Same day discharge following mastectomy and immediate tissue expander reconstruction: The effect of patient expectations.

Background And Purpose: Within, we compare the short-term outcomes of patients receiving same day mastectomy and tissue expander reconstruction for those discharged on postoperative day one versus those discharged immediately following surgery to explore the safety, efficacy, and potential impact on hospital processes.

Methods: This was a retrospective review of patients undergoing mastectomy with immediate TE reconstruction from March 2019 to March 2021. Patients were stratified into two cohorts; observation overnight (OBS), and discharge on same day of surgery (DC).

A Novel Framework for Optimizing Efficiency and Education in Microsurgical Breast Reconstruction.

Deep inferior epigastric perforator (DIEP) flaps are becoming the most frequent choice for autologous breast reconstruction. There are many benefits to DIEP flaps, but the procedures can be lengthy and have a steep learning curve. The balance of efficiency and education can be difficult to achieve.

Revisiting Bipedicled Flaps for Lower Extremity Distal Third Defects.

Background: Lower extremity reconstruction of the distal third of the leg is challenging. Free tissue transfer is the criterion standard. The COVID-19 pandemic encouraged seeking alternatives for resource consuming procedures.

Evaluation of Prepectoral Breast Tissue Expander Reconstruction Intraoperative Fill: Air or Saline?

Summary: Staged implant-based breast reconstruction with immediate tissue expanders (TEs) is the most common method of breast reconstruction after mastectomy. TEs traditionally are filled with saline for expansion. Some surgeons have advocated initial intraoperative fill of the TE with air to avoid excess pressure on ischemic mastectomy skin flaps.

Supraclavicular Approach to the Brachial Plexus.

Unlabelled: The brachial plexus consists of an intricate array of nerves originating from the C5-T1 ventral rami of the spinal cord. Their course is complex and can be substantially distorted after injury. Thus, dissection of the brachial plexus can be difficult.

Outcomes after Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer.

 Ulnar nerve lesions proximal to the elbow can result in loss of intrinsic muscle function of the hand. The anterior interosseous nerve (AIN) to deep motor branch of the ulnar nerve (DBUN) transfer has been demonstrated to provide intrinsic muscle reinnervation, thereby preventing clawing and improving pinch and grip strength. The purpose of this study was to evaluate the efficacy of the AIN to DBUN transfer in restoring intrinsic muscle function for patients with traumatic ulnar nerve lesions.

Comparison of Breast Reconstruction Outcomes Using Oxychlorosene versus Triple Antibiotic Solution for Pocket Irrigation.

Background: Breast pocket irrigation with antiseptic solutions is performed to reduce contamination with breast implants. The optimal antiseptic irrigation solution and the efficacy of individual practices are unclear. Oxychlorosene sodium is frequently used at our institution.

Optimizing tissue expander breast reconstruction in nicotine users: An algorithmic approach.

Introduction: Smoking is a risk factor for post-operative complications following breast reconstruction. Abruptly refraining from all nicotine products may be difficult for patients with a new cancer diagnosis. The goal of this study is to assess complications following a distinct approach to tissue expander reconstruction in nicotine users.

Long-Term Outcomes After Treatment for Type B Ulnar Polydactyly.

Background: Type B ulnar polydactyly is a common congenital hand difference and can be treated with either ligation or surgical excision. There is a paucity of literature, however, evaluating long-term patient reported outcomes of these treatments. The purpose of this study was to compare the long-term outcomes after ligation and excision for the management of type B ulnar polydactyly.

Do Patient Expectations of Discharge Affect Length of Stay after Deep Inferior Epigastric Perforator Flap for Breast Reconstruction?

Background:  Deep inferior epigastric artery perforator (DIEP) flap is a common method of breast reconstruction. Enhanced recovery after surgery (ERAS) postoperative protocols have been used to optimize patient outcomes and facilitate shorter hospital stays. The effect of patient expectations on length of stay (LOS) after DIEP has not been evaluated.

CT-Guided Percutaneous Needle Biopsy of Retroperitoneal and Pelvic Lymphadenopathy: Assessment of Technique, Diagnostic Yield, and Clinical Value.

Purpose: To assess the technical success rate, diagnostic yield, and clinical value of computed tomography (CT)-guided percutaneous needle biopsy (PNB) for retroperitoneal and pelvic lymphadenopathy.

Materials And Methods: This retrospective study included 344 patients evaluated for safety and technique and 334 patients evaluated for diagnostic yield and clinical analyses. PNBs were performed with fine-needle aspiration (FNA) in 315 patients and with core biopsy in 333 patients.

Vasodilation associated with supplement use: potential concern for military aviators.

Military aviators are exposed to high G environments while performing certain tactical aircraft maneuvers. G forces endured during such maneuvering have been shown to reduce mean arterial blood pressure (MAP) at eye level by 22 mmHg for every G endured, leaving the average aviator with a resting G tolerance of approximately 5 to 5.5 G before losing consciousness.

Perspectives on performance assessment in medical simulation.

The work upon which this paper is based was supported by an award to Massachusetts General Hospital - CIMIT from the US Department of Defense. The opinions expressed herein are the sole responsibility of the author and do not represent the policy of the US Department of Defense.

The ABC's of stroke complications.

Stroke is the third leading cause of death in the United States, with more than 140,000 deaths per year. Complications related to stroke resulting in morbidity and mortality are very common and may result from cerebral and extracerebral causes. Cerebral causes include cerebral edema, hemorrhagic conversion of an ischemic infarct, and progression of penumbra to infarction.

Thirty years' experience with balloon dilation of benign postoperative biliary strictures: long-term outcomes.

Purpose: To determine the effectiveness of percutaneous balloon dilation of benign postoperative biliary strictures.

Materials And Methods: We received approval from our institutional review board to undertake this retrospective HIPAA-compliant study, and informed consent was waived. From April 1, 1977, to April 1, 2007, percutaneous biliary balloon dilation (PBBD) was performed in 85 patients with benign biliary strictures.

The origins of Better Jobs Better Care.

Better Jobs Better Care was the nation's largest single initiative created to reduce the high vacancy and turnover rates of direct care workers and improve workforce quality through both policy and practice changes. In this article, we describe the important role and key characteristics of direct care workers, what motivated the unique partnership between a provider association and a direct care worker advocacy organization to create this initiative, and how the initiative was designed to respond to the key challenges through applied research and demonstration projects. We conclude by discussing how BJBC has influenced providers, policy makers, and direct care workers to think about these frontline caregivers, who are the crux of the long-term care workforce.