Do female and male chests feel the same? A comprehensive quantitative sensory analysis.

Introduction: There is growing interest in understanding chest sensory function due to the significant morbidity associated with impaired sensation following nerve injury. While the baseline quantitative sensory and pain thresholds in female and male patients have been studied in various other anatomic areas, there is little knowledge on quantitative sensation at the chest as well as the presence of possible gender differences. Therefore, this study aimed to conduct a comprehensive quantitative sensory analysis to determine if female and male chests feel the same.

Targeted Reinnervation During Gender-Affirming Mastectomy and Restoration of Sensation.

Importance: During gender-affirming mastectomy, nerves are transected, resulting in sensory loss. Nerve preservation using targeted nipple-areola complex (NAC) reinnervation (TNR) may restore sensation.

Objective: To determine the quantitative and patient-reported sensory outcomes of TNR.

Surgical treatment delay in patients with headache disorders and neuralgia correlates with poor postoperative outcome.

Introduction: Although nerve decompression surgery has proven to be effective in reducing symptoms in patients with head and neck neuralgia and headache disorders, it is currently not part of the treatment algorithms for headache disorders. Therefore, patients wait an average of 20 years from the onset of symptoms to surgery, resulting in high conservative treatment costs ($989,275.65 per patient) and patient morbidity.

The neuroma map: A systematic review of the anatomic distribution, etiologies, and surgical treatment of painful traumatic neuromas.

Background: This study analyzed all reported cases of painful traumatic neuromas to better understand their anatomic distribution, etiologies, and surgical treatment.

Methods: PubMed, Embase, Cochrane, and Web of Science were searched in October 2023 for articles describing painful traumatic neuromas.

Results: In total, 414 articles reporting 5,562 neuromas were included and categorized into head/neck, trunk, upper extremity, lower extremity, and autonomic nerves.

Improving the Retention of Low-Volume Autologous Fat Grafting: A Comparative Analysis of Lipoaspirate Processing Techniques for Facial Feminization.

Background: Outcomes following autologous fat grafting have historically been unpredictable because of variability in fat retention rates. The novel poloxamer wash, absorption, mesh filtration system (PWAS) uses proprietary technology to stabilize and concentrate lipoaspirate. Its use in low-volume fat grafting has not been reported.

Aetiologies of iatrogenic occipital nerve injury and outcomes following treatment with nerve decompression surgery.

Introduction: This study analyzed the etiologies and treatment of iatrogenic occipital nerve injuries.

Methods: Patients with occipital neuralgia (ON) who were screened for occipital nerve decompression surgery were prospectively enrolled. Patients with iatrogenic occipital nerve injuries who underwent nerve decompression surgery were identified.

Surgical Management of Headache Disorders - A Systematic Review of the Literature.

Purpose Of Review: This review article critically evaluates the latest advances in the surgical treatment of headache disorders.

Recent Findings: Studies have demonstrated the effectiveness of innovative screening tools, such as doppler ultrasound, pain drawings, magnetic resonance neurography, and nerve blocks to help identify candidates for surgery. Machine learning has emerged as a powerful tool to predict surgical outcomes.

Micro-Coring: A Novel Approach to Perioral Rejuvenation.

Background: A long philtrum and poor perioral skin quality are stigmata of the aging face. Micro-Coring is a novel technology that allows for scarless skin removal.

Objectives: In this study we aimed to determine whether micro-coring can shorten the philtrum and improve perioral skin quality.

Reoperation following Primary Greater Occipital Nerve Decompression Surgery: Incidence, Risk Factors, and Outcomes.

Background: Although nerve decompression surgery is an effective treatment for refractory occipital neuralgia, a proportion of patients experience recurrence of pain and undergo reoperation. This study analyzes the incidence, risk factors, and outcomes of reoperation following primary greater occipital nerve (GON) decompression.

Methods: A total of 215 patients who underwent 399 primary GON decompressions were prospectively enrolled.

Readability analysis and concept mapping of PROMs used for headache disorders.

Objective: To assess the readability and the comprehensiveness of patient-reported outcome measures (PROMs) utilized in primary headache disorders literature.

Background: As the health-care landscape has evolved toward a patient-centric model, numerous PROMs have been developed to capture treatment outcomes in patients with headache disorders. For these PROMs to advance our understanding of headache disorders and their treatment impact, they must be easy to understand (i.

A Relative Value Unit-Based Model for Targeted Nipple-Areola Complex Neurotization in Gender-Affirming Mastectomy.

Background: For transmasculine individuals, double-incision mastectomy with free nipple grafts is the most common procedure for gender-affirming chest masculinization. However, patients report decreased sensation postoperatively. Direct coaptation of intercostal nerves to the nipple-areolar complex (NAC) is an experimental technique that may preserve postoperative sensation, yet whether reimbursements and billing codes incentivize hospital systems and surgeons to offer this procedure lacks clarity.

Prospective Sensory Outcomes for Targeted Nipple Areola Complex Reinnervation (TNR) in Gender-Affirming Double Incision Mastectomy with Free Nipple Grafting.

