bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients: a meta-analysis of randomized controlled trials
Authors: Feng Xixia , Yang Pingliang , Liao Zaibo , Zhou Ruihao , Chen Lu , Ye Ling
Published: March 2023

Background:

Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.

Methods:

We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients’ satisfaction and side effects.

Results:

Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = −0.71, 95% confidence interval [CI]: −1.01 to −0.41; P < 0.001; I
2 = 93%), demonstrated better relief from visceral pain (MD = −1.22, 95% CI: −1.58 to −0.85; P < 0.001; I
2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35–1.19; P < 0.001; I
2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35–0.60; P < 0.001; I
2 = 11%). There was no statistical difference in the degree of patients’ satisfaction (OR = 1.13, 95% CI: 0.88–1.44; P = 0.33; I
2 = 72%) and drug consumption (MD = −5.55, 95% CI: −14.18 to 3.08; P = 0.21; I
2 = 93%).

Conclusion:

Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries.

Registration:

PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.
Global burden prediction of gastric cancer during demographic transition from 2020 to 2040
Authors: Yan Chao , Shan Fei , Ying Xiangji , Li Ziyu
Published: March 2023

Background:

Despite the decline in the incidence and mortality rates of gastric cancer (GC), the impact of demographic transition on the global burden of GC remains unclear. The current study aimed to estimate the global disease burden through 2040 by age, sex, and region.

Methods:

GC data for incident cases and deaths by age group and sex were taken from The Global Cancer Observatory (GLOBOCAN) 2020. The incidence and mortality rates were predicted through 2040 by fitting a linear regression model over the most recent trend period with the Cancer Incidence in Five Continents (CI5) data.

Results:

The global population will grow to 9.19 billion by 2040, accompanied by increasing population ageing. The incidence and mortality rates of GC will show a persistent decrease, with an annual percent change of –0.57% for males and –0.65% for females. East Asia and North America will have the highest and lowest age standardized rates, respectively. A slowdown in the growth of incident cases and deaths will be observed worldwide. The proportion of young and middle-aged individuals will decline, while the percentage of the elderly will increase, and the number of males will be almost twice the number of females. East Asia and high human development index (HDI) regions will be heavily burdened by GC. East Asia had 59.85% of the new cases and 56.23% of deaths in 2020; these will increase to 66.93% and 64.37% by 2040, respectively. The interaction between population growth, the change in ageing structure and the decline in incidence and mortality rates will lead to an increased burden of GC.

Conclusions:

Ageing and population growth will offset the decline in the incidence and mortality rate of GC, resulting in a substantial increase in the number of new cases and deaths. The age structure will continue to change, especially in high HDI regions, requiring more targeted prevention strategies in the future.
Laser Ablation of Pilonidal Sinus Disease: A Pilot Study
Authors: Williams Michael D. , Sullivan Gwynneth A. , Nimmagadda Neha , Gulack Brian C. , Madonna Mary Beth , Hayden Dana M. , Govekar Henry , Shah Ami N.
Published: March 2023

BACKGROUND:

Pilonidal disease is classically treated with a wide local excision, though a number of minimally invasive approaches are currently under investigation. We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus disease.

IMPACT OF INNOVATION:

Laser ablation provides a minimally invasive means of obliterating pilonidal sinus tracts without a need for excessive tract dilation. Laser ablation can be performed more than once on the same patient if necessary.

TECHNOLOGY MATERIALS AND METHODS:

We used the NeoV V1470 Diode Laser (NeoLaser LTD, Caesarea, Israel) with a 2 millimeter probe. We performed laser ablation in adults and pediatric patients.

PRELIMINARY RESULTS:

We performed 27 laser ablation procedures in 25 patients, with a median operative time of 30 minutes. Eighty percent of patients reported either no pain or mild pain at 2-week postoperative visit. Median time to return to work or school was 3 days. Eight-eight percent of patients reported being satisfied or very satisfied with the procedure at their most recent follow-up (median, 6 months). Eighty-two percent of patients were healed at 6 months.

CONCLUSIONS AND FUTURE DIRECTIONS:

Laser ablation of pilonidal disease is safe and feasible. Patients experienced short recovery time, and reported low levels of pain and high levels of satisfaction.
Autologous Fat Grafting: Evaluation of Efficacy in Pain Relief
Authors: Klomparens Kara , Simman Richard
Published: March 2023

Introduction:

Autologous fat grafting (AFG) has been used in reconstructive plastic surgery for over a century. Although it has obvious benefits to the aesthetic appearance of many reconstructive surgeries, less appreciated advantages of fat grafting have also been shown in potential pain reduction. This can be seen across the board from head to toe with examples ranging from facial nerve injury to pedal atrophy and foot ulcers. The purpose of this literature review is to evaluate the efficacy of AFG for pain relief in various indications and serve as a reference for clinicians to gain insight on potentially beneficial therapies for their patients.

Methods:

A broad literature review was performed to analyze the various uses of AFG for pain management by various indications including postmastectomy pain syndrome, scar pain, neuromas, chronic wounds and many more. The PubMed, Science Direct and Scopus online databases were searched using keywords such as “autologous fat grafting,” “reconstruction,” “pain,” and “therapy.”

