bluuebunny/crossref_metadata_2025 huggingface dataset:
Intranasal Dexmedetomidine Use in Pediatric Patients for Anxiolysis in the Emergency Department
Authors: Kenneally Allison , Cummins Megan , Bailey Abby , Yackey Katelyn , Jones Landon , Carter Craig , Dugan Adam , Baum Regan A.
Published: February 2023

Objectives

In recent years, dexmedetomidine has gained traction as a treatment for anxiolysis in the emergency department (ED). When used with an atomizer, it may also be given intranasally for anxiolysis. The primary objective was to determine the level of ED provider satisfaction and comfort with intranasal (IN) dexmedetomidine for anxiolysis in pediatric patients with behavioral agitation and/or acute psychosis. The secondary objectives included determining safety, rates of therapy failure, and ED length of stay compared with oral midazolam. The efficacy of IN dexmedetomidine versus oral midazolam in patients with autism spectrum disorder (ASD) was also evaluated.

Methods

This was a single-center, prospective study in a pediatric ED from March 1 to December 31, 2021. Patients were included in the study if the ED provider requested IN dexmedetomidine anxiolysis and completed a postadministration survey. Safety and efficacy outcomes were assessed by chart review and compared with patients who received oral midazolam during the same study period. Efficacy was defined as the rate of treatment failure, as the need for procedural termination, progression to procedural sedation, or the requirement of additional medications for anxiolysis.

Results

Sixty-two patients received IN dexmedetomidine {median dose [interquartile range (IQR)] of 3.05 [2.04–4.00] μg/kg/dose} compared with 58 who received oral midazolam [median (IQR) dose of 0.29 (0.25–0.48) mg/kg/dose). Providers reported high comfort and satisfaction scores, with median (IQR) scores of 90 (75–100) and 88 (60–100) of 100. Twenty-nine percent of patients experienced treatment failure, most commonly because of the need for additional medications. Those who received IN dexmedetomidine had a longer ED length of stay (6.0 vs 4.4 hours, P = 0.010). Among the patients with ASD, those who received IN dexmedetomidine had a lower rate of treatment failure compared with oral midazolam (21.2% vs 66.7%, P = 0.039).

Conclusions

This study demonstrates that IN dexmedetomidine has high levels of provider comfort and satisfaction, moderately high success rate, and a promising safety profile. In addition, IN dexmedetomidine may be superior to oral midazolam in patients with ASD for anxiolysis, but additional studies are needed.
Nuclear β-Catenin Expression in the Context of Abnormal p53 Expression Indicates a Nonserous Histotype in Endometrial Carcinoma
Authors: Keyhanian Kianoosh , Yang Eric J. , Howitt Brooke E.
Published: February 2023

The interobserver reproducibility is poor for histotyping within the p53-abnormal molecular category of endometrial carcinomas (ECs); therefore, biomarkers that improve histologic classification are useful. β-catenin has been proposed to have prognostic significance in specific clinicopathologic and molecular contexts. The diagnostic utility for β-catenin expression patterns in determining the histotype of p53-abnormal ECs has not been well studied. We identified ECs molecularly classified as “p53-abnormal.” The p53-abnormal classification was assigned when (1) no POLE exonuclease domain hotspot mutations identified, (2) mismatch-repair protein expression was retained, and (3) abnormal p53 expression (null or overexpression) was present. Morphology was re-reviewed and β-catenin immunohistochemistry was scored as abnormal (nuclear) or normal (membranous, non-nuclear). Eighty ECs were identified in the “p53-abnormal” category; 27 (33.75%) were uterine serous carcinomas, and 53 were of nonserous histotype: 28 uterine carcinosarcomas (35%), 16 endometrioid carcinomas (20%), 2 clear cell carcinomas (2.5%), and 7 high-grade EC with ambiguous morphology (8.75%). All 27 uterine serous carcinomas demonstrated membranous β-catenin staining. Of the 53 nonserous ECs, 11 (21%) showed abnormal β-catenin expression: 6 endometrioid carcinomas, 4 uterine carcinosarcoma, and 1 high-grade EC with ambiguous morphology. The specificity of abnormal β-catenin expression for nonserous EC is high (100%) but the sensitivity is low (21%) with positive and negative predictive values of 100% and 60%, respectively. Our data shows that abnormal β-catenin expression in the context of p53-abnormal EC is highly specific, but not sensitive, for nonserous ECs and may be of value as part of a panel in classifying high-grade EC, particularly to exclude uterine serous carcinoma when nuclear staining is present.
Short- and long-term effects of repetitive transcranial magnetic stimulation on post stroke visuospatial neglect: a systematic review and meta-analysis of randomized controlled trials
Authors: Yang Fu-An , Lin Chien-Lin , Cho Sheng-Yun , Chou I-Ling , Han Ting-I , Yang Pei-Yu
Published: February 2023

Objective

This systematic review and meta-analysis aimed to assess the effects of repetitive transcranial magnetic stimulation (rTMS) and select a suitable protocol for post stroke visuospatial neglect.

Design

PubMed, Cochrane Library, and Embase databases were searched for relevant studies from the inception date to October 31, 2021. The inclusion criteria were (1) randomized controlled trials (RCTs), (2) people with visuospatial neglect, (3) treatment with different rTMS protocols, (4) comparison with sham or blank control, and (5) reports of performance measurements.

