bluuebunny/crossref_metadata_2025 huggingface dataset:
Abandoning the SIEA flap for the “Dual-Plane” DIEP Reduces Fat Necrosis and Flap Failure
Authors: Hembd Austin , Liu Yulun , Haddock Nicholas T. , Teotia Sumeet S.
Published: February 2023

Purpose:

Despite its limitations in abdominally based breast reconstruction, utilizing the superficial inferior epigastric artery (SIEA) flap or system can be advantageous in specific clinical scenarios. To optimize outcomes in these cases, we performed a retrospective review of our flap series to advocate a new algorithm to use the superficial system.

Methods:

A retrospective analysis was performed on 1700 consecutive free abdominal flaps for presence of a dominant superficial system or poor deep inferior epigastric artery perforators (DIEP) on clinical exam or angiography. In this setting, we analyzed the primary outcome measures of fat necrosis and flap failure with utilizing the superficial system alone versus a “dual-plane DIEP”, where there was an intra-flap anastomosis performed between the DIEP pedicle and SIEA pedicle. A multivariable analysis was performed with 21 other potentially confounding variables and compared to outcomes with traditionally perfused DIEP flaps.

Results:

Fat necrosis was present in 13% of 506 DIEP flaps, 34.1% of 41 SIEA system flaps, and 2.7% of 37 dual-plane DIEP flaps. Superficial system only flaps were independent predictors of fat necrosis (OR, 6.55; p < 0.001) and flap failure (OR, 9.82; p= 0.002) compared to dual-plane DIEP flaps when utilized for the same indications.

Conclusions:

In settings of superficial dominance or need to augment perfusion to lateral zones in abdominal free flaps, performing a dual-plane DIEP instead of utilizing the superficial system vasculature alone with an SIEA flap can decrease the odds of fat necrosis and flap failure to equal that of standard DIEP flap.
Autologous Platelet-Rich Plasma Treatment for Androgenic Alopecia: A Systematic Review and Meta-analysis of Clinical Trials on Patient Safety, Efficacy and Outcomes.
Authors: Papakonstantinou Menelaos , Siotos Charalampos , Gasteratos Konstantinos C. , Spyropoulou Georgia-Alexandra , Gentile Pietro
Published: February 2023

Background:

Androgenic alopecia (AGA) is a common condition associated with hair loss both in men and women (female pattern hair loss, FPHL), causing considerable psychological distress. Ongoing research focuses on novel safe, cost-effective and efficient treatments with the best patient outcomes. Autologous platelet-rich plasma (PRP) has become increasingly popular in the treatment of AGA compared to hair transplantation techniques. The present study aims to evaluate the outcomes of PRP as a treatment for AGA/FPHL.

Methods:

A computerized literature search was conducted on PubMed, clinicaltrials.gov and Cochrane Library for articles published until November 2020. The online screening process was performed by two independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses), and it was registered at the International Prospective Register of Systematic Reviews (PROSPERO) of the National Institute for Health Research (NIHR). Meta-analyses were performed by employing the Random Effects Model using the RevMan software.

Results:

The initial search yielded 49 randomized controlled clinical trials (RCTs). Eleven RCTs were included in the study based on a priori criteria. PRP injections significantly increased the number of hair follicles, hair thickness and density compared to placebo interventions. Also, the patients reported high overall satisfaction with the PRP treatment. Only temporary minor side effects were noted, including localized pain, bleeding and itching.

Conclusion:

Autologous PRP significantly improves alopecia in select patients. Future research should focus on optimizing PRP treatment protocols and minimizing possible adverse reactions.
“Perioperative intermittent fasting protects ischemic musculocutaneous flap tissue from necrosis”
Authors: Weinzierl Andrea , Harder Yves , Menger Michael D. , Laschke Matthias W.
Published: February 2023

Background:

Dietary restriction, such as intermittent fasting (IF), has previously been shown to protect various tissues from ischemia-induced necrosis. Based on this finding, we herein evaluated for the first time the tissue-protective effects of IF in musculocutaneous flaps.

Methods:

Male C57BL/6N mice were randomly assigned to an IF-group (n = 8) and a control group with unrestricted access to standard diet (n = 8). IF animals were put on a perioperative feeding schedule with 8 hours unrestricted access to standard diet per day starting 7 days before flap elevation up to 3 days after surgery. Random pattern musculocutaneous flaps were raised and mounted into a dorsal skinfold chamber. Intravital fluorescence microscopy was performed on days 1, 3, 5, 7 and 10 after surgery for the quantitative assessment of angiogenesis, nutritive blood perfusion and flap necrosis. After the in vivo observation period, the flaps were harvested for additional histological and immunohistochemical analyses.

Results:

We found that the IF-group exhibited more newly formed microvessels and a higher functional capillary density within the flap tissue when compared to controls. This was associated with a significantly lower rate of tissue necrosis. Immunohistochemical detection of different inflammatory cell subtypes revealed a markedly reduced number of invading myeloperoxidase positive neutrophilic granulocytes in the musculocutaneous tissue of IF-treated animals.

