar, Anand R.; Barmettler, Anne; Prendes, Mark A.; Davidson, Edward H.
      Abstract: imageSummary: Early identification of surgical indication is critical to optimizing outcomes in orbital floor fracture management. However, identifying those at risk for delayed enophthalmos and requiring subsequent repair has remained a challenge. This study aimed to validate the Orbital Index, a prediction tool using computed tomography to stratify risk for delayed enophthalmos and establish a threshold for repair. The Orbital Index stratifies fractures by size, location, and inferior rectus rounding (a surrogate for fascioligamentous sling disruption) on a scale 0 to 6. A 22-year (1998 to 2020) multi-institution analysis of unilateral isolated orbital floor fractures was performed. Index scores were assigned to each scan, unoperated patients invited for blinded Hertel exophthalmometry assessment, and enophthalmos measurements correlated with Index scores. Interobserver scoring reproducibility was assessed with weighted Cohen kappa. Preintervention and postintervention Likert scale surveys were administered to determine whether this tool improved understanding and communication. The Orbital Index demonstrated high fidelity and interobserver reproducibility and identified a score of four or greater as a surgical threshold. Of 1769 computed tomography scans, 395 met criteria and were included for analysis. Eighty of 395 were managed operatively (operative rate, 20.3 percent). Of 315 patients managed nonoperatively, 41 (13.0 percent) agreed to follow-up evaluation and 28 (68.3 percent) were found to have enophthalmos. Unoperated patients with an Orbital Index score of 4 or higher were more likely to have enophthalmos than those with a score of 3 or less (p = 0.001). The mean weighted Cohen kappa was 0.73, corroborating reproducibility. Communication (p = 0.0003) and ability to correctly identify surgical need (p = 0.01) were improved with use of this tool. The Orbital Index is a reproducible tool to stratify risk for enophthalmos in orbital floor fracture management.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Surgical Treatment for Postparalytic Facial Synkinesis: A 35-Year
           Experience

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      Authors: Chuang; David Chwei-Chin; Chang, Tommy Nai-Jen; Lu, Johnny Chuieng-Yi; Zavala, Abraham
      Abstract: imageBackground: Surgical intervention with combined myectomy and neurectomy followed by functioning free muscle transplantation has been proposed to effectively resolve the problem of postparalytic facial synkinesis since 1985, and it continues to be the authors’ standard of care. The authors aim to provide evidence that this surgical strategy is effective for treatment of synkinesis and smile quality.Methods: One hundred three patients with postparalytic facial synkinesis were investigated (1985 to 2020). They all underwent extensive removal of the synkinetic muscles and triggered facial nerve branches in the cheek, nose, and neck regions, followed by gracilis functioning free muscle transplantation for facial reanimation. Ninety-four patients (50 with type II and 44 with type III postparalytic facial synkinesis), all of whom had at least 1 year of postoperative follow-up, were included in the study. Patient demographics and functional and aesthetic evaluations before and after surgery were collected.Results: In the yearly distribution of the facial paralysis reconstruction, the incidence of surgical intervention increased from 15 percent before 2012 up to 24 percent in the years after. Young adults (79 percent) and female patients (63 percent) were the dominant population. Results showed a significant improvement of the facial smile quality, with more teeth visible while smiling, and a long-lasting decrease of facial synkinesis. Ninety-six percent of patients did not require botulinum toxin type A injection after surgery. Revision surgery for secondary deformity was 53 percent.Conclusions: Combined myectomy and neurectomy followed by functioning free muscle transplantation for type II and III synkinetic patients leads to promising and long-lasting results despite high revision rates. Refined techniques to decrease the revision rates are needed in the future.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Discussion: Surgical Treatment for Postparalytic Facial Synkinesis: A
           35-Year Experience

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      Authors: Rozen; Shai M.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • An Algorithm for Reconstruction of Electrical Injuries of the Scalp

