Reconstruction after Mohs Surgery for Digit Melanoma: Description of Techniques and Postoperative Limb Function.

Introduction: Mohs surgery and reconstruction has enabled tissue-preserving resection of cutaneous malignancies. The goal of our case series evaluation is to present reconstructive techniques and functional outcomes in patients undergoing digit-sparing treatment for primary melanoma.

Materials And Methods: A chart review was performed to identify consecutive patients undergoing Mohs surgery and reconstruction for melanoma of the digits.

Subungual Schwannoma, a Rare Entity: A Case Report and Literature Review.

We present a case of a 26-year-old right hand dominant male landscaper with a slow growing right ring finger subungual mass. MRI confirmed a 0.9 × 1.

The Effects of Adjunctive Pain Medications on Postoperative Inpatient Opioid Use in Abdominally Based Microsurgical Breast Reconstruction.

Background: The purposes of this study were to quantify the amount of opioid medication used postoperatively in the hospital setting after abdominally based microsurgical breast reconstruction, to determine factors that are associated with increased opioid use, and to identify other adjunctive medications that may contribute to decreased opioid use.

Methods: An electronic medical record data pull was performed at the University of Pennsylvania from November 2016 to October 2018. Cases were identified using Current Procedural Terminology code 19364.

Strabismus in Unicoronal Craniosynostosis: Effect of Orbital Dysmorphology and Fronto-Orbital Advancement and Remodeling.

Background: The purpose of this study was to determine what craniometric changes occur to both orbits of unicoronal craniosynostosis patients undergoing fronto-orbital advancement and remodeling, and which of these changes are associated with new onset of postoperative strabismus.

Methods: A retrospective analysis was performed of the preoperative and postoperative orbits of 24 unicoronal craniosynostosis patients and the orbits of 24 control subjects, totaling 144 orbits. Eight parameters were evaluated using multivariate logistic regression analysis.

Flap Reconstruction of the Hand.

Learning Objectives: After studying this article, the participant should: 1. Be familiar with local, regional, and free flaps for reconstruction of the hand. 2.

International Adoptees With Cleft Lip and/or Palate: Lessons Learned From a Growing Population.

Background: International adoptees with cleft lip and palate (CLP) are a growing population in the United States. They represent a clinical challenge, presenting at various ages and stages of cleft repair.

Methods: A retrospective review of patients seen at the CLP Program at the Children's Hospital of Philadelphia (CHOP) between 1998 and 2012 with a history of international adoption was performed.

Mortality after inpatient open ventral hernia repair: developing a risk stratification tool based on 55,760 operations.

Background: The medical complexity of hernia patients imparts higher risk for complications, and mortality is a distinct reality. No study has stratified patients based on preoperative risk for open ventral hernia repair (VHR) specifically. We utilized the American College of Surgeons National Surgical Quality Improvement Program to create a mortality risk stratification model following VHR.

A Cost-Utility Assessment of Mesh Selection in Clean-Contaminated Ventral Hernia Repair.

Background: Mesh reinforcement can reduce hernia recurrence, but mesh selection is poorly understood, particularly in contaminated defects. Acellular dermal matrix has enabled single-stage ventral hernia repair in clean-contaminated wounds but can be associated with higher complications and cost compared with synthetic mesh. This study evaluated the cost-utility of synthetic mesh and acellular dermal matrix for clean-contaminated ventral hernia repairs.

An analysis of early oncologic head and neck free flap reoperations from the 2005-2012 ACS-NSQIP dataset.

Background: There are limited population-based studies that examine perioperative factors that influence postoperative surgical take-backs to the OR following free flap (FF) reconstruction for head/neck cancer extirpation. The purpose of this study was to critically analyse head/neck free flaps (HNFF) captured in the ACS-NSQIP dataset with a specific focus on postoperative complications and the incidence of factors associated with re-operation.

Methods: The 2005-2012 ACS-NSQIP datasets were accessed to identify patients undergoing FF reconstruction after a diagnosis of head/neck cancer.

Racial and age disparities persist in immediate breast reconstruction: an updated analysis of 48,564 patients from the 2005 to 2011 American College of Surgeons National Surgery Quality Improvement Program data sets.

Background: Immediate breast reconstruction (IBR) rates continue to rise, yet recent patterns based on race, age, and patient comorbidities have not been adequately assessed.

Methods: Women undergoing mastectomy only or mastectomy with IBR from 2005 to 2011 were identified in the American College of Surgeons-National Surgical Quality Improvement (NSQIP) data sets. A multivariate logistic regression was performed to determine factors independently associated with receipt of IBR.

Striving for Normalcy after Lower Extremity Reconstruction with Free Tissue: The Role of Secondary Esthetic Refinements.

Background: Many patients with successful lower extremity salvage have postoperative functional and esthetic concerns. Such concerns range from contour irregularity preventing proper shoe-fitting to esthetic concerns involving color, contour, and texture match. The purpose of this study is to determine the overall incidence as well as factors associated with an increased likelihood of undergoing secondary, esthetic refinements of lower extremity free flaps and to review current revision techniques.

Cost-utility analysis of the use of prophylactic mesh augmentation compared with primary fascial suture repair in patients at high risk for incisional hernia.

Background: Although hernia repair with mesh can be successful, prophylactic mesh augmentation (PMA) represents a potentially useful preventative technique to mitigate incisional hernia risk in select high-risk patients. The efficacy, cost-benefit, and societal value of such an intervention are not known. The aim of this study was to determine the cost-utility of using prophylactic mesh to augment fascial incisions.