Conclusion:

Taken together, these findings indicate that IF prevents flap necrosis by maintaining nutritive tissue perfusion and suppressing ischemia-induced inflammation.
Preoperative Exam Is Not Associated with Postoperative Function following Radial Forearm Free Flap Harvest
Authors: Emanuelli Elisa , Egan Katie G , Bins Griffin , Nazir Niaman , Bur Andres M , Kakarala Kiran , Przylecki Wojciech , Endress Ryan
Published: February 2023

Purpose:

There is debate on utility of preoperative Allen’s test or ultrasound prior to radial forearm flap harvest. This study sought to evaluate correlations between preoperative testing and donor site morbidity.

Methods:

A survey of plastic surgery and otolaryngology radial forearm flap patients was conducted at a midwestern academic center. The modified Cold Intolerance Symptom Severity (modCISS) and Quick Disabilities of the Arm, Shoulder and Hand (QDASH) were administered. A retrospective chart review was performed to assess perioperative factors.

Results:

Of 212 radial forearm flaps completed over seven years, 144 patients were contacted and 71 patients completed the survey (33% response rate). Preoperative Allen’s test was negative in 92% of patients (65/71). There was no statistical association between Allen’s test and duplex ultrasound findings (p=.19). Cold intolerance screening was positive on 20% of donor arms (14/71), with an average positive modCISS score of 39.0 (SD 14.7). Disability was reported on the QDASH by 76% of patients (54/71), with an average score of 21.0 (SD 22.3). There was no statistical correlation between preoperative Allen’s test or ultrasound classification and modCISS or QDASH score. There was a borderline positive correlation between modCISS and QDASH scores that did not reach statistical significance (r=0.22, p=.067). Operative characteristics also did not predict modCISS or QDASH scores.

Conclusions:

Following radial forearm flap harvest, donor extremity cold intolerance is reported in 20% of patients, and extremity related disability in the majority of patients. Preoperative ultrasound and physical exam findings are not predictive of morbidity.
An Evidence-Based and Case-Based Comparison of Modern Facelift Techniques
Authors: Avashia Yash J. , Stuzin James M. , Cason Roger W. , Savetsky Ira L. , Rohrich Rod J.
Published: February 2023

Background:

Facial aging is a multifactorial process that affects each component of facial anatomy. The two general groups of facelift techniques are superficial musculoaponeurotic system (SMAS) elevation and SMAS manipulation. The purpose of this article is to describe and compare the advantages, disadvantages, and limitations of facelift techniques.

Methods:

A systematic review was performed to describe current outcomes evidence for facelift technique. A subcohort of articles were selected for case-based analysis based on designated facial assessment criteria. Analysis was performed to determine the advantages, disadvantages, and limitations of each respective technique.

Results:

A total of 65 articles were selected for systematic review of which 15 articles met criteria for case-based review. Patient satisfaction was found to be equivocal for various facelift techniques. Specific advantages and disadvantages for each facelift technique were dependent on the techniques’ approach to skin shift vector along with its degree of mobilizing superficial facial fat. Facial fat grafting was universally applicable for restoration of deep malar volume. Facial fat grafting was also used differently depending on the SMAS technique to address its specific limitations.

Conclusion:

Our review confirms that there are many methods to obtain excellent outcomes in facial rejuvenation. Experienced surgeons are able to obtain consistent results through a variety of techniques based on understanding the aesthetic needs of the individual patient, the quality of the soft tissues being manipulated, as well as how to vary a specific technique to reach desired aesthetic endpoints.
Turnover lengthening of the ECRB tendon does not alter the biomechanical strength of PT to ECRB tendon transfer
Authors: Weber Erin L. , Schmidt Elaine C. , Steinberger Zvi , Dardas Agnes Z. , Hast Michael W. , Levin L. Scott
Published: February 2023

Background:

The pronator teres (PT) to extensor carpi radialis brevis (ECRB) tendon transfer reestablishes wrist extension. Occasionally, the PT periosteal extension is of suboptimal quality to support a strong transfer. In these instances, turnover lengthening techniques can increase usable tendon length. This study characterized the optimal length of tendon turnover and the effect of lengthening on transfer strength.

Methods:

Twenty-seven cadaveric extensor tendons were lengthened using the turnover lengthening technique with 1-3 centimeters of tendon overlap. PT to ECRB tendon transfers were performed with native or lengthened ECRB tendons. Tensile testing was used to evaluate stress-relaxation and load to failure.

Results:

The median maximum load to failure increased with increasing overlap length, measuring 35.6 N (Q1 30.2, Q3 38.6) for 1 cm, 66.0 N (59.1, 74.7) for 2 cm, and 96.6 N (85.9, 114.9) for 3 cm of overlap (p<0.05). Failure occurred most frequently at the junction of the central overlap and native tendon. Tendons lengthened with 2 and 3 cm of overlap displayed greater stiffness than with 1 cm (p<0.05). Lengthening the ECRB tendon with 2 or 3 cm of overlap did not disrupt the strength or stiffness of subsequent PT to ECRB tendon transfers.

Conclusions:

Turnover tendon lengthening does not detrimentally affect PT to ECRB tendon transfer.

Greater overlap lengthening distance confers greater stiffness and resistance to rupture. When the periosteal extension of the PT tendon avulses or is poor quality, the ECRB tendon can be lengthened using the turnover tendon lengthening technique to facilitate a robust transfer.
TikTok: Is it Time to Start Trending with #PlasticSurgery?
Authors: Long Emily A. , Shiah Eric , Lin Samuel J.
Published: February 2023

Background:

TikTok is a short-form video social media platform created in 2016 that has rapidly grown in popularity. The aim of this study was to examine trending plastic surgery videos on TikTok and to understand the dynamics of the #PlasticSurgery conversation on this relatively new social media platform.

