Assessing the Effect of Time from Injection of Collagenase to Manipulation on Success Rates in Dupuytren Disease.

Purpose: Dupuytren disease can be managed with an injection of collagenase Clostridium histolyticum enzyme followed by manual manipulation. Although the recommended time from injection to manipulation is 24-72 hours, patient and physician schedules may not accommodate this time frame. Therefore, we sought to study the impact of time from injection to manipulation on outcomes and complications of collagenase injection.

Initial Assessment of VECTRA Three-Dimensional Imaging to Accurately Simulate Breast Volume Changes in Transfeminine Patients: A Mannequin Study.

Background: Methods that aim to accurately measure and predict breast development can be utilized in gender-affirming treatment planning, patient education, and research.

Objectives: The authors sought to evaluate whether three-dimensional (3D) stereophotogrammetry accurately measures transfeminine breast volume changes on a masculine frame when simulating anticipated changes in soft tissue after gender-affirming surgical therapy. Then, we describe the innovative application of this imaging modality in a transgender patient to illustrate the potential role of 3D imaging in gender-affirming surgical care.

Rating the Rater: A Technique for Minimizing Leniency Bias in Residency Applications.

Unlabelled: Each program in the highly competitive match for a surgical residency needs a way to review applicants effectively. Often this task is undertaken by individual faculty members, reviewing an applicant's file and assigning a score. Despite being asked to rate on a standardized scale, our program found that ratings of the same applicants varied dramatically, with certain faculty consistently scoring higher or lower than others.

Airway Edema after Keloid Resection and Superficial Radiation: Unexpected Event in an Unusual Location.

Postoperative radiation therapy has been shown to significantly reduce recurrence rates of keloids after surgical excision. Adverse effects of radiation therapy in this setting are generally minimal because the radiation utilized quickly dissipates below the skin, and the radiation effects on the internal organs are usually negligible. This case report describes a patient who underwent excision of a wide anterior neck keloid and received postoperative external beam radiation therapy of the incision.

Personal Safety of the Plastic Surgeon: Keeping Yourself Healthy While You Work.

Learning Objectives: After reading this study, the participant should be able to: 1. Recognize the primary physical and mental risks faced by the practicing plastic surgeon. 2.

Eliminating Geographic Bias Improves Match Results: An Analysis of Program Preferences and Their Impact on Rank Lists and Results.

Background: Previous studies have demonstrated that programs emphasize United States Medical Licensing Examination scores, publications, and geography in creating rank lists. The authors aimed to quantify the importance of geography and to determine how eliminating geographic preferences would affect Match outcomes.

Methods: The Match algorithm was implemented and validated on 6 years of deidentified data from the San Francisco Match (2009 to 2014).

Defining Temporal Hairline Landmarks.

Brow dermoids are benign pediatric neoplasms. Endoscopic resection requires incisions placed within the temporal hairline, which is often difficult to reliably locate in infants. The authors studied adult and pediatric patients to define the location of the hairline in relationship to simple facial landmarks.

Versatility of the Profunda Artery Perforator Flap: Creative Uses in Breast Reconstruction.

Background: Flaps based on the profunda artery perforators were first used for reconstruction of pressure sores, burn contractures, and extremity wounds. Recently, a revised profunda artery perforator flap was introduced for breast reconstruction. However, the flap is rarely used despite interesting reports on its use.

Correlation between Facial Nerve Axonal Load and Age and Its Relevance to Facial Reanimation.

Background: Two-stage facial reanimation procedures with a cross-facial nerve graft often have unsatisfactory results in the older patient. Although the cause of result variability is likely multifactorial, some studies suggest that increased donor nerve axonal load improves function of a free muscle transfer after a cross-facial nerve graft. This study attempts to characterize the relationship between age and facial nerve axonal load.

Neurectomy for the Treatment of Chronic Postoperative Pain after Surgery of the Trunk.

Background: Incidence of chronic postoperative neurogenic pain after open and laparoscopic trunk operations is reported between 1 and 20 percent, rendering a large population in the United States and worldwide. One possible treatment is selective surgical neurectomy.

Methods: All patients who underwent neurectomy for chronic trunk or groin postoperative neurogenic pain were identified.

The Indian Nose.

Despite the growing number of rhinoplasty procedures being performed on Indian patients, there is a very limited body of literature regarding nuances of the Indian rhinoplasty. The authors review the spectrum of nasal phenotypes that fall under the category of the Indian nose; goals of rhinoplasty in these patients; operative techniques that can be used to address them; and, importantly, the specific pitfalls to be avoided in these groups.