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      Authors: Khalid; Farrukh A.; Ahmed, Omar A.; Jibran Rabbani, Muhammad; Saleem, Muhammad; Amin, Muhammad; Malik Mujahid, Abdul; Younas Mehrose, Muhammad; Tarar, Moazzam N.; Shahzad, Farooq
      Abstract: imageBackground: Electrical injuries of the scalp are a frequent occurrence in developing countries. Burns can be contact or conductive and result in extensive tissue damage. The authors present their experience with treatment of scalp and calvarial electrical injuries and propose a management algorithm.Methods: This was a retrospective cohort study comprising all patients with electrical injuries of the scalp treated at the authors’ center between January of 2010 and December of 2016. Noncontrast computed tomography scans were obtained to assess viability of the calvarium in patients who presented more than 2 weeks after injury. Single-stage débridement and reconstruction were performed. All nonviable soft tissue and bone was removed. Soft-tissue reconstruction was performed with skin grafts, local scalp flaps, pedicled trapezius flaps, and free flaps (anterolateral thigh, latissimus dorsi, and scapular). Cranioplasty was performed in a delayed manner with autologous bone grafts.Results: Over a 7-year period, a total of 52 patients underwent scalp reconstruction for high-voltage (44 patients) and low-voltage (eight patients) electrical injury. All patients underwent successful soft-tissue reconstruction. Osteomyelitis with draining sinuses developed in three patients; these patients underwent flap re-elevation and bone débridement, which resulted in a healed wound and stable reconstruction. Cranioplasty was performed with split calvarial grafts in two patients and split rib grafts in four patients. One patient underwent scalp tissue expansion for hair restoration.Conclusion: The authors propose an algorithm for reconstruction of electrical injuries of the scalp. Thorough débridement of the calvarium is the most important determinant of a successful outcome.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Refined Concept of Motor Supply to the Medial Periorbital Area Relevant to
           Periorbital Surgery

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      Authors: Choi; Yeop; Kim, In-Beom
      Abstract: imageBackground: Mimetic muscles in the medial periorbital area have been thought to be innervated solely by the angular nerve. Recently, however, the upper medial palpebral branch and lower palpebral branch were reported as additional motor suppliers in this area. This study aimed to define all the motor nerve systems passing through the medial canthal area.Methods: Motor nerve branches that passed through the medial canthal region were identified and traced thoroughly from the parotid gland to their destinations under a surgical microscopic field in 74 hemifaces. The courses, anatomical positions of, and anatomical relationships between the angular nerve and the upper medial palpebral branch were observed.Results: The upper medial palpebral branch and the angular nerve were found in all samples within a 3-mm to 6-mm area lateral to the intersecting point of the medial orbital rim and medial canthal ligament. The upper medial palpebral branch supplied the upper eyelid, whereas the angular nerve supplied the extraorbicularis muscles in the medial periorbital area. The medial pretarsal area of the upper eyelid was supplied solely by the pretarsal branches of the upper medial palpebral branch, which was formed by uniting three or four minor branches that traveled throughout the anterior cheek.Conclusions: Two separate motor nerve systems, the upper medial palpebral branch and the angular nerve, exist in the medial canthal area. The upper medial palpebral branch course along the medial orbital rim is considered as a facial nerve danger zone.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Introduction of a Low-Cost and Automated Four-Dimensional Assessment
           System of the Face