Methods:

A prospective analysis of TikTok videos identified by directly querying the platform using #PlasticSurgery was performed during November 2020. Top trending videos at time of data collection, defined as having greater than 100,000 likes, were included. Videos were analyzed for user credentials, video engagement (number of views, likes, shares, and comments), associated hashtags, and video purpose and content.

Results:

The top 376 trending videos were viewed a total of 1,680,910,700 times at time of analysis. Videos made by board-certified plastic surgeons on average were more popular than videos made by non-plastic surgeons (490.4 vs. 378.6 million likes, p=0.006; 5.1 vs. 3.8 billion views, p=0.046). The most popular procedures featured were augmentation mammoplasty (531,143,800 views; 42,825,400 likes), followed by body contouring procedures such as liposuction and abdominoplasty (276,810,500 views; 22,362,000 likes), and rhinoplasty (243,724,100 views; 27,588,200 likes). Educational videos on average had significantly higher levels of engagement than entertainment-focused videos (549,336 vs. 340,163 likes, p=0.002; 6.3 vs. 2.9 million views, p<0.001).

Conclusions:

Videos about plastic surgery, particularly educational videos by board-certified plastic surgeons, perform exceptionally well on the TikTok platform. TikTok presents an opportunity for plastic surgeons to educate patients about plastic surgery procedures and to present themselves as board-certified plastic surgeons.
Analysis of Contralateral Perfusion in the DIEP Flap Using a Response Surface Methodology: Role of the Location of the Perforator, Umbilicus, and Midline Crossing-over Vessel
Authors: Min Kyunghyun , Oh So Min , Kim Eun Key , Eom Jin Sup , Han Hyun Ho
Published: February 2023

Background:

During breast reconstruction, predicting contralateral perfusion of the deep inferior epigastric artery perforator (DIEP) flap can help minimize tissue necrosis. This study aimed to quantify the area of contralateral perfusion and identify the factors affecting it.

Methods:

A retrospective study was conducted on unilateral breast reconstructions with a single perforator-based DIEP flap, for the period 2017–2019. Data on the distance between the perforator and the umbilicus, and the grade of the midline crossing-over vessel (G0: no vessel, G1: suspicious vessel, G2: definite vessel) were collected. Contralateral perfusion was estimated using intraoperative indocyanine green angiography, and the degree of contralateral circulation based on perforator location was assessed using a response surface methodology (RSM) analysis.

Results:

The study included 143 patients (G0: 62, G1: 45, G2: 36). The average length of transverse contralateral flap perfusion (contralateral circulation area / vertical height of the flap) increased as the crossing-over vessel grade increased (G0: 62.96 ± 20.33 mm, G1: 71.69 ± 20.66 mm, G2: 81.1 ± 19.32 mm; p = 0.0002). In the RSM analysis, contralateral perfusion was the least when the perforator was located near the umbilicus (G0: within a 10 mm radius, G1: less than 10 mm transverse distance; 16 mm to 22 mm vertical distance, G2: within a 20 mm radius).

Conclusions:

The umbilicus can interfere with contralateral perfusion; thus, a definite presence of a midline crossing-over vessel ensures robust contralateral perfusion. The results of this study would help surgeons select the optimal single perforator prior to surgery.
Prophylactic application of human adipose tissue-derived products to prevent radiation disorders
Authors: Sowa Yoshihiro , Inafuku Naoki , Kishida Tsunao , Mori Masanori , Mazda Osam , Yoshimura Kotaro
Published: February 2023

Introduction:

Radiation therapy is now a mainstay treatment for malignancies, but it can induce deterministic adverse effects in surrounding healthy tissues, including atrophy, fibrosis, ischemia, and impaired wound healing. In this exploratory study, we aimed to investigate whether a prophylactic administration of products containing adipose tissue-derived stem cells immediately after radiotherapy could prevent the development of long-term functional disorders in irradiated tissues.

Methods:

A total irradiation dose of 40 Gy (10 Gy, four times weekly) was delivered to the dorsal skin of nude mice. Subsequently, a prophylactic treatment with vehicle, fat tissue, stromal vascular fraction (SVF), or micronized cellular adipose matrix (MCAM) was subcutaneously injected into the irradiated area. Six months after these prophylactic treatments, a cutaneous punch wound was created to evaluate histological changes and wound healing.

Results:

Histological assessments demonstrated dermal thickening, atrophy, and increased collagen deposits in the subcutaneous fatty layer 6 months after radiotherapy. In addition, wound healing was significantly delayed. The prophylactic treatments with three different types of human adipose tissue-derived products significantly prevented the radiation-induced histological changes and accelerated wound healing compared with the vehicle-treated irradiated group.

