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Plastic and Reconstructive Surgery
Journal Prestige (SJR): 1.731
Citation Impact (citeScore): 2
Number of Followers: 36  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0032-1052 - ISSN (Online) 1529-4242
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • The Goldilocks Procedure with and without Implant-Based Immediate Breast
           Reconstruction in Obese Patients: The Mayo Clinic Experience

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      Authors: Bustos; Samyd S.; Nguyen, Minh-Doan; Harless, Christin A.; Tran, Nho V.; Martinez-Jorge, Jorys; Lin, Jason; Forte, Antonio J.; Casey, William J. III; Boughey, Judy C.; McLaughlin, Sarah A.; Gray, Richard; Manrique, Oscar J.
      Abstract: imageBackground: Obesity is a risk factor for complications in breast reconstruction. Thus, implant-based immediate breast reconstruction in obese women may be controversial. The authors analyzed obese patients who underwent skin-sparing mastectomy using Wise-pattern incisions (Goldilocks procedure) and compared outcomes between two groups: Goldilocks with immediate breast reconstruction and Goldilocks only.Methods: A retrospective review was performed of patients with a body mass index of 30 kg/m2 or higher who underwent the Goldilocks procedure at the Mayo Clinic Health System from 2012 to 2019. Data were extracted from electronic medical records. Minor complications (partial-thickness wound dehiscence or flap necrosis, or tissue expander/implant malposition) and major complications (full-thickness wound dehiscence or flap necrosis, capsular contracture, tissue expander/implant explantation, or unplanned reoperation or readmission) were compared between groups. Patient-reported outcomes using BREAST-Q questionnaires were also assessed.Results: One hundred five patients (181 breasts) were included. Mean ± SEM age and body mass index were 57.1 ± 10.4 years and 37.9 ± 5.8 kg/m2 for the Goldilocks-only group and 51.5 ± 1.1 years and 35.5 ± 0.4 kg/m2 for the Goldilocks with immediate breast reconstruction group, respectively. Median follow-up time was 15.1 months (interquartile range, 10.0 to 28.6 months). Overall, 96 breasts underwent the Goldilocks-only procedure and 85 Goldilocks with immediate breast reconstruction. Multivariable analyses revealed a higher rate of minor complications (adjusted hazard ratio, 2.83; 95 percent CI, 1.22 to 7.02) and major complications (adjusted hazard ratio, 2.26; 95 percent CI, 1.25 to 4.24) in the Goldilocks with immediate breast reconstruction group compared with the Goldilocks-only group, at any given time. Patient satisfaction was not statistically different between groups.Conclusions: The Goldilocks procedure is a feasible breast reconstructive option in obese patients; however, when it is performed with immediate breast reconstruction, it is associated with higher rates of complications. For patients with a body mass index of 40 kg/m2 or greater, the authors recommend the Goldilocks-only procedure or delayed reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Discussion: The Goldilocks Procedure with and without Implant-Based
           Immediate Breast Reconstruction in Obese Patients: The Mayo Clinic
           Experience

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      Authors: Nahabedian; Maurice Y.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Perceived versus Patient-Reported Significance of Surgeon Gender in Breast
           Reconstruction

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      Authors: Hsu; Jessica J.; Kubiak, Carrie A.; Billig, Jessica I.; Qi, Ji; Hamill, Jennifer B.; Kim, Hyungjin M.; Wilkins, Edwin G.; Kung, Theodore A.
      Abstract: imageBackground: Previous investigators demonstrated that female patients often prefer female providers. However, these studies have not determined whether there are gender preferences for breast reconstruction surgeons or whether the effects of surgeon gender impacts patient-reported outcomes.Methods: Adult women were crowdsourced using Amazon Mechanical Turk to characterize societal preferences for the gender of breast and plastic surgeons in a hypothetical scenario. The authors also used data from the Mastectomy Reconstruction Outcomes Consortium to determine the association between surgeon gender and patient satisfaction after breast reconstruction. The BREAST-Q questionnaire was used to assess patient-reported outcomes at 3 months and 2 years following reconstruction. Regression analyses were performed to investigate the effects of surgeon gender on patient-reported outcomes.Results: In total, 1413 surveys were collected. Forty-two percent preferred female plastic surgeons, 5 percent preferred male surgeons, and 53 percent reported no preference. The Mastectomy Reconstruction Outcomes Consortium analysis included 2236 patients of 55 male and nine female plastic surgeons. In this cohort, 1921 patients (82.2 percent) had male surgeons, whereas 415 patients (17.8 percent) had female surgeons. Regression analysis at 2 years revealed no differences in satisfaction with surgeon, outcome, or psychosocial well-being. Only satisfaction with information differed, as patients of female surgeons reported greater satisfaction in this category, with an adjusted mean difference of 2.82 (p = 0.018).Conclusions: Although nonpatient women hypothetically prefer female providers, surgeon gender makes little difference in actual patient satisfaction with breast reconstruction. More investigation is needed to determine whether the difference in information delivery is clinically significant and whether it reflects variations in practices between male and female surgeons.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • A Matched Comparison of the Benefits of Breast Reduction on Health-Related
           Quality of Life

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      Authors: Elfanagely; Omar; Othman, Sammy; Rios-Diaz, Arturo J.; Cunning, Jessica R.; Whitely, Cutler; Butler, Paris; Fischer, John P.
      Abstract: imageBackground: Breast reduction surgery has consistently fallen within the top 10 surgical procedures performed by plastic surgeons. This is because of its capability to relieve the physical and psychological impact of macromastia. Although numerous women pursue consultation, many never undergo the procedure. The authors aim to quantify the impact of breast reduction surgery on quality of life by comparing patients who underwent breast reduction surgery with those who did not.Methods: Patients seeking breast reduction surgery between 2016 and 2019 were identified. As standard-of-care, patients are surveyed during the consultation visit and postoperative visits using the BREAST-Q. The preoperative survey was readministered a second time for those who did not undergo breast reduction surgery. Propensity score matching, based on patient demographics, comorbidities, and breast examination, was used to balance baseline characteristics.Results: A total of 100 propensity-matched patients were identified (operative, n = 78; nonoperative, n = 22). Mean participant age was 39.5 ± 25 years and mean body mass index was 31.1 ± 7.4 kg/m2. Quality of life significantly improved in each domain for those in the operative group (p < 0.05). Those who did not undergo breast reduction surgery realized no improvement in quality of life and had a downward trend in quality of life across two of the four domains.Conclusions: Breast reduction surgery offers a significant improvement in quality of life for macromastia. This matched study demonstrates that patients who are able to undergo breast reduction surgery have a statistically significant improvement in all aspects of quality of life, whereas nonsurgical patients experience no benefit with time, with a trend toward deterioration in specific domains.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Incidence of Occult Malignant and High-Risk Pathologic Findings in
           Breast Reduction Specimens

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      Authors: Razavi; Seyed Amirhossein; Hart, Alexandra M.; Betarbet, Udayan; Li, Xiaoxian; Carlson, Grant W.; Losken, Albert
      Abstract: imageBackground: The goal of this study was to determine the incidence of occult malignancy and high-risk breast pathologic findings in patients who undergo breast reduction procedures.Methods: Medical records of consecutive patients who underwent reduction mammaplasty performed by the senior authors (A.L. and G.W.C.) at Emory University Hospital between 1997 and 2018 were reviewed. Data regarding patient demographics, personal or family history of malignancy, operative technique, pathologic findings, and follow-up were extracted. Patients were categorized into two groups, those with and those without breast cancer. Group A patients underwent reduction for symptomatic macromastia, and group B underwent contralateral reduction for unilateral breast cancer treated with oncoplastic partial or total breast cancer reconstruction. Pathologic findings were divided into four groups; normal, benign, high-risk, and malignant.Results: A total 1014 patients (1419 breast reductions) were included in the study. Comparing groups A and B, mean age was 37.8 ± 16.2 years versus 54.5 ± 11.1 years (p < 0.001), mean body mass index was 34.1 ± 7.6 kg/m2 versus 33.3 ± 7.4 kg/m2 (p = 0.2), and average reduction weight was 875.6 ± 491 g versus 723.7 ± 438 g (p < 0.001). The incidence of high-risk or malignant lesions was 1.8 percent (n = 15) in group A and 8 percent (n = 49) in group B (p < 0.001). On multivariable logistic regression analysis, age and personal history of breast cancer were positive predictors for high-risk and malignant lesions.Conclusions: The incidence of abnormal pathologic findings in breast reduction specimens is not uncommon, and occult malignancy or high-risk lesions can be found, especially in patients with contralateral breast cancer. Appropriate specimen orientation, diligence with checking the pathologic findings, and open communication with the pathologist are crucial.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Technical Refinement in Three-Dimensional Nipple-Areola Complex Tattooing
           of the Reconstructed Breast