An Assessment of 30-Day Complications in Primary Cleft Palate Repair: A Review of the 2012 ACS NSQIP Pediatric.

Objective: This study uses the American College of Surgeons Pediatric National Surgical Quality Improvement Program (ACS NSQIP Pediatric), a multicenter database, to identify risk factors for complications after cleft palate repair.

Design: Patients undergoing Current Procedural Terminology (CPT) codes 42200 and 42205 were extracted from the 2012 ACS NSQIP Pediatric. Patients older than 36 months or those who had undergone an additional surgery that altered the risk were excluded.

Venous thromboembolism in body contouring: an analysis of 17,774 patients from the National Surgical Quality Improvement databases.

Background: The purpose of this study was to examine the incidence and predictors of venous thromboembolism following body contouring.

Methods: The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2012 for all body contouring cases. A multivariate logistic regression was performed to determine predictors of venous thromboembolism, and used to define risk scores for each significant predictor.

Surgical Site Infections after Free Flap Breast Reconstruction: An Analysis of 2,899 Patients from the ACS-NSQIP Datasets.

Background: Surgical site infections (SSIs) are a costly complication, resulting in lower patient satisfaction and higher health care expenditures. Incidence varies widely in the literature by surgery type, yet few studies focus exclusively on autologous breast reconstruction, an increasingly common surgery. The aim of this study is to identify risk factors for SSIs in free flap breast reconstruction using the National Surgical Quality Improvement Program Database (NSQIP).

Volumetric changes in cranial vault expansion: comparison of fronto-orbital advancement and posterior cranial vault distraction osteogenesis.

Background: Posterior cranial vault distraction osteogenesis has recently been introduced to treat patients with multisuture syndromic craniosynostosis and is believed to provide greater gains in intracranial volume. This study provides volumetric analysis to determine the gains in intracranial volume produced by this modality.

Methods: This was a two-center retrospective study of preprocedure and postprocedure computed tomography scans of two groups of 15 patients each with syndromic multisuture craniosynostosis treated with either fronto-orbital advancement or posterior cranial vault distraction osteogenesis.

An Assessment of 30-Day Complications in Primary Cleft Lip Repair: A Review of the 2012 ACS NSQIP Pediatric.

Objective: The aim of this study is to identify risk factors associated with complications and readmissions following cleft lip repair using the multicenter American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric.

Design: Patients undergoing CPT codes 40700, 40701, and 40702 were extracted from the ACS NSQIP Pediatric. Fisher exact, χ(2), and rank-sum tests were used to evaluate risk factors.

Analysis of risk factors associated with 30-day readmissions following pediatric plastic surgery: a review of 5376 procedures.

Background: Unplanned surgical readmissions represent a benchmark outcome and pose a considerable cost burden for health care systems. The authors evaluated risk factors associated with readmission following pediatric plastic surgery using a prospective, validated, national database.

Methods: Patients younger than 18 years who underwent primary pediatric plastic surgery procedures were identified from the 2013 pediatric American College of Surgeons National Surgical Quality Improvement Program database.

Earlier evidence of spheno-occipital synchondrosis fusion correlates with severity of midface hypoplasia in patients with syndromic craniosynostosis.

Background: The spheno-occipital synchondrosis is an important driver of facial and cranial base growth. The current study characterizes its fusion in patients with Apert, Crouzon, and Pfeiffer syndromes and correlates early fusion with the presence, and degree, of midface hypoplasia.

Methods: A retrospective case-control study was performed of all syndromic patients treated between 1996 and 2012.

Treatment of large calvarial defects with bone transport osteogenesis: a preclinical sheep model.

Background: Bone transport osteogenesis (BTO), distraction of a free portion of bone across a defect, offers an autologous solution to large cranial defects that may allow treatment without permanent hardware implantation. This study establishes a sheep model to evaluate the feasibility and distraction kinetics of BTO.

Methods: Subtotal cranial defects (3.

Optimizing patient selection in ventral hernia repair with concurrent panniculectomy: an analysis of 1974 patients from the ACS-NSQIP datasets.

Background: Panniculectomy (PAN) during ventral hernia repair (VHR) can be a challenging procedure associated with added risk. We utilized the ACS-NSQIP datasets to generate a risk model of morbidity following these combined interventions.

Methods: The 2005-2012 ACS-NSQIP databases were queried to identify all patients undergoing VHR-PAN.

Analysis of perioperative factors associated with increased cost following abdominal wall reconstruction (AWR).

Background: Ventral hernias are a common, challenging, and expensive problem for both the general and reconstructive surgeons; therefore, the aim of this study is to critically assess perioperative factors related to cost in abdominal wall reconstructions (AWR).

Methods: A retrospective review of AWR patients from 2007 and 2012 was performed. Analysis of perioperative factors associated with total cost of reconstruction was performed.

Predictive risk model of 30-day mortality in plastic and reconstructive surgery patients.

Background: Death following surgical procedures, although uncommon, represents the most significant and costly postoperative complication. The authors delineate several key independently associated risk factors for 30-day mortality in a large nationwide plastic surgery population and generate a simple risk-assessment tool.

Methods: Patients who underwent a primary plastic surgery procedure (n=24,778) were identified from the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program databases.