Conclusion:

This is the first study to demonstrate a potential of the prophylactic treatments after radiotherapy, which could prevent the progression of chronic radiation disorders. The results could have a substantial impact on current anticancer radiotherapies; a next-generation radiation therapy may need to be always combined with a stem cell therapy. Such prophylactic treatments have the potential to improve wound healing of irradiated tissue and clinical outcomes of reconstructive surgery required after cancer radiotherapy.
Outcomes, Evolving Concepts, Technical Refinements, and Challenges in the Repair of Full-Thickness Nasal Defects Requiring Microvascular Lining
Authors: Menick Frederick , Salibian Arthur
Published: February 2023

Repair of full thickness nasal defects may require distant tissue, when local or regional donors are inadequate or unavailable. Our microvascular designs, technical details, and complications using a radial forearm flap to restore nasal lining have been described in past publications. In this paper, we review Stages 2-5, using a forehead flap and rib grafts to resurface the nose and build a support framework. We examine our complications, long term aesthetic and functional outcomes, clinical refinements, and continuing reconstructive challenges.

Materials and Methods:

38 full thickness nasal defects were repaired between 2001 and 2018. Records review identified the type and frequency of complications and their management. Patients were surveyed to determine their overall satisfaction, quality of life, restoration to a normal appearance, donor scars, the value of a late revision, airway function and need for nasal stents. Postoperative results were classified by independent evaluators as very good, good, fair, and poor.

Results:

Repair was completed in 35 of 38 patients. 53% of patients returned an anonymous survey. 85% were very satisfied. 75% declared excellent, very good or good breathing. 75% used stents never/rarely. 95% looked normal. 95% would recommend to other patients. An independent review classified the aesthetic results as 94% very good to good, 3% fair and 3% poor.

Conclusions:

A folded Radial Forearm Lining Flap, a 3 Stage Full Thickness Forehead Flap for cov er and a Late Revision can repair difficult nasal defects, as shown in a large series of patients with long term follow-up.
Impact of Adding Carpal Tunnel Release or Trigger Finger Release to Carpometacarpal Arthroplasty on Postoperative Complications”
Authors: Trinh Pavin , Luan Anna , Tawfik Vivianne L. , Sheckter Clifford , Rochlin Danielle , Fox Paige , Curtin Catherine
Published: February 2023

Background:

This study assessed whether adding trigger finger or carpal tunnel release at the time of thumb carpometacarpal (CMC) arthroplasty would increase postoperative opioid use, readmissions, complications, and development of CRPS.

Methods:

Using the IBM ® MarketScan ® Research Databases from 2012 to 2016, we identified a two groups of CMC arthroplasty patients. The “CMC only” group only had a CMC arthroplasty on the day of operation. The “multiple procedures” group had a CMC arthroplasty and concurrent carpal tunnel and / or trigger finger release. Between the two groups, we compared persistent opioid use, 30-day readmissions, 30-day complications, and diagnosis of complex regional pain syndrome (CRPS).

Results:

The CMC only group consisted of 18,010 patients. The multiple procedures group consisted of 4,064 patients. These patients received a CMC arthroplasty and a carpal tunnel release (74%), a trigger finger release (20%), or both (6%). CMC only patients had lower rates of persistent opioid use compared to patients who underwent multiple procedures (16% vs 18%). Readmission rates were also lower for CMC only patients (3% vs 4%). CMC only patients had decreased odds of persistent opioid use (OR=0.85; 95% CI, 0.75-0.97, p=0.013) and readmissions (OR=0.80; 95% CI, 0.67-0.96, p=0.016). The most common reason for readmission was pain (16%).

Conclusions:

Adding another procedure to a CMC arthroplasty slightly increases the odds of adverse outcomes such as persistent opioid use and readmission. Patients and providers should weigh the efficiency of doing these procedures concurrently against the risk of performing multiple procedures at once.

Clinical Question / Level of Evidence:

Risk, II
Systematic review: Platelet-rich plasma (PRP) use in facial rejuvenation.
Authors: Gentile Pietro , Garcovich Simone
Published: February 2023

Background:

An increasing interest in maintaining a youthful appearance has led to the development of innovative and non-invasive aesthetic procedures for the treatment of facial aging as the recent use of Autologous Platelet-Rich Plasma (PRP).

Objectives:

This article aims to review the literature and critically appraise the available evidence regarding the efficacy of autologous activated PRP (AA-PRP) and/or not-activated PRP (ANA-PRP) injection used for facial rejuvenation.

Methods:

A systematic review regarding the clinical use of AA-PRP and ANA-PRP injection in facial rejuvenation against signs of aging was performed using PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus, and Cochrane databases. The protocol was developed following the Preferred Reporting for Items for Systematic Reviews-Protocols (PRISMA-P) guidelines. The included studies had to match predetermined criteria according to the PICOS approach.

Results:

Eleven of the twelve studies identified, including three randomized split-face trials, showed improved results despite differences in study design and outcome measures, many of which were subjective.

Conclusions:

Further randomized controlled trials and related systematic reviews, as evidence-based medicine (EBM) studies of level 1 are required to confirm PRP injection efficacy in facial rejuvenation, to consolidate the promising results of the studies identified in this systematic review.
Five Principle and Five Step Liquid Rhinoplasty
Authors: Rohrich Rod J. , Novak Matthew , Alleyne Brendan , Bellamy Justin
Published: February 2023

Liquid rhinoplasty, otherwise known as nonsurgical or filler rhinoplasty, has earned increased attention for its ability to provide surgical rhinoplasty results at a fraction of the cost and without incising the skin. However, significant complications can arise such as tissue necrosis, filler embolus, and vascular compromise if performed without considering the principles and anatomy of the face and nose. As demonstrated in the following article, a stepwise and patient specific approach to performing liquid rhinoplasty will ensure safe, consistent, and desirable results.
Compound Muscle Action Potential Amplitude as a Predictor of Functional and Patient-Reported Outcomes in Ulnar Neuropathy at the Elbow
Authors: Florczynski Matthew M. , Kong Lingxuan , Burns Patricia B. , Wang Lu , Chung Kevin C.
Published: February 2023

Background:

Ulnar neuropathy at the elbow (UNE) is a debilitating upper extremity condition that often leaves patients with residual symptoms even after surgical treatment. The role of electrodiagnostic studies (EDX) in guiding the treatment of UNE is not well established, and conventional electrodiagnostic parameters may not reflect the severity of disease. Compound muscle action potential (CMAP) amplitude is a parameter that corresponds with axonal injury and motor symptoms and may more accurately predict the severity of neurologic injury.

