bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scrotal Tissues: The Perfect Material for Urogenital Reconstruction
Authors: Adamyan Ruben T. , Kamalov Armais A. , Ehoyan Misak M. , Starceva Olesya I. , Urshevich Eduard N. , Sinelnikov Mikhail Y. 
Published: January 2021

Background:
Correction of male urogenital pathology of different severity is complicated by the anatomical aspects of the penis. Skin texture, internal structures, and perfusion dynamics of the urogenital area make it a difficult area to reconstruct. We provide our experience with axial scrotal flaps for correction of penile defects of different severity and believe that these local flaps offer sufficient tissue characteristics for proper restoration of this complex region.

Methods:
Forty-eight patients were divided into 3 groups depending on penile defect genesis and severity. Axial scrotal flap reconstruction was used for the correction of defects in all cases, when necessary in combination with other flaps.

Results:
Axial scrotal flaps for total and subtotal penile reconstruction serve as valuable material for reconstruction of the urogenital area, and are to be combined with other flaps for restoration of bulk tissues. Localized defects of the penis and urethra reconstructed by axial scrotal flaps provide excellent aesthetic results with minimal scaring, stable perfusion dynamics, and high satisfaction rate.

Conclusions:
Scrotal tissues provide an excellent reconstruction material for penile defects because of their highly similar tissue structure as that of the penis. Scrotal axial flaps do not provide excess bulking in the postoperative period and are recommended for reconstruction of urethral and localized penile defects. Multistage surgery is recommended in cases of severe tissue damage, in combination with other flaps (inguinal, thoracodorsal, and radial).
Four Ways Plastic Surgeons Can Fight Climate Change
Authors: Brown Ciara , Meals Clifton 
Published: January 2021

Background:
The climate crisis demands that surgeons reduce their environmental impact. Operating rooms are resource-intensive and are often wasteful. This makes them fitting targets for climate-conscious decision making.

Methods:
We searched for peer-reviewed literature describing how plastic surgeons might positively affect the environment through action in the operating room.

Results:
Several evidence-based, pro-climate practices may be undertaken by plastic surgeons. These strategies may be grouped into 4 types: material, energy, technique, and dissemination. Each strategy is a way to reduce, reuse, recycle, research, or rethink.

Conclusions:
Administrative obstacles to greener operating rooms are predictable and surmountable, especially because environmentally minded decisions are likely to save money. We anticipate a surge of environmental consciousness in healthcare. Plastic surgeons, as thought leaders, are well positioned to champion this cause.
The Prepectoral, Hybrid Breast Reconstruction: The Synergy of Lipofilling and Breast Implants
Authors: Stillaert Filip B. J. L. , Lannau Bernd , Van Landuyt Koenraad , Blondeel Phillip N. 
Published: January 2021

Background:
Breast reconstruction modalities are based on autologous tissue transfer, implants, or a combination of both. The aim of an allogeneic breast reconstruction is to minimize the impact of the implant on surrounding tissues to achieve an aesthetically pleasing result. Accurate tissue coverage, proper implant selection, and implant location are the absolute concerns in planning an implant-based reconstruction.

Methods:
A single surgeon’s experience with the ergonomic, hybrid approach in primary and secondary breast reconstructions is presented. The hybrid approach is based on tissue expansion followed by serial sessions of fat grafting to augment the residual autologous (subcutaneous) compartment. The last step included the insertion of a prepectoral, ergonomic implant to obtain central core projection and additional volume.

Results:
Fifty-six hybrid breast reconstructions were performed with a mean follow-up of 24.1 months. Aesthetic outcomes and patient satisfaction have been good with pleasing breast projection, natural breast motion, and optimal coverage of the prepectoral implants.

Conclusions:
The hybrid reconstructive approach is a reliable technique to improve the outcomes in implant-based breast reconstructions. The 2-step, prepectoral approach with expander-to-implant exchange allows better control of the final breast shape, and complications related to submuscular approaches are avoided. Fat grafting adds an autologous benefit to obtain natural results.
A Unique Case of Lower Limb Soft Tissue Reconstruction with a Prefabricated Bipedicled Deep Inferior Epigastric Artery Flap
Authors: Melnikov Dmitriy V. , Starceva Olesya I. , Ivanov Semen I. , Garmi Rachid , Sinelnikov Mikhail Y. 
Published: January 2021