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      Authors: Ruffolo; Alexis M.; Bruce, William J.; Daugherty, Timothy H. F.; Lee, Jason; Sommer, Nicole Z.
      Abstract: imageSummary: Three-dimensional nipple-areola complex tattooing has previously been described as an alternative to surgical reconstruction using local flaps and grafts. This technique offers patients an option that can achieve aesthetically pleasing results without a donor site, changes in projection over time, or additional scarring. Plastic surgeons may be limited in their ability to create a realistic-appearing nipple-areola complex because of limited experience with basic tattooing techniques and unfamiliarity with the artistic principles of light and shadow required to create depth on a two-dimensional surface. Consistent results can be achieved with attention to the technical pearls discussed in this article.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Revision Rhinoplasty after Open Rhinoplasty: Lessons from 252 Cases and
           Analysis of Risk Factors

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      Authors: Sibar; Serhat; Findikcioglu, Kemal; Pasinlioglu, Burak
      Abstract: imageBackground: In this study, patients who required aesthetic revision surgery after open rhinoplasty were retrospectively screened for risk factors.Methods: Two hundred fifty-two patients who underwent revision were included in the study. Nasal deformities before the revision were determined for each patient and evaluated in terms of their statistical relationship with preoperative nasal morphology and surgical techniques used.Results: The revision rate was found to be 10.8 percent. The three most common aesthetic reasons for revision were insufficient nasal tip rotation (37.7 percent), hanging columella (30.2 percent), and supratip deformity (28.6 percent). According to logistic regression analysis, the use of a strut increased the risk of inadequate nasal tip rotation by 5.3-fold compared to the tongue-in-groove technique, whereas inadequate nasal tip projection before surgery increased this risk by 2-fold. Being older than 40 years increased the risk of hanging columella by 6.8-fold, whereas the use of strut grafting instead of the tongue-in-groove technique increased this risk by 5.9-fold. The use of strut grafts instead of the tongue-in-groove technique increased the risk of supratip deformity by 2.2-fold.Conclusions: To ensure adequate nasal tip rotation after surgery in patients with advanced age and low nasal tip projection and rotation, it will be more appropriate to either use the tongue-in-groove technique or rotate the nasal tip more than normal. In patients with advanced age (>40 years) and low nasolabial angle before surgery, the use of tongue-in-groove technique instead of strut grafting may be advantageous for reducing the incidence of supratip and hanging columella.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Discussion: Revision Rhinoplasty after Open Rhinoplasty: Lessons from 252
           Cases and Analysis of Risk Factors

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      Authors: Toriumi; Dean M.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Subfascial versus Subglandular Breast Augmentation: A Randomized
           Prospective Evaluation Considering a 5-Year Follow-Up

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      Authors: Graf; Ruth M.; Junior, Ivan Maluf; de Paula, Dayane R.; Ono, Maria C. C.; Urban, Linei A. B. D.; Freitas, Renato S.
      Abstract: imageBackground: Subfascial breast augmentation is becoming popular because of a better understanding of breast anatomy. However, because the subglandular approach is also another popular method, it is critical to assess the influence of the superficial fascia of the pectoralis major muscle on the subfascial and subglandular pockets to determine if one method is superior to another. This study investigated whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation.Methods: Twenty patients were recruited, and each was randomly sorted to the subfascial and/or subglandular pocket per breast. Both patients and surgeons were blinded. Differences were evaluated through five independent surgeons and by magnetic resonance imaging scans. Subsequently, 1-year and 5-year follow-ups were conducted.Results: The results of the 5-year follow-up considering the aesthetics of the breast contour were significantly different between groups, with more good and excellent evaluations in the subfascial group. Regarding breast shape, there were also statistical differences, also with more good and excellent evaluations in the subfascial group. For breast consistency, subglandular had 84.20 percent of patients classified into Baker I and II, whereas subfascial had 100 percent. Magnetic resonance imaging scans showed a smaller implant base in the subglandular pockets, which was a significant result. There were no significant differences in implant projection. Comparison of the number of folds revealed significant differences between groups, with more folds in the subglandular group.Conclusion: Statistical differences between methods were found regarding breast shape and contour, capsular contracture, implant base, and the number of folds, showing that subfascial breast augmentation is superior to subglandular breast augmentation.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Discussion: Subfascial versus Subglandular Breast Augmentation: A
           Randomized Prospective Evaluation Considering a 5-Year Follow-Up

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      Authors: Calobrace; M. Bradley
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Risk Factors for Complications after J Medial Thighplasty following
           Massive Weight Loss: A Multivariate Analysis of 94 Consecutive Patients

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      Authors: Bertheuil; Nicolas; Duisit, Jérôme; Bekara, Farid; Watier, Eric; Gandolfi, Silvia; Bergeat, Damien
      Abstract: imageBackground: Bariatric surgery has increased the number of patients requiring medial thighplasty after massive weight loss. However, despite the various complications, the procedure improves quality of life. The authors report postoperative complications of vertical J-shaped medial thigh lift in a series of patients and identify preoperative risk factors.Methods: For almost 5 years, the details of all J medial thighplasties performed by a single surgeon were recorded; detailed medical records were also available. Complications can be major (e.g., need for early surgical revision or readmission) or minor (delayed wound healing).Results: During the study period, 94 patients were treated and only minor complications were recorded (42.5 percent). On multivariate analysis, older age (OR, 1.05; 95 percent CI, 1.01 to 1.10) and a body mass index greater than or equal to 30 kg/m2 (OR, 2.82; 95 percent CI, 1.10 to 7.22) were independent risk factors for postoperative complications.Conclusions: As with other postbariatric operations, medial thighplasty is associated with significant morbidity, but the risk thereof can be easily established and managed. Specific algorithms for determining the risk of postoperative complications based on age and body mass index are needed to guide preoperative discussions with patients and perform patient selection.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Enhancing the Appearance of the “Six-Pack” Muscles Using
           Cryolipolysis: A Safe and Effective Method

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      Authors: Lim; Tingsong; Ding, Siew Wen; Chua, Chong Hwee; Moey, Hui Xian
      Abstract: imageSummary: Many individuals desire a defined and athletic body with “six-pack” abdominal muscles, but even with a strict regimen of diet and exercise, this result is unattainable for many. Cryolipolysis is a noninvasive method of reducing the subcutaneous adipose tissues lying above the rectus abdominis muscles, enhancing the six-pack appearance. Eleven nonobese adults with an average body mass index of 22.5 kg/m2 were enrolled in this study. All subjects were treated with the CoolSculpting cryolipolysis system, with most of them undergoing two rounds of treatment. Improvement in appearance of the abdominal muscles was rated using the Global Aesthetic Improvement Scale, and adverse events and subjects’ satisfaction scores were recorded. Treatments were well tolerated, with no reported instances of blanching, bruising, or blistering, and with only mild cases of edema, erythema, and numbness reported by some. Mean Global Aesthetic Improvement Scale rating was 1.7, corresponding to a rating of improved to much improved. Subjects were comfortable with the procedure and satisfied with the results. In conclusion, cryolipolysis is an effective and well-tolerated method for noninvasive enhancement of abdominal muscle definition.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Expanded Role of Alar Contour Grafts

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      Authors: Rohrich; Rod J.; Durand, Paul D.
      Abstract: imageSummary: Alar rim deformities are among the most common problems affecting patients undergoing both primary and secondary rhinoplasty. They can be caused by several factors such as congenital hypoplasia or malpositioning of the lateral crura, and from acquired surgical weakening during rhinoplasty. Even though altering the structure of the lower lateral cartilage complex can help prevent and correct alar rim deformities, this may not always allow for sufficient control of the alar rim. Alar contour grafts have been proven efficacious not just in the treatment of specific rim deformities but also in their prevention. In this article, the authors present four types of alar contour grafts and discuss their expanded role in the prevention and treatment of alar rim deformities.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Efficacy of Schwann-Like Differentiated Muscle-Derived Stem Cells in
           Treating Rodent Upper Extremity Peripheral Nerve Injury

