Work Where You Live or Live Where You Work? Resident Work and Sleep Patterns While on "Home Call".

Background: Unlike in-house call, the Accreditation Council for Graduate Medical Education (ACGME) does not require a postcall day for "home call" shifts. Despite this, we hypothesize that on-call residents are still in the hospital for the majority of their shift despite having the luxury of home call and, thus, are not protected by ACGME postcall duty hour regulations.

Methods: A prospective single center survey study was conducted by surveying junior and senior residents who completed overnight call shifts from January 2023 to April 2023 at one of the busiest level 1 trauma centers in the United States.

Elevating Lower Extremity Reconstruction: An Algorithmic Approach to Free Flap Re-elevation.

Background:  Free flap (FF) reconstruction is frequently required for soft-tissue coverage after significant orthopaedic trauma of the lower extremity (LE). While usually the final step in limb salvage, re-elevation of the previously inset FF may be necessary to restore a functional limb. In this study, we present our algorithm for LE FF re-elevation and review our experience to identify factors associated with successful limb salvage and return to ambulation.

Effectiveness of Risk Analysis Index Frailty Scores as a Predictor of Adverse Outcomes in Lower Extremity Reconstruction.

Background:  The rising clinical importance of assessing frailty is driven by its predictive capability for postoperative outcomes. This study assesses the effectiveness of RAI-rev (Revised Risk Analysis Index) in predicting adverse outcomes in lower extremity (LE) flap reconstruction.

Methods:  Analyzing NSQIP (National Surgical Quality Improvement Program) data from 2015 to 2020, we compared demographics, perioperative factors, and 30-day outcomes in all locoregional and free-flap cases.

The Hidden Risks of Perioperative Transfusions in Traumatic Lower Extremity Free Flap Reconstruction.

Background:  Blood transfusions have been associated with surgical complications; however, these studies are not specific to lower extremity (LE) reconstruction. We evaluated the effect of perioperative packed red blood cell (PRBC) transfusions on LE free flap outcomes in trauma patients.

Methods:  Patients undergoing LE free flap reconstruction following acute injuries from 2016 to 2021 were retrospectively analyzed.

We are moving the needle: Improving racial disparities in immediate breast reconstruction.

Background: Although racial disparities in receipt of immediate breast reconstruction (IBR) have been previously reported, prior studies may not have fully assessed the impact of recent advocacy efforts as healthcare disparities gain increased national attention. The aim of this study is to assess more recent racial differences and annual trends in receiving IBR.

Methods: Using the National Surgery Quality Improvement Program database, black or white women over 18 years who underwent mastectomy from 2012 to 2021 were included.

The Profunda Artery Perforator Flap: A Versatile Option for Head and Neck Reconstruction.

Background: Although the profunda artery perforator flap has gained popularity in breast reconstruction, it has not been well described for reconstruction of head and neck defects. The authors report their experience with free profunda artery perforator flaps in postoncologic head and neck reconstruction.

Methods: A retrospective review of all free profunda artery perforator flaps used for head and neck reconstruction from 2016 to 2019 was performed.

Comparing Independent and Integrated Plastic Surgery Residency Models: A Review of the Literature.

There are currently 2 approved residency training models in the United States conferring eligibility for the American Board of Plastic Surgery examination-the integrated pathway and the independent pathway. While both pathways allow for board certification, there has been much debate regarding the effectiveness of one training model over the other. In this article, we review the existing literature to compare these pathways with regard to quality of trainees, proficiency of graduates, and practice or career outcomes.

Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap.

Objective: The anterolateral thigh (ALT) free flap is a soft tissue flap used in head and neck reconstruction. Occasionally, its perforators to the skin paddle are absent or too small to support the flap. Salvage options in this scenario have not been well described for head and neck reconstruction.

Pedicled, vascularized occipital bone graft to supplement atlantoaxial arthrodesis for the treatment of pseudoarthrosis.

Atlantoaxial pseudoarthrosis is a challenging postoperative complication. The use of a local, vascularized bone graft, without free tissue transfer, to support a revision atlantoaxial fusion has not been previously described. We report the first surgical patient who received a semispinalis capitis muscle pedicled, occipital bone graft for supplementation of a revision atlantoaxial arthrodesis.

Strategy Assessment for the Medical Professional.

While medical professionals are superbly trained in treating patients, they are not often trained in quality improvement principles. In this article, the authors present a framework for strategy assessment commonly used in the business sector to identify areas for improvement and measure the improvement of interventions. This framework can be adapted to the medical field and used to improve the delivery of health care at a systems level.

Approach to Reconstruction of Cheek Defects.

The cheek is the largest facial unit with a prominent position on the face. Trauma, burns, and the resection of skin cancers constitute common sources of injury, potentially resulting in defects that, through natural healing, produce noticeable scarring. Surgical repair focuses on the reformation of three-dimensional geometries, proper establishment of symmetry, and the minimization of color and texture discrepancies to the surrounding.

Orbital Decompression for Thyroid Eye Disease.

Although most cases of thyroid eye disease (TED) can be managed medically, some refractory or severe cases are treated surgically with orbital decompression. Due to a lack of randomized controlled trials comparing surgical techniques for orbital decompression, none have been deemed superior. Thus, each case of TED is managed based on patient characteristics and surgeon experience.

Posterior cranial vault distraction in the treatment of shunt-induced craniosynostosis.

Cerebrospinal fluid shunt placement is the most common surgical intervention for hydrocephalus. In rare cases, cerebrospinal fluid shunting has been associated with the development of secondary craniosynostosis. Posterior cranial vault distraction osteogenesis is an emerging technique used for the treatment of craniosynostosis.

Full-thickness skin grafting in nasal reconstruction.

Skin grafting in nasal reconstruction, long used by dermatologists, can provide superior results and can well be the "go to" procedure for nasal reconstruction. The upper two-thirds of the nose is composed of both flattened, featureless and often thin skin that is well recreated with defect-only full-thickness grafting. Skin grafting for the lower third of the nose has been practiced for years by dermatologists; over the last 4 to 5 years, it has been embraced by plastic surgeons.

The ultra-thin, fascia-only anterolateral thigh flap.

Background: While many potential donor sites have been described for fascial (fascia-only) flaps, a fascial flap harvested from the anterolateral thigh (ALT) donor site has not gained popularity, likely because of concerns regarding inadequate perfusion of the deep fascia. However, recent clinical experience demonstrates that the ALT fascia-only flap is a suitable option for reconstructions necessitating thin and pliable coverage.

Methods: In this study a retrospective chart review was performed examining the clinical experience of two plastic surgeons with the fascia-only ALT perforator flap from 2008 to 2012.