bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality Improvement: Effect of Standardized Plastic Surgery Consultation Note Templates on Charge Capture
Authors: Schaeffer Christine V. , Park Rachel , Lane Jaina , DeGeorge Brent R. 
Published: November 2021

Background:
Effective medical record documentation is imperative for both patient care and reimbursement for care provided. The purpose of this study was to compare coding/billing patterns for plastic surgery consultations before and after implementation of a standardized documentation protocol.

Methods:
Standardized hand, facial trauma, and general plastic surgery consult note templates were created. Following institutional approval, records were reviewed for all plastic surgery consultations from January to October 2019. Template notes were universally implemented in July 2019. Medical coding was performed by a certified professional coder using the 1995 Evaluation and Management Review Worksheet. Coding/billing patterns between groups were compared with and without standardized documentation using univariate analysis.

Results:
Seventy-five consecutive preimplementation consult notes and 75 consecutive postimplementation consult notes were selected for review. Each group included 25 hand, 25 facial trauma, and 25 general plastic surgery consultation notes. The history and physical examination components of the visit code were more frequently coded as “comprehensive”postimplementation (P = 0.000). There was no significant difference in coding for medical decision making between the two groups (P = 0.340). The final visit code was significantly higher in the postimplementation group (45.3% 99254/99284 versus 2.7%, P = 0.000), and the charges were significantly higher post implementation—average charge per consult $250 versus $203 (P = 0.000) with a 22.8% increase in total charges generated.

Conclusion:
Utilization of standardized consultation note templates increases the accuracy of coding and associated billing of inpatient and emergency department plastic surgery consultations through documentation and reflection of level of service provided.
FFF Utilizing an Arteriovenous Vascular Loop of Two Peroneal Venae Comitantes for a PAM
Authors: Huddleston Hailey P. , Kurtzman Joey S. , Koehler Steven M. 
Published: November 2021

Summary:
Vascularized bone grafting is widely used for reconstruction of osseous defects of the forearm. Fibular free flap (FFF) is one option, which relies on harvesting the peroneal artery. This procedure is subject to lower extremity anatomic variants; therefore, some recommend preoperative angiography. However, high quality evidence for this approach and its cost-effectiveness are lacking and instead one can diligently assess the vascular anatomy intraoperatively. Here, we describe a case of a 73-year-old man who was found to have a peronea arteria magna intraoperatively during an FFF for a left radius reconstruction secondary to an infectious nonunion. We describe an approach to performing an FFF using an arteriovenous vascular loop through the fibula employing the two accompanying peroneal venae comitantes. The patient had no complications and was found to have appropriate healing of the upper extremity without lower extremity compromise at 3-month follow-up. This report illustrates an alternative to using an interpositional venous graft for peronea arteria magna found intraoperatively during FFFs.
How to Organize Affordable Microsurgical Training Laboratory: Optimal Price-quality Solution
Authors: Khachatryan Arbak , Arakelyan Gevorg , Tevosyan Artur , Nazarian David , Kovaleva Daria , Arutyunyan Grant , Gabriyanchik Mark , Dzhuganova Victoria , Yushkevich Alexey 
Published: November 2021

Summary:
Today, microsurgery is an integral part of plastic surgery, maxillofacial surgery, hand surgery, and neurosurgery. More and more surgical procedures are accompanied by microsurgical intervention. Long training is required to develop the necessary skills for fine work with microsurgical instruments and delicate tissues under magnification. We suggest a methodology as to how to organize an inexpensive microsurgical training laboratory with minimal investment. Suggested guidelines provide information about cost-effective ways of arranging a comfortable training environment. An adapted stereoscopic microscope allows working with a wide range of magnification and focus distance. An ergonomic working position is set up by adjustable handmade table and chair. For performing basic microsurgical manipulations, a set of four instruments and inexpensive suture materials are used. A total amount of 323.5 USD was spent to purchase all of the necessary components for the microsurgical laboratory. The described components are available worldwide regardless of manufacturers. We suggest an inexpensive way to arrange a microsurgical laboratory. This approach is especially beneficial for students and residents from low-income countries.
Double-sided Nipple-areola Complex Marker for Masculinizing Chest Surgery
Authors: Mundinger Gerhard S. (Sol) 
Published: November 2021