Results

Data were obtained from 11 RCTs. The effects of immediate and one-month post intervention were measured using line bisection test, cancellation test and Catherine Bergego Scale. Results showed statistically significant improvement when applying low-frequency (0.5–1 Hz) rTMS or continuous theta burst stimulation to the left hemisphere on short- and long-term line bisection test [SMD = −1.10, 95% CI [−1.84, −0.37]; SMD = −1.25, 95% CI [−2.11, −0.39]] and cancellation test [SMD = 1.08, 95% CI [0.45, 1.71]; SMD = 1.45, 95% CI [0.42, 2.47]].

Conclusions

rTMS may be considered a treatment option for post stroke visuospatial neglect. This review proves that a decrease in neuronal excitation in the left hemisphere, which restores the interhemispheric balance, benefits post stroke visuospatial neglect.
Development of connective tissue area increases by initial impact with high-intensity exercise after reloading in rat soleus muscle
Authors: Tanaka Shoji , Inaoka Pleiades Tiharu , Madokoro Sachiko , Yamazaki Toshiaki
Published: February 2023

Objective

To clarify whether or not high-intensity exercise in atrophied skeletal muscle after reloading 1) increases the injury and promotes the development of the muscle connective tissue area (mCTA) in the soleus muscle, and 2) delays muscle strength recovery.

Design

Rats had their hindlimbs suspended for 14 days followed by hindlimb reloading and squat exercise of 30% or 70%-one repetition maximum exercise (30%Ex or 70%Ex) until 14 days of reloading (R14d). The influences of reloading and exercise in muscles were examined by histological and immunofluorescence analyses based on the exercise load.

Results

70%Ex increased the extramyofiber area more than the control group and the central nuclear fiber number than the other groups after 7 days of reloading (R7d). 70%Ex resulted in a larger mCTA than the control and reload groups after R14d. Myogenin and M2-type macrophages after R7d increased by reloading but were not increased by the exercise load.

Conclusions

70%Ex to atrophied muscle increased injury early in post-reloading and increased the mCTA after R14d, but evidence that it delays muscle strength recovery was lacking. Therefore, mCTA induced by high-intensity exercise after reloading appears to be associated with initial exercise damage but not with repetition over 14 days.
Treatment and Management of Work-Related Mild Traumatic Brain Injury in Physical Medicine and Rehabilitation
Authors: Andreae Mollie E. , Grafton Lori M. , Hong Justin S. , Vidt Meghan E.
Published: February 2023

The purpose of this narrative review was to assess work-related mild traumatic brain injury (mTBI) treatment approaches and outcomes. Literature indicates that incidence of work-related mTBI is high. Ability to return to work after injury is variable, with differences identified across industry sector, mechanisms of injury, sex, and timely treatment and referral. Additional challenges exist in the context of secondary gains (e.g. financial) and the potential for symptom exaggeration. Emerging evidence from studies outside the United States (US) demonstrate the benefits of proactive assessment and treatment at the time of injury. These benefits can be further augmented by early referral to multidisciplinary treatment teams led by Physical Medicine and Rehabilitation (PM&R) physicians. Opportunities for ongoing research and development of strategies to improve treatment, management, and more timely return to work for patients with occupational mTBI are discussed. It is concluded that challenges persist in treatment and management of patients with work-related mTBI as they present unique challenges not seen in those with non-work related mTBIs. The unique position of PM&R and the skills of physiatrists render them poised to lead multidisciplinary treatment teams for these patients and contribute to the development of a new guideline for return to work, with an emphasis on functional recovery.
Medical Leadership in Inpatient Rehabilitation Facilities in the United States
Authors: Davis Shane M. , Davis Austin , Wong Theodora , Mekany Majid , Majors David , Perret Karimi Danielle
Published: February 2023

Objective

Inpatient rehabilitation facilities (IRFs) treat patients with extensive post-acute care rehabilitation needs. Physiatrists are uniquely trained in the complexities of such patients, however, not all IRFs employ physiatrists as medical leadership. This study identifies the training background and credentials of medical directors in all IRFs within the United States.

Design

Using internet search, e-mail and telephone communication, the following data was collected: medical director credential and specialty information, board certification rates and years of practice experience, as well as bed numbers for each IRF listed on The Centers for Medicare & Medicaid Services (CMS) website. Data was collected between November 2019 and November 2020.

Results

Of the 1,114 open facilities, 85% have medical directors with an MD, while 13% have a DO. 2% reported no physician medical director. Physiatry is the most common specialty (80%), followed by internal medicine, family medicine, neurology, orthopedic surgery, general surgery and medicine/pediatrics. The mean number of beds per facility is 35.6 (median 24, range 4-350). There is an average of 11.4 IRF beds per 100,000 people nationally.

Conclusion

Physiatry is the predominant specialty to fulfill medical leadership at IRFs, although there remains room for growth. Additionally, MDs greatly outnumber DOs in medical leadership.
EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Knee
Authors: Pirri Carmelo , Stecco Carla , Güvener Orhan , Mezian Kamal , Ricci Vincenzo , Jačisko Jacuk , Novotný Tomáš , Kara Murat , Chang Ke-Vin , Dughbaj Muhammad , Jain Nitin B. , Özçakar Levent
Published: February 2023

In this dynamic scanning protocol, ultrasound examination of the knee is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of the daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.
Correlation of Glenohumeral Internal Rotation Deficit with Shoulder Pain in Elite Table Tennis Players
Authors: Zhang Botao , Wang Kaili , Zhang Enming , Shang Xuedong
Published: February 2023

Objective

(1) To investigate glenohumeral internal rotation deficit (GIRD: a difference in internal rotation of 15.6° or more between dominant and nondominant shoulders) and its correlation with self-reported shoulder pain in table tennis players. (2) To find the optimal cutoff point for the difference in the internal rotation (IR) range of motion (ROM) between dominant and nondominant shoulders of self-reported shoulder pain.