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      Authors: Xun; Helen; Yesantharao, Pooja; Musavi, Leila; Quan, Amy; Xiang, Sinan; Alonso-Escalante, Jose C.; Wang, Howard; Tammia, Markus; Cetinkaya-Fisgin, Aysel; Lee, W. P. Andrew; Brandacher, Gerald; Kumar, Anand; Lopez, Joseph
      Abstract: imageBackground: There is a pressing need to identify alternative mesenchymal stem cell sources for Schwann cell cellular replacement therapy, to improve peripheral nerve regeneration. This study assessed the efficacy of Schwann cell–like cells (induced muscle-derived stem cells) differentiated from muscle-derived stem cells (MDSCs) in augmenting nerve regeneration and improving muscle function after nerve trauma.Methods: The Schwann cell–like nature of induced MDSCs was characterized in vitro using immunofluorescence, flow cytometry, microarray, and reverse-transcription polymerase chain reaction. In vivo, four groups (n = 5 per group) of rats with median nerve injuries were examined: group 1 animals were treated with intraneural phosphate-buffered saline after cold and crush axonotmesis (negative control); group 2 animals were no-injury controls; group 3 animals were treated with intraneural green fluorescent protein–positive MDSCs; and group 4 animals were treated with green fluorescent protein–positive induced MDSCs. All animals underwent weekly upper extremity functional testing. Rats were euthanized 5 weeks after treatment. The median nerve and extrinsic finger flexors were harvested for nerve histomorphometry, myelination, muscle weight, and atrophy analyses.Results: In vitro, induced MDSCs recapitulated native Schwann cell gene expression patterns and up-regulated pathways involved in neuronal growth/signaling. In vivo, green fluorescent protein–positive induced MDSCs remained stably transformed 5 weeks after injection. Induced MDSC therapy decreased muscle atrophy after median nerve injury (p = 0.0143). Induced MDSC- and MDSC-treated animals demonstrated greater functional muscle recovery when compared to untreated controls (hand grip after induced MDSC treatment: group 1, 0.91 N; group 4, 3.38 N); p < 0.0001) at 5 weeks after treatment. This may demonstrate the potential beneficial effects of MDSC therapy, regardless of differentiation stage.Conclusion: Both MDSCs and induced MDSCs decrease denervation muscle atrophy and improve subsequent functional outcomes after upper extremity nerve trauma in rodents.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Intravenous Infusion of Mesenchymal Stem Cells Promotes the Survival of
           Random Pattern Flaps in Rats

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      Authors: Nakagawa; Tsugufumi; Sasaki, Masanori; Kataoka-Sasaki, Yuko; Yotsuyanagi, Takatoshi; Radtke, Christine; Kocsis, Jeffery D.; Honmou, Osamu
      Abstract: imageBackground: Surgical reconstruction options of soft-tissue defects often include random pattern skin flaps. Flap survival depends on flap size and rotation arc and can be challenging regarding flap perfusion, leading to wound healing complications, insufficient wound coverage, and even flap loss. Therefore, novel approaches that promote skin flap survival are required. Bone marrow–derived mesenchymal stem cells intravenous infusion is therapeutically effective in various experimental disease models by means of multimodal and orchestrated mechanisms including anti-inflammatory and immunomodulatory effects, and by means of microvasculature reestablishment.Methods: A modified McFarlane-type rodent skin flap model was used. After skin flap surgery, intravenous infusion of mesenchymal stem cells or vehicle was performed. In vivo optical near-infrared imaging using indocyanine green was performed, followed by histologic analysis, including hematoxylin and eosin and Masson trichrome staining, and gene expression analysis.Results: The flap survival area was greater in the mesenchymal stem cell group. In vivo optical near-infrared perfusion imaging analysis suggested that skin blood perfusion was greater in the mesenchymal stem cell group. Ex vivo histologic analysis demonstrated that the skin structure was more clearly observed in the mesenchymal stem cell group. The dermal thickness was greater in the mesenchymal stem cell group, according to the Masson trichrome staining results. The authors observed a higher expression of fibroblast growth factor 2 mRNA in the tissues of the mesenchymal stem cell group using quantitative reverse-transcription polymerase chain reaction.Conclusion: These results suggest that intravenous infusion of bone marrow–derived mesenchymal stem cells promotes skin survival of random pattern flaps, which is associated with increased blood perfusion and higher expression of fibroblast growth factor 2.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Thumb Carpometacarpal Arthritis Surgery: The Patient Experience

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      Authors: Hawken; Jessica B.; Yousaf, Imran S.; Sanghavi, Kavya K.; Higgins, James P.; Giladi, Aviram M.; Means, Kenneth R. Jr.
      Abstract: imageBackground: Patients with symptomatic recalcitrant thumb carpometacarpal arthritis often undergo surgery. Although most surgical patients do well, the authors anticipated that a substantial portion of their thumb carpometacarpal surgery patients would have unsatisfactory experiences and express unmet expectations, dissatisfaction, and regret, regardless of surgical procedure performed. The authors hypothesized those experiences would correlate with patient-reported outcomes scores.Methods: The authors identified patients who had undergone trapeziectomy alone or with ligament reconstruction 1 to 4 years previously for primary thumb carpometacarpal arthritis. One hundred twelve patients completed Quick Disabilities of the Arm, Shoulder and Hand and visual analogue scale pain, expectations, satisfaction, and regret questionnaires.Results: More than 40 percent of patients expected to “return to normal” after surgery for pain, strength, and/or function. Including all patients, 7, 19, and 11 percent had unmet expectations for improvement in pain, strength, and function, respectively. Twelve percent expressed dissatisfaction with their outcome. Although just 4 percent regretted undergoing surgery, 13 percent would likely not recommend the procedure to someone they care about. There were no statistically significant differences for any patient-reported outcomes between trapeziectomy-alone (n = 20) and trapeziectomy with ligament reconstruction (n = 92). Visual analogue scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire scores were both moderately correlated with expectations being met for pain, strength, and function and for satisfaction with surgical outcome.Conclusions: Patients’ thumb carpometacarpal surgical experiences vary considerably. Many express dissatisfaction or a lack of expectations met with the two most common procedures. A thorough understanding and review of expectations preoperatively may be uniquely pertinent for these patients. Further research should determine predictors and potentially modifiable factors for unsatisfactory outcomes.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • A 17-Year Experience in Hand and Digit Replantation at an Academic Center

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      Authors: Billington; Alicia R.; Ogden, Benjamin W.; Le, Nicole K.; King, Kathryn S.; Rotatori, R. Maxwell; Kim, Ryan L.; Nydick, Jason
      Abstract: imageBackground: Results of replantation surgery following upper extremity traumatic amputation are extensively described in the literature, with success rates varying from 57 to 100 percent. The purpose of this study was to evaluate replantation success rate at a Level I trauma center over a 17-year period and to assess definable factors contributing to these results.Methods: A retrospective review of all digit and hand replantations at a Level I trauma center was performed using CPT codes from 2001 through 2018. Descriptive analyses, Mann-Whitney test, Kruskal-Wallis test, and logistic regressions were used. Significance was defined as p ≤ 0.05.Results: Analysis consisted of 76 patients with 101 amputated parts (93 digits and eight hands). Fifty-six single digit amputations (30 percent success rate), 37 multidigit injuries (22 percent digit success rate), and eight hand amputations (50 percent success rate) were attempted. The overall success rate was 25 of 76 patients (33 percent) and 29 of 101 parts (29 percent). The most common mechanism of injury was laceration (n = 56), followed by crush (n = 30), and avulsion (n = 11), with repair of laceration-type injuries having the greatest success rate (36 percent).Conclusions: The authors report a lower success rate of hand and digit replantation than previously described in the literature. Whole hand and thumb replantations resulted in the highest survival rate in our series. Laceration mechanism showed a higher success rate than crush or avulsion-type injuries. The authors’ modest results highlight the importance of effective internal auditing of low-volume replantation centers such as their own. Quality improvement measures are proposed for higher future success in replantation surgery at the authors’ institution.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Discussion: A 17-Year Experience in Hand and Digit Replantation at an
           Academic Center

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      Authors: Levin; L. Scott
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Chronic Nerve Pain after Burn Injury: An Anatomical Approach and the
           Development and Validation of a Model to Predict a Patient’s Risk

