Nerve Allografts: Current Utility and Future Directions.

Processed nerve allograft is a widely accepted tool for reconstructing peripheral nerve defects. Repair parameters that need to be considered include gap length, nerve diameter, nerve type (motor, sensory, or mixed), and the soft tissue envelope. Although the use of processed nerve allograft must be considered based on each unique clinical scenario, a rough algorithm can be formed based on the available animal and clinical literature.

Quality Improvement: A Primer for Plastic Surgeons.

It is the duty of all health care workers to improve the quality of care and patient outcomes. Quality improvement is a component of health policy required by residency accrediting bodies and is a mandatory component of postgraduate medical education. It is imperative for plastic surgeons to develop skills in quality improvement to ensure that they can cope with increased patient volumes while ensuring that their patients have access to care that is safe, equitable, effective, efficient, timely, and patient-centered.

Operative Trends in Orthopaedic Hand Surgery Fellowships.

 Since 1958, more than 50 postresidency fellowship programs in hand surgery have been introduced within the United States. Ongoing changes in health care and medical education necessitate the evaluation of these fellowships. The purpose of this study is to identify trends in operative experience over time regarding procedure volume, surgery type, and anatomic region.

Initial Treatment Choice Affects Cost-Effectiveness and Reintervention Rates for Dupuytren Contracture: A National Census Among Veterans Affairs Patients.

Background: A multitude of treatments for Dupuytren contracture are available, including both invasive and minimally invasive options. This study compares the reintervention rates and costs associated with various treatment options for Dupuytren disease (DD) within the Veterans Affairs (VA) Health Administration.

Methods: Using the Corporate Data Warehouse, a national census was performed including all patients treated for DD in years 2014 to 2020 within the VA health care system.

Preparation for Hand Surgery Fellowship: A Comparison of Resident Training Pathways.

Background: Hand surgery is a unique subspecialty in which one can train after completion of either a plastic, orthopedic, or general surgical residency. This study compared hand surgery experience in residency among these different training pathways.

Methods: The Accreditation Council for Graduate Medical Education case logs of graduating residents in general surgery, orthopedics, and plastic surgery were evaluated for years 2009 through 2018.

Thrombolytic Salvage of the Frostbitten Upper Extremity: A Systematic Review.

Background: Vascular thrombosis secondary to frostbite can lead to ischemic tissue damage in severe cases. Threatened extremities may be salvaged with thrombolytics to restore perfusion; however, current data are limited to single institution case series. The authors performed a systematic review to determine the efficacy of thrombolytic therapy in treating upper extremity frostbite.

An Analysis of Complications and Bone Defect Length With the Use of Induced Membrane Technique in the Upper Limb: A Systematic Review.

The induced membrane technique was originally described as a technique for the reconstruction of long bone defects. The authors performed a systematic review to determine whether the use of the induced membrane technique is effective in large bony defects in the upper extremity. A qualitative systematic review was conducted using PubMed, EBSCO, and Google Scholar databases to record all studies reporting on complications of the induced membrane technique in the upper extremity.

Residency Training and Hand Surgery Practice Patterns: A National Surgical Quality Improvement Program Database Analysis.

 Fellowship-trained hand surgeons may have residency training in either orthopedic, plastic, or general surgery, generating significant variability in education background. To study the effect of different training backgrounds on practice pattern variations, we utilized the NSQIP (National Surgical Quality Improvement Database) database to assess hand surgery volumes and case variety by specialty.  NSQIP years 2008 to 2017 was queried with hand surgery current procedural terminology codes defined by the American Board of Orthopedic Surgery.

What urologists need to know about male to female genital confirmation surgery (vaginoplasty): techniques, complications and how to deal with them.

Vaginoplasty is the most commonly performed genital surgery for gender affirmation. Male-to-female (MTF) patients are roughly four times more likely to undergo genital surgery than female-to-male (FTM) patients. Penile inversion vaginoplasty is the most common technique used today, although there are also lesser used alternative methods including visceral interposition and pelvic peritoneal vaginoplasty.

Thrombolytic Salvage of Threatened Frostbitten Extremities and Digits: A Systematic Review.

Frostbite is a cold injury that results in soft tissue loss and can lead to amputation. Vascular thrombosis following injury causes ischemic tissue damage. Despite understanding the pathology, its treatment has remained largely unchanged for over 30 years.

Head and Neck Reconstruction: Does Surgical Specialty Affect Complication Rates?

Background:  Reconstruction of head and neck defects resulting from resection of head and neck masses is performed by both plastic surgeons and otolaryngologists. The American College of Surgeons National Surgical Quality Improvement (NSQIP) database allows one to directly compare the outcomes for a given procedure based upon specialty. The purpose of this study is to compare outcomes and resource utilization of microvascular head and neck reconstruction between plastic surgery and otolaryngology.

Depression is associated with worse outcomes among women undergoing breast reconstruction following mastectomy.

Background: The causes of depression after breast reconstruction include worse outcomes, longer recovery times, and, sometimes, additional operations. Despite a plethora of data examining the effect of depression after breast reconstruction, there is little information to assess if concurrent depression affects patient outcomes in a similar manner. Thus, we sought to answer this question: Do depressed women undergoing breast reconstruction have worse outcomes?

Methods: The United States National Inpatient Sample was queried during 2010-2013 for all patients undergoing breast reconstruction after mastectomy.

Examining the Role of Antimicrobial Irrigation and Capsular Contracture: A Systematic Review and Meta-analysis.

Purpose: The purpose of this study was to conduct a meta-analysis to determine if irrigation of breast implant pockets with antibiotics reduces the rate of capsular contracture (CC). Capsular contracture is the most common complication after primary augmentation mammoplasty, yet its etiology remains cryptogenic.

Methods: PubMed was searched for publications from January 1 of 2000 through October of 2015.

Left-Sided Breast Irradiation does not Result in Increased Long-Term Cardiac-Related Mortality Among Women Treated with Breast-Conserving Surgery.

Background: Standard therapy following lumpectomy for breast cancer has included adjuvant whole-breast radiotherapy. Recent, long-term studies have suggested a possible association between left-sided whole breast radiotherapy and long-term cardiac-related mortality. We sought to determine whether left-sided breast cancers treated with breast-conserving treatment have worse cardiac-related outcomes.

Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets: A Placebo-controlled Single Practice Cohort Study.

Background: Capsular contracture is the most common complication following primary augmentation mammoplasty. It remains poorly understood but is attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The infectious theory of contracture has lead to the practice of irrigating implant pockets with a triple antibiotic solution.

Evaluation of Antibiotic Irrigation Versus Saline Irrigation in Reducing the Long-Term Incidence and Severity of Capsular Contraction After Primary Augmentation Mammoplasty.

Background: Capsular contracture is the most frequent complication after primary augmentation mammoplasty. The practice of irrigating implant pockets with a triple antibiotic solution has been widely adopted in an attempt to prevent capsular contracture, despite a limited understanding of the inciting pathophysiology. Capsular contracture is commonly attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants.

Learning the oral and cutaneous signs of micronutrient deficiencies.

Wound healing is a complex process that is influenced by multiple systemic factors, including nutritional status. While nutritional support is commonly recognized as an important aspect of comprehensive wound management, the focus is typically on replacement of macronutrients, specifically calories and protein. Our experience strongly suggests that micronutrients are equally important, that micronutrient deficiencies are common, and that correction of these deficiencies frequently leads to wound healing when incorporated into a comprehensive wound management program.