Results:

At this point, there is decent evidence to support AFG’s role in pain resolution in postmastectomy pain syndrome, neuropathic scar pain, and pedal injury. There is also ample low-level evidence for pain efficacy in autoimmune diseases, neuromas, vulvar lichen sclerosis, burns, and radiation-induced wounds.

Conclusions:

While there is a clear lack of higher-level evidence based studies conducted on AFG for all indications, the existing literature shows a definite trend of reconstructive efficacy and pain management that can be clearly appreciated. With the increasing popularity of this procedure for reconstruction, higher-level studies are beginning to take place pertaining to AFG’s efficacy not only in reconstruction, but pain management as well.
Humicola Trauma-related Invasive Fungal Infection in an Immunocompetent Patient
Authors: Gonte Madeleine R. , Ranganathan Kavitha L. , Helliwell Lydia A.
Published: March 2023

The majority of invasive fungal infections arise in immunocompromised patients; however, there exist many clinical interventions and physiologic phenomena in the setting of traumatic injury that induce immunosuppressant states. Enhanced clinical suspicion and early detection of invasive fungal infections has played an increasingly pertinent role in clinical management of patients admitted for traumatic injury, given its substantial morbidity and mortality rates. In this case report, we discuss a case of trauma-related invasive fungal infection by a rare humicola pathogen in a previously immunocompetent patient. We present this case in hopes of instilling a high index of clinical suspicion for trauma-related invasive fungal infections. We also discuss the role of negative pressure wound therapy and aggressive surgical management, including debridement and various levels of amputation to optimize patient outcomes. Clinical management of trauma-related IFI has adopted increasingly aggressive approaches with respect to its formidable morbidity and mortality rates. Multidisciplinary discussions and patient-centered care are essential when making surgical decisions that impact quality of life such as amputation level.
Atasoy Flap Fingertip Reconstruction: Long-term Patient-reported Outcomes in Male Laborers
Authors: Franke Jacob D. , Kraft Leighton T. , Mailey Brian A.
Published: March 2023

Background:

Atasoy flaps (AFs) are commonly used to reconstruct digits after fingertip injuries. However, recent literature reports that some surgeons prefer skeletal shortening and closure, presumably because the procedure can be performed in the emergency department without the risk of flap-associated complications. The purpose of the present outcome study is to evaluate patient-reported, long-term satisfaction of AF reconstructions for fingertip injuries.

Methods:

Adult, male patients working in manual labor occupations who underwent AF reconstruction for fingertip injuries were identified from an institutional database. Patients were administered an injury-specific questionnaire relating to nail growth, function, aesthetics, cryalgia, and hypersensitivity. They were then administered the QuickDASH questionnaire to report standardized functional impairment and asked about their overall satisfaction with their reconstructed finger.

Results:

Twelve patients underwent AF fingertip reconstruction between 2015 and 2020. Eleven of these patients agreed to be interviewed, the majority having been treated in the emergency department setting. The overall satisfaction rate was 91% (n = 10). Common sequelae included hook nail 64% (n = 7), cold sensitivity 45% (n = 5), and hypersensitivity 27% (n = 3). There were no flap failures or tissue necrosis. One patient reported a second surgery for improvement of a hook nail deformity.

Conclusions:

Long-term outcomes of AF reconstruction for fingertip injuries demonstrate high overall satisfaction. Patients appreciated tissue salvage to preserve digit length, even in those unconcerned with aesthetics. Issues reported by patients, such as cold intolerance, hook nail, and decreased tactile sensation, are similar to other treatment options for fingertip injuries.
Breast Decisions: Recommender System for Appearance Counseling about Breast Reconstruction
Authors: Nicklaus Krista M. , Cheong Audrey , Sampathkumar Urmila , Liu Jun , Chopra Deepti , Hoffman Aubri , Merchant Fatima A. , Hanson Summer E. , Markey Mia K. , Reece Gregory P.
Published: March 2023

Background:

Appearance counseling is an important component of the consent process for breast reconstruction. The purpose of appearance counseling is to help the patient form realistic expectations of what she might look like after breast reconstruction. In this article, we introduce a recommender system, “BreastDecisions,” for appearance counseling that suggests photographs of previous patients that are tailored to a specific patient to help her form realistic expectations of her own reconstruction.

Methods:

We present user specifications and algorithm parameters needed to incorporate the recommender system into the appearance counseling workflow. We demonstrate the system for a common counseling scenario using a knowledgebase of previous breast reconstruction patients. The medical appropriateness of the recommended photographs for use in appearance counseling was evaluated by experts using a four-point rating system.

Results:

The recommender system presents photographs that are medically appropriate for counseling a specific patient, depicts typical outcomes, and adapts to a variety of clinical workflows. For each of 33 patients taken as examples of breast reconstruction patients, we used the system to identify photographs for appearance counseling. The baseline average medical appropriateness of the recommended photographs was between mostly appropriate (some explanation needed) and medically appropriate (minimal explanation needed). We demonstrate filtering and ranking steps to reduce the number of recommended photographs and increase the average medical appropriateness.

