Moving Towards the Outpatient DIEP Flap: Factors Influencing Early Discharge.

Background: Enhanced Recovery After Surgery (ERAS) protocols can reduce the length of stay (LOS) for surgical patients, including those undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, allowing most patients to be discharged by postoperative day 2. However, some patients require a prolonged inpatient stay due to difficulty completing postoperative milestones. This study aims to identify factors associated with increased LOS after DIEP flap breast reconstruction and assess safety of earlier discharge.

Enhancing Patient Decision-Making in Breast Reconstruction: A Systematic Review of Decision Aid Efficacy.

Background: Patients often struggle to select a breast reconstruction option that aligns with their personal values. Decision aids have become popular tools to assist patients in navigating these choices. This systematic review assesses the effectiveness of available breast reconstruction decision aids.

Trends and Early Complications in Direct-to-Implant Breast Reconstruction: An Updated Analysis of the ACS-NSQIP Database.

Rates of direct-to-implant (DTI) breast reconstruction, in which breast implants are placed at the time of mastectomy, have been consistently rising. Advances in surgical adjuncts and technology, such as acellular dermal matrices (ADM), have made DTI reconstruction safer and more reliable. However, few studies have characterized early (30-day) postoperative complications following DTI.

Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy.

Background:  Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported outcomes with the BREAST-Q (patient reported outcome measure for breast reconstruction patients, in patients receiving) in patients receiving deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.

Methods:  We retrospectively examined patients who received DIEP flaps at our institution from 2010 to 2019.

Early Complications in Prepectoral Tissue Expander-Based Breast Reconstruction.

Background: Prepectoral implant placement for postmastectomy breast reconstruction has increased in recent years. Benefits of prepectoral reconstruction may include lack of animation deformities and reduced postoperative pain, but its complication profile is currently unclear. This study aimed to examine the complication profile of prepectoral tissue expanders (TEs) to determine factors associated with TE loss.

The evolution of pediatric soft-tissue free flap reconstruction of the lower extremity after oncologic resection: A 30 year experience.

Introduction: Limb salvage has become the standard of care for lower extremity tumors because of improvements in adjuvant treatments and reconstructive techniques. While there is literature assessing pediatric lower extremity free flap reconstruction in the setting of trauma, there is a paucity of literature that analyzes oncologic free flap reconstruction in this patient population. We report our long-term experience and evolution of care for lower extremity oncologic free flap reconstruction in pediatric patients.

Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes.

Background: Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PROs) are limited. The purpose of this study was to classify complications and PROs in patients opting for surgical management of textured implants.

Decreasing length of stay in breast reconstruction patients: A national analysis of 2019-2020.

Background: The effects of COVID-19 on breast reconstruction included shifts toward alloplastic reconstruction methods to preserve hospital resources and minimize COVID exposures. We examined the effects of COVID-19 on breast reconstruction hospital length of stay (LOS) and subsequent early postoperative complication rates.

Methods: Using the National Surgical Quality Improvement Program, we examined female patients who underwent mastectomy with immediate breast reconstruction from 2019 to 2020.

Early Complications in Prepectoral Breast Reconstructions with and without Acellular Dermal Matrix: A Preliminary Analysis of Outcomes.

Background: Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is usually performed in conjunction with insertion of acellular dermal matrix (ADM). However, the effects of ADM use on TE loss or other early complications remain unknown. Therefore, the aim of this study was to compare early postoperative complications in patients who underwent prepectoral breast implant reconstruction with or without ADM use.

A Regional Analysis of Hospital Readmissions Following Total Hip and Knee Arthroplasty and the Impact of Medicaid Expansion.

The Hospital Readmissions Reduction Program (HRRP) works to temper nationally rising readmission rates. Total knee arthroplasty (TKA) and total hip arthroplasty (THA) have a 30-day readmission cost burden of $889,300 and $689,400, respectively. No research has compared TKA and THA readmission rates by region and Medicaid expansion status.

A Characterization of Pediatric Craniofacial Injuries from Children's Toys.

Introduction: Playing with toys contributes significantly to the cognitive, physical, and social development of children. Certain toys, unfortunately, carry the potential for serious craniofacial injury. There is a gap in the literature regarding the comprehensive assessment of toy-related craniofacial injuries.

National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction.

Background: Implant-based reconstruction is the most common method of immediate breast reconstruction in the United States, with acellular dermal matrices (ADMs) playing a significant role in implant support and coverage. This study evaluated recent national trends in ADM use in immediate breast reconstruction and assessed patient characteristics and 30-day complication rates.

Methods: The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients undergoing immediate breast reconstruction from 2015 to 2020.

Air versus Saline in Initial Prepectoral Tissue Expansion: A Comparison of Complications and Perioperative Patient-Reported Outcomes.

