A Novel Rat Model to Simulate Positive Margins in the Wound Bed of a Resected Sarcoma.

Background: One reason for local recurrence is the presence of positive surgical margins after tumor resection. An animal model accurately representing the microtumor burden will improve our understanding of these surgical margins. Using a rat model, we report a new methodology for creating microscopic tumors.

The Small Finger Reverse Ulnar Digital Artery Hypothenar Palmar Perforator Flap: An Anatomical Study With Clinical Examples.

Background: Local flaps are commonly used for reconstruction of digital soft-tissue defects. There remains a paucity of options available for small finger volar and dorsal soft-tissue defects distal to the proximal interphalangeal joint. The purpose of this study was to analyze perforators along the hypothenar palmar region arising from the artery of the ulnar side of the small finger as it comes off the superficial palmar arch for consistency and potential to be used for perforator-based flap reconstruction of soft-tissue defects and joint coverage of the small finger.

Autologous Skin Grafts, versus Tissue-engineered Skin Constructs: A Systematic Review and Meta-analysis.

Unlabelled: For over 100 years, autologous skin grafts have remained the gold standard for the reconstruction of wounds but are limited in availability. Acellular tissue-engineered skin constructs (acellular TCs) and cellular tissue-engineered skin constructs (cellular TCs) may address these limitations. This systematic review and meta-analysis compare outcomes between them.

Efficacy of leupeptin in treating ischemia in a rat hind limb model.

Prolonged tourniquet use can lead to tissue ischemia and can cause progressive muscle and nerve injuries. Such injuries are accompanied by calpain activation and subsequent Wallerian-like degeneration. Several known inhibitors, including leupeptin, are known to impede the activity of calpain and associated tissue damage.

Negative-Pressure Wound Therapy versus Standard Surgical Dressings after Malignant Tumor Resection: A Systematic Review and Meta-Analysis.

Background: 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.

Six-year Burden of Care for Nonsyndromic Unilateral Cleft Lip and Palate Patients: A Comparison Between Cleft Centers and Noncleft Centers.

Objective: To determine differences in burden of care between nonsyndromic patients with unilateral cleft lip and palate undergoing treatment at American Cleft Palate-Craniofacial Association (ACPA)-accredited centers and nonaccredited centers in New York State.

Design: A retrospective review of the New York Statewide Planning and Research Cooperative System database from January 2001 to December 2014 was performed using ICD-9 and CPT coding.

Patients, Participants: This study included patients with unilateral cleft lip and palate who underwent both lip and palate repairs during their first  6 years of life.

An Anatomical Feasibility Study on the Use of the Hypoglossal and Hemihypoglossal Nerve as a Donor Motor Nerve for Free Functioning Muscle Transfer in Upper Extremity Reconstruction.

Purpose: Brachial plexus injuries (BPI) with complete root avulsions remains a clinical challenge due to a paucity of nerves available for nerve transfer and innervation of free functioning muscle transfers (FFMT). The hypoglossal and hemihypoglossal nerve has not been studied as a donor nerve option for FFMTs in brachial plexus reconstruction, despite successful outcomes of hypoglossal nerve transfers in facial reanimation surgery. We hypothesized that the hypoglossal nerve could be an appropriate candidate for surgical repair of BPI using FFMT.

Engineering functional skin constructs: A quantitative comparison of three-dimensional bioprinting with traditional methods.

Tissue engineering has been successful in reproducing human skin equivalents while incorporating new approaches such as three-dimensional (3D) bioprinting. The latter method offers a plethora of advantages including increased production scale, ability to incorporate multiple cell types and printing on demand. However, the quality of printed skin equivalents compared to those developed manually has never been assessed.

Routine Postoperative Antibiotics After Tissue Expander Placement Postmastectomy Does Not Improve Outcome.