Conclusions:

Our recommender system automatically suggests photographs of previous breast reconstruction patients for use in counseling a patient about appearance outcomes. The system is patient-specific and customizable to a particular surgeon’s practice.
Access to Breast Reconstruction in Kuwait: Assessing Surgeon-related Factors as a Barrier to Referral
Authors: Burhamah Waleed , Alshawaf Solaiman M. , Al Safi Sarah , Alabduljalail Abdullah , AlYouha Sarah
Published: March 2023

Background:

It is not uncommon for breast cancer patients to undergo a mastectomy without receiving or being presented with the option of having a breast reconstruction. With a low rate of breast reconstruction in Kuwait, we aim to assess physician-related factors as a barrier to referral.

Methods:

This is an online questionnaire-based study to investigate the variation in the referring general surgeons’ knowledge and perception towards breast reconstructive surgery.

Results:

A total of 141 general surgeons responded to the questionnaire, and only 63 (44.7%) always discuss the available options for reconstruction with their breast cancer patients. When asked about referral to a plastic surgeon, only 49 (34.8%) responded with always, and the majority (N = 61; 43.3%) responded with sometimes. More than half (N = 73; 51.8%) believe that the general surgeon should determine patient suitability for referral to a plastic surgeon, while only 53 (37.6%) agree that breast cancer patients should always be referred to a plastic surgeon for consideration of reconstruction. The mean knowledge score was 6.6 of 8, while the mean perception score was 8.9 of 12. Responders with a higher total knowledge score were more likely to discuss with patients the availability of reconstruction.

Conclusions:

Despite the acceptable knowledge scores in our general surgeons, there is a low rate of referral for breast reconstruction in Kuwait. There is a pressing need to generate legislations and a streamlined protocol for referral that facilitate access to breast reconstructive services.
Factors Influencing Preferences for Plastic Surgery Conferences: A Conjoint Analysis
Authors: Chung William T. , Baxter Natalie B. , Chung Kevin C.
Published: March 2023

Background:

The increase in virtual conferences during the COVID-19 pandemic provided unexpected advantages such as increased accessibility, while also creating concern about the effectiveness of online networking and career development. Given that a variety of conference attributes are impacted by changes in conference format, we sought to investigate how plastic surgeons prioritize key aspects of conference conduct.

Methods:

We sent a survey based on conjoint analysis, a statistical method for evaluating consumer preferences, to active members of the American Society of Plastic Surgeons. Respondents were asked to choose between pairs of conference options, each with unique attributes. Their answers were used to calculate feature importance values and utility coefficients for the conference attributes. Subgroup analyses were conducted based on demographic factors.

Results:

A total of 263 respondents completed the survey. Respondents were mostly White (181 individuals [68.8%]) and men (186 [70.7%]). Nearly half (122 [46.4%]) had been practicing 20 or more years. Conference attributes with the highest feature importance values (SDs) were cost of attendance (30.4% [14.2%]) and conference format (28.8% [14.2%]). Equity initiatives (14.5% [10.1%]), reimbursement for cost (11.1% [5.7%]), and opportunities for networking (9.5% [6.0%]) had intermediate feature importance values. Environmental impact had the lowest feature importance (5.7% [3.8%]).

Conclusions:

Surgeons’ conference preferences depend highly on format and the presence of equity initiatives, both of which can be incorporated or modified in future conferences to ensure inclusive and successful events. Meanwhile, environmental impact is less important to surgeons, suggesting a pressing need to bring sustainability issues to their attention.
Management of Extruded Porous High-density Polyethylene Implant in the Internal Nasal Valve
Authors: Diaz Anise M. , Tham Tristan , Saleem Matthew I. , Ponder Brent , Georgolios Alexandros
Published: March 2023

Porous high-density polyethylene (PHDPE) has been used since the 1990s as an alternative to autologous grafts. Implant extrusion is a rare but well-known complication of PHDPE and other alloplastic implants. This article discusses the case of PHDPE implant extrusion in a 69-year-old man with unsuccessful previous alar batten graft placement for internal nasal valve insufficiency. We detail the surgical techniques engaged in removing the implant from the internal nasal valve, postoperative results, and care, and present a histologic study of the removed implants.
Peripherally Inserted Central Line Catheters following Hand and Wrist Infections
Authors: Park Rachel H. , Stephens Kristen L. , Forster Grace L. , Freilich Aaron M. , DeGeorge Brent R.
Published: March 2023

Background:

Hand and wrist infections may cause varying degrees of morbidity requiring antibiotic therapy of variable duration and often operative intervention. Peripherally inserted central line catheters (PICCs) are placed when an extended course of intravenous antibiotics is anticipated. The present study aims to analyze utilization and impact of PICC placement on the management of hand, wrist, and forearm infections.

Methods:

The PearlDiver Patients Records Database was queried to identify patients who underwent treatment for infection of the hand, wrist, and forearm between 2010 and 2018. Logistic regression analysis was utilized to evaluate the association of patient-related risk factors with PICC utilization, complications, readmissions, and length of stay (LOS).