Summary:
In addition to chest contour and incision placement, nipple-areola complex size, orientation, and position is a primary concern of patients undergoing masculinizing chest surgery with free nipple grafting for gender dysphoria or gynecomastia. The author has developed a double-sided nipple-areola complex harvest and inset marker that facilitates graft healing in an optimized masculine orientation.
Primary and Revision Rhinoplasty: A Single Surgeon Experience and Patient Satisfaction
Authors: Suresh Rishi , Doval Andres F. , Newstrom Emily , Pham Truce , Alford Eugene L. 
Published: November 2021

Background:
There is minimal information describing the common characteristics among patients seeking primary/revision rhinoplasty. Success is traditionally interpreted from the surgeon's viewpoint, without considering the patient's perspective. The study's aims were to (1) identify/compare anatomic and functional characteristics commonly found in patients seeking primary and revision rhinoplasties; (2) assess patient satisfaction using a survey; and (3) explore whether graft choice (auricular cartilage versus rib cartilage) affects patient satisfaction and outcome in revision rhinoplasty.

Methods:
A retrospective review of all rhinoplasties by a single surgeon from June 2016 to January 2020 was performed, focusing on preoperative anatomic/functional characteristics and operative interventions performed. A survey was then used to assess patient satisfaction. Finally, survey outcomes were compared between patients who received auricular and rib cartilage grafts in revision rhinoplasty.

Results:
A total of 102 rhinoplasties (53 primary and 49 revisions) were included. Primary rhinoplasties were noted to have more patients with “big” noses (P = 0.015) or humps (P < 0.010). Patients undergoing revision rhinoplasties more commonly exhibited middle vault collapse (P = 0.022). The survey response rate was 60%. Revision rhinoplasty patients had a higher incidence of dissatisfaction with their outcome

Conclusions:
Several features among patients seeking revision rhinoplasties could have been created in the primary operation. The rhinoplasty surgeon should be careful to not introduce new issues or create worse deformities than those seen following the initial operation. Survey-based outcome analysis demonstrated that revision rhinoplasty patients are more likely to have a greater rate of dissatisfaction following their operation.
A Ventral Hernia-repair–related Mycobacterium mageritense Mesh Infection Treated with NPWT without Mesh Removal
Authors: Ando Junji , Miyata Riyo , Harada Masayuki , Takeuchi Mika , Kasahara Kei , Yoshimoto Yuji , Koyama Fumikazu , Kuwahara Masamitsu 
Published: November 2021

Summary:
Abdominal hernias are often repaired using prosthetic mesh, which is susceptible to infections. Normally, it is necessary to remove the mesh. However, successful mesh salvation with negative-pressure wound therapy (NPWT) has recently been reported. We encountered Mycobacterium(M) mageritense infection after hernia repair using the mesh. M. mageritense is classified as a fast-growing nontuberculous mycobacterium, but few cases have been reported. Nontuberculous mycobacterium can cause rare chronic infections. Skin and soft-tissue infections by nontuberculous mycobacterium involving localized abscess formation and chronic abscesses under various situations have been reported. We report an 85-year-old woman in whom a ventral hernia repair-related M. mageritense mesh infection was treated with NPWT without mesh removal. The hernia was repaired using Bard Ventralex mesh. Pus discharge was seen on the seventh postoperative day, and there was a small area of necrosis under the mesh. From the 13th postoperative day, NPWT was performed for 4 weeks. On the 29th postoperative day, a M. mageritense infection was diagnosed, which was resistant to multiple drugs. After the NPWT, most of the wound showed good granulation tissue formation. In conclusion, the mesh used to repair a hernia became infected with M. mageritense, but NPWT was able to salvage it. In cases of mesh infection involving small necrotic areas, performing NPWT under the guidance of an infectious disease expert may make it possible to preserve the mesh.
Posttraumatic Vascular Anomalies in Hand Surgery—A Case-based Approach
Authors: Scheer Helene Sophie , Banz Yara , Grobbelaar Adriaan O. , Vögelin Esther 
Published: November 2021