Facial Nerve Axonal Analysis and Anatomical Localization in Donor Nerve: Optimizing Axonal Load for Cross-Facial Nerve Grafting in Facial Reanimation.

Background: Donor nerve axonal count over 900 in two-stage reconstructions using cross-facial nerve grafts is possibly associated with improved outcomes in facial reanimation. Facial nerve axonal analysis was performed to determine the ideal location for optimizing axonal load. Correlation of axonal number, branch diameter, and age was also assessed.

Varied Definitions of Nasolabial Angle: Searching for Consensus Among Rhinoplasty Surgeons and an Algorithm for Selecting the Ideal Method.

Background: The nasolabial angle (NLA) is an important aesthetic metric for nasal assessment and correction. Although the literature offers many definitions, none has garnered universal acceptance.

Methods: To gauge the consensus level among practitioners, surveys were administered to a convenience sample of rhinoplasty surgeons soliciting practice characteristics, self-assessment of rhinoplasty experience and expertise, and preferred NLA definition.

No-drain DIEP Flap Donor-site Closure Using Barbed Progressive Tension Sutures.

Background: The use of progressive tension sutures has been shown to be comparable to the use of abdominal drains in abdominoplasty. However, the use of barbed progressive tension sutures (B-PTSs) in deep inferior epigastric artery perforator (DIEP) flap donor-site closure has not been investigated.

Methods: A retrospective chart review was performed on patients with DIEP flap reconstruction in a 3-year period at 2 institutions by 2 surgeons.

Allergan Style 410 Implants for Breast Reconstruction: A Prospective Study in Efficacy, Safety, and Symmetry.

Background: Implant-based breast reconstruction is performed with both saline and silicone. In 2001, a study was conducted in which a novel implant made of highly cohesive silicone gel in anatomical shape was used. It differs from others because it holds its anatomical shape and forces tissue to conform to the implant.

Role of the Cephalic Trim in Modern Rhinoplasty.

There have been a variety of techniques describing nasal tip refinement. The cephalic trim has long been accepted as a means for shaping the nasal tip, but it has been misinterpreted by many surgeons. The improper use of a cephalic trim poses potential long-term sequelae.

The Profunda Artery Perforator Flap: Investigating the Perforasome Using Three-Dimensional Computed Tomographic Angiography.

Background: The profunda artery perforator flap has been emerging as an alternative method of autologous breast reconstruction. This flap uses upper posterior thigh tissue. The profunda artery perforator perforasome is investigated using three-dimensional computed tomographic angiography.

Public reporting of patient safety metrics: ready or not?

In its 1999 report, the Institute of Medicine estimated that medical error leads to between 44,000 and 98,000 deaths per year. Given that statistic, public reporting of quality and safety metrics is a welcome response that may serve to reduce the rate of adverse events and restore patients' trust in the health care system. To ensure that any public reporting system fulfills its potential, several questions must be addressed: Are we measuring the right metrics? Are the metrics accurate, valid, and is their public reporting effecting change? Based on a review of the literature, it is clear that current metrics suffer from low reliability, low validity, and possibly minimal relevance to the intended consumer.

Soccer-related Facial Trauma: Multicenter Experience in 2 Brazilian University Hospitals.

Background: Soccer is the most popular sport in Brazil and a high incidence of related trauma is reported. Maxillofacial trauma can be quite common, sometimes requiring prolonged hospitalization and invasive procedures. To characterize soccer-related facial fractures needing surgery in 2 major Brazilian Centers.

Insights from San Francisco match rank lists, part II: are programs doing it wrong?

Background: It is well known that the ideal method of creating rank lists for the match is the "true-preference" strategy. However, there is anecdotal and survey-based evidence that programs and applicants often deviate from this strategy. We analyzed rank lists of applicants and programs participating in the Plastic Surgery San Francisco Match to investigate whether programs were following an optimal strategy.

Insights from the San Francisco Match rank list data: how many interviews does it take to match?

Background: For many years, the independent plastic surgery match has been regarded as a competitive process. Applicants expend significant time and resources applying to, and interviewing with, many programs to increase their chance for success. Public data from the San Francisco (SF) Match provide no predictors of success in the Match.

The assassination of John F. Kennedy: revisiting the medical data.

Doubt continues to surround the assassination of President Kennedy to this day. Unfortunately, the controversy was not diminished by the multiple commissions and panels that were convened to investigate it. This was in large part because these various panels continued to propagate much of the confusion and lack of precision that plagued the initial medical reports, and introduced some new confusion of their own.