Background: One option to optimize prepectoral tissue expander fill volume while minimizing stress on mastectomy skin flaps is to use air as an initial fill medium, with subsequent exchange to saline during postoperative expansion. The authors compared complications and early patient-reported outcomes (PROs) based on fill type in prepectoral breast reconstruction patients.

Methods: Prepectoral breast reconstruction patients who underwent intraoperative tissue expansion with air or saline from 2018 to 2020 were reviewed to assess fill-type utilization.

Three-Dimensional Surface Analysis for Preoperative Prediction of Breast Volume: A Validation Study.

Background: Few studies have examined whether preoperative three-dimensional surface imaging can accurately predict breast volume. Reliably predicting breast volume preoperatively can assist with breast reconstruction planning, patient education, and perioperative risk stratification.

Methods: The authors conducted a review of patients who underwent mastectomy from 2020 to 2021 and included all patients who had preoperative VECTRA XT three-dimensional imaging.

Increasing rates of general anesthesia use in lumpectomy procedures: A 15-year trends analysis.

Background: Anesthesia methods in oncologic breast surgery have evolved with less invasive practices. The aims of this study were primarily to examine trends in anesthesia type used during lumpectomy.

Methods: We analyzed lumpectomy procedures from 2005 to 2019 using the NSQIP database.

An updated systematic review of esthetic grading tools in postmastectomy breast reconstruction.

Background And Objectives: We ascertained whether a validated esthetic grading tool for breast reconstruction had been developed and widely adopted since the last published systematic review on the topic from 2015.

Methods: We performed a systematic review identifying all studies using a grading tool to assess breast reconstruction, using search terms associated with all types of breast surgery and outcomes research. Articles were assessed for patient number, validated scale use, assessor type and training, assessor blinding, assessment method, scoring system type, type and timing of reconstruction, and usage of corroborating scales.

Optimizing Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quality Improvement Study.

Deep inferior epigastric perforator (DIEP) flap surgery commonly involves multiday hospitalization, although data suggest 95% of complications after unilateral DIEP flap breast reconstruction occur within the first 24 hours. The aim of this study was to decrease hospitalization time and optimize care of patients undergoing unilateral DIEP flap breast reconstruction. Our study followed Six Sigma's DMAIC (define, measure, analyze, improve, control) framework.

A characterization of home maintenance equipment-related hand and lower arm injuries.

Background: Thousands of Americans sustain injuries from various household appliances each year, though injury patterns have not been well characterized. We thus sought to determine the incidence, characteristics, and trends of household appliance-related hand injuries over the past decade.

Methods: The National Electronic Injury Surveillance System database (NEISS) was queried from 2010 through 2019.

Effects of COVID-19 on mastectomy and breast reconstruction rates: A national surgical sample.

Background: The COVID-19 pandemic profoundly impacted breast cancer treatment in 2020. Guidelines initially halted elective procedures, subsequently encouraging less invasive surgeries and restricting breast reconstruction options. We examined the effects of COVID-19 on oncologic breast surgery and reconstruction rates during the first year of the pandemic.

Craniofacial Injuries From Personal Watercraft Accidents.

Personal watercraft (PWC) use is a popular leisure activity. Although injuries associated with PWCs have been examined broadly, there is a lack of investigation into craniofacial injuries within this setting. This paper reviews the literature discussing PWC incidents and PWC-related craniofacial injuries.

Revisiting the Pericranial Flap for Scalp Reconstruction.

Soft tissue deficits of the scalp due to trauma, infection, or tumor resection present a unique challenge to the reconstructive surgeon whose goal is to achieve excellent cosmesis in a hair bearing area without compromising coverage. While extensive undermining for large rotation flaps or free tissue transfer can provide necessary coverage, the pericranial flap is an excellent alternative for less ideal surgical candidates who cannot tolerate more extensive interventions or for patients who require long-term cancer surveillance. Elevation of the pericranial flap limits the need for back cuts through the skin and uses blunt dissection to preserve overlying hair follicles.

The 50 Most Cited Articles in Meniscal Injury Research.

Background: Meniscal injuries are among the most common orthopaedic injuries, with a significant volume of published literature.

Purpose: To perform a comprehensive bibliometric analysis that appropriately evaluates the 50 most cited articles in meniscal research.

Study Design: Cross-sectional study.

Rolling With the Punches: A National Electronic Injury Surveillance System Database Study of Craniofacial Injuries in Boxing.

Introduction: Boxing is a popular combat sport in which competitors may sustain high impact blows to the face. For this reason, they are at high risk for craniofacial injuries; however, data on facial injuries specific to boxing remains sparse. Studies on safety measures, such as headgear, to prevent such injuries in boxing have been inconclusive.

Kick Start to an Epidemiological Report of Soccer-Related Craniofacial Trauma Analysis.

Introduction: Soccer is a global sport played by millions annually with an increasing popularity in the United States. Game is played by a wide range of participants from all ages and levels of competition. This scenario leads to a potential disparity in the injury profile based on quantifiable demographics.