Summary:
The field of vascular anomalies (VA) has been subject to changes during the last few decades. The current classification of the International Society for the Study of Vascular Anomalies (ISSVA) offers a simple diagnostic structure. Hand surgeons commonly appear to have limited exposure to VA. Already recognized for more than 120 years, pyogenic granuloma (PG) is by far the most commonly described VA by different disciplines with accordingly diverse treatment strategies and theories behind it. Arteriovenous fistula (AVF), venous aneurysms (VAN), and venous malformations (VM) are, however, rare in hand surgery. With a compilation of four illustrative cases of posttraumatic entities such as AVF, VAN, VM, and PG, we would like to highlight possible daily exposure to VA in the general hand surgery practice. We discuss diagnostic and therapeutic options as well as the current literature with focus on posttraumatic VA.
Facial and Eyelid Changes in Thyroid Eye Disease Are Reversed by Teprotumumab
Authors: Ugradar Shoaib , Braun Jenna , Wang Yao , Zimmerman Erin , Douglas Raymond S. 
Published: November 2021

Background:
Thyroid eye disease (TED) causes orbital soft-tissue expansion. Recent studies have suggested that brow and temple changes may also occur. Teprotumumab, a monoclonal antibody to the insulin-like growth factor 1 receptor reduces soft-tissue swelling in TED. In this study, we quantified the changes to pan facial soft-tissue volumes and eyelid position, following treatment with teprotumumab.

Methods:
In this prospective study, consecutive patients who were treated with teprotumumab were appraised for study eligibility. All patients had 3D facial imaging using the Vectra H2. Soft-tissue volume changes in the upper face, periorbita, temples, midface, and lower face were quantified before and after teprotumumab therapy. Furthermore, the marginal reflex distance (MRD)1, MRD2, and intercanthal distance were also measured pretreatment and posttreatment.

Results:
Twenty-three patients were included in the study. The mean duration of TED was 29 months (38). Following teprotumumab therapy, the mean (SD) decrease in volume for each region was 0.75 mL (0.84) in the upper face, 1.8 mL (1.3) in the periorbital region, 0.17 mL (0.5) in the temples, 1.62 mL (3.16) in the midface, and 2.67 mL (4.6) in the lower face. The mean (SD) decrease in the volume of the full face was 8.9 mL (8.7). There was also a significant reduction in MRD1, MRD2, and the intercanthal space following treatment. There was no relationship between previous steroid use and total body weight reduction and changes in facial volume.

Conclusion:
TED may cause significant tissue expansion across the entire face and this may be reduced following teprotumumab therapy.
The Butterfly Technique: A Retrospective Study for Labia Minora Reduction Using an Integrated Approach
Authors: Tremp Mathias , Oranges Carlo M. , Schaefer Dirk J. , Waldkircher Natascha J. , Schleh Andrea C. , Kalbermatten Daniel F. 
Published: November 2021

Background:
In recent years, the demand for genital plastic procedures has increased. Of those, the reduction of the labia minora has become very popular. Several techniques are described, with all its advantages and disadvantages. The aim of this study is to introduce a novel approach combining de-epithelialization with wedge resection.

Methods:
In this retrospective study, we included patients seen between September 2011 and April 2014 with hypertrophic labia minora. The surgical technique consisted in an integrated approach of de-epithelialization and wedge excision. Patients were examined for early and late postoperative complications. Furthermore, patient satisfaction was evaluated at the final follow-up.

Results:
A total of 17 labioplasties (Franco type II–IV) in 10 patients with a mean age of 29 ± 12 years (range 20–62 y) were performed. Three patients experienced wound-healing problems, requiring surgical revision. After a median follow-up of 39 ± 6 months (range 28–48 mo), a high overall patient satisfaction has been achieved (8.6 ± 1.1). No dyspareunia, hypertrophic scarring, or micturition problems have been reported.

Conclusions:
By using our integrated approach, hereby called the “butterfly technique,” the neurovascular supply remains preserved, and an efficient volume reduction can be achieved with a concealed scar. Nevertheless, suture techniques and suture materials have to be tested to reduce the incidence of wound dehiscence rate.
Comparison of Surgical and Oncological Outcomes between Chest Wall Perforator Flaps and Therapeutic Mammoplasty
Authors: Khan Samreen , Mathew John 
Published: November 2021

Background:
Chest wall perforator flaps (CPF) and therapeutic mammoplasty (TM) are often done in patients with anticipated poor cosmetic outcome with level 1 breast conservation surgery. The aim of this study was to assess the complications and oncological outcomes between CPF and TM.

