The University of Pennsylvania Flap Course Enters Virtual Reality: The Global Impact.

Unlabelled: The purpose of this study was to evaluate participants from the in-person Penn Flap Course (PFC) and virtual PFC to determine if the virtual PFC increased diversity in culture, sex, education, and surgical specialties internationally and within the United States. Our hypothesis is that the virtual PFC increases diversity internationally and within the United States.

Methods: A retrospective descriptive comparison was performed between participants from the in-person PFC from the years 2017 to 2019 and virtual PFC in 2020.

A Tale of Two Sisters: Breast Reconstruction Options for Women With or at High Risk of Breast Cancer.

Breast reconstructive surgery has changed significantly over the past decade. The incidence of nipple-sparing procedures and prophylactic mastectomy has also increased significantly as women and their surgeons use shared decision-making strategies. The following case history of two sisters, one with breast cancer and one at elevated risk for breast cancer, highlights the current standard of care with newer gold-standard procedures for mastectomy and subsequent reconstruction.

The Role of Cadaver-Based Flap Course in Microsurgical Education and Practice Patterns of Attendees: A Survey Study.

Background:  In 2017, our institution initiated a cadaver laboratory-based course dedicated to teaching reconstructive microsurgery indications, preoperative planning, and flap dissection. The goals of this study are to describe the demographics and experience of participants/instructors and to evaluate the learning objectives and effectiveness of the course.

Methods:  Penn Flap Course (PFC) participants were sent an anonymous survey at the inaugural PFC 2017.

Does Realism Matter? A Randomized Controlled Trial Comparing Models for Medical Student Suture Education.

Background: We hypothesized that medical students trained in suturing using high-fidelity models (cadaveric tissue) would demonstrate greater proficiency when compared with those trained using low-fidelity models (synthetic tissue).

Methods: Forty-three medical students were randomized into 2 groups. Group 1 consisted of students taught to perform simple interrupted sutures using synthetic tissue, and group 2 consisted of those taught using human cadaveric tissue.

The Use of Emotional Artificial Intelligence in Plastic Surgery.

Background: The use of social media to discuss topics related to and within plastic surgery has become widespread in recent years; however, it remains unclear how to use this abundance of largely untapped data to propagate educational research in the field of plastic surgery. In this prospective, observational study, the authors aimed to delineate which plastic surgery-related topics evoked a significant emotional response within the study population and to assess the utility of motivational artificial intelligence within the field of plastic surgery.

Methods: Over a 4-month period (January to April of 2018), Cognovi Lab's artificial intelligence technology was used to search and analyze emotional reactions to several commonly hashtagged words.

The Utility of a Master of Business Administration Degree in Plastic Surgery: Determining Motivations and Outcomes of a Formal Business Education Among Plastic Surgeons.

Background: With the increasing complexity of health care, the knowledge of business in medicine is growing more valuable. Plastic surgeons in all practice settings are constantly forced to navigate endeavors that could be better faced with the leadership, management, and administrative skills honed through a formal business education. The purpose of this study was to gather data and draw conclusions related to the motivations and outcomes of plastic surgeons with a Master of Business Administration degree (MBA).

Evaluation of skin viability in nipple sparing mastectomy (NSM).

Nipple sparing mastectomy (NSM) is quickly becoming the standard of care due to earlier stage of breast cancer diagnosis, increased prevalence of prophylactic mastectomies, improved surgical techniques, and the desire of women to keep their nipples. However, the procedure is plagued with problems of nipple and skin necrosis due to the inherent ischemic nature of mastectomy. Indocyanine green (ICG) technologies offer surgeons new information that is helpful in the battle to reduce these devastating complications.

Indications and Controversies for Implant-Based Breast Reconstruction Utilizing Biological Meshes.

The advent of acellular dermal matrices (ADMs) has changed the way implant reconstruction is performed and has opened the door to muscle-sparing techniques that can be performed as an NSM (nipple-sparing mastectomy) with DTI (direct to implant) with excellent cosmesis and less patient morbidity. The article discusses differences in types of ADMs and outlines some current strategies and controversies with ADM use.

Optimizing Outcomes of Postmastectomy Breast Reconstruction With Acellular Dermal Matrix: A Review of Recent Clinical Data.

This article reports on the current use of acellular dermal matrix in breast reconstruction. A literature review of articles on acellular dermal matrix in breast reconstruction from January 1, 2010, through December 20, 2016, was performed and analyzed for trends in acellular dermal matrix use and differences between commonly used acellular dermal matrixes. Clinical findings varied but include improved cosmesis and more 1-stage reconstructions using acellular dermal matrix.

A Direct Comparison of Alloderm-Ready to Use (RTU) and DermACELL in Immediate Breast Implant Reconstruction.

The objective of this study was to compare the 2 leading human acellular dermal matrices in breast reconstruction with implants. This retrospective study draws on the experience of 2 expert surgeons with a history of long-standing use of the Alloderm-RTU (LifeCell Corporation, Branchburg, NJ) product who switched to the DermACELL acellular dermal matrix (LifeNet Health, Virgina Beach, Va) product. The consecutive nature of these data over this change allowed comparison between the 2 products without the confounding effects of patient selection or change in technique.

The Role of Intraoperative Perfusion Assessment: What Is the Current State and How Can I Use It in My Practice?

Evolving intraoperative technology has an increased presence and usefulness in aiding surgeon clinical judgment. Many surgical devices are readily available as an adjunct to this gold standard assessment of adequate tissue perfusion. Intraoperative perfusion monitoring provides surgeons with the ability to interpret additional information that enhances surgical decision-making in real-time.

Successful Translation of Fluorescence Navigation During Oncologic Surgery: A Consensus Report.