Methods:

This prospective multi-center study recruited 78 patients in the Surgery of the Ulnar Nerve (SUN) project. Patients underwent electrodiagnostic testing, clinical assessment of motor and sensory function, and completed patient-reported outcome (PRO) questionnaires, including the Michigan Hand Questionnaire (MHQ), Disability of the Arm, Shoulder and Hand (DASH) questionnaire, and Carpal Tunnel Questionnaire (CTQ). Correlations were measured among each of the electrodiagnostic parameters and outcomes and predictive models for each outcome were subsequently developed.

Results:

Of all the electrodiagnostic parameters measured, only CMAP amplitude was predictive of scores on the MHQ, DASH, CTQ function scale, and motor impairment in grip and pinch strength. None of the parameters were predictive of scores on the CTQ symptom scale or sensory impairments as measured with 2-point discrimination or Semmes-Weinstein monofilament testing.

Conclusions:

CMAP amplitude, but not other conventional electrodiagnostic parameters, is predictive of functional outcomes in UNE. This electrodiagnostic measurement can alert the clinician to severe cases of UNE and inform surgical decision-making.
The fate of sensation in non-innervated perforator free flaps in the lower extremity
Authors: Kim Hyung Bae , Cho Jung Mok , Abdelfattah Usama , López Roberto Vilchis , Pak Changsik John , Suh HyunSuk Peter , Hong Joon Pio
Published: February 2023

Introduction:

The recovery of sensation for non-innervated perforator flap is not well understood. This prospective study aims to evaluate the quality, tendency and related factors for recovery of sensation.

Material and Methods:

Total of 187 patients over a 6-year period were evaluated at 3, 6, 12, +24 months intervals for demographic data and sensory tests (Semmes-Weinstein(SW) monofilament test, static two-point discrimination(2PD), temperature and pain) on peripheral and central region of the flap. Further detailed assessment using SW monofilament test was made according to flap thickness, size, type and recipient sites. Factors correlated to poor recovery was evaluated.

Results:

Among the flaps tested, 5.07 SW monofilament test revealed the peripheral flap sensory recovery was achieved in 72% at +24 months with a significantly increasing linear trend (P<0.001). However, the central recovery was noted only in 26-28%. The 2PD was achieved in 21% without a significant trend whereas temperature and pain showed significant improvement achieving 49% and 64% on the peripheral and 22% and 31% for central region respectively. The flap thickness, size, type and recipient sites did not exert significance. Only smoking was a significant factor of 13-times higher odds hindering sensory recovery.

Conclusion:

The SW monofilament test, temperature and pain sensation on the periphery of the flap showed increasing trend of recovery over the +24 months. Among the various factors, only smoking attenuated recovery. Understanding the fate of sensory recovery in non-innervated perforator flaps will allow the surgeons to further customize the reconstruction based on the defect and maximize efficiency.
Prevention and resolution of silicone implant related problems in secondary rhinoplasty with cross-linked human acellular dermal matrix (MegaDerm TM)
Authors: Kook Won Suk , Ryu Da Hye , Baek Wooyeol , Kook Hye Min , Jang Yoon young , Lew Dae Hyun
Published: February 2023

Background:

Silicone implant augmentation rhinoplasty along with various tip plasties are commonly performed in Asians but requires a revision rhinoplasty due to various problems frequently. Secondary rhinoplasties are often done using silicone, dermo-fat, costal cartilage block or diced rib cartilage, but often result in unsatisfactory outcomes. This study assessed the surgical outcomes and complications of cross-linked-ADM as an alternative biological substitute for silicone implant in secondary rhinoplasty.

Methods:

We prospectively studied 56 patients with a minimum follow-up of 1 year among 104 patients who underwent secondary rhinoplasty in our clinic between Jan.2015-Dec.2018. Silicone implant, capsule, scar tissue were removed, underwent dorsal augmentation with ADM, and tip plasty using autogenous cartilage for all of them. The results were assessed using modified ROE consisting of 10-item questionnaire which were fulfilled on 3 separate occasions, preoperative, 6 months postop and over 1 year postop.

Result:

One infection and 3 cases of excessive resorption were noted with no other major complications. The mean modified ROE score was 31.7 on preoperative evaluation, 77.3 on postop. 6 month and 81.4 on a year over postop. (mean difference was 45.6, 49.7 respectively; P<0.001).