Methods:
Prospectively collected data of breast conservation surgery between September 2016 and January 2021 by a single surgeon were reviewed. Specific outcomes included complications needing intervention, re-excision and mastectomy rate, locoregional recurrence, and distant metastasis. Patients were followed up at 3 months and then every 12 months. Statistical analysis included chi-squared test and independent t test, and a P value of less than 0.05 was considered significant.

Results:
There was no statistically significant difference between CPF and TM with regard to patient characteristics except for BMI and bra cup size, which was significantly higher in the TM group. One patient who had TM returned to the operating room for a hematoma evacuation, and one patient who had CPF had fat grafting, for unsatisfactory cosmetic outcome. Five of the 30 patients having CPF had further re-excision surgery for inadequate margins, but none needed mastectomy, and four of the 43 patients having TM had further surgery (one had re-excision of margins and three had mastectomy) and this was not statistically significant (P = 0.346). There was no locoregional recurrence in CPF and TM groups after a median follow-up of 22 months and 25 months, respectively.

Conclusion:
There is no significant difference in early complications and oncological outcomes between CPF and TM.
Injection Cryolipolysis: First-in-human Study
Authors: Kandula Prasanthi , Javorsky Emilia , Austen William G. , Kaminer Michael S. 
Published: November 2021

Background:
Injection cryolipolysis using an ice slurry has been hypothesized to be a novel method of reducing fat. The present first-in-human pilot study aims to investigate the feasibility, safety, and tolerability of ice slurry injection into human subcutaneous fat.

Methods:
Preabdominoplasty subjects were recruited. Baseline measurements and serial follow-up visits following a single ice slurry injection procedure into tissue to be excised during abdominoplasty were performed. Melted ice slurry injection was used as control. Feasibility using standard injection techniques was assessed. Thermal imaging was used to determine cooling efficacy. Safety was assessed by adverse event monitoring. Tolerability was assessed by subject-reported pain score. Histology and ultrasound were monitored for structural changes associated with cryolipolysis.

Results:
A single injection of ice slurry was feasible and sufficient to cool adipose below the target temperature (10C). There were no serious adverse events. The most common adverse events were bruising and erythema. The mean pain score for ice slurry-injected sites was 1.9/10 and 1.3/10 in control injection sites. Evidence of cryolipolysis was observed on ultrasound and tissue histology in ice slurry-injected sites.

Conclusions:
Ice slurry injections are feasible, with an observed safety and tolerability profile comparable to topical cryolipolysis. The ice slurry can cool tissue to induce cryolipolysis, as observed by thermal imaging, ultrasound, and tissue histology, and is selective for ice-injected sites. No significant changes were observed in control sites. The ice slurry may be a promising candidate to enable more precise, effective, and customizable aesthetic fat reduction that warrants further investigation.
Concurrent Excision of Dorsal Nasal Scars and Reduction Rhinoplasty: A Retrospective Cross-sectional Study
Authors: Omranifard Mahmood , Zare Neda , Mahabadi Maryam 
Published: November 2021

Background:
Skin lesions and traumas can affect the skin by leaving scars. The purpose of this study was evaluating the results of a new technique in reconstructive surgery of scars on the nose. In this technique, extra skin remaining from reduction rhinoplasty is applied to the defect remained from removing the scar.

Methods:
This is a retrospective cross-sectional study performed on 33 patients who underwent reduction rhinoplasty from 2013 to 2018 due to scars on the dorsal nasal skin. Five sets of standards, criteria, and questionnaires were used to evaluate the cosmetic outcomes, scars, and nasal function. These included the Cakir concept, visual analogue scale, patient reported outcome measurement, Stony Brook scar evaluation scale, and sino-nasal outcome test-22.

Results:
According to the surface polygon concept, or Cakir concept, the number of affected polygons due to scars decreased in all included patients (P < 0.05). In addition, constant improvement in patients’ satisfaction, based on patient reported outcome measurement (P < 0.001) and visual analogue scale (P ≤ 0.05), as well as physicians’ satisfaction, based on Stony Brook scar evaluation scale, were determined. Furthermore, evaluating the patients’ breathing, based on sino-nasal outcome test-22 criteria (P < 0.09), indicated no adverse effects.