Navigation with fluorescence guidance has emerged in the last decade as a promising strategy to improve the efficacy of oncologic surgery. To achieve routine clinical use, the onus is on the surgical community to objectively assess the value of this technique. This assessment may facilitate both Food and Drug Administration approval of new optical imaging agents and reimbursement for the imaging procedures.

A new option with the pedicle thoracoacromial artery perforator flap for hypopharyngeal reconstructions.

Objectives/hypothesis: The reconstruction of hypopharyngeal defects should focus on minimizing morbidity in a high-risk population while achieving adequate functional results with regard to the restoration of speech, swallowing, and airway control. We introduce the clinical application of the thoracoacromial artery perforator (TAAP) flap as a new reconstructive option for hypopharyngeal defects.

Methods: This method was used to restore oncologic hypopharyngeal defects in nine patients: three who had previous irradiation and surgery, one who had previous surgery only, and another who had previous radiotherapy only.

Structural insights into cargo recognition by the yeast PTS1 receptor.

The peroxisomal matrix protein import is facilitated by cycling import receptors that shuttle between the cytosol and the peroxisomal membrane. The import receptor Pex5p mediates the import of proteins harboring a peroxisomal targeting signal of type I (PTS1). Purified recombinant Pex5p forms a dimeric complex with the PTS1-protein Pcs60p in vitro with a KD of 0.

Early Postoperative Complications following Gracilis Free Muscle Transfer for Facial Reanimation: A Systematic Review and Pooled Data Analysis.

Background: Multiple studies have detailed promising smile restoration following gracilis free muscle transfer for facial reanimation but information detailing the potential complications is lacking. The aim of this study is to systematically review the literature to evaluate the reported complication rate associated with this procedure. We also aim to determine the most common occurring complications.

Contemporary solutions for the treatment of facial nerve paralysis.

Learning Objectives: After reviewing this article, the participant should be able to: 1. Understand the most modern indications and technique for neurotization, including masseter-to-facial nerve transfer (fifth-to-seventh cranial nerve transfer). 2.

FRET-based screening assay using small-molecule photoluminescent probes in lysate of cells overexpressing RFP-fused protein kinases.

An assay was developed for the characterization of protein kinase inhibitors in lysates of mammalian cells based on the measurement of FRET between overexpressed red fluorescent protein (TagRFP)-fused protein kinases (PKs) and luminophore-labeled small-molecule inhibitors (ARC-Photo probes). Two types of the assay, one using TagRFP as the photoluminescence donor together with ARC-Photo probes containing a red fluorophore dye as acceptor, and the other using TagRFP as the acceptor fluorophore in combination with a terbium cryptate-based long-lifetime photoluminescence donor, were used for FRET-based measurements in lysates of the cells overexpressing TagRFP-fused PKs. The second variant of the assay enabled the performance of the measurements under time-resolved conditions that led to substantially higher values of the signal/background ratio and further improved the reliability of the assay.

Staged immediate breast reconstruction.

With the increasing popularity and acceptance of nipple-sparing mastectomy with immediate reconstruction comes an associated higher complication rate of nipple and skin necrosis. Historically, management of this risk has been addressed by predictive technologies or staged surgery with placement of an initial tissue expander. Certain high-risk patients, such as those with large cup size, previous surgery, or previous radiation, may not even be considered for an immediate nipple-sparing mastectomy approach due to even higher rates of complications.

Bipaddle radial forearm flap for head and neck reconstruction.

Background: Although the radial forearm free flap has become a workhorse flap in head and neck reconstruction, the skin grafting of the donor is the main drawback resulting in an unacceptable contour deformity and an unsightly appearance. Several technical modifications have been therefore applied to the radial forearm (RF) flap marking, elevation, and inset to overcome this major shortcoming. In this article, we report our clinical series with the bipaddle RF flap.

Multidisciplinary approach to treatment of radiation-induced chest wall sarcoma.

Radiation-induced sarcoma (RIS) is a rare complication following therapeutic external irradiation for lung cancer patients. Patients with RIS may develop recurrence or metastasis of the previous disease and also at high risk for early chest wall complications following operation, which requires close follow-up and multidisciplinary approach. We present a challenging case of RIS with a multidisciplinary teamwork in the decision-making and successful management.

A national snapshot of satisfaction with breast cancer procedures.

Purpose: Women with early-stage breast cancer face the complex decision to undergo one of three equally effective oncologic surgical strategies: breast-conservation surgery with radiation (BCS), mastectomy, or mastectomy with breast reconstruction. With comparable oncologic outcomes and survival rates, evaluations of satisfaction with these procedures are needed to facilitate the decision-making process and to optimize long-term health.

Methods: Women recruited from the Army of Women with a history of breast cancer surgery took electronically administered surgery-specific surveys, including the BREAST-Q© and a background survey evaluating patient-, disease-, and procedure-specific factors.

Evolving Trends in Autologous Breast Reconstruction: Is the Deep Inferior Epigastric Artery Perforator Flap Taking Over?

Background: Enthusiasm for the deep inferior epigastric artery perforator (DIEP) flap for autologous breast reconstruction has grown in recent years. However, this flap is not performed at all centers or by all plastic surgeons for breast reconstruction, and it is unclear whether practice patterns have measurably changed. This study aimed to (1) evaluate changing trends in breast flap use in the United States in recent years and (2) identify how these trends have affected charges and costs associated with autologous breast reconstruction.

A detailed evaluation of the anatomical variations of the profunda artery perforator flap using computed tomographic angiograms.

Background: The profunda artery perforator flap is a new option for breast reconstruction in appropriate patients. While the basic anatomy is known, detailed profunda perforator anatomy has never fully been described and we present new data that will aid dissection.

Methods: Fifty consecutive lower extremity computed tomography angiogram scans (100 legs) were retrospectively analyzed to acquire profunda artery perforator measurements.