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      Authors: Petrides; George A.; Joy, Christopher; Dolk, Oliver; Low, Tsu-Hui (Hubert; Lovell, Nigel; Eviston, Timothy J.
      Abstract: imageSummary: Existing automated objective grading systems either fail to consider the face’s complex three-dimensional morphology or have poor feasibility and usability. Consumer-based red, green, and blue depth sensors or smartphone integrated three-dimensional hardware can inexpensively collect detailed four-dimensional facial data in real time but are yet to be incorporated into a practical system. This study aimed to evaluate the feasibility of a proof-of-concept automated four-dimensional facial assessment system using a red/green/blue depth sensor (OpenFAS) for use in a standard clinical environment. This study was performed on healthy adult volunteers and patients with facial nerve palsy. The setup consists of the Intel (Santa Clara, Calif.) RealSense SR300 connected to a laptop running the OpenFAS application. The subject sequentially mimics the facial expressions shown on screen. Each frame is landmarked and automatic anthropometric calculations are performed. Any errors during each session were noted. Landmarking accuracy was estimated by comparing the ground-truth position of landmarks annotated manually with those placed automatically. Eighteen participants were included in the study, nine healthy participants and nine patients with facial nerve palsy. Each session was standardized at approximately 106 seconds. A total of 61.8 percent of landmarks were automatically annotated within approximately 1.575 mm of their ground-truth locations. The findings support that OpenFAS is usable and feasible in routine settings, laying down the critical groundwork for a facial assessment system that addresses the shortcomings of existing tools. The iteration of OpenFAS presented in this study is nascent; future work, including improvements to landmarking accuracy, analyses components, and red/green/blue depth technology, is required before clinical application.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Older Patients and Patients with Severe Arteriosclerosis Are Less Likely
           to Develop Keloids and Hypertrophic Scars after Thoracic Midline Incision:
           A Survey-Based Analysis of 328 Cases

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      Authors: Sugimoto; Atsuko; Ono, Shimpei; Usami, Satoshi; Nitta, Takashi; Ogawa, Rei
      Abstract: imageBackground: Surgery is a well-known trigger of keloid and hypertrophic scarring. Sternotomy scars are subject to high skin tension, which is known to promote pathologic scarring. This suggests that sternotomies in adults are associated with high pathologic scarring rates, which aligns with the authors’ anecdotal experience. However, this notion has never been examined formally. Therefore, the authors conducted a survey-based cohort study of patients who had undergone a sternotomy.Methods: All consecutive Japanese adults (18 years of age or older) who underwent cardiovascular surgery with sternotomy in 2014 to 2017 were identified in 2019 by chart review and sent a questionnaire. Respondents formed the study cohort. The questionnaire presented randomly ordered photographs of representative mature, keloid, and hypertrophic scars and asked the patients to choose the image that best resembled their midline scar when it was particularly noticeable. The incidence of self-reported pathologic scarring (keloids and hypertrophic scars were grouped together) and the patient demographic (age and sex) and clinical characteristics (intima–media thickness of the left and right common and internal carotid arteries) that were associated with pathologic scarring were determined.Results: Of the 548 patients who underwent sternotomy, 328 responded for a 60 percent response rate. The mean patient age was 67 years, and 68.0 percent were male. Of these patients, 195 (59.5 percent) reported they had a pathologic scar. Compared with patients who had a mature scar, patients who had a pathologic scar had younger mean age (65 versus 69 years; p = 0.0002) and lower intima–media thickness (0.92 versus 1.05 mm; p = 0.028).Conclusions: Sternotomy was associated with a high rate of pathologic scarring. Older age and arteriosclerosis were associated with less pathologic scarring.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Association of Unilateral Latissimus Dorsi Muscle Harvest for Breast
           Reconstruction with Postoperative Spinal Posture

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      Authors: Kim; Jisu; Lee, Hojune; Pyon, Jai-Kyong; Mun, Goo-Hyun; Bang, Sa Ik; Jeon, Byung-Joon; Lee, Kyeong-Tae
      Abstract: imageBackground: The latissimus dorsi muscle originates from the lower thoracic spine with broad attachment and plays a subsidiary role in spinal postural stability. The authors investigated whether harvesting unilateral latissimus dorsi muscle for breast reconstruction could influence spinal posture in the long term.Methods: Patients who underwent immediate unilateral breast reconstruction between 2002 and 2010 were reviewed. They were grouped according to reconstruction methods: latissimus dorsi muscle flap and tissue expander/implant. The Cobb angle was assessed twice at each of five different time points (preoperatively and 2, 4, 6, and 8 years postoperatively) by an independent physician blinded to the reconstruction modality. Postoperative scoliosis was defined as a mean Cobb angle greater than 10 degrees at 8 years postoperatively. The trends of changes in Cobb angle over time and the rates of postoperative scoliosis were compared between reconstruction methods.Results: In total, 153 women were analyzed, including 102 using latissimus dorsi muscle flap and 51 using tissue expander/implant, with a median follow-up of 103 months. The latissimus dorsi flap group showed enhanced trends of increasing postoperative Cobb angles as compared with the tissue expander/implant group, and the difference remained significant after adjusting for other variables (p = 0.001). The rate of postoperative scoliosis was significantly higher in the latissimus dorsi flap group than in the control group (p = 0.029). Multivariable analyses revealed that use of the latissimus dorsi flap was associated with a significantly increased rate of postoperative scoliosis.Conclusion: Unilateral latissimus dorsi muscle flap harvest for breast reconstruction might be associated with changes in spinal posture in the long term.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Negative-Pressure Wound Therapy versus Standard Surgical Dressings after
           Malignant Tumor Resection: A Systematic Review and Meta-Analysis