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      Authors: Klifto; Kevin M.; Yesantharao, Pooja S.; Lifchez, Scott D.; Dellon, A. Lee; Hultman, C. Scott
      Abstract: imageBackground: A model that predicts a patient’s risk of developing chronic, burn-related nerve pain may guide medical and/or surgical management. This study determined anatomy-specific variables and constructed a mathematical model to predict a patient’s risk of developing burn-related nerve pain.Methods: A retrospective analysis was conducted from 1862 adults admitted to a burn center from 2014 to 2019. One hundred thirteen patients developed burn-related nerve pain. Comparisons were made using 11 anatomy-specific locations between patients with and without burn-related nerve pain. The modified Delphi technique was used to select 14 potential risk variables. Multivariate regression techniques, Brier scores, area under the curve, Hosmer-Lemeshow goodness-of-fit, and stratified K-fold cross-validation was used for model development. Chronic pain was defined as pain lasting 6 or more months after release from the Burn Center.Results: Prevalence rates of burn-related nerve pain were similar in the development (6.1 percent) and validation (5.4 percent) cohorts [Brier score = 0.15; stratified K-fold cross-validation (K = 10): area under the curve, 0.75; 95 percent CI, 0.68 to 0.81; Hosmer-Lemeshow goodness-of-fit, p = 0.73; n = 10 groups]. Eight variables were included in the final equation. Burn-related nerve pain risk score = −6.3 + 0.02 (age) + 1.77 (tobacco use) + 1.04 (substance abuse) + 0.67 (alcohol abuse) + 0.84 (upper arm burn) + 1.28 (thigh burn) + 0.21 (number of burn operations) + 0.01 (hospital length-of-stay). Burn-related nerve pain predicted probability = 1 − 1/[1 + exp(burn-related nerve pain risk score)] for 6-month burn-related nerve pain risk score. As the number of risk factors increased, the probability of pain increased.Conclusions: Risk factors were identified for developing burn-related nerve pain at 11 anatomical locations. This model accurately predicts a patient’s risk of developing burn-related nerve pain at 6 months. Age, tobacco use, substance abuse, alcohol abuse, upper arm burns, thigh burns, the number of burn operations, and hospital length of stay represented the strongest predictors.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Using Rasch Analysis to Validate the Michigan Hand Outcomes Questionnaire
           from the Wrist and Radius Injury Surgical Trial

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      Authors: Jayaram, Mayank; Wang, B.S; Chang; Shauver, Melissa J.; Wang, Lu; Chung, Kevin C.
      Abstract: imageBackground: The Michigan Hand Outcomes Questionnaire is a patient-reported outcome measure that has been validated in many upper extremity disorders using classic test theory. Rasch measurement analysis is a rigorous method of questionnaire validation that offers several advantages over classic test theory and was used to assess the psychometric properties of the Michigan Hand Outcomes Questionnaire. This study used Rasch analysis to evaluate the questionnaire for distal radius fractures in older adults. The incidence and costs of distal radius fractures are rising, and reliable assessment tools are needed to measure outcomes in this growing concern.Methods: Rasch analysis was performed using 6-month assessment data from the Wrist and Radius Injury Surgical Trial. Each domain in the Michigan Hand Outcomes Questionnaire was independently analyzed for threshold ordering, person-item targeting, item fit, differential-item functioning, response dependency, unidimensionality, and internal consistency.Results: After collapsing disordered thresholds and removing any misfitting items from the model, five domains (Function, Activities of Daily Living, Work, Pain, and Satisfaction) demonstrated excellent fit to the Rasch model. The Aesthetics domain demonstrated high reliability and internal consistency but had poor fit to the Rasch model.Conclusions: Rasch analysis further supports the reliability and validity of using the Michigan Hand Outcomes Questionnaire to assess hand outcomes in older adults following treatment for distal radius fractures. Results from this study suggest that questionnaire scores should be interpreted in a condition-specific manner, with more emphasis placed on interpreting individual domain scores, rather than the summary Michigan Hand Outcomes Questionnaire score.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Premature Fusion of the Sagittal Suture as an Incidental Radiographic
           Finding in Young Children

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      Authors: Manrique; Monica; Mantilla-Rivas, Esperanza; Porras Perez, Antonio R.; Bryant, Justin R.; Rana, Md Sohel; Tu, Liyun; Keating, Robert F.; Oh, Albert K.; Linguraru, Marius G.; Rogers, Gary F.
      Abstract: imageBackground: Craniosynostosis typically develops prenatally and creates characteristic changes in craniofacial form. Nevertheless, postnatal forms of craniosynostosis have been described. The purpose of this study was to determine the prevalence of incidentally identified, but temporally premature, cranial suture fusion in normocephalic children.Methods: Computed tomographic scans obtained from children aged 1 to 5 years evaluated in the authors’ emergency department between 2005 and 2016 were reviewed for evidence of craniosynostosis. Patients with prior ventriculoperitoneal shunt, brain or cranial abnormality, or known syndromes were excluded. The presence of craniosynostosis and cranial index was assessed by a panel of three craniofacial surgeons and one pediatric neurosurgeon. Demographic information, fusion type, reason for the computed tomographic scan, and medical history were recorded as covariates. Cranial shape and intracranial volume were calculated using a previously validated automated system.Results: Three hundred thirty-one patients met the inclusion criteria. The mean age was 2.4 ± 1.3 years. Eleven patients (3.3 percent) were found to have a complete (n = 9) or partial (n = 2) fusion of the sagittal suture. All patients had a normal cranial index (0.80; range, 0.72 to 0.87) and a grossly normal head shape. Only two fusions (18.2 percent) were documented by the radiologist. Cranial shape analysis performed in five of the 11 patients showed subtle phenotypic changes along the scaphocephaly spectrum in four patients, with a normal shape in the remaining case.Conclusions: Sagittal fusion is present in 3.3 percent of otherwise phenotypically normal children aged 1 to 5 years. The clinical significance of this result is unclear, but routine screening of affected patients is paramount.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Safety of Contemporary Resorbable Fixation Systems for Craniofacial
           Reconstruction in Pediatric Patients

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      Authors: Kalmar; Christopher L.; Bushold, Julia; Carlson, Anna R.; Zapatero, Zachary D.; Kosyk, Mychajlo S.; Swanson, Jordan W.; Taylor, Jesse A.; Bartlett, Scott P.
      Abstract: imageBackground: Resorbable hardware allows adequate strength for maintaining the relative position of the craniofacial skeleton during osseous healing, and allowing subsequent growth in pediatric patients. The purpose of this study was to determine the complication profile of the latest copolymer of resorbable plates for craniofacial reconstruction in pediatric patients.Methods: Retrospective query of the operative billing record was performed for use of the DePuy Synthes Rapidsorb Fixation System at the authors’ tertiary children’s hospital from 2015 to 2019. Three hundred twenty-five patients were randomly selected for analysis of complications within the first postoperative year.Results: Median age at craniofacial reconstruction was 3.0 years, with 127 procedures (39.9 percent) performed for an intracranial mass and 141 procedures (44.3 percent) performed for craniosynostosis. Overall, 7.9 percent patients had a postoperative wound complication. The most common complications were dehiscence (3.8 percent), hematoma/seroma (3.5 percent), and infection (2.5 percent). There were no instances of extrusion, plate fracture, or screw loosening. Hardware complications in the temporoparietal region were more likely to occur at incision sites (p = 0.001), whereas wound complications at the frontal region were more likely to occur away from incision sites (p < 0.001). There were no differences in complications between plates secured with resorbable screws or with the resorbable injectable polymer system (p ≥ 0.161 for all). Radiotherapy was significantly implicated in development of clinical infection (p = 0.001), culture-positive infection (p < 0.001), readmission (p = 0.007), reoperation (p = 0.003), and plate removal (p = 0.007).Conclusion: Resorbable cranial hardware has an overall favorable complication profile for craniofacial reconstruction in pediatric patients undergoing surgical intervention for craniosynostosis or intracranial mass resection.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Global Burden of Orofacial Clefts and the World Surgical Workforce