Design

The IR ROM of both shoulders of 46 table tennis players was measured in the supine and side-lying positions, the external rotation ROM was measured in the supine position.

Results

Significant differences existed in IR ROM between the two sides in the supine (z = 6.53, p < 0.001) and side-lying positions (z = 5.67, p < 0.001). Self-reported shoulder pain was associated with GIRD (OR = 6.86, 95% CI: 1.752–26.832, P = 0.006). The cutoff points for the difference in IR ROM between the sides of self-reported shoulder pain were 17.9° in the supine position and 11.1° in the side-lying position.

Conclusions

Table tennis players exhibited GIRD. There was a correlation between GIRD and self-reported shoulder pain in the past year; therefore, GIRD may be a risk factor for shoulder pain in table tennis players.
Acute and Chronic Injury Patterns in Competitive Paraclimbing Sports
Authors: von Essen Daniel , Schöffl Volker Rainer
Published: February 2023

Objective

This is the first study to evaluate sport-related injuries in competitive Paraclimbing athletes with the aim of creating a medical database for future research on injury prevention.

Design

Descriptive epidemiology study. Data collection in two parts. First part: Online survey (n = 81). Second part: Three competitions (n = 273) of the 2021 International Federation of Sport Climbing Paraclimbing competitions. Injury severity grading: IFSC Climbing Injury Score.

Results

Online survey: 76 injuries were reported. 62% acute and 38% chronic injuries. Injury severity: 21 score 1, 34 score 2a, 19 score 2b and 2 score 3. Most injured body region: upper extremity(66%), shoulder injuries(29%) most common. 53% reported regular pain/discomfort during training/competition, 16% used NSAIDs regularly to prevent pain/discomfort when training.

2021 IFSC Paraclimbing competitions: 8 injuries were recorded. Injury severity: 7 score 1 and 1 score 2a. Most injured body region: upper extremity(47%). Overall: 975 hours calculated climbing time, injury incidence risk: 8.21/1000 h.

Conclusion

Compared to non-disabled climbers, the injury pattern seems to be sport-dependent but influenced by the unique impairments of the athletes.

In Paraclimbing competitions the injury severity is mostly mild with an overall low injury incidence.

A concern is the number of athletes with pain/discomfort during training/competition with regular NSAID intake.
Mechanical micronization of lipoaspirates combined with fractional CO2 laser for the treatment of hypertrophic scars via inducing adipogenesis
Authors: Xiao Shune , Qi Jianghong , Li Jianyi , Wu Bihua , Li Hai , Liu Zhiyuan , Yang Chenglan , Wei Zairong , Wang Dali , Deng Chengliang
Published: February 2023

Background:

Treating hypertrophic scars remains challenging. Stromal vascular fraction (SVF) gel is produced by a purely mechanical process from lipoaspirates, rich in adipose-derived stem cells, and have showed therapeutic potential on scars. However, controversial effects on hypertrophic scars are emerging. This study aimed to assess the therapeutic effects of SVF gel combined with fractional CO2 laser on hypertrophic scars.

Methods:

A rabbit ear hypertrophic scar model was established. SVF gel combined with fractional CO2 laser was conducted for hypertrophic scars in rabbit. Scar alleviation in rabbits was observed based on the appearance and histology of scars, and the underlying mechanism was investigated by tissue immunological analyses and qRT-PCR. At last, six patients with hypertrophic scar were treated by SVF gel combined with fractional CO2 laser. Therapeutic effects were assessed using the Vancouver Scar Scale (VSS).

Results:

Following the treatments, hypertrophic scars became less apparent and softer, the dermis became thinner, and collagen fibers appeared looser and arranged in a more organized pattern. SVF gel plus fractional CO2 laser group showed the most obvious improvement. Besides, SVF gel combined with fractional CO2 laser increased adipogenesis in scar tissue, and adipose tissue regeneration was observed. Hypertrophic scars in patients were alleviated after the treatment of SVF gel combined with fractional CO2 laser.

Conclusions:

SVF gel transplantation combined with fractional CO2 laser showed encouraging therapeutic effects on hypertrophic scars. Although further investigation is necessary, this technique has great potential for clinical application to treat hypertrophic scars.
Dupuytren’s disease: Prevalence, incidence, and lifetime risk of surgical intervention A population-based cohort analysis
Authors: Broekstra Dieuwke C. , Kuo Rachel Y.L. , Burn Edward , Prieto-Alhambra Daniel , Furniss Dominic
Published: February 2023

BACKGROUND:

Healthcare burden due to Dupuytren’s disease (DD) is largely unknown. We determined 1) the prevalence and incidence of DD, 2) incidence of first surgical intervention, and 3) lifetime risk of surgical intervention in the UK National Healthcare Service (NHS).