Results:

A total of 24,665 patients with an upper extremity infection were included in the study. Ultimately, 416 patients required a PICC placement (1.69%). Patients with older age, male gender, certain medical comorbidities, and infection involving deeper structures were more likely to require a PICC. Ninety-day all-cause medical complication rates were significantly higher for the PICC group (19.7% versus 6.7%) compared to those without. Any hospital readmission rates were significantly higher for PICC group at 90 days (28.4% versus 6.3%) and 1 year (35.8% versus 10.9%). Readmission rates remained slightly higher at 1 year for both groups. The PICC group demonstrated significantly longer LOS by 2 days (7.72 days versus 5.14 days).

Conclusion:

While not required for the majority of hand, wrist, and forearm infections, PICC placement is associated with increased medical complications, more frequent hospital readmissions, and longer LOS.
Utilization of the Rat’s Tail as a Novel Model for Arterialized Venous Flap
Authors: Lu Johnny Chuieng-Yi , Mallarino-Restrepo Gonzalo , Camuzard Olivier , Chang Tommy Nai-Jen , Chuang David Chwei-Chin
Published: March 2023

Arterialized tissues provide longevity and coverage of critically exposed tissue, and in pliable areas of the body, thin flaps are needed. Arterialized venous flaps provide all the aforementioned qualities, yet unpredictability in flap perfusion requires further investigation in experimental studies. Existing animal models are thicker in nature and rarely mimic commonly used venous flaps in clinical practice. A novel design of the rat’s tail provides an ideal model for arterialized venous flaps. Eleven venous flaps were harvested from the rats’ tail, all presenting with two parallel veins in configuration. Arterialization of veins using the femoral artery was done in either along-valve or against-valve fashion, with the purpose of testing the flap’s response to different clinical configurations. The vessel diameter and flap thickness were measured. Flap viability was monitored for 7 days after surgery to ensure stable flap viability. Thickness of the tail flap ranged from 1.0 to 1.2 mm, while the abdomen skin thickness ranged from 1.4 to 1.5 mm. The mean diameter of the lateral veins was 0.85 ± 0.08 mm, which was in between the average femoral artery diameter (mean 0.76 ± 0.1 mm) and the average femoral vein diameter (1.28 ± 0.2 mm). Four of the nine against-valve flaps achieved more than 50% flap survival, while all along-valve flaps achieved flap viability of more than 75%, as evident by indocyanine green imaging. This flap demonstrates similar properties to thin venous flaps used in clinical situations. Standardization of this model can push forth better understanding of the arterialization phenomenon in venous flaps for future studies.
Modified Bidirectional Adipodermal Mastopexy, Nipple-sparing Mastectomy, and Direct-to-implant Reconstruction in Patients with Significant Ptosis
Authors: Schwartz Jean-Claude D.
Published: March 2023

Background:

Nipple-sparing mastectomy (NSM) and direct-to-implant reconstruction (DTIR) allow patients to complete their surgical care in one surgery. However, for women with significant ptosis, NSM is frequently not offered or requires multiple procedures.

Methods:

We performed a retrospective review of a single-surgeon practice from 2016 to 2021 of a single-stage, modified, bidirectional adipodermal mastopexy to facilitate NSM and DTIR in patients with breast cancer and grades 2-3 ptosis. Demographics, intraoperative details, and postoperative outcomes were recorded. We also conducted a literature review and compared our technique to previously published approaches.

Results:

Sixty breast cancer patients (105 breasts) with grades 2-3 ptosis underwent NSM and prepectoral DTIR using this technique. The average nipple-areola complex (NAC) lift was 9cm (range, 4 -15cm), and the average preoperative nipple to inframammary fold distance was 12cm (range, 8 -17cm). Overall complications included seroma [n = 8 (8%)], T-junction dehiscence [n = 6 (6%)], mastectomy flap necrosis [n = 6 (6%)], and superficial/partial NAC necrosis [n = 2 (2%)] with no incidence of complete NAC necrosis. Comprehensive literature review confirmed that the modified, bidirectional adipodermal mastopexy has a favorable complication profile when compared with other previously described approaches despite its application to more challenging patient populations undergoing DTIR.

Conclusions:

The modified bidirectional adipodermal mastopexy safely facilitates NSM and DTIR in breast cancer patients with ptosis without requiring multiple procedures or leaving behind breast tissue and, in our hands, is the preferred approach in this difficult patient population.
How Early Can We Predict the Need for VPI Surgery?
Authors: Pitkänen Veera V. , Alaluusua Suvi A. , Geneid Ahmed , Vuola Pia M. B. , Leikola Junnu , Saarikko Anne M.
Published: March 2023

Background:

Velopharyngeal dimensions change as a child with cleft palate (CP) grows. The aim of this study was to assess if the decision for velopharyngeal insufficiency (VPI) surgery can be made by the age of 3 years among CP children with moderate-to-severe VPI. In addition, we sought to clarify if speech therapy before VPI surgery is beneficial for VPI speech characteristics.