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      Authors: Massenburg; Benjamin B.; Hopper, Richard A.; Crowe, Christopher S.; Morrison, Shane D.; Alonso, Nivaldo; Calis, Mert; Donkor, Peter; Kreshanti, Prasetyanugraheni; Yuan, Jie; On behalf of the Global Burden of Disease 2017 Orofacial Clefting Collaborators
      Abstract: imageBackground: Orofacial clefts are one of the most common congenital anomalies, but this disease burden is unevenly distributed worldwide. The authors hypothesize that this burden falls disproportionately on the countries with the smallest surgical workforce or lowest Socio-Demographic Index, rather than those with the highest prevalence of disease.Methods: The authors estimated the prevalence and disease burden of orofacial clefting from 1990 to 2017 in 195 countries using the Global Burden of Disease methodology. Prevalence and disability-adjusted life-years were compared geographically, temporally, and against the size of the national surgical workforce, Socio-Demographic Index, and income status. Linear and logarithmic regressions were performed.Results: In 2017, the prevalence of orofacial clefting was estimated to be 10.8 million people, representing a disease burden of 652,084 disability-adjusted life-years, with most of this disease burden experienced by low- and middle-income countries (94.1%). From 1990 to 2017, there was a decrease in disease burden (-70.2%) and prevalence (-4.9%). There was negative logarithmic association between surgical workforce size and disease burden, with a surgical workforce of greater than six providers per 100,000 population (3.6 disability-adjusted life-years versus 22.4 disability-adjusted life-years per 100,000 population; p < 0.0001).Conclusions: Burden of orofacial clefting has a strong negative association with the size of the surgical workforce, suggesting that strengthening the surgical workforce will help alleviate this burden. Epidemiologic data on countries and regions with inadequate surgical workforces and high disease burden should guide future research efforts and allocation of resources, and guide the treatment and educational goals of international charitable organizations.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Discussion: Global Burden of Orofacial Clefts and the World Surgical
           Workforce

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      Authors: Swanson; Jordan W.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Ear Reconstruction with the Combination of Expanded Skin Flap and Medpor
           Framework: 20 Years of Experience in a Single Center

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      Authors: Wang; Yongzhen; Zhang, Jinming; Liang, Weiqiang; Xiao, Xiaolian; Zhang, Jiaqi; Zhang, Jian; Su, Zheng; Liu, Meng; Chen, Yuhong; Ji, Chenyang
      Abstract: imageBackground: In ear reconstruction, the difficulty lies in reestablishing the ear’s bionic form with adequate skin coverage and an appropriate framework. Skin expansion and a porous polyethylene (i.e., Medpor) framework are often used for ear reconstruction. However, a long-term review of the combined application of the expanded skin and Medpor framework has not been reported. This article reviews ear reconstruction combining these two factors over the past 20 years in the authors’ center to summarize the surgical technique and analyze the postoperative results and complications.Methods: A retrospective review was performed that included all patients who underwent ear reconstruction with expanded skin and Medpor framework in the authors’ center between 1998 and 2018.Results: A total of 68 patients with microtia who were admitted to the authors’ center for surgical ear reconstruction were included, and 70 ears were reconstructed. Fifty-seven of the patients (83.82 percent) felt satisfied with their reconstructed ear, five patients (7.35 percent) were not satisfied with the reconstructed ear, and six patients (8.82 percent) had the frameworks removed. Fifteen patients (22.06 percent) developed complications, including framework exposure (13.24 percent), infection (4.41 percent), scar hypertrophy (4.41 percent), and hematoma (2.94 percent).Conclusions: Framework exposure limits the combined application of expanded skin flap and Medpor framework when reconstructing the ear without additional fascial interposition. Using a temporoparietal fascia or postauricular fascia flap during the operation is effective to decrease the exposure rate; however, this complication cannot be completely avoided. Using postauricular fascia and skin graft may lead to scar hypertrophy; thus, these techniques should be used with caution.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • A Prediction Model for Selective Use of Facial Computed Tomography in
           Blunt Head Trauma Patients

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      Authors: Huang; Li-Kuo; Huang, Chih-Sheng; Tu, Hsi-Feng; Chiang, Kuo-Hsien; Bajani, Francesco; Fu, Chih-Yuan
      Abstract: imageBackground: Head trauma patients may have concomitant facial fractures, which are usually underdetected by head computed tomography alone. This study aimed to identify the clinical indicators of facial fractures and to develop a risk-prediction model to guide the discriminative use of additional facial computed tomography in head trauma.Methods: The authors retrospectively reviewed head trauma patients undergoing simultaneous head and facial computed tomography at a Level II trauma center from 2015 to 2018. Multivariate logistic regression analysis was used to evaluate independent risk factors for concomitant facial fractures in head trauma patients using data collected from 2015 to 2017, and a risk-prediction model was created accordingly. Model performance was validated with data from 2018.Results: In total, 5045 blunt head trauma patients (development cohort, 3534 patients, 2015 to 2017; validation cohort, 1511 patients, 2018) were enrolled. Concomitant facial fractures occurred in 723 head trauma patients (14.3 percent). Ten clinical and head computed tomographic variables were identified as predictors, including age, male sex, falls from elevation, motorcycle collisions, Glasgow Coma Scale scores less than 14, epistaxis, tooth rupture, facial lesions, intracranial hemorrhage, and skull fracture. In the development cohort, the model showed good discrimination (area under the receiver operating characteristic curve = 0.891), calibration (Hosmer-Lemeshow C test, p = 0.691), and precision (Brier score = 0.066). In the validation cohort, the model demonstrated excellent discrimination (area under the receiver operating characteristic curve = 0.907), good calibration (Hosmer-Lemeshow C test, p = 0.652), and good precision (Brier score = 0.083). With this model, 77.1 percent of unnecessary facial computed tomography could be avoided.Conclusion: This model could guide the discriminative use of additional facial computed tomography to detect concomitant facial fractures in blunt head trauma.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Applying Computerized Adaptive Testing to the FACE-Q Skin Cancer Module:
           Individualizing Patient-Reported Outcome Measures in Facial Surgery

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      Authors: Ottenhof; Maarten J.; Geerards, Daan; Harrison, Conrad; Klassen, Anne F.; Hoogbergen, Maarten M.; van der Hulst, René R. W. J.; Lee, Erica H.; Pusic, Andrea L.; Sidey-Gibbons, Chris J.
      Abstract: imageBackground: Skin cancer is among the most frequently occurring malignancies worldwide, which creates a great need for an effective patient-reported outcome measure. Providing shorter questionnaires reduces patient burden and increases patients’ willingness to complete forms. The authors set out to use computerized adaptive testing to reduce the number of items needed to predict results for scales of the FACE-Q Skin Cancer Module, a validated patient-reported outcome measure that measures health-related quality of life and patient satisfaction in facial surgery.Methods: Computerized adaptive testing generates tailored questionnaires for patients in real time based on their responses to previous questions. The authors used an open-source computerized adaptive testing simulation software to run item responses for the five scales from the FACE-Q Skin Cancer Module (i.e., scar appraisal, satisfaction with facial appearance, appearance-related psychosocial distress, cancer worry, and satisfaction with information about appearance). Each simulation continued to administer items until prespecified levels of precision were met, estimated by standard error. Mean and maximum item reductions between the original fixed-length short forms and the simulated versions were evaluated.Results: The number of questions that patients needed to answer to complete the FACE-Q Skin Oncology Module was reduced from 41 items in the original form to a mean of 23 ± 0.55 items (range, 15 to 29) using the computerized adaptive testing version. Simulated computerized adaptive testing scores maintained a high correlation (0.98 to 0.99) with the score from the fixed-length short forms.Conclusions: Applying computerized adaptive testing to the FACE-Q Skin Cancer Module can reduce the length of assessment by more than 50 percent, with virtually no loss in precision. It is likely to play a critical role in the implementation in clinical practice.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Computational Fluid Dynamics Modeling of Nasal Obstruction and
           Associations with Patient-Reported Outcomes