METHODS:

In this population-based dynamic cohort analysis, data of the Clinical Practice Research Datalink (CPRD) was linked to Hospital Episode Statistics (HES), to characterize the diagnosis and surgical treatment of DD. Secular trends of incidence of DD diagnosis and first surgical treatment were calculated for 2000-2013. A multi-state Markov model was designed to estimate the lifetime risk of first surgical intervention.

RESULTS:

A total of 10,553,454 subjects were included in the analyses, 5,502,879 (52%) females. 38,707 DD patients were identified. Point prevalence in 2013 was 0.67% (99%CI: 0.66-0.68). Incidence of DD almost doubled from 0.30 (99%CI: 0.28-0.33)/ 1000 person-years in 2000, to 0.59 (99%CI: 0.56-0.62) in 2013. Incidence of first surgical intervention similarly increased from 0.29 (99%CI: 0.23-0.37) to 0.88 (99%CI: 0.77-1.00) in the same period. A man or woman newly diagnosed with DD at age 65 has a lifetime risk of surgical intervention of 23% and 13% respectively, showing only a very subtle decrease when diagnosed later in life.

CONCLUSIONS:

DD is an important health condition in the elderly population, since prevalence and incidence rates have almost doubled in the last decade. Estimated lifetime risk of surgical treatment is relatively low, but almost twice in males compared with females.
Long-term Outcome of Primary Rhinoplasty with Overcorrection in Patients with Unilateral Cleft Lip Nose Deformity: Avoiding Intermediate Rhinoplastyrinisha
Authors: Murali P. , Denadai Rafael , Sato Nobuhiro , Lin Hsiu-Hsia , Hsiao Jonathan , Pai Betty CJ , Chou Pang-Yun , Lo Lun-Jou
Published: February 2023

Background:

No consensus exists regarding the timing or technique of rhinoplasty for correction of the unilateral cleft lip nose deformity, with few studies examining the long-term effects of a single technique. This study appraised the long-term outcomes of primary rhinoplasty using the Tajima technique for overcorrection in a cohort of patients with unilateral cleft lip nose deformity after attaining skeletal maturity.

Methods:

Consecutive non-syndromic patients with unilateral cleft lip nose deformity (n=103) who underwent primary rhinoplasty with overcorrection by a single surgeon between 2000 and 2005 were reviewed. Patients with unilateral cleft lip and nasal deformity who underwent primary rhinoplasty, but with no overcorrection (n=30), and non-cleft individuals (n=27) were recruited for comparison. Outcomes were assessed through FACE-Q scales evaluating satisfaction with appearance of nose and nostrils (2 scales) and computer-based objective photogrammetric analysis of nasal symmetry (nostril height, nostril width, nostril area, alar height and alar width parameters).

Results:

Significant differences (all p<0.001) were observed between the Tajima and non-Tajima groups for all but one photogrammetric nasal parameter (nostril area), with the Tajima group demonstrating closer mean values to the non-cleft group. The Tajima and non-cleft groups demonstrated no significant difference (all p>0.05) for scores of FACE-Q nose and nostrils scales.

Conclusion:

This study indicated that the patients who underwent primary rhinoplasty with overcorrection had improved results with no necessity for intermediate rhinoplasty, emphasizing that the procedure is an effective approach to correct the unilateral cleft nose deformity.
The Impact of Age, BMI and Resection Weight on Post-Operative Complications in Reduction Mammaplasty”
Authors: Payton Jesse I. , Abraham Jasson T. , Novak Matthew D. , Monsivais Sharon E. , Hammonds Kendall P. , Altman Andrew M.
Published: February 2023

BACKGROUND:

We seek to evaluate the impact of age, BMI, and resection weight, on post-operative complications in women undergoing primary bilateral reduction mammaplasty.

METHODS:

A retrospective review of all primary bilateral reduction mammaplasties between February 2014 and August 2018 was performed. Patient demographics, medical co-morbidities, tobacco use, BMI, operative technique, operative time, resection weight, and complications were reviewed.

RESULTS:

277 women were included. Mean age was 35.71 years, and BMI was 30.17 kg/m2 . An inferior pedicle (53.07%) with Wise pattern resection (53.43%) was utilized most commonly. The minor complication rate was 49.1%, with superficial wounds (42.1%) occurring most commonly. 33 women (11.9%) required greater than 2 months to heal. The major complication rate was 4.31%.

BMI was not associated with minor or major complications on univariate analysis (p=0.1003, and p=0.6163), but was associated with wound healing requiring greater than 2 months (p=0.0009), longer operative times (p=0.0002), and higher resection weights (p<0.00001). Greater age was associated with higher minor complication rates (p=0.0048). On multivariate analysis, BMI was associated with wound healing requiring greater than 2 months (p=0.0137), and age with minor complications (p=0.0180). No factors impacted major complication rates.

CONCLUSIONS:

Women with higher BMI are more likely to require larger resections, longer operative times, and are at higher risk for wound healing requiring greater than 2 months. While BMI is an important consideration for determining operative candidacy, the benefits of reduction may outweigh these risks in carefully selected patients.
Decompression with complete brachioradialis tenotomy improves pain and quality of life for patients with compression of the sensory branch of the radial nerve
Authors: Hill Elspeth J , Padovano William , Krauss Emily M , Patterson J Megan M. , Yee Andrew , Crock Lara W. , Mackinnon Susan E.
Published: February 2023

Background:

Decompression of the sensory branch of the radial nerve (SBRN) with complete brachioradialis tenotomy may treat pain in both simple and complex cases of SBRN compression neuropathy.