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      Authors: Hays; Thomas R.; Singh, Gurtej; Saragossi, Jamie; Park, Jason; Shekar, Shruthi; Marquez, Jocellie E.; Dagum, Alexander B.; Khan, Sami U.; Khan, Fazel A.; Bui, Duc T.
      Abstract: imageBackground: Negative-pressure wound therapy offers many advantages over standard surgical dressings in the treatment of open wounds, including accelerated wound healing, cost savings, and reduced complication rates. Although contraindicated by device manufacturers in malignancy-resected wounds because of hypothesized risk of tumor recurrence, negative-pressure wound therapy is still applied postoperatively because of limited clinical support. The authors performed a systematic review with meta-analysis to compare negative-pressure wound therapy outcomes with those of standard surgical dressings on open wounds, with their null hypothesis stating there would be no outcome differences.Methods: A systematic review of the literature on negative-pressure wound therapy and standard surgical dressings on malignancy-resected wounds was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Embase, CINAHL, and Cochrane Central databases. Meta-analysis compared group outcomes, including malignancy recurrence, wound complication, and surgical site infection rates, with a random effects model.Results: A total of 1634 studies were identified and 27 met eligibility criteria, including four randomized controlled trials, four prospective cohort studies, and 19 retrospective reviews. Eighty-one percent of articles (n = 22) recommended negative-pressure wound therapy in malignancy-resected wounds. Meta-analysis determined that the treatment yielded significantly lower overall surgical site infection (p = 0.004) and wound complication (p = 0.01) rates than standard surgical dressings; however, there were no statistically significant differences found for other outcomes between the two groups.Conclusions: This review demonstrates favorable outcomes of negative-pressure wound therapy over standard surgical dressings for malignancy-resected wounds without an increased risk of malignancy recurrence. However, because limited randomized controlled trials (detailing only incisional wounds for limited malignancies and anatomic regions) are available, additional high-power randomized controlled trials are recommended.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • “Thou Shalt Not Throw Away a Living Thing”: Innovative Use of
           Perforator Flaps in Abdominal Wall Reconstruction

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      Authors: Brunetti; Beniamino; Morelli Coppola, Marco; Ciarrocchi, Silvia; Salzillo, Rosa; Tenna, Stefania; Persichetti, Paolo
      Abstract: imageSummary: Abdominal wall reconstruction represents a complex challenge for plastic surgeons, given the variable range of clinical situations requiring restoration of abdominal wall integrity. When significant myofascial defects are encountered, repair with either a synthetic or biological mesh is indicated, both of which have advantages and drawbacks. Taking inspiration from Gillies’ fourth commandment of plastic surgery—Thou shalt not throw away a living thing—an innovative technique to obtain a vascularized autologous mesh from the tissues usually discarded during abdominal contouring procedures was conceived. The authors describe how to maximize the use of perforator flaps derived from abdominoplasty excision patterns in abdominal wall reconstruction to simultaneously obtain restoration of abdominal wall integrity and improvement of the abdominal contour.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Island Perforator Muscle Flaps for Chronic Osteomyelitis of the Lower
           Extremities: A Retrospective Analysis of 21 Consecutive Cases