Methods:

This retrospective study reviewed documentation of children with moderate-to-severe VPI at age 3 years who did not undergo VPI surgery until age 5 years. Based on the national cleft register, 959 patients with syndromic and nonsyndromic CP were treated by the craniofacial team at Helsinki University Hospital, Finland between 2000 and 2014. Eighty-six patients fulfilled the study inclusion criteria. The speech pathologist evaluated velopharyngeal function at age 3, 5, and 8 years.

Results:

Of the 86 children presenting with moderate-to-severe VPI at age 3 years, 94% still had moderate-to-severe VPI at age 5 years, even though speech therapy was offered to 77%. Of those whose velopharyngeal function improved by age 5 years, function regressed to incompetent over time. Overall, 93% underwent VPI surgery and 82% underwent VPI surgery between ages 5 and 8 years. Only 23% at age 8 years still had moderate-to-severe VPI. Speech therapy alone did not improve VPI speech characteristics.

Conclusions:

Moderate-to-severe VPI did not improve from 3 to 5 years or improved but subsequently relapsed. This suggests that the decision for VPI surgery can be made for children aged 3 years with moderate-to-severe VPI.
A Novel Mouse Model for Investigating the Effects of Gender-affirming Hormone Therapy on Surgical Healing
Authors: Reiche Erik , Tan Yu , Louis Matthew R. , Keller Patrick R. , Soares Vance , Schuster Calvin R. , Lu Tingying , O’Brien Coon Devin
Published: March 2023

Wound healing problems are a major cause of morbidity for gender-affirming surgery (GAS) patients. Prior studies have shown sex differences in wound healing may exist. We hypothesized exogenous testosterone supplementation may impair post-GAS wound healing and developed a model to investigate this phenomenon. Mice were randomized by hormone regimen and gonadectomy (OVX). Gonadectomy or sham occurred on day 0 and mice were assigned to no testosterone (-T), mono- or bi-weekly (T/2T) testosterone groups. Dorsal splinted wounding occurred on day 14 and harvest on day 21. Serum testosterone levels were quantified with mass spectrometry. Tissue underwent analysis with planimetry, qPCR, ELISA, and immunofluorescence. Mean testosterone trough levels for bi-weekly regimen were higher compared to mono-weekly (397 versus 272 ng/dL; P = 0.027). At POD5, 2T injections led to 24.9% and 24.7% increases in mean wound size relative to SHAM and OVX/-T, respectively (P = 0.004; 0.001). Wounds in OVX/+2T mice demonstrated increased gene expression for inflammatory cytokines and macrophage marker F4/80 (P < 0.05). ELISA confirmed elevated wound TNFα levels (P < 0.05). Quantitative multiplex immunofluorescence with F4/80/NOS2/ARG1 showed significant increases in macrophage prevalence in OVX/+2T (P < 0.05). We developed a novel model of GAS hormonal milieu to study effects of exogenous testosterone on wound healing. Optimized twice-weekly dosing yielded serum levels comparable to clinical therapy. We showed exogenous testosterone administered to XX/OVX mice significantly impairs wound healing. A hyperinflammatory wound environment results in increased macrophage proliferation and elevated cytokines. Future efforts are directed toward mechanistic investigation and clinical validation.
Visual Preoperative Risk Depiction Tools for Shared Decision-making: A Pilot Study from the Surgeon’s Perspective
Authors: Bhat Saiuj , Wang Alice T. , Wood Fiona , Orgill Dennis P.
Published: March 2023

Background:

Shared decision-making (SDM) and effective risk communication improve patient satisfaction, adherence to treatment, and understanding of perioperative care pathways. Available risk calculators are less relevant for low-risk operations. The aim of this pilot study was to develop graphical risk visualization tools to enhance surgical SDM discussions preoperatively.

Methods:

Complications for reduction mammoplasty and skin grafting in a burns setting were sourced from the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator, the American Society of Plastic Surgeons website, peer-reviewed literature, and available clinical data. Pre- and postoperative patient satisfaction data were collected from the published literature on Breast-Q patient-reported outcomes for reduction mammoplasty. Everyday risk comparisons were collected from a general online database search. Three distinct risk depiction tools (spiral, tile, and scatter plot) were developed in the Microsoft Office Suite. Anonymous REDCap surveys were sent to healthcare practitioners for feedback.

Results:

Twenty-six survey results were collected. Twenty-four respondents (92%) agreed these graphics would be useful for SDM discussions. Nineteen respondents (73%) either agreed or strongly agreed that these graphics depicted risk in a meaningful way. Fifteen respondents (58%) indicated they would use these graphics in daily practice. The majority of respondents preferred the spiral design (58%). Areas for improvement included design simplification and written explanations to accompany graphics. Feedback from the survey was incorporated into the spiral design.