Methods:

A retrospective chart review was performed of consecutive patients undergoing this procedure between 2008-2020 including post-operative outcomes within 90 days. Data were collected and analysed including patient and injury demographics, pain descriptors, and patient-reported pain questionnaire, including reported pain severity and impact on quality of life (QoL) using visual analogue scales (VAS). Within group pre- and post-surgical analyses and between group statistical analyses were performed.

Results:

Thirty-three of 58 patients met inclusion criteria. Median time of symptom onset to surgery was 300 days, and median postoperative follow-up time was 37 days. 25% of patients (n=8) underwent isolated SBRN decompression. The remainder had concomitant decompression of another radial (48%, n=16) or peripheral (36%, n=12) entrapment point. 10 of 33 patients (30%) had resolution of pain at final follow-up (p=0.004). Median change in “worst pain over the previous week” was -4 (p<0.001), and “average pain over the last month” was -2.75 (p<0.001) on the VAS scales. The impact of pain on QoL showed a median change of -3 (p<0.001) on the VAS scales.

Conclusions:

Decompression of the sensory branch of the radial nerve including a complete brachioradialis tenotomy improves pain and quality of life VAS scores in patients with both simple compression neuropathy and complex nerve compression syndromes.

Level of evidence:

IV, retrospective cohort study
Laryngochondroplasty: A Systematic Review of Safety, Satisfaction, and Surgical Techniques
Authors: Hamidian Jahromi Alireza , Horen Sydney R. , Bonett Andrew M. , Schechter Loren S. , Dorafshar Amir H.
Published: February 2023

Background:

Since first performed in 1975, two main surgical techniques for laryngochondroplasty have evolved: anatomic localization and direct endoscopic visualization. The aim of this study is to evaluate which method is safest and has the highest patient reported satisfaction rates, and whether these outcomes have changed over time.

Methods:

A systematic review and meta-analysis following PRISMA guidelines was performed to find and analyze all medical publications related to laryngochondroplasty. Of these studies, patients who underwent laryngochondroplasty for gender affirmation surgery were evaluated. Surgical and patient reported outcomes were compared between different surgical techniques and between studies prior to and after the year 2010.

Results:

A total of 226 patient have been reported to have undergone laryngochondroplasty for gender affirmation surgery. Overall transient and long-term complication rates were 14% and 0%, respectively. A 97% satisfaction rate was reported overall. Endoscopic visualization techniques were associated with lower short-term complications (OR, 21.11; 95%CI, 7.56-58.93); there was no difference in long-term complications (OR, 7.81; 95%CI, 0.31-194.37) or patient satisfaction (OR, 5.73; 95%CI, 0.32-101.97). Studies performed prior to the year 2010 had a significantly greater number of short-term complications compared to studies performed after the year 2010 (OR, 10.16; 95%CI, 3.71-27.82) with no difference in long-term complications (OR, 4.56; 95%CI, 0.18-113.25) or patient satisfaction (OR, 4.99; 95%CI, 0.59-42.20).

Conclusion:

All laryngochondroplasty techniques result in high patient satisfaction. Endoscopic visualization may help facilitate safe surgery and should be used in conjunction with anatomical familiarity. Technique choice should be dictated by the surgeon’s experience and patient desires.
Free Fibula Flap for Extremity Oncologic Defects: Factors Influencing Union and Functional Outcomes
Authors: Mericli Alexander F. , Asaad Malke , Lewis Valerae O. , Lin Patrick P. , Goodenough Christopher J. , Adelman David M. , Oates Scott D. , Hanasono Matthew M.
Published: February 2023

Background:

The goal of this study was to evaluate outcomes following vascularized bone flap (VBF) reconstruction of oncologic bony extremity defects. A secondary goal was to compare union rates based on various insetting methods, including onlay, intermedullary, and intercalary.

Methods:

We conducted a retrospective review of consecutive patients who received an extremity reconstruction with a fibula flap after oncologic resection between 2001 and 2019.

Results:

We identified a total of 60 fibular VBF in 55 patients (67% lower extremity, 33% upper extremity). The overall union rate was 91.7% (55/60). For lower extremity reconstructions, the mean time to full weightbearing was 16 months (range = 4-44 months). Fibula VBFs were onlay in 65%, intercalary in 23% of cases, and intramedullary in 12%. Forty-three percent of patients required a reoperation as a result of a surgical complication. Immediate femur reconstruction subgroup analysis demonstrated that onlay fibula flap orientation was associated with a significantly increased risk for any complication (OR=6.3, 95% CI, 1.4-28.7;p=0.03) as well as an increased risk for requiring conversion to an endoprostheses due to nonunion (OR=12.1, 90% CI 1.03-143.5;p=0.03) compared to intramedullary placement.

Conclusion:

The free vascularized fibula flap is a reliable option for functional reconstruction of any long bone extremity defect although complications in these complex surgeries are not uncommon. In patients with immediate femur reconstructions, intramedullary fibula placement was associated with significantly lower complication and lower metallic implant conversion rates, and a trend toward a more rapid early union compared to onlay VBF.
“The Treatment of Complex Extremity Wounds Using External Tissue Expansion: A Case Series”
Authors: Chan Peter Y.W. , Michel Chris , Colon Anthony F. , Clune James , Shah Ajul
Published: February 2023

The goal of wound reconstruction is the approximation of soft tissue and re-establishment of an acceptable appearance with minimal risk of complications. For large wound closure in the extremities, skin graft and flap reconstruction are common treatments but are associated with a variety of complications. Comparatively, tissue expansion can provide the opportunity to reconstruct large wounds with native, durable, and sensate tissue without significant donor site morbidity. Specifically, external tissue expansion is less invasive and avoids complications associated with internal expansion.