Purpose: In an attempt to reduce the incidence of infectious complications after tissue expander-based breast reconstruction, the routine administration of postoperative antibiotics regimen is common in many practices. In recent years, there has been a plethora of reports scrutinizing the prophylactic use of postoperative antibiotics in this setting. The aim of this study was to determine the efficacy of prolonged administration of postoperative antibiotics compared with perioperative-only antibiotic administration for prophylaxis after tissue expander placement for immediate mastectomy reconstruction.

Screening and Intervention for Skin Cancer in the Galapagos.

Objective: This study aimed to assess the general dermatological needs and correlation of tentative skin cancer screening diagnoses with histopathological confirmation in the highly sun-exposed locals of the Galapagos Islands.

Methods: An institutional review board-approved prospective study was performed at Blanca's House, a nonprofit surgical volunteer organization, free clinics in the Galapagos. After consent, a 40-item modified SPOTme-inspired questionnaire was completed.

Clinical Outcomes After Hematoma Development: A Study of 627 Tissue Expander Breast Reconstructions.

Background: Hematomas after tissue expander immediate breast reconstruction (TE-IBR) pose a significant challenge during the recovery period. In this study, we aim to evaluate whether hematoma formation leads to subsequent complications and how management can impact final reconstructive goals.

Methods: A single-institution retrospective review of TE-IBRs from 2001 to 2018 was performed using an established breast reconstruction database.

Do Postoperative Prophylactic Antibiotics Reduce Highly Virulent Infections?: An Analysis of 660 Tissue Expander Breast Reconstructions.

Background: Many surgeons are reluctant to discontinue prophylactic antibiotics after 24 hours in tissue expander breast reconstruction (TEBR) because of fear of increased risk of surgical site infection (SSI). Currently, there is no consensus regarding antibiotic prophylaxis duration in TEBR. In addition, there remains a lack of research investigating microorganisms involved in SSI across various perioperative antibiotic protocols.

Postoperative Venous Thromboembolism Prophylaxis Utilizing Enoxaparin Does Not Increase Bleeding Complications After Abdominal Body Contouring Surgery.

Background: Venous thromboembolism (VTE) chemoprophylaxis warrants an individualized, risk-stratified approach, and constitutes a relatively controversial topic in plastic surgery.

Objectives: The aim of this study was to determine the safety of a 7-day postoperative enoxaparin regimen for VTE prophylaxis compared with a single preoperative dose of heparin in abdominal body contouring surgery.

Methods: This single-institution pre-post study investigated the safety of a 7-day enoxaparin postoperative regimen in abdominal body contouring procedures performed by a single surgeon from 2007 to 2018.

Acellular Dermal Matrix Sterility: Does It Affect Microbial and Clinical Outcomes Following Implantation?

Unlabelled: The use of acellular dermal matrices (ADMs) in breast reconstruction is a controversial topic. Recent literature has investigated the effects of ADM sterilization on infectious complications, although with varying conclusions. Previous work by our group showed no difference between aseptic and sterilized products immediately out of the package.

Development of In Vitro Bioengineered Vascular Grafts for Microsurgery and Vascular Surgery Applications.

Introduction: The use of vascular grafts is continuing to rise due to the increasing prevalence of coronary artery bypass grafting and microvascular flap-based tissue reconstructions. The current options of using native vessels (saphenous vein) or the synthetic grafts (Dacron) have been unable to manage current needs. In this study, we employed an original tissue engineering approach to develop a multi-layered vascular graft that has the potential to address some of the limitations of the existing grafts.

The Effect of Axillary Lymph Node Sampling during Mastectomy on Immediate Alloplastic Breast Reconstruction Complications.

Background: Tissue expander-based immediate breast reconstruction is currently the most common technique used for postmastectomy breast reconstruction. During mastectomy, axillary lymph nodes are biopsied to stage patients. The purpose of this study is to investigate postoperative complications with respect to extent of lymph node dissection.

Digital Image Speckle Correlation to Optimize Botulinum Toxin Type A Injection: A Prospective, Randomized, Crossover Trial.