Conclusion:

Various problems that occur after the primary rhinoplasty using silicone implant can be successfully resolved with the secondary rhinoplasty by dorsal augmentation using the cross-linked human ADM along with various nasal tip works using autogenous cartilage. Surgical outcome showed favorable resolution of contracture deformities, low infection rate, firm fixation of the implant, good skin texture/thickness of SSTE, and gain of desired height and dorsal line.
Cranial Shape Changes in Non-syndromic Unilateral Lambdoid Synostosis after Open Posterior Vault Remodeling
Authors: Nguyen Andy , Purnell Chad , Mercan Ezgi , Lee Amy , Birgfeld Craig B. , Susarla Srinivas , Ellenbogen Richard G. , Hopper Richard A.
Published: February 2023

Background:

The purpose was to quantify change in cranial morphology in non-syndromic unilateral lambdoid craniosynostosis (ULC) patients from presentation (t0), after open posterior switch-cranioplasty (t1), and at two-year follow-up (t2).

Methods:

Volumetric, linear and angular analysis were performed on computed tomographic scans at the three timepoints and against normal controls. Significance was set at p<0.05.

Results:

Twenty-two patients were included. ULC cranial vault asymmetry index (CVAI) was higher than controls before surgery (6.22 ± 3.55) but decreased after surgery (3.00 ± 2.53) to become comparable to the normal asymmetry range present in the controls. After surgery both diagonals increased, but more on the fused side. In the two years after surgery, both diagonals in ULC grew proportionately, but the fused diagonal remained slightly shorter than the patient side. Total cranial volume was higher in ULC than controls after surgery but became comparable at t2. Cranial base angulation improved by t2 but did not approach normal and ear position remained unchanged. The facial twist was higher than controls at t0 and t1 but was comparable at t2. Coronal asymmetry improved with surgery but remained under-corrected at t2, with the greatest residual asymmetry at opisthion.

Conclusions:

Open switch cranioplasty normalizes CVAI by increasing the fused cranial diagonal more than the patent and is stable at two years. Skull base twist does not normalize but facial twist approaches normal. Technique improvement should focus on residual coronal asymmetry present at opisthion.

LEVEL OF EVIDENCE:

III
“Facial Expression After Face Transplant: The First International Face Transplant Cohort Comparison”
Authors: Dorante Miguel I. , Wang Alice T. , Kollar Branislav , Perry Bridget J. , Ertosun Mustafa G. , Lindford Andrew J. , Kiukas Emma-Lotta , Özkan Ömer , Özkan Özlenen , Lassus Patrik , Pomahac Bohdan
Published: February 2023

Background:

Assessment of motor function restoration following face transplant (FT) is difficult as standardized, bilateral tests are lacking. This study aims to bolster support for software-based analysis through international collaboration.

Methods:

FaceReader (Noldus, Wageningen, Netherlands), a facial expression analysis software, was used to analyze post-transplant videos of 8 FT patients from Boston, USA (range, 1–9 years), 2 FT patients from Helsinki, FIN (range, 3–4 years), and 3 FT patients from Antalya, TUR (range, 6.5–8.5 years). Age-matched healthy controls from respective countries had no history of prior facial procedures. Videos contained patients and controls performing facial expressions evaluated by software analysis using the Facial Action Coding System. Facial movements were assigned intensity score values between 0 (absent) and 1 (fully present). Maximum values were compared to respective healthy controls to calculate percent restoration.

Results:

Out of 13 FT patients, 8 were full FT, 5 were partial FT and 2 patients were female. Compared to healthy controls, the median restoration of motor function was 36.9% (IQR 28.8%-52.9%) for all patients with FT (p=0.151). The median restoration of smile was 37.2% (IQR 31.5%- 52.7%) in all patients with FT (p=0.065). When facial nerve coaptation was performed at distal branch level, average motor function restoration was 42.7% ± 3.61% compared to 27.9% ± 6.71% at proximal trunk coaptation level (p=0.032). Use of interpositional nerve grafts had no influence on motor outcomes.

Conclusion:

Software-based analysis is suitable to assess motor function after FT. International collaboration strengthens outcome data for FT.
Variable Anatomy of the Lateral Upper Arm Lymphatic Channel: A Potential Anatomic Risk Factor for the Development of Breast Cancer Related Lymphedema
Authors: Granoff Melisa D. , Pardo Jaime , Shillue Kathy , Fleishman Aaron , Teller Paige , Lee Bernard T. , James Ted , Singhal Dhruv
Published: February 2023

Background:

The lateral upper arm channel is an accessory lymphatic pathway that drains the upper extremity via the deltopectoral groove and supraclavicular nodes, thereby bypassing the axilla. Its variable connectivity to the forearm has not been studied in vivo.

Methods:

Indocyanine green (ICG) lymphography was performed pre-operatively to map the superficial and functional arm lymphatics in breast cancer patients without clinical or objective evidence of lymphedema. A retrospective review was performed to extract demographic, ICG imaging, and surgical data.

Results:

Sixty patients underwent ICG lymphography prior to axillary lymph node dissection between June 2019 and October 2020. In 59%, the lateral upper arm lymphatic channel was contiguous with the forearm (long bundle). In 38%, the lateral upper arm lymphatic channel was present but not contiguous with the forearm (short bundle). In 3%, the lateral upper arm pathway was entirely absent. Seven patients developed at least one sign of lymphedema during post-operative surveillance, of which 71% demonstrated the short bundle variant.

