Control versus Choice in Deciding Career Pathway in Plastic Surgery: The Perfect Ratio.

Background: The decisions and components of a career in medicine have changed. Historically, a career selection was often a decision between joining an institution or academic center versus the fiscal risks associated with private practice. This created a relatively simple risk versus reward equation: those in private practice made more money if it went well.

Revision Rates in Cosmetic Plastic Surgery with and without Resident Involvement.

Background: Changes in surgical education have caused concern over residents' preparedness for independent practice. As the field of otolaryngology requires such a wide breadth of expertise, ill preparation becomes especially costly. This study explores how the presence and participation of a postgraduate year 3 (PGY3) otolaryngology resident in surgery impacts revision rates and operating time as gauges for the resident competency and indirect training costs.

Operation Diversify Plastic Surgery: An Innovative Strategy to Increase Diversity in Plastic and Reconstructive Surgery.

Healthcare disparities remain a significant problem facing the US healthcare system with recent evidence of persistent racial and ethnic disparities especially among patients from minority backgrounds. Recent studies have documented advantages to a racially and ethnically diverse surgical workforce such as higher patient satisfaction scores, superior patient compliance with physician recommendations, and increased participation in clinical research studies by minority patients. In plastic and reconstructive surgery (PRS), there is a noted deficit among residents and faculty that come from ethnically underrepresented in medicine (URiM) backgrounds despite recent efforts to increase diversity in PRS surgeons.

Rates of National Institutes of Health Funding for Surgeon-Scientists, 1995-2020.

Importance: Surgeon-scientists are uniquely positioned to facilitate translation between the laboratory and clinical settings to drive innovation in patient care. However, surgeon-scientists face many challenges in pursuing research, such as increasing clinical demands that affect their competitiveness to apply for National Institutes of Health (NIH) funding compared with other scientists.

Objective: To examine how NIH funding has been awarded to surgeon-scientists over time.

Gender Disparity in National Institutes of Health Funding Among Surgeon-Scientists From 1995 to 2020.

Importance: Surgical diseases account for approximately 30% of the global burden of disease. Gender diversity in biomedical research is critical to generate innovative patient-centered research in surgery.

Objective: To examine the distribution of biomedical research funding by the National Institutes of Health (NIH) among women and men surgeon-scientists during a 25-year period.

The geography of talent development.

Geography (i.e., birthplace) is one of many factors that influence talent development.

Effects of intraoperative positive end-expiratory pressure and fraction of inspired oxygen on postoperative oxygenation in dogs undergoing stifle surgery.

Objective: To compare the effects of fraction of inspired oxygen (FiO) with the addition of positive end-expiratory pressure (PEEP) during anesthesia on arterial oxygenation in the first 4 postoperative hours in dogs. We hypothesized that compared with dogs breathing FiO ≥ 0.95 and no PEEP (ZEEP), the use of intraoperative PEEP would improve postoperative oxygenation, and that the use of PEEP combined with an FiO of 0.

The Canine Postamputation Pain (CAMPPAIN) initiative: a retrospective study and development of a diagnostic scale.

Objective: To develop a scale to diagnose and assess the severity of postamputation pain (PAP) in dogs.

Study Design: Single-center retrospective study.

Animals: A total of 66 dogs that underwent thoracic or pelvic limb amputation and 139 dogs that underwent tibial plateau leveling osteotomy (TPLO) at a veterinary teaching hospital.

Value-based focused global population health management.

In 2018, approximately 18 million people worldwide were diagnosed with cancer and are predicted to double by 2040. The global quality chasm in improving health care worldwide requires "systems thinking" as the key to success. Aligning the goal around person-centered care captures the total needs of care of a population and not just disease categories.

Patterns of invasive recurrence among patients originally treated for ductal carcinoma in situ by breast-conserving surgery versus mastectomy.

Purpose: Local recurrence after treatment of ductal carcinoma in situ (DCIS) with breast-conserving surgery (BCS) is more common than after mastectomy, but it is unclear if patterns of invasive recurrence vary by initial surgical therapy. Among patients with invasive recurrence after treatment for DCIS, we compared patterns of first recurrence between those originally treated with BCS vs. mastectomy.

An Analgesic Regimen for Opioid Reduction in Elective Plastic Surgery: A Randomized Prospective Study.

Background: Prescription opioid misuse has been recognized as a national epidemic. The implications of this problem are especially important to consider, as postoperative opioid abuse can give rise to true addiction for surgical patients. The concept of enhanced recovery after surgery is increasingly used across various specialties to decrease the overabundance of postoperative opioid use.

