Preoperative Vascular Imaging in Lower Extremity Free Flap Reconstruction: Comparison Between Imaging Modalities.

Background: Adequate vascular anatomy and perfusion status are essential for successful lower extremity free tissue transfer. Computed tomography angiography (CTA) is widely available, minimally invasive, and enables visualization of soft tissues and bones. Angiography permits temporal evaluation of flow, identifies potential needs for concurrent endovascular interventions, and enhances visibility in the setting of hardware.

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries.

Background: Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries.

Methods: The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022.

Dual-port and single-port tissue expanders in postmastectomy breast reconstruction: A retrospective cohort study.

Background: Novel dual-port tissue expanders allow easy access to the periprosthetic space for seroma drainage and potentially reduce risk of infection or reconstruction failure. We analyzed outcomes after first-stage alloplastic breast reconstruction in patients receiving dual-port tissue expanders in comparison to those of patients receiving traditional, single-port devices.

Methods: We retrospectively reviewed patients who underwent tissue expander placement from 2020 to 2021.

Point-of-Care Tissue Oxygenation Assessment with SnapshotNIR for Alloplastic and Autologous Breast Reconstruction.

Unlabelled: In breast reconstruction, mastectomy and free flaps are susceptible to vascular compromise and tissue necrosis. The SnapshotNIR device (Kent Imaging, Calgary, AB, Canada) utilizes near-infrared spectroscopy to measure tissue oxygen saturation (StO) and hemoglobin concentration. Here, we report on the use of this device for StO monitoring among patients receiving alloplastic or autologous breast reconstruction.

Association between Bioimpedance Spectroscopy and Magnetic Resonance Lymphangiography in the Diagnosis and Assessment of Lymphedema.

Background:  This study assesses associations between bioimpedance spectroscopy (BIS) and magnetic resonance lymphangiography (MRL) in the staging and assessment of lymphedema.

Methods:  Adults who received MRL and BIS between 2020 and 2022 were included. We collected fluid, fat, and lymphedema severity ratings, and measured fluid stripe thickness, subcutaneous fat width, and lymphatic diameter on MRL.

Technical Variables in Lower Extremity Free Flap Reconstruction.

Background:  Lower extremity free flap failure rates are higher than in other areas of the body. While prior studies assessed the effect of intraoperative technical variables, these generally investigated individual variables and did not examine relationships between the many individual technical decisions made during free tissue reconstruction. Our purpose was to investigate the effect of variation in intraoperative microsurgical techniques on flap outcomes in a diverse cohort of patients requiring lower extremity free flap coverage.

Secondary Surgery after Lower Extremity Free Flap Reconstruction.

Background: Microsurgical free tissue transfer may be the only reconstructive option for lower extremity limb salvage. However, the functional and aesthetic results following free tissue transfer after initial salvage may be suboptimal, thus requiring secondary operations to facilitate definitive wound healing and/or refinement.

Methods: A multi-institutional retrospective cohort study was performed including patients who underwent lower extremity free tissue transfer from January of 2002 to December of 2020.

Compound Effect of Hypoalbuminemia and Obesity on Complications after Autologous Breast Reconstruction.

Background: Obesity is among the risk factors identified that impair postoperative wound healing. Recently, malnutrition and sarcopenia have also been found to correlate with poor surgical outcomes; however, the effect of malnutrition in the setting of obesity is understudied, particularly in reconstructive surgery. The authors examine the American College of Surgeons National Surgery Quality Improvement Program database to determine the impact of obesity plus hypoalbuminemia on complications after autologous breast reconstruction.

The Association between Breast Cancer Related Lymphedema and Area Deprivation Index.

Background:  Lymphedema affects up to 34% of patients after breast cancer treatment but remains underdiagnosed and undertreated. Here, we use area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, to determine how socioeconomic status may affect risk for and diagnosis of breast cancer-related lymphedema.

Methods:  Records of patients who underwent surgical treatment of breast cancer between 2017-2020 were examined.

The impact of the COVID-19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes.

Background: Immediate alloplastic breast reconstruction shifted to the outpatient setting during the COVID-19 pandemic to conserve inpatient hospital beds while providing timely oncologic care. We examine the National Surgical Quality Improvement Program (NSQIP) database for trends in and safety of outpatient breast reconstruction during the pandemic.

Methods: NSQIP data were filtered for immediate alloplastic breast reconstructions between April and December of 2019 (before-COVID) and 2020 (during-COVID); the proportion of outpatient procedures was compared.

National Outcomes of Prophylactic Lymphovenous Bypass during Axillary Lymph Node Dissection.