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      Authors: Barbarite; Eric; Gadkaree, Shekhar K.; Melchionna, Simone; Zwicker, David; Lindsay, Robin W.
      Abstract: imageBackground: Nasal obstruction is a common problem, with significant impact on quality of life. Accurate diagnosis may be challenging because of the complex and dynamic nature of the involved anatomy. Computational fluid dynamics modeling has the ability to identify specific anatomical defects, allowing for a targeted surgical approach. The goal of the current study is to better understand nasal obstruction as it pertains to disease-specific quality of life by way of a novel computational fluid dynamics model of nasal airflow.Methods: Fifty-three patients with nasal obstruction underwent computational fluid dynamics modeling based on computed tomographic imaging. Nasal resistance was compared to demographic data and baseline subjective nasal patency based on Nasal Obstructive Symptom Evaluation scores.Results: Mean Nasal Obstructive Symptom Evaluation score among all patients was 72.6. Nasal Obstructive Symptom Evaluation score demonstrated a significant association with nasal resistance in patients with static obstruction (p = 0.03). There was a positive correlation between Nasal Obstructive Symptom Evaluation score and nasal resistance in patients with static bilateral nasal obstruction (R2 = 0.32) and poor correlation in patients with dynamic bilateral obstruction caused by nasal valve collapse (R2 = 0.02). Patients with moderate and severe bilateral symptoms had significantly higher nasal resistance compared to those with unilateral symptoms (p = 0.048).Conclusions: Nasal obstruction is a multifactorial condition in most patients. This study shows correlation between simulated nasal resistance and Nasal Obstructive Symptom Evaluation score in a select group of patients. There is currently no standardized diagnostic algorithm or gold standard objective measure of nasal airflow; however, computational fluid dynamics may better inform treatment planning and surgical techniques on an individual basis.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, V.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through
           Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective
           Clinical Before-and-After Study

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      Authors: Kagaya; Yu; Arikawa, Masaki; Akazawa, Satoshi; Miyamoto, Shimpei
      Abstract: imageBackground: The clinical application of flow-through anastomosis has been reported in various studies; however, no studies have quantitatively evaluated and compared the actual hemodynamics in flow-through anastomosis and end-to-end anastomosis. This study quantitatively evaluated the blood inflow (volumetric flow rate) and vascular resistance (pulsatility index) of flow-through arterial anastomosis using an ultrasonic flowmeter, and compared these values with those of end-to-end anastomosis in actual clinical settings. In addition, factors affecting the outcomes have also been examined.Methods: Twenty-eight patients who underwent free flap reconstruction after tumor resection were subjected to flow-through arterial anastomosis and flow examination. First, in the end-to-end state, the proximal anastomotic site was measured. This was followed by the opening of the distal arterial clamp, and measurement was then continued (in the flow-through state).Results: In flow-through arterial anastomosis compared with end-to-end anastomosis, the volumetric flow rate was significantly increased (18.9 ± 14.1 ml/minute versus 6.0 ± 6.3 ml/minute) and the pulsatility index was significantly decreased (5.2 ± 3.7 versus 13.6 ± 10.2), when comparing paired data. Multiple regression analyses revealed that a perforator flap (versus a musculocutaneous flap) was independently associated with both reduced volumetric flow rate and increased pulsatility index in end-to-end anastomosis, and that hypertension was independently associated with an increased pulsatility index in end-to-end anastomosis. However, no factors in flow-through anastomosis were significantly associated with those values.Conclusion: In terms of blood flow and vascular resistance, flow-through arterial anastomosis was considered to have promising quantitative effects and should be performed when the conditions of both the donor and recipient vessels meet the requirements.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Evidence-Based Wound Irrigation: Separating Fact from Fiction

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      Authors: Saeg; Fouad; Schoenbrunner, Anna R.; Janis, Jeffrey E.
      Abstract: imageSummary: The relationship between wound irrigation and healing has been recognized for centuries. However, there is little evidence and no official recommendations from any health care organization regarding best wound irrigation practices. This is the first review of wound irrigation that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence into a practical format. In this comprehensive review, the authors outline the irrigation fluids and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize irrigation effectiveness, and propose evidence-based guidelines to improve wound healing outcomes and enhance the consistency of wound irrigation. Thirty-one high-quality studies with a combined total of 61,808 patients were included. Based on the current evidence provided by this review, the authors propose the following guidelines: (1) acute soft-tissue wounds should receive continuous gravity flow irrigation with polyhexanide; (2) complex wounds should receive continuous negative-pressure wound therapy with instillation with polyhexanide; (3) infected wounds should receive continuous negative-pressure wound therapy with instillation with silver nitrate, polyhexanide, acetic acid, or povidone-iodine; (4) breast implant wounds should receive gravity lavage with povidone-iodine or antibiotics; and (5) surgical-site infection rates can be reduced with intraoperative povidone-iodine irrigation.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Risk Factors for Loss to Follow-Up in the Lower Extremity Limb Salvage
           Population

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      Authors: Sharif-Askary; Banafsheh; Zolper, Elizabeth G.; Deldar, Romina; Tefera, Eshetu; Tirrell, Abigail R.; Abu El Hawa, Areeg A.; Attinger, Christopher E.; Evans, Karen K.; Fan, Kenneth L.
      Abstract: imageBackground: Limb salvage for chronic lower extremity wounds requires long-term care best delivered by specialized multidisciplinary centers. This optimizes function, reduces amputation rates, and improves mortality. These centers may be limited to urban/academic settings, making access and appropriate follow-up challenging. Therefore, the authors hypothesize that both system- and patient-related factors put this population at exceedingly high risk for loss to follow-up.Methods: Records were reviewed retrospectively for 200 new patients seen at the Georgetown Center for Wound Healing in 2013. The primary outcome was loss to follow-up, defined as three consecutive missed appointments despite explicit documentation indicating the need for return visits. Demographic, clinical, and geographic data were compared. Multivariate logistic regression analysis for loss to follow-up status controlled for variables found significant in the bivariate analysis. Spatial dependency was evaluated using variograms.Results: Over a 6.5-year-period, 49.5 percent of patients followed were lost to follow-up. Male sex and increased driving distance to the limb salvage center were risk factors for loss to follow-up. Wound-specific characteristics including ankle and knee/thigh location were also associated with higher rates of loss to follow-up. There was no spatial dependency or discrete clustering of at-risk patients.Conclusions: This study is the first of its kind to investigate the demographic and clinical characteristics that predispose chronic lower extremity wound patients to loss to follow-up. These findings inform stakeholders of the high rates of loss to follow-up and support decentralized specialty care, in the form of telemedicine, satellite facilities, and/or dedicated case managers. Future work will focus on targeting vulnerable populations through focused interventions to reduce patient and system burden.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Long Pedicled Superficial Circumflex Iliac Artery Flap Based on a Medial
           Superficial Branch

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      Authors: Kwon; Jin Geun; Pereira, Nicolas; Tonaree, Warangkana; Brown, Erin; Hong, Joon Pio; Suh, Hyunsuk Peter
      Abstract: imageBackground: A superficial circumflex iliac artery perforator flap has several advantages, such as reduced thickness, minimal donor-site morbidity, and inconspicuous scar. However, the application of a superficial circumflex iliac artery perforator flap is restricted because of its limited pedicle length. The aim of this article was to outline the technical modifications of superficial circumflex iliac artery perforator flap elevation to obtain long pedicles.Methods: This is a prospective study of 31 consecutive patients who required a long pedicled superficial circumflex iliac artery perforator flap between September of 2016 and December of 2019 at the authors’ center. According to a preoperatively marked pathway of the superficial branch of the superficial circumflex iliac artery, the superficial circumflex iliac artery perforator flap was designed. During the elevation, the design was modified according to the perforator location in the free-style technique. The characteristics of the patients and the flaps, including pedicle length, were recorded. The revision rate, complication rate, and need for a secondary procedure were analyzed.Results: The mean follow-up period was 563 days (range, 92 to 1383 days). The mean length of the pedicle obtained was 6.9 cm (range, 6 to 8 cm) from the point where the pedicle merges into the flap. Long pedicles were anastomosed to the main source vessel or branch without tension. No major complications were reported.Conclusions: Overcoming the short pedicle length of a superficial circumflex iliac artery perforator flap by designing the flap laterally and performing an intraflap dissection is a reliable option when a longer pedicle is required, irrespective of the specific anatomy of the superficial circumflex iliac artery.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Modern Fat Grafting Techniques to the Face and Neck

