Combined Targeted Muscle Reinnervation With Regenerative Peripheral Nerve Interfaces Decreases Long-Term Narcotic Use in Amputees: A Case Control Study.

Purpose: Combined targeted muscle reinnervation with regenerative peripheral nerve interfaces ("TMRpni") is a recently described nerve management strategy that leverages beneficial elements of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) techniques. This study aimed to evaluate the effect of TMRpni on long-term opioid consumption after amputation. We hypothesize that TMRpni decreases chronic opioid consumption in amputees.

Revision Labiaplasty After Penile Inversion Vaginoplasty Using Costal Cartilage Allograft.

Background: Gender-affirming surgery leads to high satisfaction for patients; however, patients often require revision surgery. Revision labiaplasty is one of the most common surgeries following vaginoplasty. The labia minora commonly become incorporated into the labia majora and lose definition even after revision leading to patient dissatisfaction.

Surgical Techniques Following Free Cartilage Grafting.

Background: Reconstruction of surgical defects with free cartilage grafts poses unique challenges.

Objectives: To characterize surgical techniques following free cartilage grafting.

Materials And Methods: A literature review was performed using the Embase, PubMed Medline, Cochrane Library, ClinicalTrials.

ACTA2 Mutation: Microsurgeon Beware!

Patients with the alpha actin 2 genetic mutation suffer early onset aneurismal and vascular-occlusive conditions due to dysfunctional smooth muscle contractility. Outcomes of free flap reconstruction in this patient population are unknown. Here we report the case of a 21-year-old woman with alpha actin 2 mutation who required decompressive hemicraniectomy following an acute stroke.

TMRpni: Combining Two Peripheral Nerve Management Techniques.

Amputee patients suffer high rates of chronic neuropathic pain, residual limb dysfunction, and disability. Recently, targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are 2 techniques that have been advocated for such patients, given their ability to maximize intuitive prosthetic function while also minimizing neuropathic pain, such as residual and phantom limb pain. However, there remains room to further improve outcomes for our residual limb patients and patients suffering from symptomatic end neuromas.

Pulley Release and Reconstruction With Acellular Dermal Matrix After Zone 2 Flexor Tendon Injury.

Zone 2 flexor tendon repair has been historically associated with poor outcomes, mainly due to stiffness. In an effort to minimize adhesions, accommodate flexor digitorum profundus and flexor digitorum superficialis bulk, and prevent bowstringing, we have developed a novel approach to flexor tendon repair that relies on aggressive flexor tendon pulley release and pulley reconstruction with acellular dermal matrix. This technique leverages the antiadhesive properties and high tensile strength of acellular dermal matrix to maximize gliding and prevent bowstringing.

Pyogenic Flexor Tenosynovitis Caused by Shewanella putrefaciens.

Flexor tenosynovitis is a surgical emergency due to the risk of tendon necrosis which can lead to subsequent amputation. We report a case of flexor tenosynovitis with Shewanella putrefaciens as the implicated organism, though the patient's mechanism of penetrating trauma did not involve a marine exposure. Shewanella are Gram negative bacilli associated with marine environments and have rarely been implicated in human disease.

Trainee Operative Autonomy in Plastic Surgery.

Background: Appropriate, progressive trainee autonomy is critical for training competent plastic surgeons who are adequately prepared to enter independent practice. Evaluation and reporting of meaningful operative autonomy among trainees in plastic surgery are understudied.

Methods: Parallel survey instruments were developed using the Zwisch metric for progressive operative autonomy and distributed electronically to trainees and faculties in all accredited training programs.

The Anterolateral Thigh-Medial Femoral Condyle Chimeric Flow-through Flap for Posttraumatic Wrist Arthrodesis.

Wrist arthrodesis in the setting of segmental bone loss can have high failure rates. Therefore, vascularized bone grafting has been advocated for select patients. Patients suffering concomitant large soft tissue loss present even greater challenge.

Efficacy of Surgical Treatment of Migraine Headaches Involving the Auriculotemporal Nerve (Site V).

Background: This study reports the surgical technique and efficacy of treatment for the less commonly studied auriculotemporal nerve (site V). The aim was to evaluate symptom relief and differences in migraine headache parameters (i.e.

Use of a Doppler signal to confirm migraine headache trigger sites.

Background: The senior author (B.G.) has been able to use the Doppler as a tool for identifying the site of irritation of a nerve by an adjacent artery in different migraine trigger sites.

An in vitro fluid dynamic study of pediatric cannulae: the value of animal studies to predict human flow.

A challenge to the development of pediatric ventricular assist devices (PVADs) is the use of the aortic cannulae attached to the devices. Cannulae used for pediatric application have small diameters and large pressure drops. Furthermore, during the development of the 12cc Penn State pediatric PVAD, particle image velocimetry (PIV) illustrated that hematocrit levels, through changes in blood viscoelasticity, affected the fluid dynamics.

The influence of operational protocol on the fluid dynamics in the 12 cc Penn state pulsatile pediatric ventricular assist device: the effect of end-diastolic delay.

The success of adult ventricular assist devices (VADs), coupled with the high transplant waiting list mortality of infants (40%) has prompted Penn State to develop a pediatric version of the clinically successful adult device. Although the primary use of this device will be bridge-to-transplant, there has been sufficient clinical data to demonstrate the efficacy of VADs in a bridge-to-recovery setting. However, removing the patient from the device, a process known as weaning, demands operation of the device at a lower beat rate and concomitant increased risk for thromboembolism.

The 12 cc Penn State pulsatile pediatric ventricular assist device: fluid dynamics associated with valve selection.

The mortality rate for infants awaiting a heart transplant is 40% because of the extremely limited number of donor organs. Ventricular assist devices (VADs), a common bridge-to-transplant solution in adults, are becoming a viable option for pediatric patients. A major obstacle faced by VAD designers is thromboembolism.

The 12 cc Penn State pulsatile pediatric ventricular assist device: flow field observations at a reduced beat rate with application to weaning.

Ventricular assist devices (VADs) have become a viable option for adult patients with end-stage heart failure during the bridge-to-transplant period and have recently shown promise in aiding in myocardial recovery. Because the number of available organs is insufficient, mechanical circulatory support systems such as VADs are also being developed for use in pediatric patients. During myocardial recovery, the system must be weaned from the patient to prepare for explant; for pulsatile devices, this often includes a reduction in flow rate, which can change the fluid dynamics of the device.