Alpha Defensin-1 Level Correlates with Periprosthetic Infection Severity following Implant-based Breast Reconstruction.

Background: Accurate diagnosis of periprosthetic infections following breast reconstructions is paramount to reduce morbidity. Alpha defensin-1 (AD-1) is an antimicrobial peptide released by neutrophils. This study evaluates the relationship between quantitative AD-1 levels and infection severity in patients with suspected periprosthetic infection.

The Impact of Venous Reconstruction on Finger Replantation Success Rates Based on Level of Injury.

Purpose: The requirement for anatomic venous reconstruction in digit replantation is an ongoing area of research. In this study, we evaluated our institutional experience to study whether replantation success is affected by the presence or absence of vein repair, stratified by the level of injury.

Methods: A retrospective review was performed at an urban, level-1 trauma center of all single-digit replantations performed in adults from 2012 to 2021.

Alpha Defensin-1 Biomarker Outperforms Culture in Diagnosing Breast Implant-Related Infection: Results from a Multicenter Prospective Study.

Background: Prompt diagnosis of breast implant infection is critical to reducing morbidity. A high incidence of false-negative microbial culture mandates superior testing modalities. Alpha defensin-1 (AD-1), an infection biomarker, has outperformed culture in diagnosing periprosthetic joint infection with sensitivity/specificity of 97%.

Symptomatic hernia of the thigh musculature requiring reconstruction: A rare late presenting sequela after fascial release for compartment syndrome.

Acute compartment syndrome (ACS) of the lower extremity is a surgical emergency, often secondary to severe crush injury, and requires immediate fascial release. In treatment of ACS, the underlying fascia is left unrepaired and the subsequent fascial defect does not generally cause negative consequences. Here, we present a 24-year-old man who developed symptomatic muscle herniation 3-years after undergoing fascial release secondary to ACS of the anterior thigh.

3D Printed N-95 Masks During the COVID-19 Pandemic: Lessons Learned.

Early in 2020, the pandemic resulted in an enormous demand for personal protective equipment (PPE), which consists of face masks, face shields, respirators, and gowns. At our institution, at the request of hospital administration, the Lifespan 3D Printing Laboratory spearheaded an initiative to produce reusable N95 masks for use in the hospital setting. Through this article, we seek to detail our experience designing and 3D printing an N95 mask, highlighting the most important lessons learned throughout the process.

The Economic Impact of Extensor Tendon Lacerations of the Hand in the United States.

Purpose: Extensor tendon lacerations (ETLs) are a common and debilitating injury for thousands of Americans annually. No study has attempted to estimate their economic impact. The objective of this study was to estimate the economic impact of ETLs in America.

Limited Flexor Sheath Incision and Drainage in the Emergency Department in the Management of Early Pyogenic Flexor Tenosynovitis.

Background: Pyogenic flexor tenosynovitis (PFT) has been considered a surgical emergency. Varying operative approaches have been described, but there are limited data on the method, safety, and efficacy of nonoperative or bedside management. We present a case series where patients with early flexor tenosynovitis are managed using a limited flexor sheath incision and drainage (I&D) in the emergency department (ED) to both confirm purulence within the flexor sheath and as definitive treatment.

Changes in Academic Plastic Surgery Programs During the COVID-19 Pandemic.

Background: The COVID-19 pandemic has presented unprecedented challenges for surgical teaching programs, as operating rooms closed and resources were redirected for patient care. As a result, both educational challenges and opportunities emerged. The objective of this study was to assess the changes used by plastic surgery programs as a result of the pandemic.

The Impact of the COVID-19 Pandemic on Plastic Surgery Consultations in the Emergency Department.

Unlabelled: Stay-at-Home (SAH) orders implemented in the United States to combat COVID-19 had a significant impact on health care delivery for patients with all conditions. In this study, we examined the effect SAH orders had on the Emergency Department (ED) consultation volume, injury patterns, and treatment of patients managed by our plastic surgery service.

Methods: In Rhode Island, SAH orders were instituted from March 28, 2020, to June 30, 2020.

Improved Diagnostic Accuracy of Periprosthetic Breast Infection: Novel Application of the Alpha Defensin-1 Biomarker.

Unlabelled: Prompt, accurate diagnosis of breast implant infection is critical to minimizing patient morbidity. Bacterial culture false negative rate approaches 25%-30%, and better costeffective testing modalities are needed. Alpha defensin-1 (AD-1) is a neutrophil-mediated biomarker for microbial infection.

The Economic Impact of Flexor Tendon Lacerations of the Hand in the United States.