Conclusions:

Risk visualization tools meaningfully depict surgical risks to improve communication in SDM. This study proposes a tool that can be adapted for many surgical procedures.
Review of Statutory Obligations for Reporting Ballistic Injuries
Authors: Gemayel Kristina T. , Hiro Matthew E. , Sullivan Rachel R. , Payne Wyatt G.
Published: March 2023

Background:

Traumatic ballistic injury is an unfortunate and commonly encountered problem seen by surgeons. An estimated 85,694 nonfatal ballistic injuries occur annually, and in 2020 there were 45,222 firearm-related deaths in the United States. Surgeons of all subspecialties may provide necessary care. Acute care injuries are generally reported to authorities immediately; however, delayed presentation of ballistic injuries may go unreported despite regulations to do so. We present a case of a delayed ballistic injury and a comparative review of individual states’ reporting requirements to highlight statutory obligations and penalties as an educational reference for surgeons treating ballistic injuries.

Methods:

Google and PubMed searches were performed utilizing keywords “ballistic,” “gunshot,” “physician,” and “reporting” as terms. Inclusion criteria included the English language, official state statute sites, legal and scientific articles, and websites. Exclusion criteria included nongovernmental sites and information sources. Data collected were analyzed to include statute numbers, time to report, infraction consequences, and monetary fines. The resultant data are reported by state and region.

Results:

All but two state jurisdictions mandate healthcare providers to report knowledge and/or treatment of ballistic injuries, regardless of the timeline of injury. Violations of mandatory reporting may lead to fines or imprisonment, depending on the specific state. The timeline for reporting, fines, and subsequent legal action varies by state and region.

Conclusions:

Requirements for reporting injuries exist in 48 of 50 states. The treating physician/surgeon should thoughtfully question patients with a chronic ballistic injury history and provide reports to local law enforcement.
Algorithmic Approach to Management of Complications of Permanent Facial Filler: A Saudi Experience
Authors: Alarfaj Seham , Zino Alarki Subhi M.K. , Habib Ovais , Wani Shabeer Ahmad , AlSalmi Loai Abdullah
Published: March 2023

Background:

Facial filler is the most common type of cosmetic surgery next to Botox. Permanent filler is preferred nowadays due to low cost brought about by nonrecurring injection appointments. However, such fillers pose a higher risk for complications, with even greater adverse effects when the procedure is done using unknown dermal filler injections. This study aimed to establish an algorithm to categorize and manage patients that receive permanent fillers.

Methods:

Twelve participants were presented to the service through emergency or as outpatient from November 2015 to May 2021. Demographic characteristics such as age, sex, date of injection, time of onset, and types of complications were collected. After examination, all cases were managed based on an algorithm established. FACE-Q was used to measure overall satisfaction and psychological well-being.

Results:

An algorithm to diagnose and manage these patients effectively with high satisfaction rate was established in this study. All participants were non-smoking women, with no known medical comorbidities. The algorithm determined the treatment plan when faced with complications. Results revealed high appearance-related psychosocial distress before surgery, which significantly dropped after surgery. FACE-Q was able to establish evidence of satisfactory rating among patients before and after surgery.

Conclusion:

This treatment algorithm can guide the surgeon in formulating a suitable plan with less complications and high satisfaction rate.
Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia
Authors: Rakhorst Hinne A. , Gresnigt Tom M. , van Kooten Oscar , Nishikawa Hiroshi , Fourie Leroux , Mizen Kelvin D.
Published: March 2023

Background:

Noma is an infectious disease affecting mostly children aged 0–10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa’s Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from the gums and progressively expanding into the cheek, nose, or eye regions. In an estimated 90% of cases, the disease is lethal as a result of systemic sepsis. For survivors, typical results are extensive defects of the cheek, nose, and periorbital and perioral regions. Due to the defects, extensive scarring is common, which leads to secondary problems such as growth alterations in an infant’s skeleton due to inhibition and restraint of growth resulting typically in cicatricial skeletal hypoplasia. Other sequelae include trismus, partially caused by scarring or complete fusion between maxilla/zygomatic arch and mandible. The resulting overall disfiguring facial appearance results in patients being disabled and socially isolated.

Methods:

Facing Africa is a UK-based non-governmental organization that treats the secondary problems of Ethiopian noma survivors. Operations are performed in Addis Ababa by a visiting expert team. Postoperatively, patients are seen annually for years after the surgery.

Results:

This article discusses basic principles, goals, and a practical surgical algorithm for operating on lip, cheek, and oral defects, based on 210 noma patients who were operated on in Ethiopia over a period of 11 years.

Conclusions:

The suggested algorithm has proven to work for the Facing Africa team members and is considered shareware for all surgeons to use and benefit from.
Antibiotic Prophylaxis for Distal Interphalangeal Joint Arthrodesis
Authors: Vohra Sahil F. , Beck Jadon H. , Barrett Patrick C. , Bravo Cesar J. , Apel Peter J.
Published: March 2023

Background:

Prior evidence is clear that in clean, elective soft-tissue hand procedures less than 2 hours, antibiotic prophylaxis is not indicated. However, there is a lack of consensus regarding the boney procedures of the hand involving implanted hardware. Previous studies reviewing complications after distal interphalangeal (DIP) joint arthrodesis did not analyze whether patients receiving antibiotics before surgery had a significant difference in the infection rate.