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      Authors: Zhao; Xiaozhuo; Shen, Yuming
      Abstract: imageBackground: One of the procedures for treating chronic osteomyelitis is the management of dead space resulting from aggressive débridement of the marrow cavity. To fill the void created by débridement, various muscle flaps have been recommended by many surgeons for their convenience and antiinfective properties. The objective of this study was to evaluate the efficacy of island perforator muscle flaps for the reconstruction of chronic osteomyelitis débridement defects of the lower extremities and provide indications for the selection of the muscle flap.Methods: A retrospective review of consecutive patients with chronic osteomyelitis of the lower extremities who underwent reconstruction using the island perforator muscle flap procedure from 2015 through 2018 was conducted. Data were collected on characteristics of the patients, wound site, wound size, surgical procedure, muscle choice, and wound healing.Results: For the 21 patients included in the study, all muscle flaps survived. Wounds healed completely within 4 weeks. No infection relapses were identified during the follow-up period of at least 12 months. Simple primary closure, with no additional incision in the donor site, was achieved in five patients. In eight patients, an additional incision was made to harvest a muscle flap, but both the wound and donor site were closed primarily.Conclusion: The results showed that the island perforator muscle flap is less invasive, easy to harvest, and effective, and can be a good choice for the management of dead space resulting from débridement for chronic osteomyelitis in the lower extremity.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • The First Dorsal Metacarpal Artery Perforator Free Flap: The Comet Flap

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      Authors: Abu-Ghname; Amjed; Lazo, Daniel; Chade, Salomao; Fioravanti, Alex; Colicchio, Olimpio; Alvarez, Daniel; Junior, Ernani; Maricevich, Marco
      Abstract: imageBackground: Distal extremity defects pose a particular challenge to the reconstructive surgeon; however, advances in perforator flaps have expanded the potential reconstructive options. In this article, the authors present their experience in reconstructing distal extremity defects using a thin, cutaneous free flap based on the perforator of the first dorsal metacarpal artery: the comet flap.Methods: A retrospective review was performed on all patients who presented with a distal extremity defect and underwent reconstruction using a comet flap between 2015 and 2019. Patient demographics, flap anatomy and harvest, and postoperative course were reviewed and analyzed.Results: A total of 16 patients were included. The mean patient age was 36.5 years. Trauma was the most common cause. The average defect size was 5.4 × 3.2 cm. The average pedicle length of the comet flap ranged from 3.5 to 30 cm, depending on involvement of the radial vessels. All donor sites underwent uncomplicated closure with local rhomboid flaps. One flap was complicated by an acute venous thrombosis that was successfully treated operatively. The flap survival rate was 95 percent. All patients were able to maintain their preoperative range of motion and were satisfied with their final outcome. Follow-up time ranged from 6 to 50 months.Conclusions: Local flaps remain an important reconstructive approach for distal extremity defects; however, in complex soft-tissue injuries, free tissue transfers become necessary. The comet flap is a safe, versatile, and reliable flap for reconstructing upper and lower extremity defects that can be performed in a single procedure under regional anesthesia.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Optimizing the Use of Autografts, Allografts, and Alloplastic Materials in
           Rhinoplasty

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      Authors: Chen; Kevin; Schultz, Benjamin D.; Mattos, David; Reish, Richard G.
      Abstract: imageLearning Objectives: After studying this article, the participant should be able to: 1. Understand the autologous graft options available to the rhinoplasty surgeon, including septal cartilage, auricular cartilage, costal cartilage, and bone. 2. Understand the autograft and allograft options available to the rhinoplasty surgeon, including cadaveric costal cartilage, silicone, Medpor, and Gore-Tex. 3. Identify the ideal situations to use each of these implant materials. 4. Understand the advantages and disadvantages of the different autografts, allografts, and implants in rhinoplasty.Summary: This review focuses on the graft options available to the modern rhinoplasty surgeon. Autologous options are varied in the quality of cartilage harvested and the morbidity of the donor site. In addition, surgeons should understand the allograft options should autologous grafting be unfeasible or undesirable. New technological advances in processing of allograft cartilage makes this an attractive secondary option.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Designing a Plastic and Reconstructive Surgery Virtual Curriculum:
           Assessment of Medical Student Knowledge, Surgical Skill, and Community
           Building

