Surgical Team Trips to Vietnam: Implementation of a Dedicated Cleft Palate Perioperative Program Improves Fistula Rates.

Background: ReSurge International is a nongovernmental organization that organizes surgical team trips to low- and middle-income countries. Cleft palate repair is commonly performed on these trips. A comprehensive cleft care program was implemented to help reduce postoperative palatal fistula rates.

Use of hyaluronic acid filler for enhancement of nipple projection following breast reconstruction: An easy and effective technique.

Background: Breast reconstruction improves the psychological well-being of patients with breast cancer. Patients who complete nipple-areolar reconstruction are even more satisfied with their final reconstructive result. Nipple flattening is a common complication.

Economic Benefit of Hand Surgical Efforts in Low- and Middle-Income Countries: A Cost-Benefit Analysis.

Background: Hand surgeons can alleviate the burden associated with various congenital anomalies, burn sequelae, and trauma that debilitate individuals in low- and middle-income countries. Because few surgeons in these areas have the necessary resources to perform complex hand surgery, surgical trips provide essential surgical care. The authors aimed to determine the economic benefit of hand surgical trips to low- and middle-income countries to comprehensively determine the economic implications of hand surgery trips in low-resource settings.

The versatile free medial sural artery perforator flap: An institutional experience for reconstruction of the head and neck, upper and lower extremities.

Background: The medial sural artery perforator (MSAP) flap is an increasingly versatile and reliable flap for soft tissue reconstruction. This study investigates complication rates and long-term outcomes of the MSAP flap.

Methods: A retrospective review was performed on consecutive patients undergoing MSAP flap reconstruction at Chang Gung Memorial Hospital from 2006 through 2017.

Evaluating the Economic Impact of Plastic and Reconstructive Surgical Efforts in the Developing World: The ReSurge Experience.

Background: As the global burden of disease continues to rise, it becomes increasingly important to determine the sustainability of specialty surgery in the developing world. The authors aim to (1) evaluate the cost-effectiveness of plastic and reconstructive surgery in the developing world and (2) quantify the economic benefit.

Methods: In this study, the authors performed a retrospective analysis of surgical trips performed by ReSurge International from 2014 to 2017.

Microsurgical Reconstruction of the Smile: A Critical Analysis of Outcomes.

Background: Facial paralysis is a significant problem with functional, psychological, and esthetic consequences. Free muscle transfer for reanimation of the smile has been established as the preferred reconstructive method. However, little has been reported on the complications after this procedure.

Cost-Effectiveness Analysis of Humanitarian Hand Surgery Trips According to WHO-CHOICE Thresholds.

Purpose: Hand surgery outreach programs to low- and middle-income countries (LMICs) provide much-needed surgical care to the underserved populations and education to local providers for improved care. The cost-effectiveness of these surgical trips has not been studied despite a long history of such efforts. This study aimed to examine the economic impact of hand surgery trips to LMICs using data from the Touching Hands Project and ReSurge International.

The ReSurge Global Training Program: A Model for Surgical Training and Capacity Building in Global Reconstructive Surgery.

Background: A paradigm shift is underway in the world of humanitarian global surgery to address the large unmet need for reconstructive surgical services in low- and middle-income countries (LMICs). Here, we discuss the ReSurge Global Training Program (RGTP), a model for surgical training and capacity building in reconstructive surgery in the developing world. The program includes an online reconstructive surgery curriculum, visiting educator trips, expert reconstructive surgeon involvement, trainee competency tracking system, and identification of local outreach partners to provide safe reconstructive surgery to the neediest of patients in the developing world.

Practical Applications of Delayed-Immediate Autologous Breast Reconstruction: A Flexible and Safe Operative Strategy.

Background: Timing is an important consideration in patients undergoing mastectomy for breast cancer. While immediate reconstruction results in superior aesthetic outcomes, the need for postmastectomy radiation can often only be ascertained after review of surgical pathology. Delayed-immediate autologous reconstruction (DIAR) is a reconstructive approach that consists of mastectomy with tissue expander placement in the first stage and flap-based breast reconstruction in the second stage.

Analysis of Aesthetic Outcomes and Patient Satisfaction After Delayed-Immediate Autologous Breast Reconstruction.

Background: Patients with breast cancer frequently opt to undergo breast reconstruction after mastectomy. The timing and aesthetic outcome of the breast reconstruction may be affected by the need for radiation therapy (RT). Delayed-immediate autologous reconstruction (DIAR) is a novel surgical approach for patients in whom the need for adjuvant RT after mastectomy is preoperatively unknown.