Background: Historically, physicians have relied on their subjective measures when determining the site and dosages for botulinum toxin type A injections. Digital image speckle correlation is a technology that tracks pore movement from rest to maximal exertion, allowing for the determination of the optimal sites of injection. In this prospective, randomized, crossover trial, the efficacy of using digital image speckle correlation was compared to physician assessment in choosing botulinum toxin type A injection sites.

Collagenase Clostridium histolyticum for the Treatment of Distal Interphalangeal Joint Contractures in Dupuytren Disease.

Purpose: To explore the efficacy of injectable collagenase Clostridium histolyticum (CCH) in distal interphalangeal (DIP) joint contractures in Dupuytren disease.

Methods: A retrospective review was conducted for patients with DIP joint contractures treated with CCH. Baseline contracture and posttreatment residual contracture were recorded.

The Delay Phenomenon: Is One Surgical Delay Technique Superior?

Background: Surgical delay remains a common method for improving flap survival. However, the optimal surgical technique has not been determined. In this article, we compare flap perfusion, viable surface area, and flap contraction of 2 surgical delay techniques.

Biomechanics and Pinch Force of the Index Finger Under Simulated Proximal Interphalangeal Arthrodesis.

Purpose: To analyze the effect of simulated proximal interphalangeal (PIP) joint arthrodesis on distal interphalangeal (DIP) joint free flexion-extension (FE) and maximal voluntary pinch forces.

Methods: Five healthy subjects were tested with the PIP joint unconstrained and constrained to selected angles to produce (1) free FE movements of the DIP joint at 2 selected angles of the metacarpophalangeal joint, and (2) maximal voluntary tip (thumb and index finger) and chuck (thumb, index, and middle fingers) pinch forces. Kinematic data from a motion analysis system, pinch force data from a mechanical pinch meter, and electromyography (EMG) data recorded from 2 flexor and extensor muscles of the index finger were collected during free FE movements of the DIP joint and pinch tests for distinct PIP joint constraint angles.

Infectious Loss of Tissue Expanders in Breast Reconstruction: Are We Treating the Right Organisms?

Background: Postoperative infections following tissue expander-based breast reconstruction represent a significant threat to the reconstructive process. Studies have found the incidence to be as high as 29%. There has been abundant research into the risk factors associated with these infections, although very few studies have focused on the causative organisms.

A Comparison of Barbed Sutures and Standard Sutures with regard to Wound Cosmesis in Panniculectomy and Reduction Mammoplasty Patients.

Cosmesis is a vital concern for patients undergoing plastic and reconstructive surgery. Many variations in wound closure are employed when attempting to minimize a surgical scar's appearance. Barbed sutures are one potential method of achieving improved wound cosmesis and are more common in recent years.

Is Sterile Better Than Aseptic? Comparing the Microbiology of Acellular Dermal Matrices.

Introduction: Postoperative infections are a major complication associated with tissue-expander-based breast reconstruction. The use of acellular dermal matrix (ADM) in this surgery has been identified as a potential reservoir of infection, prompting the development of sterile ADM. Although aseptic and sterile ADMs have been investigated, no study has focused on the occurrence and clinical outcome of bacterial colonization before implantation.

A prospective analysis of physical examination findings in the diagnosis of facial fractures: Determining predictive value.

Background: There are >150,000 patient visits per year to emergency rooms for facial trauma. The reliability of a computed tomography (CT) scan has made it the primary modality for diagnosing facial skeletal injury, with the physical examination playing more a cursory role. Knowing the predictive value of physical findings in facial skeletal injuries may enable more appropriate use of imaging and health care resources.

Are Prophylactic Postoperative Antibiotics Necessary for Immediate Breast Reconstruction? Results of a Prospective Randomized Clinical Trial.

Background: Closed-suction drains, implants, and acellular dermal matrix (ADM) are routinely used in tissue expander-based immediate breast reconstruction (TE-IBR). Each of these factors is thought to increase the potential for surgical site infection (SSI). Although CDC guidelines recommend only 24 hours of antibiotic prophylaxis after TE-IBR, current clinical practices vary significantly.