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      Authors: Shen; Abra H.; Alfonso, Allyson R.; Cuccolo, Nicholas G.; Johnson, Anna Rose; Lee, Bernard T.; Lin, Samuel J.
      Abstract: imageBackground: The COVID-19 pandemic displaced medical students from their rotations and into virtual classrooms. The authors aimed to develop a virtual curriculum with the goals for students to gain knowledge in plastic surgery, to acquire technical skills, and to be able to promote community.Methods: The authors developed a 4-week educational curriculum of topics in plastic surgery using the American Society of Plastic Surgeons Resident Education Curriculum and an online plastic surgery curriculum. Virtual flipped classroom case discussions and weekly surgical skills workshops were offered. Precourse and postcourse surveys were administered, and results were analyzed using IBM SPSS Statistics version 25.0.Results: Three hundred three medical students and recent graduates enrolled in the course in June of 2020. One hundred eighty-two students completed the precourse survey (60 percent response rate), and of those, 50.0 percent (n = 91) completed the postcourse survey for paired comparison. Students reported significant improvement in confidence discussing the relevant anatomy, workup, and surgical approaches to clinical cases, in addition to confidence in knowledge of all topic areas (p < 0.001). Confidence in suturing and knot-tying techniques improved significantly among workshop participants (p < 0.001). Students applying to residency programs this cycle felt significantly more prepared for subinternships (p < 0.001) and significantly more connected to the community of applicants (p < 0.001).Conclusions: The Plastic and Reconstructive Surgery Virtual Curriculum improved knowledge, surgical skills, and community in the field among medical student participants. This course may serve to provide a framework for structured virtual learning activities for students interested in plastic surgery and may have significant long-lasting utility for students interested in the field.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Impact of the Virtual Format on Plastic Surgery Residency and Fellowship
           Interviews: A National Cross-Sectional Study

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      Authors: Ferry; Andrew M.; Asaad, Malke; Elmorsi, Rami; Rajesh, Aashish; Williams, Elizabeth M.; Wolf, Steven E.; Rohrich, Rod J.; Pederson, William C.; Maricevich, Renata S.
      Abstract: imageBackground: The 2020 to 2021 residency and fellowship application cycles were profoundly affected by the introduction of virtual interviews. The authors investigated the impact the virtual format had on plastic surgery residency and fellowship interviews from the perspectives of program directors.Methods: Surveys were sent to program directors of integrated plastic surgery residency and fellowship programs to ascertain their perspectives regarding the virtual format’s impact on residency and fellowship interviews. Program directors were stratified into residency and fellowship cohorts, and comparative analysis was performed.Results: Ninety-two program directors, 28 from integrated plastic surgery residency programs and 64 from fellowship programs, completed our survey (35 percent). Compared to in-person interviews, virtual interviews were reported to be more economical and time efficient by program directors of residency (100 percent and 46 percent, respectively) and fellowship programs (97 percent and 48 percent, respectively). Consequentially, 36 percent and 47 percent of residency and fellowship programs were able to interview more applicants, respectively. Program directors of residency and fellowship programs reported that virtual interviews hindered their ability to assess applicants’ fit with the program (75 percent and 63 percent, respectively), personality and communication skills (75 percent and 64 percent, respectively), and commitment to the field, along with their ability to function as a trainee (57 percent and 50 percent, respectively). Overall, 71 percent of program directors of residency and 58 percent of program directors of fellowship programs preferred in-person interviews. The majority of residency (71 percent) and fellowship (56 percent) program directors intend to conduct both in-person and virtual interviews in future application cycles (p = 0.12).Conclusions: Despite preferring in-person interviews, program directors intend to host both in-person and virtual interviews in future application cycles. It remains to be seen how virtual interviews will be used moving forward.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Know Thyself: Natural and Adapted Behavior Styles of General and Plastic
           Surgery Residents

