National patterns in flap reconstruction for sternal wound infections following coronary artery bypass grafting.

Background: Sternal wound infection (SWI) is a serious and life-threatening complication of open cardiac surgery. Debridement and flap reconstruction has become standard of care, but data on national practice patterns are limited.

Methods: We queried the National Inpatient Sample from 2016-2018 for patients with SWI who underwent coronary artery bypass grafting (CABG).

Disparities in pathways to reduction mammaplasty: A single institution review of 425 women with macromastia.

Background: Reduction mammaplasty improves the quality of life by providing functional and aesthetic benefits to women with macromastia. This study contributes to the existing literature on socioeconomic and clinical barriers to referral for plastic surgery procedures by focusing specifically on reduction mammaplasty.

Methods: Patients with macromastia were identified via a chart review in a single institution from 2021-2022.

Predictors of extended length of stay following outpatient reduction mammaplasty.

Purpose: Reduction mammaplasty has transitioned into a largely outpatient procedure in the United States. Following planned outpatient procedures, patients may still be admitted for additional inpatient care, incurring clinical and economic burden. Prior literature has not explored the preoperative and perioperative determinants of extended lengths of stay (LOS) after breast reduction surgery.

Use of Absorbable Dermal Staples in Bilateral Breast Reduction Surgery: Effects on Operative Times, Surgical Outcomes, and Procedure Charges.

Background: Use of the absorbable deep dermal stapler in wound closure has become more common in plastic surgery because of its possible reduction in operative times and subsequent decrease in operative room costs. In this study, we examine the effects of this stapler on operative times and postoperative complications in bilateral reduction mammaplasties.

Methods: A retrospective, observational cohort study was conducted via electronic chart review on patients who underwent bilateral reduction mammaplasties.

Impact of Sociodemographic and Hospital Factors on Inpatient Bilateral Reduction Mammaplasty: A National Inpatient Sample Analysis.

Background: Although reduction mammaplasty remains a common procedure in plastic surgery, its interaction with sociodemographic and economic disparities has remained relatively uncharacterized on a nationwide scale.

Methods: Patients who underwent reduction mammaplasty were identified within the 2016-2018 National Inpatient Sample databases. In addition to clinical comorbidities, sociodemographic characteristics, hospital-level variables, and postoperative outcomes of each patient were collected for analysis.

Flap management following orthotopic heart transplantation: A single institution's review of 66 sternal wound complications.

Background: Sternotomy wound complications are more frequent after orthotopic heart transplantation (OHT) compared to other cardiac surgeries, primarily due to additional risk factors, including immunosuppression. Flap closure often becomes necessary for definitive treatment, although there is a scarcity of data on the outcomes of sternal wound reconstruction in this specific population.

Methods: A retrospective analysis was conducted on 604 sternal wound reconstructions performed by a single surgeon between 1996 and 2023.

Contralateral prophylactic mastectomy: Weighing the risks of delayed chemotherapy, radiotherapy, and hormonal therapy.

Background: Many patients with unilateral breast cancer opt for contralateral prophylactic mastectomy (CPM) at the time of therapeutic mastectomy (immediate CPM) or following completion of adjuvant therapy. Studies show that immediate CPM increases the risk of surgical complications related to unilateral mastectomy (UM) alone, which may lead to delays in adjuvant therapy initiation. However, it is unclear if these complications cause clinically significant delays in initiating adjuvant chemotherapy, radiotherapy, or hormonal therapy.

The impact of a shadowing program on medical students' interest in plastic surgery.

Given the lack of formal education on plastic surgery services during the preclinical years of medical school, many medical students commonly misunderstand the breadth and depth of the field. Shadowing is highly impactful in shaping students' desire to pursue surgery, but the impact of plastic surgery shadowing remains unexplored. The study design utilized an anonymous web-based survey containing questions surrounding prior interest in surgery, race, gender, medical school progress, and clinical versus OR shadowing.

A Review of 559 Sternal Wound Reconstructions at a Single Institution: Indications and Outcomes for Combining an Omental Flap With Bilateral Pectoralis Major Flaps in a Subset of 17 Patients With Infections Extending Into the Deep Mediastinum.

Background: Sternal wound infection (SWI) and dehiscence after median sternotomy for cardiac surgery remain challenging clinical problems with high morbidity. Bilateral pectoralis major myocutaneous flaps are excellent for most sternal wounds but do not reach deeper mediastinal recesses. The omental flap may be a useful adjunct for addressing these deeper mediastinal infections.

Lymphatic Microsurgical Preventive Healing Approach for the Primary Prevention of Lymphedema: A 4-Year Follow-Up.

Background: Axillary lymph node dissection (ALND) remains the leading cause of lymphedema nationally, and there is still no cure for the disease. The lymphatic microsurgical preventive healing approach (LYMPHA) is a promising option for lymphedema prophylaxis in patients undergoing ALND, but long-term outcomes of the LYMPHA are not well established.

Methods: The authors conducted a retrospective review of patients undergoing ALND at their center from November of 2012 to November of 2016 and assembled two cohorts, those who received the LYMPHA and those who did not (non-LYMPHA).