Methods:

A retrospective review of clean, elective DIP arthrodesis was conducted between September 2018 and September 2021. The subjects were aged 18 years and older and underwent elective DIP arthrodesis for the treatment of osteoarthritis or deformity of the DIP joint. All the procedures were performed using an intramedullary headless compression screw. The rates of postoperative infections and treatments required for infections were recorded and analyzed.

Results:

Overall, 37 unique patients had at least one case of DIP arthrodesis that met the criteria for inclusion in our analysis. Twenty of the 37 patients did not receive antibiotic prophylaxis, and 17 of the 37 patients received antibiotic prophylaxis. Five of the 20 patients who did not receive antibiotics prophylactically developed infections, and none of the 17 patients who received antibiotics prophylactically developed an infection. Fisher exact test revealed a significant difference in the infection rates between the two groups (P < 0.05). There was no significant difference in infections with respect to smoking or diabetes status.

Conclusion:

Antibiotic prophylaxis should be administered for clean, elective DIP arthrodesis, using an intramedullary screw.
Ant Waist Surgery: Aesthetic Removal of Floating Ribs to Decrease the Waist-hip Ratio
Authors: Chiu Yen-Hao , Chiu Yu-Jen , Lee Chia-Chun , Wang Tien-Hsiang , Lee Jin-Liang
Published: March 2023

Decreasing waist circumference has become an essential feature in modern body contouring surgery owing to the attractiveness of hourglass body shapes. Traditionally, this can be achieved through lipomodeling and abdominal musculature strengthening techniques. An adjunctive procedure for ideal shaping of the waistline is resection of the 11th and 12th ribs, referred to as floating ribs. This study aimed to report and analyze clinical outcomes and self-reported patient satisfaction after “ant waist” surgery (floating rib removal) for aesthetic reasons. We retrospectively reviewed the medical records of five patients who had undergone bilateral 11th and 12th rib resections at a single institute in Taiwan in an outpatient setting. The mean lengths of the resected left and right 11th ribs were 9.1 and 9.5 cm, respectively. The mean lengths of the resected left and right 12th ribs were 6.3 and 6.4 cm, respectively. The mean waist-to-hip ratio decreased from 0.78 preoperatively to 0.72 postoperatively, with a mean decrease of 7.7%. No adverse events were reported. Generally, all patients reported being satisfied with the operation. Floating rib resection proved useful and effective in decreasing the waist-to-hip ratio using a safe, simple, and reproducible technique without significant complications. Although preliminarily, the authors’ comprehensive demonstration of this ant waist surgery supports further studies focusing on waistline contouring.
Reduction of Teprotumumab-Induced Hearing Loss With Comparable Efficacy Using Half-Dose Therapy
Authors: Phansalkar Ragini , Lu Tracy , Alyono Jennifer , Lee Jennifer , Dosiou Chrysoula , Kossler Andrea Lora
Published: March 2023

Teprotumumab has been shown to be effective in the treatment of thyroid eye disease, a potentially vision-threatening condition. Adverse events, including sensorineural hearing loss, have been associated with teprotumumab. The authors present the case of a 64-year-old female who discontinued teprotumumab due to significant sensorineural hearing loss after 4 infusions, along with other adverse events. The patient was unresponsive to a subsequent course of intravenous methylprednisolone and orbital radiation, during which she experienced worsening thyroid eye disease symptoms. Teprotumumab was restarted 1 year later, at a half dose of 10 mg/kg for 8 infusions. Three months post-treatment, she retains resolution of double vision and orbital inflammatory signs, and significant improvement in proptosis. She tolerated all infusions with an overall reduction in the severity of her adverse events and without return of significant sensorineural hearing loss. The authors conclude that a lower dose of teprotumumab can be effective for patients with active moderate-severe thyroid eye disease who experience significant or intolerable adverse events.
Metastasis of Conjunctival Melanoma to the Cardiac Atrium: A Case Report
Authors: Hopkins Nikolas S. , Laplant Jacquelyn F. , Randall M. Barry , Wilson Matthew W.
Published: March 2023

The authors present an unreported case of malignant conjunctival melanoma with metastasis to the right cardiac atrium. A 67-year-old woman with history of conjunctival melanoma of the OS presented with asymptomatic recurrence with new extension to the fornix. Surgical management was planned; however, the patient was admitted to the hospital with symptoms of heart and respiratory failure. She was found to have a large mass in the right atrium. The mass was resected and was found to be metastatic conjunctival melanoma. The patient received chemotherapy and her symptoms have improved. This case highlights the high recurrence rate of conjunctival melanoma and the importance of tumor surveillance.
Influence of Mild Traumatic Brain Injury History and Mental Health Status on Alcohol and Cannabis Use in University Athletes
Authors: Wilson Alyssia , Gicas Kristina , Wojtowicz Magdalena
Published: March 2023

Objective:

This study examined the relationship between mild traumatic brain injury (mTBI) history, mental health, and sex with single and polysubstance use in university athletes.

Design:

Observational study.

Setting:

University in Ontario, Canada.