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      Authors: Meade; Anna; Chang, Victor; Duque, Sofia; Farmer, Suzanne J.; Zhang, Andrew Y.
      Abstract: imageBackground: Resident miscommunication and fractured team dynamics are associated with decreased quality of patient care. Interventions to improve resident communication and team coordination include behavioral assessments, which promote leadership and communication skills.Methods: In this retrospective review, general and plastic surgery residents voluntarily completed the DISC (dominance, influence, steadiness, and compliance) behavioral assessment. This validated tool is composed of four behavioral categories: dominance (D), influence (I), steadiness (S), and compliance (C). It is used to classify an individual’s natural and adapted behavior styles. Results were anonymously collected and analyzed using the Pearson chi-square test.Results: Of 94 surgery residents, 84 completed the survey (89 percent): 43 men and 41 women. Surgery residents combined had a significantly higher percentage of natural C’s compared to the general population (23 percent versus 14 percent; p = 0.02). The majority of surgery residents adapted to C in the work environment (39 versus 36 percent; p = 0.85). There was a significant difference in male and female general surgery adapted D profiles (4 percent versus 23 percent; p = 0.05).Conclusions: The pressure of accuracy in surgical residency attracts natural C individuals. Residents without a natural C behavioral profile tend to adapt to the C profile. The ability to recognize behavior traits is crucial in surgical residency. Developing a better understanding of one’s own behavior will provide insight into personal risk factors for miscommunication and inefficient team dynamics.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Board Certification in Cosmetic Surgery: An Analysis of Punitive Actions

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      Authors: Gabrick; Kyle; Makhoul, Alan T.; Riccelli, Vincent; Perdikis, Galen; Janis, Jeffrey E.; Drolet, Brian C.
      Abstract: imageBackground: American Board of Plastic Surgery (ABPS) diplomates complete training in aesthetic surgery through an Accreditation Council of Graduate Medical Education–accredited program. American Board of Cosmetic Surgery (ABCS) diplomates complete residency training in a “related” specialty, some historically nonsurgical, followed by an American Association of Cosmetic Surgery fellowship. Unlike the ABPS, the ABCS is not recognized by the American Board of Medical Specialties as an equivalent certifying board. This study evaluated differences in the rates of punitive action against diplomates of the ABPS and the ABCS.Methods: Diplomates were accessed from their respective society’s websites. Punitive action data were obtained by search of publicly available state medical board databases. A comparative analysis was performed between ABPS and ABCS.Results: One thousand two hundred eight physicians were identified for comparative analysis. Two hundred sixty-six (22 percent) were members of the American Society of Plastic Surgeons, and 549 (49 percent) were members of The Aesthetic Society. ABCS diplomates had significantly higher rates of disciplinary administrative action by their respective state medical boards [n = 31 (9.0 percent)] when compared with ABPS members [The Aesthetic Society, n = 26 (4.4 percent); ABPS, n = 8 (3.1 percent); p = 0.003], with a higher proportion of repeat offenders. In addition, ABCS diplomates had more public letters of reprimand [ABCS, n = 12 (3.5 percent); The Aesthetic Society, n = 6 (1.2 percent); and ABPS, n = 2 (0.8 percent); p = 0.015].Conclusions: ABCS diplomates have significantly higher rates of punitive actions than ABPS diplomates. Although the reasons for this discrepancy warrant further investigation, punitive data should be transparently and publicly available to aid patients in informed decision-making.
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • An Overproliferation of Systematic Review Studies

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      Authors: Chung; Kevin C.; Wood, Shannon M.; Colwell, Amy S.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Jack H. Sheen, M.D., 1925 to 2021

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      Authors: Constantian; Mark B.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Discussion: MemoryGel Breast Implants: Final Safety and Efficacy Results
           after 10 Years of Follow-Up