An Analysis of 400 Sternal Wound Reconstructions at a Single Institution: Bacterial Pathogens Vary With Time.

Background: Sternal wound (SW) infection and dehiscence after median sternotomy from cardiac surgery remain challenging complications with high morbidity. Knowledge of common pathogen types and variance with time from cardiac surgery can simplify the choice of antibiotics while awaiting definitive culture results.

Methods: Records of 505 patients undergoing SW reconstruction by the senior author from 1996 to 2018 at a high-volume cardiac surgery center were reviewed.

What Are the Risk Factors for Epilepsy Among Patients With Craniosynostosis?

Purpose: The purpose of this study was to determine the risk factors for epilepsy among patients with craniosynostosis.

Methods: This is a retrospective cohort study that was completed with the Kids' Inpatient Database. All patients diagnosed with craniosynostosis between the years 2000 and 2012 were included.

Dislodgement of tissue expander ports in a patient without trauma or MRI history.

Tissue expansion is involved in the majority of breast reconstruction procedures in the United States. We describe a case of a 56-year-old woman who was found to have bilateral dislodged magnetic ports in her breast tissue expanders at her surgery to replace the expanders with permanent implants. An awareness that this can occur would be helpful for all plastic surgeons who perform breast reconstruction.

Open Repair Versus Closed Repair: A Cost-Analysis of the Two Surgical Approaches for the Treatment of Craniosynostoses.

Purpose: The purpose of this study was to quantify the hospitalization charges of the 2 general surgical approaches in the treatment of craniosynostosis and determine if there was a significant difference between the 2. Several studies compared them side-by-side according to specific variables, such as success rates, postoperative complications, blood loss, and length of stay, but were limited by small sample sizes.

Methods: This is a retrospective cohort study that was conducted using the Kids' Inpatient Database (KID).

An Outcomes Review of 330 Sternal Wound Reconstructions: Timing of Closure Does Make a Difference.

Background: Sternal wound infection and dehiscence following cardiac surgery remain difficult clinical problems with high morbidity. Older classification systems regarding timing to reconstruction do not take into account recent improvements in critical care, wound vacuum-assisted closure use, or next-generation antibiotic therapies, which may prolong time to reconstruction.

Methods: Records of patients undergoing sternal wound reconstruction performed by the senior author (J.

Is It Worth the Risk? Contralateral Prophylactic Mastectomy With Immediate Bilateral Breast Reconstruction.

Background: An increasing number of women are choosing to undergo contralateral prophylactic mastectomy with immediate bilateral breast reconstruction. Operating on the contralateral noncancer side is not without its own set of risks. We sought to compare complication rates between the cancerous and contralateral prophylactic breasts.

Primary Cleft Rhinoplasty: Long-Term Outcomes of a Single Technique Used Over 2 Decades.

Background: Primary cleft rhinoplasty has become widely accepted owing to evidence of improved outcomes and need for fewer revisions. Several techniques have been described, but few surgeons have reported long-term outcomes of repairs performed via a single method. The present study examines long-term outcomes of a single surgeon's experience over 22 years using the same primary cleft rhinoplasty technique.

Extraocular sebaceous carcinoma as a rapidly growing back mass: a case report.

Sebaceous carcinoma is a rare cutaneous malignancy that frequently mimics other dermatologic conditions. Extraocular subtypes are uncommon, but when present are frequently located in the head and neck region. Herein, we present a patient with a rapidly growing upper back mass eventually diagnosed as sebaceous carcinoma and managed with wide surgical excision.

Resolution of Systemic Rheumatologic Symptoms following Breast Implant Removal.

Reports of women with breast implants who suffer a wide variety of systemic symptoms have become more and more prevalent over the past several years. This entity has become known as breast implant illness in conventional news and social media outlets but has vague and nonspecific diagnostic criteria. As a result, the phenomenon is difficult to both identify and treat.

Creation of a Rat Lower Limb Lymphedema Model.

Background: Lymphedema is a frequent complication after surgical treatments of cancer involving lymph node resection. However, research of lymphedema treatments, such as vascularized lymph node transfer, is limited by the absence of an adequate lymphedema animal model. The purpose of this study was to determine if we could create sustainable lower limb lymphedema in the rat with a combination of inguinal lymphadenectomy, circumferential skin and subcutaneous tissue excision, and radiotherapy.

The effect of operative time on complication profile and length of hospital stay in autologous and implant-based breast reconstruction patients: An analysis of the 2007-2012 ACS-NSQIP database.

Background: It is a generally accepted relationship that an increase in operative time results in an increase in postoperative morbidity. However, few studies have investigated the minute by minute effect of increased operation time on outcomes in reconstructive breast surgery. The authors examined the association between operation time and postoperative outcomes for autologous and implant-based breast reconstructions.

Sternal Wound Reconstruction Made Simple.

Sternal wounds and associated infections represent a complex reconstructive problem in a highly morbid patient population. Through strict adherence to excellent plastic surgical principles, this process can be simplified, allowing safe and effective wound closure. Emphasis is placed on thorough debridement, hardware removal, obtaining adequate tissue cultures, and finally, appropriate flap closure.