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      Authors: Azoury; Saïd C.; Shakir, Sameer; Bucky, Louis P.; Percec, Ivona
      Abstract: imageLearning Objectives: After studying this article, the participant should be able to: 1. Understand age-related changes to the face and neck and pertinent anatomy and discuss important aspects of fat graft harvesting, processing, and infiltration. 2. Recognize key differences between common techniques for fat processing and infiltration and develop a plan for patients based on site-specific facial anatomical zones. 3. Appreciate the utility of fat grafting as an adjunct to other facial rejuvenating procedures such as face lift and blepharoplasty procedures and list the potential complications from fat grafting to the face and neck.Summary: Fat grafting to the face and neck aids in volume restoration, thereby addressing soft-tissue atrophy associated with the aging face, acquired conditions, or congenital malformations. Often, fat grafting may sufficiently restore facial volume alone or in conjunction with other facial rejuvenation procedures. Facial/neck fat grafting requires a systematic and thoughtful approach, with special care to atraumatic technique. This CME article covers the principles and techniques for modern facial fat grafting to the face and neck. Increasing data support the ability of autologous fat to produce significant and sustainable appearance-related changes. The authors follow the general principles of the Coleman technique for facial fat grafting and have observed tremendous success over the years. Other techniques for facial fat grafting are also discussed including microfat and nanofat processing. As the understanding of facial fat compartments continues to evolve, the authors may better predict fat grafting outcomes following augmentation. Finally, the technique described as “lipotumescence” has been successfully used in the breast and other regions of the body that have radiation damage and is discussed in this article specifically for the face and neck.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Fine Details That Improve Nasal Reconstruction

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      Authors: Borsuk; Daniel E.; Papanastasiou, Constantine; Chollet, Andre
      Abstract: imageLearning Objectives: After studying this article, the participant should be able to: 1. Identify common negative outcomes that arise with conventional nasal reconstruction. 2. Understand the technical refinements that help avoid and reduce negative outcomes in nasal reconstruction. 3. Learn about the utility of regional axial island flaps for nasal reconstruction, in particular, the lateral nasal artery flap.Summary: Nasal reconstruction has been a preoccupation of surgeons dating to before 600 bc. The nose is the central focal point of the face and a key identifying facial feature, and surgery to the nose can prove to be challenging to even the most experienced surgeon. The objective of this CME article is to outline the most commonly used surgical options for each nasal aesthetic subunit, and the specific complications observed for each. The best surgical options and technical refinements are highlighted, and principles that may help restore the nose are outlined.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Leadership in Times of Crisis

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      Authors: Kane; Robert L.; Egan, Jennifer M.; Chung, Kevin C.
      Abstract: imageSummary: In the wake of the death toll resulting from coronavirus disease of 2019 (COVID-19), in addition to the economic turmoil and strain on our health care systems, plastic surgeons are taking a hard look at their role in crisis preparedness and how they can contribute to crisis response policies in their own health care teams. Leaders in the specialty are charged with developing new clinical policies, identifying weaknesses in crisis preparation, and ensuring survival of private practices that face untenable financial challenges. It is critical that plastic surgery builds on the lessons learned over the past tumultuous year to emerge stronger and more prepared for subsequent waves of COVID-19. In addition, this global health crisis presents a timely opportunity to reexamine how plastic surgeons can display effective leadership during times of uncertainty and stress. Some may choose to emulate the traits and policies of leaders who are navigating the COVID-19 crisis effectively. Specifically, the national leaders who offer empathy, transparent communication, and decisive action have maintained high public approval throughout the COVID-19 crisis, while aggressively controlling viral spread. Crises are an inevitable aspect of modern society and medicine. Plastic surgeons can learn from this pandemic to better prepare for future turmoil.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Evidence-Based Medicine in Plastic Surgery: From Then to Now

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      Authors: Rohrich; Rod J.; Cohen, Joshua M.; Savetsky, Ira L.; Avashia, Yash J.; Chung, Kevin C.
      Abstract: imageSummary: Evidence-based medicine, as described by Dr. Sackett, is defined as the “conscientious, explicit, and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients.” In the late 2000s, seminal articles in Clinics in Plastic Surgery and Plastic and Reconstructive Surgery introduced evidence-based medicine’s role in plastic surgery and redefined varying levels of evidence. The American Society of Plastic Surgeons sponsored the Colorado Springs Evidence-Based Medicine Summit that set forth a consensus statement and action plan regarding the increased incorporation of evidence-based medicine into the field; this key meeting ushered a new era among plastic surgeons worldwide. Over the past decade, Plastic and Reconstructive Surgery has incorporated evidence-based medicine into the Journal through an increase in articles with level I and II evidence, new sections of the Journal, and the introduction of validated tools to help authors perform prospective and randomized studies that ultimately  led to best practices used today. Plastic surgery is a specialty built on problem-solving and innovation, values starkly in-line with evidence-based medicine. Evidence-based medicine is becoming more ingrained in our everyday practice and plastic surgery culture; however, we must work actively to ensure that we continue this trend. In the next decade, we will possibly see that level I and II evidence articles start to inhabit many of our journal issues.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Overcoming the Patent Gap: A Guide to Patenting for Plastic Surgeons

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      Authors: Kisyova; Rumi; Kannan, Ruben Yap; Nadkarni, Prakash; Chandawarkar, Rajiv Yatin
      Abstract: imageBackground: Patenting protects innovation, fosters academic incentives, promotes competition, and generates new revenue for clinician-inventors and their institutions. Despite these benefits, and despite plastic surgery’s history of innovation, plastic surgery–related patent applications are few. The goal of this article was to use unpublished data and formulate a robust discussion.Methods: The U.S. Patent and Trademark Office’s boolean search was investigated between the timeline of 1975 and June 23, 2020, to identify patents related to the key phrases to contrast patent (both, issued and filed) tally in each specialty. Queries for two key phrases related to plastic surgery and a core plastic surgical activity, both with and without the added term “plastic surgery,” were performed.Results: Total patents with “cardiology” outnumber those with “plastic surgery” by 22,450 versus 7749 (i.e., almost 3:1). The overwhelming number of patents with “cosmetic” are non–plastic-surgery related: 87,910 total versus 2782 for those with plastic surgery. The corresponding numbers for “wound healing” are 36,359 versus 2703. Reasons for the patent gap between clinical innovations in plastic surgery and number of patents in our field are identified. Clear steps to bridge this gap are delineated that include a step-by-step process for patenting, from idea creation through commercialization. The authors propose “breakthrough to bank,” a framework wherein academic medical centers can create an environment of innovative freedom, establish the infrastructure for technological transfer of intellectual property, and generate a pipeline toward commercial applications.Conclusions: Innovation and inventions are important hallmarks for the progress of plastic surgery. Using a stepwise process, it may be possible to convert ideas into patents.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Discussion: Overcoming the Patent Gap: A Guide to Patenting for Plastic
           Surgeons

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      Authors: Januszyk; Michael; desJardins-Park, Heather E.; Gurtner, Geoffrey C.; Longaker, Michael T.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Medical Leadership: Experiences in the Use of Shared and Parental
           Leadership to Improve Academic Performance in the Management of a National
           Plastic Surgery Unit in China

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      Authors: Li; Jie; Ng, Sally Kiu-Huen; Xu, Yuanjin; Li, Qingfeng; Wang, Li; Zhang, Yixin
      Abstract: imageBackground: Effective leadership is an integral component for optimal academic performance of surgical units. As one of the leading plastic surgery academic medical centers in China, the authors would like to share their experiences of using the combined parental and shared leadership approach in managing their surgical staff within the department. It has taken into account the essence of Eastern moral philosophies and Western leadership theories.Methods: The authors performed a review of the academic development of their staff and changes in the academic productivity of the department between 1999 and 2018. The difference between the first 10 years (1999 to 2008) and second 10 years (2009 to 2018) was analyzed to assess the effectiveness of the authors’ leadership approach.Results: There is an increase in the number of Science Citation Index articles published in the past decade with a higher impact factor and more articles published in international journals. The timing to promotion was on average 8.4 years. The average age of promotion to consultants has increased, likely because of a later start in the training. With similar average age, prior education, and gender ratio of surgeons in the unit, the department also received 14 times more in research funding and four times more in national key topic research topic.Conclusions: The effective application of this combined leadership approach has significantly improved the academic productivity and quality of the authors’ residents and surgeons and the academic advancement of the unit.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Impact of Outcomes Research in Plastic and Reconstructive Surgery

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      Authors: Laikhter; Elizabeth; Manstein, Samuel M.; Pusic, Andrea L.; Chung, Kevin C.; Lin, Samuel J.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Plastic Surgery’isms

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      Authors: Rohrich; Rod J.; Jalalabadi, Faryan; Alleyne, Brendan; Abraham, Jasson; Bellamy, Justin
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Stanley A. Klatsky, M.D., 1934 to 2020