Complications After Two-Stage Expander Implant Breast Reconstruction Requiring Reoperation: A Critical Analysis of Outcomes.

Background: Two-stage expander implant breast reconstruction is commonly performed after mastectomy. Salvage and long-term outcomes after development of complications have not been well described. We examined a single surgeon's experience to study the rate of reoperation secondary to complications after first-stage expander placement and to evaluate their outcomes.

Mastectomy Skin Necrosis After Breast Reconstruction: A Comparative Analysis Between Autologous Reconstruction and Implant-Based Reconstruction.

Background: Mastectomy skin necrosis is a significant problem after breast reconstruction. We sought to perform a comparative analysis on this complication between patients undergoing autologous breast reconstruction and patients undergoing 2-stage expander implant breast reconstruction.

Methods: A retrospective review was performed on consecutive patients undergoing autologous breast reconstruction or 2-stage expander implant breast reconstruction by the senior author from 2006 through 2015.

Critical Evaluation of Risk Factors of Infection Following 2-Stage Implant-Based Breast Reconstruction.

Unlabelled: Infection is a dreaded complication following 2-stage implant-based breast reconstruction that can prolong the reconstructive process and lead to loss of implant. This study aimed to characterize outcomes of reconstructions complicated by infection, identify patient and surgical factors associated with infection, and use these to develop an infection management algorithm.

Methods: We performed a retrospective review of all consecutive implant-based breast reconstructions performed by the senior author (2006-2015) and collected data regarding patient demographics, medical history, operative variables, presence of other complications (necrosis, seroma, hematoma), and infection characteristics.

Management of Mastectomy Skin Necrosis in Implant Based Breast Reconstruction.

Background: Mastectomy skin necrosis is a significant problem after breast reconstruction. This complication may lead to poor wound healing and need for implant removal, which may delay subsequent oncologic treatment. We sought to characterize factors associated with mastectomy skin necrosis and propose a management algorithm.

The unusual presentation of a burn from methyl bromide exposure: A case report and review of the literature.

Methyl bromide chemical burns are rare. Only two cases have been reported to date. The presentation of methyl bromide chemical burns is unusual.

Propylene Glycol Poisoning From Excess Whiskey Ingestion: A Case of High Osmolal Gap Metabolic Acidosis.

In this report, we describe a case of high anion gap metabolic acidosis with a significant osmolal gap attributed to the ingestion of liquor containing propylene glycol. Recently, several reports have characterized severe lactic acidosis occurring in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam. To date, no studies have explored potential effects of excess propylene glycol in the setting of alcohol intoxication.

Predictors of recurrence in patients diagnosed with ductal carcinoma in situ.

Although patients diagnosed with ductal carcinoma In Situ (DCIS) enjoy a favorable prognosis, recurrence after definitive management does occur in a subset of these patients. Factors influencing the development of recurrence remain poorly understood. A retrospective chart review of 205 consecutive patients who presented to an academic breast center with DCIS from 2000 to 2003 was conducted under an Institutional Review Board-approved protocol.

Use of imiquimod for residual acral melanoma.

Recent reports suggest that topical imiquimod cream is an effective treatment option for certain types of melanomas. No reports exist on the efficacy of using imiquimod cream to treat melanoma located on the plantar surface of the foot. We present two patients with a melanoma of the foot who had residual melanoma following surgical excision with acceptable margins.

Niche reconstructive techniques for complex abdominal wall reconstruction: a review.

Abdominal wall defects resulting from recurrent hernias, trauma, and radiation necrosis are difficult and challenging to repair given the high rates of recurrence and surgical morbidity. Complex abdominal wall defects often require the transposition of autologous material to bridge the fascial gap. We present a review of niche reconstructive techniques that have been used in complex abdominal wall repair.

Hueston revisited: use of acellular dermal matrix following fasciectomy for the treatment of Dupuytren's disease.

Various surgical treatment modalities have been advocated for the treatment of Dupuytren's disease. However, recurrence following surgical treatment of Dupuytren's disease remains a common problem. Previous studies have demonstrated lower recurrence rates with use of a full-thickness skin graft.

Leptin signaling and hyperparathyroidism: clinical and genetic associations.

Background: The role of leptin in mediating calcium-related metabolic processes is not well understood.

Study Design: We enrolled patients with hyperparathyroidism undergoing parathyroidectomy in a prospective study to assess postoperative changes to serum leptin and parathyroid hormone levels and to determine the presence of LEPR (leptin receptor) polymorphisms. Patients undergoing hemithyroidectomy under identical surgical conditions were enrolled as controls.