The authors treated a total of 11 patients with varying extremity wound types and sizes with an external tissue expansion device (DermaClose ®). Patient age ranged from 18 to 68 with an average age of 43.7 years (SD ± 13.1 yr). Average wound surface area was approximately 235 cm2 (SD =±135.3 cm2). Device(s) were affixed and left for 7-11 days before closure of the wounds. Outcomes were assessed at 2-36 weeks post-operative follow up. All wounds were fully closed after treatment without need for secondary reconstructive procedures. No patients experienced major complications. All patients demonstrated intact sensation within the area of reconstruction equivalent to surrounding tissues.

External tissue expansion is an excellent treatment option in the algorithm of extremity reconstruction, as it is efficacious and associated with lower complication rates compared with internal tissue expansion, skin grafts, and flap reconstruction.
“Coworker Reports About Unprofessional Behavior in Plastic Surgery.”
Authors: White-Dzuro Colin G , Glassman Gabriella E , Patrinely James R , Walker Sallie , Stratton Shannon , Domenico Henry J , Galloway Mitchell , Pichert James W , Perdikis Galen , Cooper William O
Published: February 2023

Introduction:

Patient reports of unprofessional conduct by surgeons have been linked to outcomes of care, most notably in terms of post-procedure complications and increased risk for malpractice claims.

While patient complaints may focus on communication, accessibility, rudeness, and care outcomes, coworkers are also positioned to observe and report unprofessional behaviors, including concerns related to delivery of competent medical care, clear and respectful communication, integrity, and responsibility. When physicians act unprofessionally towards colleagues, team performance worsens, and their practices are associated with both increased rates of malpractice claims and greater rates of patient complications. Using data from the Coworker Observation Reporting System (CORS) database, our team sought to compare rates of coworker concerns between plastic surgeons and other physicians (other surgical specialists and non-surgeons), as well as characterize whether plastic surgery subspecialties differed in their rates of complaints.

Methods:

Coworker concern data from January 1, 2014 to December 31, 2019 were retrieved from the Vanderbilt Center for Patient and Professional Advocacy’s (CPPA) Coworker Observation Reporting System (CORS®). Specialty was classified as plastic surgery, non-plastic surgical, and non-surgical, and the plastic surgery cohort was further characterized by sex, medical school graduation year, predominant practice type (reconstructive only, aesthetic only, or hybrid), and post-residency training (i.e., completion of a fellowship).

Results:

The study cohort included 34,170 physicians (302 plastic surgeons, 7,593 non-plastic surgeons, and 26,275 non-surgeons). A greater proportion of plastic surgeons (13.6%) had one or more coworker concerns compared to non-surgeons (10.8%) and non-plastic surgeons (6.1%) (p<.001, Figure 1). The most prevalent concern category reported for plastic surgeons was Clear and Respectful Communication. Among plastic surgeons who had no concerns vs. those who had at least one concern, there was no significant difference when comparing sex, medical school graduation year, predominant practice type, or post-residency training.

Conclusion:

Plastic surgeons in this cohort study received more coworker reports than other surgeons and non-surgical physicians. These data may be used by institutions to identify plastic surgeons at risk for preventable post-procedure complications and intervene with peer feedback intended to promote self-regulation.
“Impact of ACAPS Coordinated Interview Release Policy: Applicant and Program Attitudes, Adherence and Interview Trends”
Authors: Davis Greta L. , Reghunathan Meera , Dean Riley A. , Cronin Brendan J. , Weber Robert A. , Gosman Amanda A.
Published: February 2023

Background:

This study describes the impact of a new, coordinated interview release date for integrated plastic surgery residencies.

Methods & Results:

A cross-sectional study of all 2020 integrated plastic surgery residencies and applicants was performed. Voluntary, anonymous surveys were administered following implementation of the interview policy.

Program response rate was 55.6% (initial survey) and 57.1% (follow-up survey). Programs released an average of 2.1 (95% CI: 1.8, 2.4) rounds of interview invitations and invited 39.0 (95% CI: 35.3, 42.6) applicants to interview. Policy adherence was high (91.1%). Most programs believed the interview policy was an improvement for applicants (46.5% “yes”, 9.1% “no”) and programs (41.9% “yes”, 27.0% “no”). National Residency Match Program (NRMP) data revealed that no integrated plastic surgery residency positions went unfilled following the 2020 Match.1 Median rank of matched candidates was 13, and 55.1% of programs matched candidates within the top quartile of their rank order list.

Applicant response rate was 54.3%. The average candidate applied to 72 programs, attended 11 interviews, and ranked 12 programs. Interview distribution was bimodal, with peaks at 6 and 15 total interview invitations. The top 5th, 10th, and 15th percentile of applicants, ranked according to number of interviews received, disproportionately accounted for 15.3%, 26.6% and 36.5%, respectively, of all invitations. Regarding interview policy experience, applicants ranked the following Likert items favorably (1 = strongly disagree, 5 = strongly agree): overall impression (mean score 4.04), improved travel planning (3.96), improved scheduling (3.73), and cost savings (3.55). Applicants were somewhat dissatisfied with interview distribution (2.84).