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      Authors: Singer; Robert; Bernard, Bob; Chandawarkar, Akash; Manson, Paul N.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Male Aesthetic Plastic Surgery

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      Authors: Ellis; Marco F.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Spotlight in Plastic Surgery: October 2021

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      Authors: Phillips; Brett T.; Alser, Osaid; Dickey, Ryan M.; Kapila, Ayush K.; Kareh, Aurora M.; Moura, Francisco S.; Retchkiman, Meir; Rodriguez-Unda, Nelson A.; Shulzhenko, Nikita O.; Wang, Hayson C.; Gosain, Arun K.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Safety and Effectiveness of Autologous Fat Grafting after Breast
           Radiotherapy: A Systematic Review and Meta-Analysis

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      Authors: Lisa; Andrea; Battistini, Andrea; Vinci, Valeriano; Bandi, Valeria; Klinger, Marco; Caviggioli, Fabio
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Reply: Safety and Effectiveness of Autologous Fat Grafting after Breast
           Radiotherapy: A Systematic Review and Meta-Analysis

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      Authors: Chen; Yujie; Lin, Zhiyu; Chai, Yue; Li, Guangxue
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Breast Reconstruction Using a Three-Dimensional Absorbable Mesh Scaffold
           and Autologous Fat Grafting: A Composite Strategy Based on
           Tissue-Engineering Principles

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      Authors: Hwang; Kun; Wu, Xiajing
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Comparing Outcomes of Robotically Assisted Latissimus Dorsi Harvest to the
           Traditional Open Approach in Breast Reconstruction

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      Authors: Zhang; Zixuan; Zhang, Ziying; Xin, Minqiang
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Reply: Comparing Outcomes of Robotically Assisted Latissimus Dorsi Harvest
           to the Traditional Open Approach in Breast Reconstruction

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      Authors: Selber; Jesse C.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Open Capsulotomy for Capsular Contracture after Breast Augmentation: An
           Alternative Treatment Algorithm

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      Authors: Swanson; Eric
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Reply: Surgical Treatment for Capsular Contracture: A New Paradigm and
           Algorithm

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      Authors: Hidalgo; David; Weinstein, Andrew
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Nonsurgical Rhinoplasty: A Retrospective Review of 5000 Treatments

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      Authors: Barone; Mauro; Cogliandro, Annalisa; Persichetti, Paolo
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Quality and Quantity–Cultured Human Mononuclear Cells Improve Human Fat
           Graft Vascularization and Survival in an In Vivo Murine Experimental Model
           

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      Authors: Hua; Zuguang; Wei, Peng
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Reply: Quality and Quantity–Cultured Human Mononuclear Cells Improve the
           Human Fat Graft Vascularization and Survival in an In Vivo Murine
           Experimental Model

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      Authors: Geeroms; Maxim; Fujimura, Satoshi; Hamdi, Moustapha; Tanaka, Rica
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Subcutaneous Regeneration of Engineered Cartilage: A Comparison of Cell
           Sheets and Chondrocyte-Scaffold Constructs in a Porcine Model

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      Authors: Chen; Jianguo
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Decellularized Fetal Matrix Suppresses Fibrotic Gene Expression and
           Promotes Myogenesis in a Rat Model of Volumetric Muscle Loss

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      Authors: Kuroiwa; Tomoyuki; Zhao, Chunfeng; Mazzucchelli, Lorenzo; Amadio, Peter C.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Five Essential Principles for First Web Space Reconstruction in the Burned
           Hand

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      Authors: Yamamoto; Takumi; Yamamoto, Nana
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Reply: Five Essential Principles for First Web Space Reconstruction in the
           Burned Hand

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      Authors: Donelan; Matthias B.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Tridimensional Doppler Method: A Guide to Increase the Accuracy of the
           Doppler Examination for Preoperative Perforator Assessment

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      Authors: Lombardo; Giuseppe A. G.; Tamburino, Serena; Martino, Barbara; Privitera, Francesca; Catalano, Francesca; Dražan, Lubos
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Seeing Is Not Believing: Facial Distortion in Smartphone Photography

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      Authors: Boudreau; Colton; Wong, Alison; Duncan, Anna; Coles, Jenna; Wheelock, Margaret
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Personalized Video Consent: A New Tool in the Preoperative Consent-Giving
           Process

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      Authors: Shome; Debraj; Doshi, Komal; Vadera, Sapna; Kumar, Vaibhav; Kapoor, Rinky
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Effect of Age on Satisfaction with Facial Appearance in Women Based on the
           FACE-Q Questionnaire in a Dutch Normative Population

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      Authors: Tuin; A. Jorien; van Dongen, Joris A.; van der Lei, Berend; Vissink, Arjan; Spijkervet, Frederik K. L.; Schepers, Rutger H.; Jansma, Johan
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • When Less Is More: A Costal Cartilage-Sparing Technique for Cartilage
           Graft Harvest in Rhinoplasty

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      Authors: Pfaff; Miles J.; Rezzadeh, Kameron S.; Malapati, Sri Harshini; Kim, Daniel H.; Vargo, James D.; Yaghoubian, Arezou; Roostaeian, Jason; Rudkin, George H.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • A Critical Examination of the Science and Role of Compression Garments in
           Aesthetic Surgery

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      Authors: Livermore; Nina Rae; Schoenbrunner, Anna R.; Janis, Jeffrey E.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Paraphiltral Flap for Columellar Reconstruction

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      Authors: El-Sabbagh; Ahmed Hassan
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Mixed Reality Intraoperative Navigation in Craniomaxillofacial Surgery

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      Authors: Cai; Elijah Zhengyang; Gao, Yujia; Ngiam, Kee Yuan; Lim, Thiam Chye
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Total Lower Lip Reconstruction Using the Anterolateral Thigh Donor Site: A
           Technique to Improve Oral Competence in Thin Patients

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      Authors: Polanco; Thais O.; Slutsky, Hanna; Allen, Robert J. Jr.; Mehrara, Babak J.; Nelson, Jonas A.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Microworld: A Novel Device for Training of Basic Microsurgical Skills in
           Different Vectors and Planes

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      Authors: Titov; Oleg; Salamov, Ibragim; Titov, Igor; Demidova, Maria; Bykanov, Andrey
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Basic Laws of Physics: Applied Plastic Surgery

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      Authors: Hallock; Geoffrey G.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Efficacy of Virtual Subinternships as a Novel Educational Platform for
           Education and Recruitment

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      Authors: Dinis; Jacob; Prsic, Adnan; Junn, Alexandra; Hsia, Henry; Alperovich, Michael
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Suggested Core Plastic Surgery Examination for Applicants to Integrated
           Plastic Surgery Residency Programs

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      Authors: Sharma; Sripadh; Gosain, Arun K.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Virtual Visiting Professor: Temporary Form of COVID-19 Social
           Distancing or Potential Paradigm Shift'

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      Authors: Bamba; Ravinder; Tran, Phu C.; Lester, Mary E.; Wooden, William A.; Gordillo, Gayle M.; Hadad, Ivan; Hassanein, Aladdin H.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Impact of the SARS-CoV-2 (COVID-19) Pandemic on the 2020 to 2021
           Integrated Plastic Surgery Residency Cycle

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      Authors: Allam; Omar; Park, Kitae E.; Hsia, Henry; Prsic, Adnan; Alperovich, Michael
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • From Some-tox to More-tox during the COVID-19 Pandemic

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      Authors: Gülbitti; Haydar Aslan; Waziri, Sohrab; van der Lei, Berend
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • #Trending: Why Patient Identifying Information Should Be Protected on
           Social Media

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      Authors: Hernandez; J. Andres; Glener, Adam D.; Rosenfield, Lorne K.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Are All Posts Created Equal' A Review of Academic Plastic Surgery
           Residency Programs’ Social Media Engagement Statistics

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      Authors: Irwin; Timothy J.; Ortiz, Ricardo; Leto Barone, Angelo A.; Veeravagu, Laksman; Sherif, Rami D.; Lifchez, Scott D.; Fox, Paige M.; Momoh, Adeyiza O.; Liao, Eric C.; Eberlin, Kyle R.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Times Are a Changin’: Marijuana Use among Plastic Surgery Patients

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      Authors: Teven; Chad M.; Song, David H.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • ASPS/PSF Sponsored Symposia and Workshops

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      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • International Meetings and Symposia

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      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
 
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