Three Parameters Impact the Perception of Smile Asymmetry in Patients with Facial Paralysis.

The ability to smile is impaired in patients with facial palsy, and objective parameters assessing smile symmetry to guide treatment are not well elucidated. This study seeks to identify objective facial measurements that relate smile recognition, perception of smile asymmetry, and perceived emotions from photographs of individuals with asymmetrical smiles compared with control photographs of individuals without smile asymmetry as measured by a photograph analysis application. Fifty-six photographs of smiles were categorized using objective perioral morphometric measurements (Emotrics).

Upper Extremity Surgery in Cervical Spinal Cord Injury: A Prospective Comparative Mixed-Methods Study.

Background: Cervical spinal cord injury (SCI) has a devastating effect on health and independence. Restoring upper extremity function is a top priority and can be accomplished by tendon transfer (TT) and nerve transfer (NT) surgery. The purpose of this prospective comparative study was to assess long-term changes in upper extremity function between surgical (TT or NT) and nonsurgical groups through a comprehensive mixed-methods approach.

Patient-Reported Mental Health Outcomes After Single-Digit Non-thumb Traumatic Amputation in Adults.

Background: Though traumatic digital amputations are common, outcomes data are scarce. The FRANCHISE study clarified functional outcomes after digital amputation, but little information is available regarding mental health outcomes. The aims of this study were to document patient-reported mental health outcomes after traumatic digital amputation, elucidate the relationship between mental health and functional outcomes, and determine which patient/injury attributes conferred risk of unfavorable mental health outcomes.

From Augmented to Virtual Reality in Plastic Surgery: Blazing the Trail to a New Frontier.

Background:  Augmented reality (AR) and virtual reality (VR)-termed mixed reality-have shown promise in the care of operative patients. Currently, AR and VR have well-known applications for craniofacial surgery, specifically in preoperative planning. However, the application of AR/VR technology to other reconstructive challenges has not been widely adopted.

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.

Biosensors: An Upcoming Wave of Innovation.

A biosensor uses a biological molecule to measure a chemical reaction. Wearable biosensors that attach to the body externally, including tooth enamel biosensors, contact lens biosensors, sweat biosensors, and skin tattoo biosensors, are in development. Nanoparticle-based biosensors are being developed to allow for the early detection of cancerous biomarkers.

The Yearly Periodicity of Operative Upper Extremity Trauma: A Retrospective Study of "Trauma Season".

Background: Upper extremity (UE) trauma requiring operative care increases during the summer and fall months, which the authors colloquially refer to as "trauma season."

Methods: CPT databases were queried for codes related to acute UE trauma at a single level-1 trauma center. Monthly CPT code volume was tabulated for 120 consecutive months and average monthly volume was calculated.

The Insurance Landscape for Implant- and Autologous-based Breast Reconstruction in the United States.

Unlabelled: Insurance coverage of postmastectomy breast reconstruction is mandated in America, regardless of reconstructive modality. Despite enhanced patient-reported outcomes, autologous reconstruction is utilized less than nonautologous reconstruction nationally. Lower reimbursement from Medicare and Medicaid may disincentivize autologous-based reconstruction.

Facial Trauma Operative Volume Demonstrates Consistent and Significant Yearly Periodicity.

Purpose: Facial trauma requiring operative care increases during the summer and fall months, which is colloquially referred to as trauma season. The purpose of this study is to determine if there is a quantifiable and statistically significant yearly periodicity of operative facial trauma volume.

Materials And Methods: To confirm the existence and quantify the magnitude of trauma season, we conducted a retrospective cohort study.

Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps.

Background:  Successful intraoperative microvascular anastomoses are essential for deep inferior epigastric perforator (DIEP) flap survival. This study identifies factors associated with anastomotic failure during DIEP flap reconstruction and analyzes the impact of these anastomotic failures on postoperative patient outcomes and surgical costs.

Methods:  A retrospective cohort study was conducted of patients undergoing DIEP flap reconstruction at two high-volume tertiary care centers from January 2017 to December 2020.

An Education Intervention to Raise Awareness Reduces Self-reported Opioid Overprescribing by Plastic Surgery Residents.

Purpose: The aim of this study was to understand how opioid prescribing practices of plastic surgery residents changed after instituting opioid prescribing education (OPE) interventions.

Methods: Plastic surgery residents at a single academic institution completed a survey (fall 2017) assessing opioid prescribing following 8 common procedures. The Division then completed 3 multidisciplinary OPE interventions over 2.

Quantifying Donor Deficits Following Nerve Transfer Surgery in Tetraplegia.