Participants:

Participants were identified from a dataset of 416 university athletes ages 18 to 21. Participants were classified based on their substance use habits and, 153 met criteria for the nonsubstance group, 195 for the alcohol use (AU) only group, and 64 polysubstance use group [ie, a combined substance use (AU+) group].

Independent Variables:

Athletes received baseline assessments and completed self-reported questions regarding alcohol, cannabis, or other recreational substance use, the Patient Health Questionnaire-9, self-reported mTBI history, and self-reported anxiety, and/or panic disorder endorsement information.

Main Outcome Measures:

Comparison of mTBI history and mental health status between individuals in the alcohol only or polysubstance use group.

Results:

Mild traumatic brain injury history was a significant predictor of AU (P < 0.001) and AU+ (P < 0.001). Anxiety endorsement was also a significant predictor of polysubstance use (P < 0.001) and there was a small but nonsignificant association of polysubstance use in men (P = 0.057).

Conclusions:

University athletes who experience mTBI are more likely to engage in single or polysubstance use and athletes who experience anxiety are more likely to engage in polysubstance use. Consideration of mTBI history and mental health may inform clinical concussion management for identifying potential high-risk behavior such as polysubstance use in university athletes and tailoring intervention strategies (eg, incorporating education about substance use).
Artistic Swimming Injuries in Young Elite Athletes: An 11-year Follow-Up
Authors: Vignaud Emeline , Menu Pierre , Daley Pauline , Grondin Jérôme , Dauty Marc , Fouasson-Chailloux Alban
Published: March 2023

Objective:

Artistic swimming is a highly challenging discipline, requiring physical skills and creativity. There are almost no published data on trauma. We aimed to assess the incidence and the nature of injuries in artistic swimmers.

Design:

An 11-year retrospective single-center cohort study.

Setting:

Department of Sport Medicine of a University Hospital.

Patients:

One hundred and twenty-four elite female artistic swimmers aged 12.9 ± 1.6 years.

Interventions:

The cohort was divided into 3 groups according to the competition categories (from 9 to 12 years old called “future”, 12-15 years old called “youth”, 15-19 years old called “junior”).

Main Outcome Measures:

Injury rate per season and per athlete was assessed.

Results:

The injury rate was 0.95 injuries/season/athlete and 1.05 injuries/1000 hours of practice. The most frequent injuries were rotator cuff tendinopathy (13.6%), acute low back pain (13.6%), and patellofemoral syndrome (11.9%). Swimmers in the youth and junior categories had significantly more injuries than those in the future category (P = 0.009), possibly because of more training hours (P < 0.001). Twelve major injuries occurred, all in the same group of youth swimmers.

Conclusion:

This is the first study investigating trauma during artistic swimming practice. A better knowledge of the main injuries is necessary for the physician to provide optimal care for athletes and to develop prevention. Attention should be particularly paid to the swimmers' shoulders and knees.
Myxopapillary Ependymoma in an 11-Year-Old Patient With Right-Sided Nocturnal Thigh Pain
Authors: Sim Don , Groswald Michael , Watters Aaron
Published: March 2023

This case report highlights a rare type of primary spinal cord tumor, myxopapillary ependymoma, in a pediatric patient who presented to clinic with worsening chronic unilateral thigh pain and neurologic deficits. He was appropriately treated with total gross resection of the tumor and adjuvant radiotherapy and was cleared for competitive sports without any restriction within 1 year of his diagnosis and treatment. Although most musculoskeletal complaints among pediatric patients are of benign etiology, as evidenced by our case, clinicians should have a low threshold to further investigate with advanced imaging modalities should the clinical history and examination be consistent with a more concerning pathologic process.
Novel, homozygous RAB3GAP1 c.2606 + 1G>A, p.Glu830ValfsTer9 variant and chromosome 3q29 duplication in a Turkish individual with Warburg micro syndrome
Authors: Geckinli Bilge , Turkyilmaz Ayberk , Alavanda Ceren , Sager Gunes , Arslan Ates Esra , Soylemez Mehmet Ali , Arman Ahmet
Published: March 2023

Warburg micro syndrome (WARBM) is a rare, autosomal recessive, neurodevelopmental disorder characterized by microcephaly, cortical dysplasia, corpus callosum hypoplasia, congenital hypotonia leading to subsequent spastic quadriplegia, severe developmental delay and hypogenitalism. Ophthalmologic findings that may affect any ocular segment including characteristic, small, atonic pupils. WARBM is known to be caused by biallelic, pathogenic variants in at least five genes although additional genetic loci may exist. The RAB3GAP1 c.748 + 1G>A, p.Asp250CysfsTer24 founder variant has been described in families of Turkish ancestry. We report the clinical and molecular findings in three, unrelated, Turkish families with WARBM. A novel c.974−2A>G variant causing WARBM in three siblings of Turkish descent was found. Functional studies of the novel, c.2606 + 1G>A variant in patients’ mRNA revealed skipping of exon 22 which results in a premature stop codon in exon 23. However, the clinical consequences of this variant are blended given that the individual also had a maternally inherited chromosome 3q29 microduplication.