Conclusion:
Excision of scars from dorsal nasal skin and conducting rhinoplasty surgery from the same access can be considered an option for reconstructing nasal scars.
A Case Report of Misdiagnosed Breast Implant-associated Anaplastic Large Cell Lymphoma with Lymphatic Extension
Authors: Maglic Dino , Moss Whitney , Pires Giovanna , Agarwal Archana , Matsen Cindy , Kwok Alvin 
Published: November 2021

Summary:
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma associated with textured implants and usually presents as a late-onset periprosthetic seroma. We present a 70-year-old woman with a history of left breast invasive ductal carcinoma treated with mastectomy and textured implant-based reconstruction, and subsequent adjuvant chemotherapy due to lymphovascular extension. Eleven years following her reconstruction, the patient developed a periprosthetic seroma. Fine needle aspiration and partial capsulectomy were performed, but appropriate pathologic evaluation was not initially submitted. She then presented with lymphadenopathy, which was biopsied and revealed BIA-ALCL within an axillary lymph node. Despite implant explantation, complete capsulectomy, axillary lymph node dissection, and excision of groin lymphadenopathy, no evidence of primary ALCL was appreciated. This initially misdiagnosed case demonstrates the importance of following the National Comprehensive Cancer Network guidelines when a patient presents with late onset breast periprosthetic effusions.
The “Five-flap” Technique for Nipple–Areola Complex Reconstruction
Authors: Ferraro Giuseppe Andrea , Lanzano Giuseppe , Gentile Corrado , Izzo Sara , Grella Elisa , Gubitosi Adelmo , Nicoletti Giovanni Francesco 
Published: November 2021

Background:
Nipple–areola complex reconstruction aims to be the last step in the postmastectomy treatment procedure. Different techniques have been developed with the purpose of achieving optimal symmetry in position, size, shape, pigmentation, and permanent projection of the reconstructed nipple, but to date, there is no gold standard technique. The five-flap technique provides an easy, simple nipple–areola complex reconstruction method, effectively maintaining longer nipple projection, with a negligible rate of complications.

Methods:
From November 2018 to April 2021, a total of 21 female patients with an absent unilateral nipple–areolar complex due to postoncological mastectomy were subjected to our technique consisting of a combination of local flaps and a full-thickness skin graft. Patients were observed for 6 months to estimate the percentage of the nipple projection loss. Overall satisfaction was evaluated by the patients themselves and by an external medical observer at the end of the follow-up period.

Results:
None of the reconstructed nipples experienced either total or partial necrosis. Two minor complications were observed. Nipple projection loss was negligible with an average reduction of 12% from the initial projection. The nipple–areolar complex shape remained excellent in all cases, with minimal alteration of the immediate postoperative results. The total average satisfaction score was 8.0 for patients and 9.0 for external observers.

Conclusion:
The five-flap technique represents a simple, safe, and efficacious procedure in patients with implant-based reconstruction requiring moderate to very projected nipples.
Comment on “Cornea Classic Article: Kim JC and Tseng SCG: Transplantation of Preserved Amniotic Membrane for Surface Reconstruction in Severely Damaged Rabbit Corneas (Cornea 1995;14:473–484)”
Authors: Kenyon Kenneth R. 
Published: November 2021

Abstract:
Following identification of limbal stem cells, efforts have been devoted to restore and/or replace these essential progenitors of the corneal epithelium. Limbal stem cell deficiency, commonly a consequence of ocular chemical injury, results in clinically compromised vision consequent to corneal conjunctivalization. The insight of Kim and Tseng provided experimental proof of the concept that even in the presence of total limbal stem cell deficiency, amnion membrane overlay grafts can promote limbal recovery as a means of ocular surface reconstruction.
Grouped Vesicles on an Erythematous Base
Authors: Cantos Joshua , Macknet Cathy 
Published: November 2021

ABSTRACT
Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. The following is a teledermatology case of herpes zoster.
In the store-and-forward teledermatology modality, there is an electronic transfer of a patient's medical information, which includes both the history and visual data obtained in one location, to a provider who is in another location. The construct of this column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report.