Conclusions:

A coordinated interview release date is facile to adopt and does not adversely impact program interview trends or match rates. Applicants benefit from improved scheduling, travel planning, and cost savings, yet interview distribution continues to favor top-tier candidates.
Efficacy of Vascularized Submental Lymph Node Transfer Combined With Preoperative Decongestive Therapy and Antibiotics for Early-Stage Lower Limb Filarial Lymphedema
Authors: De Santis Giorgio , Saxena Bharat , Starnoni Marta , Pappalardo Marco , Jacob Vinay
Published: February 2023

Filarial lymphedema (FLE) is the commonest cause of secondary lymphedema with endemic prevalence in developing countries. This has been traditionally managed with antibiotics and decongestive therapy (DCT) in early-stage or excisional surgery at late-stage. Results of vascularized lymph node transfer (VLNT) in post-oncological lymphedema have been encouraging, and it is currently a widely accepted surgical treatment. We advocate that the combined treatment of antibiotics, DCT, and VLNT could produce objective and subjective improvement of early-stage lower limbs FLE. Between January 2019 and January 2020, patients with early-stage lower-limb FLE who underwent VLNT were retrospectively reviewed. VLNT was harvested from the submental region in all patients. Outcomes were assessed using volume improvement, frequency of cellulitis, and lymphoscintigraphy, along with subjective scoring questionnaire. Three males and one female with an average age of 27(range 25-29) years were included. Two patients presented bilateral lymphedema. One patient was lost at three months follow-up and not included in the analysis. Patients showed an initial decrease in circumferential measurements post-antibiotics/DCT of 2074±471cc (39±9%). At a mean follow-up of 12.3±6.2 months, further improvement of limb volume of 2389±576cc (45±10%) was achieved following VSLN transfer. Lymphoscintigraphy demonstrated dye uptake by the VLNT with reduced dermal backflow, and none of the patients had episodes of postoperative cellulitis. Patients gave an excellent outcome on subjective scoring (average score 9±1), returning to their daily activities without wearing compression garments. Our early experience showed that VSLN transfer may represent an effective treatment option in the multi-modality approach to early-stage lower limb FLE.
“Landmark Plastic Surgeon Advocacy within the Federal Government: Four Case Studies”
Authors: Moss Whitney , Pires Giovanna , Reed Evelyn , Crombie Courtney , Janis Jeffrey E. , Tenzel Paul
Published: February 2023

Background:

Throughout history, plastic surgeons have advocated for the protection of the specialty and for better care for their patients. Whether through efforts to support and move legislation through Congress or through preventative advocacy in the form of lobbying against legislation, plastic surgeons have often used their expertise in the political sphere to shape patientcare. We hope to inspire current and future plastic surgeons to be politically active and to devise ways in which their expertise can be used within the legislative system to better care for their patients.

Methods:

The following manuscript highlights four historical examples of plastic surgeon led advocacy within the federal government: The U.S. Flammable Fabrics Act, ASPRS and the Federal Trade Commission -1979, the Women’s Health and Cancer Rights Act, and the Breast Cancer Patient Education Act.

Results:

We hope that plastic surgeons will – like Dr. Crikelair, Dr. Wider, and the members of ASPS/ASPRS – continue to play an active role in the shaping of the legislative system for our profession and ultimately our patients.

Conclusion:

To ensure the best care for their patients, plastic surgeons must continue to maintain their relationship with public health and legal professionals and legislators. Through relationships with patients and a firm understanding of their stories, plastic surgeons can make great impacts in all local, state, and national political spheres.
The Impact of Prepectoral Versus Subpectoral Tissue Expander Placement on Complications and Outcomes in Delayed-Immediate Autologous Patients Who Undergo PMRT
Authors: Teotia Sumeet S. , Amaya Joshua , Haddock Nicholas T.
Published: February 2023

Background:

Delayed-immediate autologous (DIA) breast reconstruction is a safe and flexible operative strategy for patients undergoing post-mastectomy radiation therapy (PMRT). Traditionally, tissue expanders (TE) are placed in the subpectoral position, but the development of acellular dermal matrix material has led to increased use of prepectoral placement strategies. Our aim is to compare the outcomes of both TE placement strategies in DIA patients who underwent PMRT and determine if they experienced similar outcomes to non-PMRT patients.

Methods:

A retrospective analysis of 4 patient groups (314 total patients) who underwent DIA reconstruction from 2012 to 2019 was performed. 98 non-PMRT prepectoral (PP), 106 non-PMRT subpectoral (SP), 39 PMRT prepectoral (PMRT PP) and 71 PMRT subpectoral (PMRT SP) patients were compared. Demographics, TE complications, flap complications and the use of large inferior skin patches were analyzed.

Results:

A significantly lower percentage of the PMRT PP cohort required large inferior skin patches (30.6% vs 55.7%; p < 0.05) and multi-flap procedures (15.4% vs 47.9%; p < 0.001) than the PMRT SP cohort. PMRT (p < 0.0001), subpectoral placement (p < 0.05), BMI (p < 0.05), autoimmune diseases (p < 0.05), bilateral mastectomy (p < 0.001) were identified as factors predictive of patients requiring a large inferior patch via multivariable analysis. More SP patients experienced flap post-op breast complications compared to PP patients (35.8% vs 12.2%; p < 0.0001).