Conclusions:

While the lateral upper arm pathway is most often present, its connections to the forearm are frequently absent (short bundle) and, in this pilot report, appears to represent a potential risk factor for the development of lymphedema.
Reducing Medication Errors in Children’s Hospitals
Authors: Liu Kai-Wen , Shih Ya-Fen , Chiang Yi-Jung , Chen Lih-Ju , Lee Cheng-Han , Chen Hsiao-Neng , Chen Jia-Yuh , Hsiao Chien-Chou
Published: February 2023

Objectives

Knowledge of the prevalence and characteristics of medication errors in pediatric and neonatal patients is limited. This study aimed to evaluate the incidence and medication error characteristics in a pediatric hospital over 5 years and to determine whether serial error prevention programs to optimize a computerized physician order entry (CPOE) system reduce error incidence.

Methods

We retrospectively reviewed medication errors documented between January 2015 and December 2019.

Results

A total of 2,591,596 prescriptions were checked, and 255 errors were identified. Wrong dose prescriptions constituted the most common errors (56.9%). Medications with the highest rate of errors were antibiotics/antiviral drugs (36.9%). Oral route medications comprised the highest portion (60.8%), followed by intravenous ones (28.6%). The most common stage for medication errors was physician ordering (93.3%). Junior residents were responsible for most errors (45.9%). Most errors occurred in the pediatric ward (53.7%). In total, 221 (86.7%) errors were near misses. Only 4 errors (1.6%) were considered significant and required active monitoring or intervention. Type of error, stage of error, staff composition, and severity level of errors were significantly related to the number of errors in different years. There was a statistically significant decrease in errors per 100,000 prescriptions across different years after optimizing the CPOE system.

Conclusions

The incidence of medication errors decreased with extensive use of the CPOE system. Continuous application of the CPOE optimization program can effectively reduce medication errors. Further incorporation of pediatric-specific decision-making and support tools and error prevention measures into CPOE systems is needed.
Race Differences in a Malpractice Event Database in a Large Healthcare System
Authors: Thomas Angela D. , Pandit Chinmay , Krevat Seth A.
Published: February 2023

Objectives

This study aimed to determine whether potential malpractice events reported by employees, malpractice events involving claims, and malpractice lawsuits differ based on patient race in a large 10-hospital healthcare system.

Methods

Data in a healthcare system’s malpractice database from July 1, 2012, to June 30, 2017, were stratified by patient race using “Black,” “White,” and “other” categories. χ
2 Goodness-of-fit tests were used to compare differences in race proportions in employee-reported observations of events that could lead to payment of a claim, claims not involving the court, and lawsuits involving the court.

Results

There were significantly more employee-reported observations and claims for White patients and significantly fewer observations and claims for Black patients than expected based on the race proportions in the overall healthcare system patient population (P < 0.001). There were no significant race differences in lawsuits (Black patients, P = 0.146; White patients, P = 0.061; other patients, P = 0.458). Four of the 10 hospitals in the healthcare system had significant race differences in potential malpractice events (hospital A, P < 0.001; hospital B, P = 0.011; hospital E, P < 0.001; hospital G, P = 0.010).

Conclusions

Our findings reveal the existence of race differences in potential malpractice events in a large healthcare system. By proactively investigating, understanding, and addressing racial disparities in patient safety events, including those recorded in malpractice databases, healthcare systems can help advance initiatives to provide high-quality and equitable care to patients.
Closed-Loop Communication in Interprofessional Emergency Teams: A Cross-Sectional Observation Study on the Use of Closed-Loop Communication Among Anesthesia Personnel
Authors: Gjøvikli Kristin , Valeberg Berit T.
Published: February 2023

Objectives

Communication failure is one of the most common causes of adverse events in hospitals and poses a direct threat to patient safety. Research recommends the use of closed-loop communication in interprofessional emergency teams to prevent such events. Multiple studies have examined closed-loop communication during simulation training, but few have investigated its use in clinical practice. The aim of the study was to explore the use of closed-loop communication by anesthesia personnel in real-life interprofessional emergency teams.

Methods

This study had a descriptive, cross-sectional design where structured field observations were used to assess anesthesia personnel’s use of closed-loop communication in real-life interprofessional emergency teams. A total of 60 interprofessional teams were observed, including 120 anesthesia personnel at a hospital in South-Eastern Norway. Data were analyzed using descriptive statistics.

Results

A total of 1626 call outs were registered, in which closed-loop communication was applied in 45%. Closed-loop communication was used more frequently when call outs were directed using eye contact and when the call outs were medication orders. There was no difference in the use of closed-loop communication between nurse anesthetists and anesthesiologists. Closed-loop communication was used more frequently in cardiac arrest teams than in trauma teams.

Conclusions

The findings in this study have contributed knowledge about anesthesia personnel’s use of closed-loop communication in real-life interprofessional emergency teams and indicate a potential for improvement. Further research is needed about real-life interprofessional emergency teams’ communication patterns and potential barriers from using closed-loop communication, with the aim to improve patient safety.
Positioning efficacy and comfort profile of shoulder support braces: A randomized repeated-measures study using three-dimensional kinematic analysis
Authors: Turgut Elif , Uysal Ozgun , Duzgun Irem
Published: February 2023

Background:

Shoulder bracing is very common in musculoskeletal rehabilitation.

Objective:

In this study, the positioning efficacy of shoulder support braces was investigated by analyzing their three-dimensional kinematic properties, as well as their perceived comfort was investigated with user ratings.