Purpose: Flexor tendon lacerations are a common and debilitating injury for thousands of Americans annually. Despite this, no study has attempted to estimate the economic impact of these injuries. The objective of this study was to estimate the economic impact of flexor tendon lacerations in America.

Burn scar regeneration with the "SUFA" (Subcision and Fat Grafting) technique. A prospective clinical study.

Background: Treatment of burn scars with traditional surgical techniques is challenging due to recurrent contractures. Fat grafting has been previously used in small clinical series and results are often biased by lack of scientific validating methods. Fat grafting in clinical practice is often evaluated for its filler properties and rarely scientifically validated for its potential in dermal regeneration.

The Use of a Magnetic Port Finder in the Retrieval of Air Rifle BBs to the Upper Extremity.

Air-powered rifles shoot ball bearings with enough kinetic energy to penetrate skin and fracture underlying bones. In addition, there are reports of these ball bearings embolizing within the vascular network, causing serious injuries such as ischemic stroke with resultant blindness. The severity of these complications warrants occasional removal of these foreign bodies; however, they can be difficult to localize.

Improving Pressure Ulcer Reconstruction: Our Protocol and the COP (Cone of Pressure) Flap.

Background: Surgical treatment of pressure ulcers is challenging for high recurrence rates. Deepithelialized flaps have been used previously with the aim to eliminate shearing forces and the cone of pressure (COP) effect. The goal of this study is to adopt a standardized protocol and evaluate if 2 different flap techniques affect outcomes.

Coding and Billing in Surgical Education: A Systems-Based Practice Education Program.

Objective: Despite increased emphasis on systems-based practice through the Accreditation Council for Graduate Medical Education core competencies, few studies have examined what surgical residents know about coding and billing. We sought to create and measure the effectiveness of a multifaceted approach to improving resident knowledge and performance of documenting and coding outpatient encounters.

Design: We identified knowledge gaps and barriers to documentation and coding in the outpatient setting.

Revenue Generation and Plastic Surgery Training Programs: 1-Year Evaluation of a Plastic Surgery Consultation Service.

Background: In academic institutions, residents make substantial contributions to clinical productivity. However, billing cannot be generated unless there is direct attending physician supervision of these services. The purpose of this study was to quantify clinical services provided by residents at a large academic medical center.

Unnecessary Emergency Transfers for Evaluation by a Plastic Surgeon: A Burden to Patients and the Health Care System.

Background: Plastic surgeons are frequently consulted for hand and facial injuries, and patients are often transferred to trauma centers for evaluation of these problems. The authors sought to identify the frequency and impact of "unnecessary" transfers for emergency evaluation by a plastic surgeon at a Level I trauma center.

Methods: The authors reviewed more than 32,000 consecutive emergency department encounters at their institution between April of 2009 and April of 2013 and found 1181 patients transferred for evaluation by plastic surgery.

EM Talk: communication skills training for emergency medicine patients with serious illness.

The emergency department visit for a patient with serious illness represents a sentinel event, signalling a change in the illness trajectory. By better understanding patient and family wishes, emergency physicians can reinforce advance care plans and ensure the hospital care provided matches the patient's values. Despite their importance in care at the end of life, emergency physicians have received little training on how to talk to seriously ill patients and their families about goals of care.

Prolonged length of stay in ED psychiatric patients: a multivariable predictive model.

Background: We aimed to evaluate factors associated with prolonged emergency department (ED) length of stay (LOS) among psychiatric patients and to develop a multivariable predictive model to guide future interventions to reduce ED LOS.

Methods: Electronic health records of ED patients receiving a psychiatric consultation and providing research authorization were reviewed from September 14, 2010, through September 13, 2013, at an academic hospital with approximately 73000 visits annually. Prolonged LOS was defined as ≥8 hours.

Evidence for safe tourniquet use in 500 consecutive upper extremity procedures.

Background: Although pneumatic tourniquets are widely used in upper extremity surgery, further evidence is needed to support their safe use. Excessive pressure and prolonged ischemic time can cause soft-tissue injury. The purpose of this study was to determine the safety of tourniquet use in a yearlong, consecutive series of patients.

Methods and pitfalls in treatment of fractures in the digits.

This article describes the indications for and methods of managing phalangeal fractures. The fractures around the finger joints are particularly difficult to treat. The technical details and pitfalls for these cases are discussed in detail.

Duty hours and home call: the experience of plastic surgery residents and fellows.

Background: Although resident duty hours are strictly regulated by the Accreditation Council for Graduate Medical Education, there are fewer restrictions on at-home call for residents. To date, no studies have examined the experience of home call for plastic surgery trainees or the impact of home call on patient care and education in plastic surgery.

Methods The Authors Distributed: an anonymous electronic survey to plastic surgery trainees at 41 accredited programs.