Conclusion:

DIA patients who undergo PMRT will require more skin and flaps if subpectoral TE placement is chosen over prepectoral TE placement.
Tranexamic acid use in breast surgery: a systematic review and meta-analysis
Authors: Liechti Rémy , van de Wall Bryan J. M. , Hug Urs , Fritsche Elmar , Franchi Alberto
Published: February 2023

Background:

The perioperative use of tranexamic acid (TXA) has become popular among plastic surgeons for a variety of surgical procedures. The aim of this study is to perform a systematic review and meta-analysis on the results reported in literature regarding the effect of perioperative systemic TXA administration in breast surgery.

Methods:

PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR) with corresponding 95% confidence interval (95%CI).

Results:

A total of 5 studies encompassing 1’139 patients undergoing mastectomy with or without immediate implant or free flap-based breast reconstruction or breast-conserving surgery with or without axillary lymph node dissection were included. Perioperative intravenous administration of TXA significantly reduced the risk for hematoma (7.3% versus 12.9%, OR 0.43, 95% CI 0.23 – 0.81) and seroma formation (11.5% versus 19.9%, OR 0.57, 95% CI 0.35 – 0.92) in comparison to the control group. In the studies measuring the postoperative drainage amount, the mean difference was 132ml (95% CI 220 – 44ml). No thromboembolic event occurred in either group. The weighted surgical site infection rate was higher in the control group (3.1 vs. 1.5%). However, these data were too sparse to perform comparative mata-analysis.

Conclusion:

Evidence of this study suggests that perioperative administration of TXA significantly reduces the risk for postoperative hematoma and seroma formation in breast surgery while the risk for thromboembolic events and postoperative infection is not increased.
New Insight into Glabellar Arteries: A 3D CT and Dissection Study
Authors: Liao Zhi-Feng , Cong Li-Yao , Luo Cheng-En , Zhan Wen-Feng , Luo Sheng-Kang
Published: February 2023

Background:

Vascular complications from glabellar intravascular filler injections are major safety concerns. Filler injection into the glabella without precise knowledge of its vascular topography poses a risk of severe complications.

Methods:

Computed tomography was used to study 90 cadaveric heads after contrast agent and filler injection, and 15 cadaveric heads were dissected.

Results:

Central, paracentral and reverse dorsal nasal arteries (CAs, PCAs, and rDNAs) were found in 70 (38.9%), 58 (32.2%), and 16 (8.9%) of the 180 hemifaces, respectively. Based on the presence of CAs, PCAs and rDNAs between the bilateral supratrochlear arteries (STAs), glabellar arteries were categorized into two main patterns: in type 1 (without named arteries between the bilateral STAs) (22/90, 24.4%), the glabella was supplied by the bilateral STAs and their branches; in type 2 (with named arteries between the bilateral STAs) (68/90, 75.6%), the glabella was supplied by the bilateral STAs and CAs, PCAs and rDNAs. Type 2 could be further divided into three subtypes: in type 2a (45/90, 50.0%), the glabella was supplied by the bilateral STAs and one of the named arteries; in type 2b (21/90, 23.3%), the glabella was supplied by the bilateral STAs and two of the named arteries; and in type 2c (2/90, 2.3%), the glabella was supplied by the bilateral STAs and unilateral CA, PCA and rDNA.

Conclusion:

This study elucidated novel arterial systems and proposed considerations for glabellar filler injection.
Variations in Incidence of Trigger Finger and Response to Corticosteroid Injection after Aromatase Inhibitor Therapy for Breast Cancer
Authors: Hollins Andrew W , Hein Rachel , Atia Andrew , Zhang Gloria , Sergesketter Amanda , Darner Grant , Morris Miranda , Mithani Suhail K.
Published: February 2023

Introduction:

Aromatase inhibitors (AI), such as letrozole and anastrozole, have been demonstrated to have significant musculoskeletal symptoms in patients. The purpose of this study was to evaluate specific AI medications effect on the incidence of trigger finger and independent factors affecting treatment outcomes within this population.

Methods:

A retrospective chart review was performed at our institution between the years 2014-2018 in patients with the diagnosis of breast cancer. This cohort was then sorted based on medication regimens, trigger finger diagnosis, steroid injections, and need for surgical release of trigger finger.

Results:

A total of 15, 144 patients were included for initial review. The overall rate of trigger finger diagnosis was 2.75% in entire breast cancer population and 4.5% for patients receiving AI therapy. Patients taking letrozole and anastrozole had an increased odds ratio of 2.0 and 1.7 respectively for developing trigger finger. Patients that switched between letrozole and anastrozole during treatment had a higher rate of failed steroid injection treatment (45.2% vs. 23.5%, p=.021). Among patients receiving AI treatment diagnosed with trigger finger, diabetics and a hemoglobin A1c greater than 6.5 were associated with significantly increased rates of failed steroid therapy.

Conclusion:

Patients receiving AI therapy have an increased incidence of trigger finger. The outcomes of treatment is equivalent between AI and non-AI trigger finger populations. However, patients that require switching of regimens due to significant musculoskeletal symptoms are more likely to fail steroid therapy. Poorly controlled diabetes was also an independent factor for compromised steroid treatment of trigger finger.