Are Surgical Drains Needed in DIEP Flap Surgery? The Drain-Free DIEP Flap Concept.

Background: Studies support an inherent morbidity associated with the use of surgical drains-such as postoperative pain, infection, reduction in mobility, and delay in patient discharge-and they do not prevent seroma or hematoma. The authors' series aims to evaluate the feasibility, benefits, and safety of performing drainless deep inferior epigastric perforator (DIEP) flap surgery and to formulate an algorithm for when this can be used.

Methods: A retrospective review of DIEP reconstruction outcomes of two surgeons was performed.

Asymmetric Four-Flap Breast Reconstruction with DIEP Flaps and PAP Flaps.

Summary: Autologous breast reconstruction is considered superior to alloplastic options. In cases of large-volume breast reconstruction, stacked flaps from a single area or multiple donor areas are required. In bilateral stacked four-flap reconstructions, when a large amount of skin is required, an asymmetric reconstruction involving the use of a conjoined deep inferior epigastric perforator (DIEP) flap with a uniform skin paddle to reconstruct the side where most skin is required and the use of two independently perfused stacked flaps to reconstruct the side that requires less skin can provide superior aesthetic results compared with the usual hemi-DIEP and profunda artery perforator (PAP) four-flap configuration.

Cross Facial Nerve Grafting for Smile Restoration: Thoughts on Improving Graft Inset.

Cross facial nerve grafts (CFNGs) are one of the most ubiquitous and time-honored surgical tools used in facial reanimation. They may be used for targeting different mimetic muscles in the subacute setting as well as to innervate newly placed muscle flaps in varied facial subunits. In our experience, when used specifically for smile reanimation in two-stage strategies with either traditional "babysitting" approaches in nerve transfers or free functional muscle transfers, the second stage may present some challenges in CFNG identification as well as injury to the previously banked nerve graft.

Disentangling the associations between past childhood adversity and psychopathology during the COVID-19 pandemic: The mediating roles of specific pandemic stressors and coping strategies.

Background: Individuals with a history of adverse childhood experiences (ACEs) display heightened symptoms of psychopathology during the COVID-19 pandemic. Yet, no study has investigated what aspects of the pandemic are of particular concern for this population and ways in which strategies to coping with pandemic stressors may exacerbate their clinical symptomatology.

Objective: This study explores what pandemic stressors and coping strategies are associated with ACEs, depression, and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic, before investigating whether the identified chief stressors and coping styles mediate the effects of ACEs on depression and PTSD.

The Role of Simulation in Microsurgical Training.

Simulation has been established as an integral part of microsurgical training. The aim of this study was to assess and categorize the various simulation models in relation to the complexity of the microsurgical skill being taught and analyze the assessment methods commonly employed in microsurgical simulation training. Numerous courses have been established using simulation models.