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      Authors: Caplin; David A.; Calobrace, M. Bradley; Wixtrom, Roger N.; Estes, Megan M.; Canady, John W.
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Discussion: MemoryGel Breast Implants: Final Safety and Efficacy
           Results after 10 Years of Follow-Up

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      Authors: Johnson; Debra J.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Tips and Tricks in Gender-Affirming Mastectomy

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      Authors: Wongkietkachorn; Apinut; Punyavong, Pattama; Surakunprapha, Palakorn
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Tips and Tricks in Gender-Affirming Mastectomy

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      Authors: Salibian; Ara A.; Gonzalez, Eduardo; Frey, Jordan D.; Bluebond-Langner, Rachel
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Botulism Due to Cosmetic Injection of Botulinum Toxin: Five-Year
           Experience

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      Authors: Carruthers; Jean D.; Fagien, Steve
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Botulism Due to Cosmetic Injection of Botulinum Toxin: Five-Year
           Experience

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      Authors: Chen; Zong; Chen, Zhi-You; Liu, Wen-Hui; Li, Guang-Shuai
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Cone-Beam Computed Tomography: A User-Friendly, Practical Roadmap to the
           Planning and Execution of Every Rhinoplasty—A 5-Year Review

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      Authors: Alí; Agustín H.; Cutini Cingozoglu, Carlos A.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Cone-Beam Computed Tomography: A User-Friendly, Practical Roadmap
           to the Planning and Execution of Every Rhinoplasty—A 5-Year Review

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      Authors: Robotti; Enrico; Leone, Francesco
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Ultra Diced Cartilage Graft in Rhinoplasty: A Fine Tool

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      Authors: Gao; Qiuni; Dai, Chuanchang
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Ultra Diced Cartilage Graft in Rhinoplasty: A Fine Tool

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      Authors: Taş; Süleyman
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Increasing Fat Graft Retention in Irradiated Tissue after Preconditioning
           with External Volume Expansion; and One-Year Outcomes of Intraarticular
           Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis: Case
           Review of 99 Joints

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      Authors: Boriani; Filippo
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Increasing Fat Graft Retention in Irradiated Tissue after
           Preconditioning with External Volume Expansion

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      Authors: Oranges; Carlo M.; Tremp, Mathias; Kalbermatten, Daniel F.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Free Flap Reconstruction of Posterior Trunk Soft-Tissue Defects:
           Single-Institution Experience and Systematic Literature Review

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      Authors: Leach; Garrison A.; Dean, Riley A.; Reid, Christopher M.; Rechnic, Mark
      Abstract: imageNo abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Free Flap Reconstruction of Posterior Trunk Soft-Tissue Defects:
           Single-Institution Experience and Systematic Literature Review

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      Authors: Akdeniz-Dogan; Zeynep; Roubaud, Margaret S.; Kapur, Sahil K.; Liu, Jun; Yu, Peirong; Selber, Jesse C.; Mericli, Alexander F.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Neourethra Creation in Gender Phalloplasty: Differences in Techniques and
           Staging

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      Authors: Roblee; Cole; Horen, Sydney R.; Hamidian Jahromi, Alireza
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Neourethra Creation in Gender Phalloplasty: Differences in
           Techniques and Staging

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      Authors: Berli; Jens Urs
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Assessment of Plastic Surgery Residency Applications without United States
           Medical Licensing Examination Step 1 Scores

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      Authors: Shahzad; Farooq
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Reply: Assessment of Plastic Surgery Residency Applications without United
           States Medical Licensing Examination Step 1 Scores

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      Authors: Irwin; Timothy J.; Eberlin, Kyle R.
      Abstract: No abstract available
      PubDate: Thu, 01 Sep 2022 00:00:00 GMT-
       
  • Closed Suction Drain Placement Using a Carroll Tendon Retriever

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      Authors: Marcaccini; Robert L.; Andersen, Emily S.; Blanchet, Nadia P.
      Abstract: No abstract available
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