Reevaluation of Recipient Vessel Selection in Breast Free Flap Reconstruction.

Background: Current consensus has established the internal mammary vessels (IMV) over the thoracodorsal vessels (TDV) as the preferred recipients for microvascular breast reconstruction due to their superior flow rates and long-established outcomes. Yet, there are occurrences where the IMVs are not reliable and may subsequently prompt intraoperative decision-making. Several options exist, including the contralateral IMVs, thoracoacromial vessels, and TDVs.

Unveiling the Need to Improve Personalized Applicant Tools: A Critical Evaluation of the Reliability of the Texas STAR database in Predicting Match Success for Plastic Surgery Applicants.

Objectives: Using Texas STAR (seeking transparency in application to residency), we aimed to 1) examine predictors of matching success in integrated plastic surgery residency programs and 2) assess the reliability of the tool.

Design, Setting, And Participants: A retrospective analysis of self-reported nationwide data of plastic surgery residency applicants between 2021 and 2023 across 146 participating medical schools were included. A comparison analysis was performed between matched and unmatched applicants using chi-squared tests, t-tests, and logistic regression models.

Chaperone Use During Plastic Surgery Physical Examinations: Nationwide Provider Practices and Impact of Level of Training.

Background: Medical chaperones often play an important role during physical examinations, providing patient comfort and serving as medicolegal witness. The purpose of this study was to evaluate and compare practices regarding chaperone use by plastic surgery attendings and trainees.

Methods: A voluntary survey was distributed to members of the American Council of Academic Plastic Surgeons.

Opioid-sparing Strategies in Alloplastic Breast Reconstruction: A Systematic Review.

Introduction: Pain and discomfort are frequently experienced following mastectomy with concomitant breast implant- or tissue expander-based alloplastic breast reconstruction (AlBR). Unfortunately, postoperative opioids have decreased efficacy in AlBR, short-term complication profiles, and are fraught by long-term dependence. This systematic review aims to identify opioid-sparing pain management strategies in AlBR.

Outcomes of microvascular bone flaps versus osteocutaneous flaps in head and neck reconstruction.

Background: Surgical resection of head and neck (H&N) neoplasms requiring osseous reconstruction have underdefined complication profiles. This study aimed to characterize postoperative outcomes of patients with H&N neoplasia undergoing osteocutaneous flap (OCF) or bare bone flap (BBF) reconstructions.

Materials And Methods: Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) 2005-2017 databases.

Assessment of Opioid-Prescribing Practices in Breast Augmentation: Future Directions for Prescribing Guidelines.

Background: The United States (US) is in the mid of an opioid epidemic propagated, in part, by prescription opioids. With excess overprescribing documented in a variety of surgical procedures, several societies have recommended opioid-prescribing guidelines. Considering the scope and postoperative pain associated with aesthetic plastic surgery procedures, earnest evaluation into opioid-prescribing practices for breast augmentation was conducted.

Racial Disparities in Outcomes of Reconstructive Breast Surgery: An Analysis of 51,362 Patients from the ACS-NSQIP.

Background:  In various surgical specialties, racial disparities in postoperative complications are widely reported. It is assumed that the effect of race can also be found in plastic surgical outcomes, although this remains largely undefined in literature. This study aims to provide data on the impact of race on outcomes of reconstructive breast surgery.

Single-Payer Health Care in the United States: Implications for Plastic Surgery.

Health care reform continues to be a topic of debate among lawmakers, politicians, physicians, and citizens of the United States. In recent years, proposed changes to the health care industry have grown in both granularity and popularity, with the possibility of adapting a single-payer health insurance system reaching an all-time high. The implications of such a policy are far-reaching and can be challenging to conceptualize, especially in isolation.

The New 2019 Institutional Review Board Common Rule Update: Implications for Plastic Surgery Research.

Clinical research remains at the forefront of academic practice and evidence-based medicine. Unfortunately, history has shown that human subjects are vulnerable to experimentation without regard for their own dignity and informed decision-making. Subsequently, it is vital for research institutes to uphold safeguards and ethical conscientiousness toward human subjects.

Photographic and Video Deepfakes Have Arrived: How Machine Learning May Influence Plastic Surgery.

Advances in computer science and photography not only are pervasive but are also quantifiably influencing the practice of medicine. Recent progress in both software and hardware technology has translated into the design of advanced artificial neural networks: computer frameworks that can be thought of as algorithms modeled on the human brain. In practice, these networks have computational functions, including the autonomous generation of novel images and videos, frequently referred to as "deepfakes.

Quantifying the Crisis: Opioid-Related Adverse Events in Outpatient Ambulatory Plastic Surgery.

Background: The United States is currently in the midst of an opioid epidemic precipitated, in part, by the excessive outpatient supply of opioid pain medications. Accordingly, this epidemic has necessitated evaluation of practice and prescription patterns among surgical specialties. The purpose of this study was to quantify opioid-related adverse events in ambulatory plastic surgery.