Study design:

A randomized repeated-measures study.

Methods:

Seventeen asymptomatic participants were included. Scapular, humeral, and thoracic kinematics for all participants were measured using an electromagnetic tracking device in 6 experiments in randomized order: no brace, neutral brace, abduction brace, internal rotation brace, 15-degree external rotation brace (ER15-B), and 30-degree external rotation brace (ER30-B). Also, comfort ratings were obtained during each session.

Results:

Internal rotation brace achieved a mean of 29.34° of humerothoracic internal rotation while providing increased scapular internal rotation and upward rotation (p < 0.05). Abduction brace achieved a mean of 45.39° of humerothoracic and 39.58° of glenohumeral elevation coupled with increased scapular upward rotation, posterior tilt, and humeral internal rotation (p < 0.05). 30-Degree external rotation brace achieved a mean of 33.25° of glenohumeral external rotation and resulted in increased scapular external rotation, upward rotation, posterior tilt, and humeral external rotation (p < 0.05). Abduction brace, internal rotation brace, ER15-B, and ER30-B moved the thoracic spine into a more axial rotation in the contralateral direction. Internal rotation brace, ER15-B, and ER30-B were rated more uncomfortable when compared with the no brace condition, with no significant differences observed among the braces.

Conclusions:

The positioning efficacy was enhanced when an abduction pillow and external rotation wedge were applied. Selection of commercially available shoulder support braces should involve consideration of whether it can achieve the desired position and orientation as well as its comfort profile.
Clinical Characteristics and Computed Tomography Findings in Adult Patients With an Aberrant Right Subclavian Artery: A Single-Center Retrospective Cohort Study
Authors: Cortés Pedro , Harris Dana M. , Stancampiano Fernando F. , Valery Jose R. , Bi Yan , Alsafi Wail , Bakhit Mohamed , Shaikheldin Ahmed , Grage Rolf A. , Stowell Justin T. , Cid Omar J. , Heckman Michael G. , White Launia , Sonavane Sushilkumar K.
Published: February 2023

Objective

We sought to determine the prevalence and possible features associated with symptoms in adult patients diagnosed with an aberrant right subclavian artery (ARSA).

Methods

In this single-center retrospective study, 386 adult patients were diagnosed with ARSA on chest CT scans performed between June 2016 and April 2021. Patients were grouped by the presence of symptoms, which included dysphagia, shortness of breath, cough, and upper airway wheezing. Four cardiothoracic radiologists reviewed the chest CT scans to assess features of ARSA. Agreement and multivariable logistic regression analyses were performed to determine interobserver variability and features associated with the presence of symptoms, respectively.

Results

The prevalence of ARSA was 1.02% and 81.3% of patients were asymptomatic. Shortness of breath (74.6%) was the most common symptom. Interobserver agreement was acceptable with most variables having an interclass correlation coefficient or κ >0.80. A patient's height > 158 cm (OR: 2.50, P = 0.03), cross-sectional area > 60 mm2 of ARSA at the level of the esophagus (OR: 2.39, P = 0.046), and angle >108 degrees formed with the aortic arch (OR: 1.99, P = 0.03) were associated with the presence of symptoms on multivariable logistic regression. A distance increase per 1 mm between ARSA and trachea (OR: 0.85, P = 0.02) was associated with decreased odds of symptoms.

Conclusions

Aberrant right subclavian artery is an incidental finding in most adult patients. The cross-sectional area at the level of the esophagus, angle formed with the medial wall of the aortic arch, distance between the ARSA and the trachea, and a patient's height were features associated with the presence of symptoms.
Ibandronate in the Prevention of Vertebral and Nonvertebral Osteoporotic Fractures
Authors: Mendes Diogo , Penedones Ana , Alves Carlos , Oliveira Tânia , Donato António , Batel-Marques Francisco
Published: February 2023

Background/Objective

This study aims to evaluate ibandronate clinical effectiveness in the prevention of osteoporosis-related vertebral fractures (VFs) and nonvertebral fractures (NVFs) in the treatment of postmenopausal osteoporosis.

Methods

This systematic review was conducted in accordance with the Centre for Reviews and Dissemination's guidance and reporting in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement 2020. A literature search was performed in PubMed and EMBASE since their inception until February 7, 2022. Randomized controlled trials (RCTs), meta-analysis, experimental, and observational studies evaluating adult patients treated with ibandronate and assessed to osteoporotic fractures prevention were included. The risk of bias was assessed according to study design. Data were analyzed using descriptive statistics.

Results

Eight references from 4 RCTs, 7 meta-analyses, and 6 observational studies were included. In RCTs, oral ibandronate was superior to placebo in the prevention of VF. However, the doses were lower than those approved. The meta-analyses confirmed these results and showed that adequate doses of oral ibandronate reduce the risk of NVF compared with insufficient doses. In observational studies, oral ibandronate (in approved doses) reduced the risk of VF compared with no treatment or risedronate or alendronate and the risk of NVF versus risedronate or alendronate; the risk of hip fractures was similar between ibandronate and other oral bisphosphonates.

Conclusions

There is strong evidence that ibandronate reduces the risk of VF in postmenopausal osteoporosis. The available evidence further suggests that ibandronate may reduce the risk of NVF versus insufficient doses of ibandronate, as well as risedronate or alendronate.