Objective: This study analyses the anatomy and sensory outcomes of targeted nipple areola complex reinnervation (TNR) in gender-affirming double incision mastectomy with free nipple grafting (FNG).

Background: TNR is a novel technique to preserve and reconstruct intercostal nerves (ICN) to improve postoperative sensation. There is little evidence on relevant anatomy and outcomes.

Refractory occipital neuralgia treatment with nerve decompression surgery: a case series.

Background: The management of refractory occipital neuralgia (ON) can be challenging. Selection criteria for occipital nerve decompression surgery are not well defined in terms of clinical features and best preoperative medical management.

Methods: In total, 15 patients diagnosed with ON by a board-certified, fellowship-trained headache specialist and referred to a plastic surgeon for nerve decompression surgery were prospectively enrolled.

Treatment delay from onset of occipital neuralgia symptoms to treatment with nerve decompression surgery: a prospective cohort study.

Background: The aims of this study were to (1) evaluate the time between onset of occipital neuralgia symptoms and nerve decompression surgery, (2) perform a cost comparison analysis between surgical and nonsurgical treatment of occipital neuralgia, and (3) report postoperative results of nerve decompression for occipital neuralgia.

Methods: Subjects (n = 1112) who underwent screening for nerve decompression surgery were evaluated for occipital neuralgia. Of those, 367 patients (33%) met the inclusion criteria.

Treatment Delay in Patients Undergoing Headache Surgery (Nerve Decompression Surgery).

Background: Although headache surgery has been shown to be an effective treatment option for refractory headache disorders, it has not been included as part of the headache disorder management algorithm by non-surgical providers. This study aims to evaluate the delay in surgical management of patients with headache disorders. In addition, a cost comparison analysis between conservative and operative treatment of headache disorders was performed, and the surgical outcomes of headache surgery were reported.

Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study.

Introduction: Chronic migraine headaches (MH) are a principal cause of disability worldwide. This study evaluated and compared functional outcomes after peripheral trigger point deactivation surgery or botulinum neurotoxin A (BTA) treatment in patients with MH.

Methods: A long-term, multicenter, and prospective study was performed.

The Use of Nerve Caps after Nerve Transection in Headache Surgery: Cadaver and Case Reports.

Background: Nerve transection with nerve reconstruction is part of the treatment algorithm for patients with refractory pain after greater occipital nerve (GON) and lesser occipital nerve (LON) decompression or during primary decompression when severe nerve injury or neuroma formation is present. Importantly, the residual nerve stump is often best addressed via contemporary nerve reconstruction techniques to avoid recurrent pain. As a primary aim of this study, nerve capping is explored as a potential viable alternative that can be utilized in certain headache cases to mitigate pain.

A Decade of Nipple-Sparing Mastectomy: Lessons Learned in 3035 Immediate Implant-Based Breast Reconstructions.

Background: Nipple-sparing mastectomy is commonly performed for breast cancer treatment or prevention. The authors present one of the largest breast reconstruction series in the literature.

Methods: A single-institution retrospective review was conducted from 2007 to 2019.

Relative Pain Reduction and Duration of Nerve Block Response Predict Outcomes in Headache Surgery: A Prospective Cohort Study.

Background: Experts agree that nerve block (NB) response is an important tool in headache surgery screening. However, the predictive value of NBs remains to be proven in a prospective fashion.

Methods: Pre-NB and post-NB visual analogue pain scores (0 to 10) and duration of NB response were recorded prospectively.

The Superficial Inferior Epigastric Artery Axial Flap to Study Ischemic Preconditioning Effects in a Rat Model.

Fasciocutaneous flaps (FCF) have become the gold standard for complex defect reconstruction in plastic and reconstructive surgery. This muscle-sparing technique allows transferring vascularized tissues to cover any large defect. FCF can be used as pedicled flaps or as free flaps; however, in the literature, failure rates for pedicled FCF and free FCF are above 5%, leaving room for improvement for these techniques and further knowledge expansion in this area.

Evidence-Based Patient Selection in Headache Surgery: Impact of Preoperative Radiofrequency Ablation on Surgical Outcomes.

Background: Radiofrequency ablation (RFA) of the greater occipital nerve (GON) is a minimally invasive treatment option commonly used in patients with occipital neuralgia. Patients who undergo occipital surgery for headaches after failed RFA treatment present a unique opportunity to evaluate RFA-treated occipital nerves and determine the impact on headache surgery outcomes.

Methods: Of 115 patients who underwent headache surgery at the occipital site, 29 had a history of RFA treatment.

Artificial Intelligence-Enabled Evaluation of Pain Sketches to Predict Outcomes in Headache Surgery.

Background: Recent evidence has shown that patient drawings of pain can predict poor outcomes in headache surgery. Given that interpretation of pain drawings requires some clinical experience, the authors developed a machine learning framework capable of automatically interpreting pain drawings to predict surgical outcomes. This platform will allow surgeons with less clinical experience, neurologists, primary care practitioners, and even patients to better understand candidacy for headache surgery.