Immediate Reconstruction After Colorectal Cancer Resection: A Cohort Analysis Through the National Surgical Quality Improvement Program and Outcomes Review.

Background: Colorectal cancer is one of the most common and fatal malignancies in the United States. When localized to the distal gastrointestinal tract, surgical therapy includes abdominoperineal resection (APR) or pelvic exenteration (PEX). Subsequent ablative defects are considerable, impart concerning morbidity, and often necessitate autologous reconstruction.

Does age or frailty have more predictive effect on outcomes following pedicled flap reconstruction? An analysis of 44,986 cases.

The elderly population in the United States is expanding rapidly, and with advancements in modern medicine, the number of elderly patients undergoing surgery has risen in parallel. The aim of this study was to evaluate the effect of age and frailty on postoperative outcomes following pedicled flap reconstruction. The 2005-2016 ACS-NSQIP databases were queried to identify cases involving pedicled flaps based on CPT codes.

The Influence of Surgical Specialty on Oncoplastic Breast Reconstruction.

Background: The integration of oncological surgery with reconstructive techniques has gained popularity in the treatment of breast cancer. oncoplastic reconstruction after partial mastectomy can be performed by the breast surgeon or in cooperation with a consulted plastic surgeon. This study aims to objectively assess the differences in outcomes for partial mastectomy and subsequent oncoplastic reconstruction performed by either general surgery alone or in combination with a plastic and reconstructive surgery team.

An Academic Tertiary Referral Center's Experience with a Vascular Surgery-Based Uterine Artery Embolization Program.

Background: Despite growing endovascular experience within the vascular surgery community, some catheter-based interventions-such as uterine artery embolization (UAE)-remain outside the clinical scope of most vascular surgeons, owing in part to established referral patterns and limited awareness among referring colleagues. We present our experience with a vascular surgery-based, multidisciplinary UAE program at an academic tertiary referral center.

Methods: In a collaborative effort between vascular surgeons and gynecologists, a pelvic vascular disease program has been established to provide palliative, prophylactic, and therapeutic embolizations including, but not limited to, UAE.

An Institution-Wide Algorithm for Treatment of Type II Endoleak Following Endovascular Aneurysm Repair (EVAR).

Objectives: Multiple endovascular techniques have been described for the treatment of persistent type II endoleaks (pT2ELs) causing aneurysm sac growth following endovascular aneurysm repair (EVAR). In the event of a failed endovascular procedure and a pT2EL, a consensus regarding further treatment is lacking, and the literature suggests repeated endovascular attempts are rarely successful. Herein, we propose an algorithm for definitive management of pT2ELs with persistent sac growth following EVAR.

Transcatheter embolization of persistent embryonic veins in venous malformation syndromes.

Persistent embryonic veins represent a major source of venous hypertension and morbidity in venous malformation syndromes, such as Klippel-Trénaunay syndrome and congenital lipomatous overgrowth, vascular malformations, epidermal nevus, and skeletal deformities syndrome. Surgical stripping and phlebectomy are the most commonly reported alternatives to compression therapy for refractory cases. These techniques, although effective in those patients who meet the necessary anatomic criteria, can be associated with bleeding, wound-related complications, and recurrence.

Chronic refractory venous ulcer exacerbated by a congenital pelvic arteriovenous malformation successfully treated by transarterial Onyx embolization.

Congenital arteriovenous malformations (AVMs) are an important but often neglected cause of lower extremity venous hypertension. A case of a chronic refractory venous stasis ulcer of the lower extremity exacerbated by a pelvic AVM is presented. Healing of the ulcer was achieved at 2 months without recurrence at 1 year after superselective ethylene vinyl alcohol copolymer (Onyx 34; ev3, Covidien, Plymouth, Minn) embolization of the AVM nidus.

Direct stick embolization of extremity arteriovenous malformations with ethylene vinyl alcohol copolymer.

Direct stick embolization (DSE) of high-flow peripheral arteriovenous malformations (AVMs) has previously been reported using n-butyl cyanoacrylate and ethanol. The use of ethylene vinyl alcohol copolymer (Onyx; Covidien, Plymouth, Minn) through this delivery route has been extremely limited, particularly in the peripheral interventional realm, owing to concerns about technique and conduit for delivery, skin discoloration, and ulceration. We describe three patients with relatively focal, symptomatic, congenital high-flow AVMs of the upper and lower extremity treated successfully by multifaceted approaches including transvenous coil embolization of the nidus venous outflow, transarterial embolization, and DSE of the AVM nidus with Onyx.

Peptides displayed as high density brush polymers resist proteolysis and retain bioactivity.

We describe a strategy for rendering peptides resistant to proteolysis by formulating them as high-density brush polymers. The utility of this approach is demonstrated by polymerizing well-established cell-penetrating peptides (CPPs) and showing that the resulting polymers are not only resistant to proteolysis but also maintain their ability to enter cells. The scope of this design concept is explored by studying the proteolytic resistance of brush polymers composed of peptides that are substrates for either thrombin or a metalloprotease.