Precaution Costs: The Presumption of Breast Cancer Seeding and Its Impact on Surgical Expenditure.

As healthcare costs continue to rise at unsustainable rates (at an average rate of 5.5% a year), expenses without measurable outcomes need review. In reconstructive surgery, empiric change of instruments between oncologic and reconstructive segments of surgery is one such practice.

Do Body Mass Index and Breast Density Impact Cancer Risk Among Women with Lobular Carcinoma In Situ?

Purpose: Both body mass index (BMI) and breast density impact breast cancer risk in the general population. Whether obesity and density represent additive risk factors in women with lobular carcinoma in situ (LCIS) is unknown.

Methods: Patients diagnosed with LCIS from 1988 to 2017 were identified from a prospectively maintained database.

Effect of Keller Funnel on the Rate of Capsular Contracture in Periareolar Breast Augmentation.

Background: Capsular contracture is 1 of the most common complications after breast implant surgery and is a major indication for reoperation. Capsular contracture is believed to be a multifactorial process that is affected by implant texture, incision type, and ultimately pocket contamination. This contamination causes a biofilm that leads to capsular contracture.

The "3-Pack" Examination Is Critical for Comprehensive Evaluation of the Biceps-Labrum Complex and the Bicipital Tunnel: A Prospective Study.

Purpose: To determine the diagnostic value of the 3-Pack examination for biceps-labrum complex (BLC) disease, assess interobserver reliability, and generate an evidence-based diagnostic and therapeutic algorithm.

Methods: A total of 145 consecutive patients were enrolled in this prospective comparative study. The study included 116 chronically symptomatic patients indicated for arthroscopic subdeltoid transfer of the long head of the biceps tendon to the conjoint tendon and 29 asymptomatic comparison subjects.

Magnetic Resonance Imaging Currently Fails to Fully Evaluate the Biceps-Labrum Complex and Bicipital Tunnel.

Purpose: To determine the diagnostic accuracy of magnetic resonance imaging (MRI) for biceps-labrum complex (BLC) lesions, including the extra-articular bicipital tunnel.

Methods: A retrospective review of 277 shoulders with chronic refractory BLC symptoms that underwent arthroscopic subdeltoid transfer of the long head of the biceps tendon (LHBT) to the conjoint tendon was conducted. Intraoperative lesions were categorized as "inside" (labral tears and dynamic LHBT incarceration), "junctional" (LHBT partial tears, LHBT subluxation, and biceps chondromalacia), or "bicipital tunnel" (extra-articular bicipital tunnel scar/stenosis, loose bodies, LHBT instability, and LHBT partial tears) based on anatomic location.

Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.

Purpose: The purpose of this study was to define the limits of diagnostic glenohumeral arthroscopy and determine the prevalence and frequency of hidden extra-articular "bicipital tunnel" lesions among chronically symptomatic patients.

Methods: Eight fresh-frozen cadaveric specimens underwent diagnostic glenohumeral arthroscopy with percutaneous tagging of the long head of the biceps tendon (LHBT) during maximal tendon excursion. The percentage of visualized LHBT was calculated relative to the distal margin of subscapularis tendon and the proximal margin of the pectoralis major tendon.

Midterm clinical outcomes for arthroscopic subdeltoid transfer of the long head of the biceps tendon to the conjoint tendon.

Purpose: The aim of this study was to assess the midterm functional outcomes for arthroscopic subdeltoid transfer of the long head of the biceps tendon (LHBT) to the conjoint tendon.

Methods: Fifty-six shoulders in 54 patients (46 men, 8 women; mean age, 42 years) who underwent isolated arthroscopic subdeltoid LHBT transfer to the conjoint tendon by a single surgeon with a minimum of 4 years follow-up were evaluated with American Society of Shoulder and Elbow Surgeons (ASES) and L'Insalata scores. A subset of patients was available for physical examination.

Allergy/hypersensitivity reactions as a predisposing factor to complex regional pain syndrome I in orthopedic patients.

Several predisposing conditions have been associated with complex regional pain syndrome I (CRPS I). The purpose of this study was to determine the relationship between a history of allergy/hypersensitivity reactions and CRPS I in orthopedic patients. Orthopedic patients with CRPS I (n=115) who experienced pain relief after a successful sympathetic nerve blockade were identified for study inclusion; a control group (n=115) matched to the CRPS I group by age, sex, and location of injury was also included.