Background:  Breast cancer treatment, including axillary lymph node excision, radiation, and chemotherapy, can cause upper extremity lymphedema, increasing morbidity and health care costs. Institutions increasingly perform prophylactic lymphovenous bypass (LVB) at the time of axillary lymph node dissection (ALND) to reduce the risk of lymphedema but reports of complications are lacking. We examine records from the American College of Surgeons (ACS) National Surgery Quality Improvement Program (NSQIP) database to examine the safety of these procedures.

Measurement Properties of the Lymphedema Life Impact Scale.

The updated Lymphedema Life Impact Scale (LLIS, version 2) has been widely used to evaluate the effect of lymphedema from the patient's perspective. We sought to assess its ability to accurately and efficiently measure lymphedema-related impact using modern psychometric techniques. We collected a total of 1054 patient-reported outcome measure scores from 285 patients with upper extremity lymphedema and 65 patients with lower extremity lymphedema between 2016 and 2020.

Efficient and precise Ultra-QuickDASH scale measuring lymphedema impact developed using computerized adaptive testing.

Purpose: This study aimed to evaluate and improve the accuracy and efficiency of the QuickDASH for use in assessment of limb function in patients with upper extremity lymphedema using modern psychometric techniques.

Method: We conducted confirmative factor analysis (CFA) and Mokken analysis to examine the assumption of unidimensionality for IRT model on data from 285 patients who completed the QuickDASH, and then fit the data to Samejima's graded response model (GRM) and assessed the assumption of local independence of items and calibrated the item responses for CAT simulation.

Results: Initial CFA and Mokken analyses demonstrated good scalability of items and unidimensionality.

Webinar during COVID-19 Improves Knowledge of Changes to the Plastic Surgery Residency Application Process.

Background: The COVID-19 pandemic has significantly impacted residency application process for all specialties, including plastic surgery residency. Almost all plastic surgery residency programs have suspended visiting sub-internship rotations. This study quantifies the impact of a webinar through an analysis of poll questions and a post-webinar survey sent to all registered participants.

Multidisciplinary Treatment to Restore Vision in Ocular Burns.

Periorbital burns generate contraction and distortion of periorbital soft tissue, causing eyelid malfunction, further contributing to loss of vision from corneal scarring or perforation. We present our multidisciplinary algorithm to restore vision in patients with burn-related bilateral corneal blindness with light perception. Chart review was performed for four consecutive burn patients requiring periocular reconstruction and keratoprosthesis.

Crowdsourcing Public Perceptions of Plastic Surgeons: Is There a Gender Bias?

Background: Implicit gender bias may result in lower wages for women, fewer leadership positions, and lower perceived competence. Understanding public and patient gender preferences for plastic surgeons may enable opportunities to address public perceptions. This investigation evaluates public preferences for a plastic surgeon's gender or demeanor.

Median Nerve Injury After Removal of Subdermal Implantable Contraceptive.

Subdermal implantable contraceptives are highly effective, approved in over 60 countries, and used by millions of women. Due to simple insertion and removal protocols, these procedures are often performed in the outpatient clinic setting, and procedural complications are rare. However, given the location of the implant in the medial antebrachial interval, there is a risk of neurovascular injury, especially with malpositioned or deeply placed implants.

Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction.

Breast reconstruction following mastectomy has evolved to preserve the native skin and nipple of the breast and create a natural-appearing reconstruction in 1 or 2 surgeries. Nipple-sparing procedures appear to be oncologically safe with low risks of cancer recurrence. In our series of 2,182 nipple-sparing mastectomies, there was no development or recurrence of cancer in the nipple.

Mesenchymal Stem Cells Enhance Nerve Regeneration in a Rat Sciatic Nerve Repair and Hindlimb Transplant Model.

This study investigates the efficacy of local and intravenous mesenchymal stem cell (MSC) administration to augment neuroregeneration in both a sciatic nerve cut-and-repair and rat hindlimb transplant model. Bone marrow-derived MSCs were harvested and purified from Brown-Norway (BN) rats. Sciatic nerve transections and repairs were performed in three groups of Lewis (LEW) rats: negative controls (n = 4), local MSCs (epineural) injection (n = 4), and systemic MSCs (intravenous) injection (n = 4).

Optimizing Reconstruction with Periorbital Transplantation: Clinical Indications and Anatomic Considerations.

Unlabelled: Complex periorbital subunit reconstruction is challenging because the goals of effective reconstruction vary from one individual to another. The purpose of this article is to explore the indications and anatomic feasibility of periorbital transplantation by reviewing our institutional repository of facial injury.

Methods: Institutional review board approval was obtained at the R Adams Cowley Shock Trauma Center for a retrospective chart review conducted on patients with periorbital defects.