Purpose: Nerve transfer (NT) surgery can improve function in people with cervical spinal cord injury (SCI). However, the impact of donor nerve deficits remains unclear. The purpose of this study was to quantify donor deficits experienced by individuals with cervical SCI following NT.

Pedicled Groin Flap for Reconstruction of Combined First Webspace and Dorsal Hand Contracture.

The combination of first webspace and dorsal hand contracture is a challenging reconstructive problem. Complete soft tissue release results in a large wraparound defect that spans the radial side of the palm, first webspace, and the transverse dimension of the entire dorsal hand. In these situations local tissue is often compromised, and free flap reconstruction is commonly indicated.

Recruiting hand therapists improves disposal of unused opioid medication.

Background: Opioids often remain unused after upper extremity surgery, and leftover prescriptions are frequently diverted. When administered in a hand surgery clinic, an educational brochure outlining a simple method of opioid disposal has been shown to improve disposal rates after surgery.

Purpose: To understand whether administration of an opioid disposal educational brochure in a hand therapy clinic would increase opioid disposal rates, compared to a hand surgery clinic.

Failed Targeted Muscle Reinnervation: Findings at Revision Surgery and Concepts for Success.

Unlabelled: Although it was initially described for improved myoelectric control, targeted muscle reinnervation (TMR) has quickly gained popularity as a technique for neuroma control. With this rapid increase in utilization has come broadening indications and variability in the described technique. As a result, it becomes difficult to interpret published outcomes.

Translating Technique into Outcomes in Amputation Surgeries.

The department of surgery at Washington University is putting increased emphasis on outcomes for amputees. This multidisciplinary effort begins with choosing the correct surgery and incorporating the latest technical advances in amputation surgery.

State-of-the-Art Lymphedema Surgery Treatment Program.

The purpose of this article is to describe the multidisciplinary lymphedema surgery treatment program at Washington University in St. Louis. In this article, we discuss our collaboration with colleagues in medicine and therapy for conservative management and lymphedema staging.

Timing of Ossification of the Anterior Skull Base in Syndromic Synostosis.

The anterior skull base undergoes a progressive ossification after birth. This has implications on the epidural dissection of early trans-craniofacial osteotomy procedures such as monobloc advancements. Our purpose was to determine the rate of ossification in syndromic synostosis patients relative to a normal cohort to establish when maturation of the anterior skull base is complete.

Nasal dermoid cysts with intracranial extension: avoiding coronal incision through midline exposure and nasal bone osteotomy.

Objective: Up to 10% of midline nasal dermoid cysts have intracranial extension. Previous techniques of excision include frontal and frontonasal craniotomies via a coronal approach, combined with a direct cutaneous excision of the dermoid cyst. While the coronal incision allows for wide visualization, it carries significant risks of transfusion, blood loss, and scarring.

Evolution of Bandeau Shape, Orbital Morphology, and Craniofacial Twist after Fronto-Orbital Advancement for Isolated Unilateral Coronal Synostosis: A Case-Control Study of 2-Year Outcomes.

Background: The authors' purpose was to quantify the change in unicoronal synostosis symmetry between presentation (time 0), after fronto-orbital advancement (time 1), and 2 years later (time 2).

Methods: Bandeau/orbital symmetry ratios and skull base/midface twists were measured on computed tomographic scans of consecutive isolated unicoronal synostosis patients. Comparisons were made across three time points and against normal controls.

Adult Quality of Life Post Cleft Palate Repair: A Comparison of Two Techniques.

Background And Purpose: In 1989, the Cleft Palate-Craniofacial Journal published the first randomized prospective cleft surgery study, comparing the Kriens intravelar veloplasty (IVV) with a non-IVV 2-flap repair. Results in that and follow-up publications yielded no difference between the 2 groups for need for secondary velopharyngeal management. The subjects have now reached adulthood.

Progressive Tightening of the Levator Veli Palatini Muscle Improves Velopharyngeal Dysfunction in Early Outcomes of Primary Palatoplasty.

Background: Management of the levator veli palatini with intravelar veloplasty has been shown to improve speech resonance. The senior author has introduced a more aggressive procedure where the levator is separately dissected, overlapped, and tightened. This study compares resonance results from four levator management protocols: non-intravelar veloplasty, Kriens intravelar veloplasty, radical intravelar veloplasty, and overlapping intravelar veloplasty.

Comparative study of cranial anthropometric measurement by traditional calipers to computed tomography and three-dimensional photogrammetry.

Craniofacial anthropometry by direct caliper measurements is a common method of quantifying the morphology of the cranial vault. New digital imaging modalities including computed tomography and three-dimensional photogrammetry are similarly being used to obtain craniofacial surface measurements. This study sought to compare the accuracy of anthropometric measurements obtained by calipers versus 2 methods of digital imaging.