Summary:
Aesthetic lower-extremity reconstruction is a secondary field in lower limb reconstructive surgery. Nevertheless, it plays an important role in the final stages of patient rehabilitation after traumatic events, treatment of deformations, and oncoplastic surgery, and in unique cases of purely aesthetic reconstruction. We present a clinical case of lower limb reconstruction with a prefabricated bipedicled deep inferior epigastric artery (DIEP) flap in a young patient who underwent a massive congenital circular pigmented nevus excision surgery. Due to the lack of sufficient donor site tissues anywhere on the body, a bilateral DIEP flap was prefabricated using tissue expansion. Two expanders were used to prepare the donor site. Six months after expansion, lower limb reconstruction was performed. A large (50 × 25cm2) surgical defect was covered by a prefabricated DIEP flap. Flap positioning was regarded with extra care due to importance of proper venous outflow in accordance with lower limb venous anatomy. Treatment results were above the satisfactory level both aesthetically and therapeutically. Aesthetic and therapeutic incentives were assessed before surgical treatment decision. Large defects of the lower limbs require significant amount of excess tissue in the donor site and may require prefabrication. In young patients with low BMI, flap transfer is nearly impossible without prior expansion. In this case, we successfully performed giant pigmented nevus excision, with immediate reconstruction with a prefabricated bilateral DIEP flap. Venous outflow was problematic due to the anatomical structure of lower limb veins. This required extra venous drainage and special regard to positioning of the flap.
Surgical Technique for Below-knee Amputation with Concurrent Targeted Muscle Reinnervation
Authors: Daugherty Timothy H. F. , Parikh Rajiv , Mailey Brian A. , Felder John M. , Bueno Reuben A. 
Published: January 2021

Summary:
Targeted muscle reinnervation (TMR) is beneficial for decreasing pain following below-knee amputation (BKA). While most current literature describes the principles behind primary TMR, they provide few principles key to the amputation, as the BKA is usually performed by another surgeon. When the BKA and TMR are performed by the same surgeon, it can be performed through the same surgical access as needed for both procedures. The purpose of this article is to describe our anatomically based BKA technique in the setting of planned primary TMR as performed by 3, single, peripheral nerve plastic surgeons at 2 institutions. Advantages of the single-surgeon technique include efficiency in dissection, preservation of donor nerve length, limited proximal dissection, early identification of recipient motor nerves for coaptation, ability to stimulate these while still under tourniquet, and decreased tourniquet and operative time. This technique is quick, reliable, and reproducible to help promote widespread adoption of TMR at the time of BKA.
Necrobiosis Lipoidica Affecting the Leg: What Is the Best Treatment in a Patient with Very High Aesthetic Demand?
Authors: Baccarani Alessio , De Maria Federico , Pappalardo Marco , Pedone Antonio , De Santis Giorgio 
Published: January 2021

Summary:
Necrobiosis Lipoidica (NL) is a rare necrotising disorder of the skin characterized by collagen degeneration, thickening of blood vessels, and granulomatous inflammatory process. Its main clinical features are brownish-red papules and yellowish plaques with atrophic central areas. NL affects 0.3% -1.2% of the diabetic population, mostly women (female/male ratio is 3:1). Management of NL is challenging, especially for large lesions refractory to medical therapy, thus requiring surgical excision as an alternative option. Due to the rare occurrence of this condition no treatment guidelines exist and individualized treatment mostly depends on the severity of the lesion, location and patient's expectations. A case of a 30-year-old diabetic woman with very high aesthetic expectations was succesfully treated with staged resections of a giant NL to the leg and reconstruction with dermal template and full thickness skin grafts. Grafts were taken from the groin region bilaterally and from the lower abdomen after a cosmetic mini-abdominoplasty procedure. This approach allowed for a stable and very satisfactory aesthetic result with no donor site exposed scars.
Surgical Simulation Course for Facial Fracture Education
Authors: Wu Shannon S. , Patel Anooj , Alleyne Brendan , Metoyer Garyn , Chandrashekar Archana , Hassan Bashar , Hemal Kshipra , Gurunian Raffi 
Published: January 2021

Summary:
A hands-on facial fracture simulation course can be an important adjunct teaching modality in resident education and training, enhancing both resident confidence and competence in treatment of facial fractures. In this study, 11 plastic surgery residents participated in a surgical wet laboratory and lecture focusing on operative management of facial fractures. Pre- and post-course questionnaires were administered as clinical knowledge assessments. Pre-course, 40% of participating residents reported feeling comfortable with facial fracture management (>5 of 10) and 50% of residents achieved competence on clinical assessment (scoring >50%). Following the simulation course, these same assessments were re-administered. Post-course, comfortability with fracture management increased to 100% among participating residents, and 90% of residents scored >50%, demonstrating improvement in clinical competency.
Early full weight-bearing in patients with isolated displaced lateral malleolar fracture after rigid internal fixation with locking plates
Authors: Yeung Chi-Yung , Hung Shih-Hsin , Hsu Kuei-Hsiang , Chiu Fang-Yao 
Published: January 2021

Background:
The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates.

Methods:
From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications.

Results:
The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed.

Conclusion:
For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.
Pancreatic cystic tumors: an update
Authors: Xiao Shu-Yuan , Ye Ziyin 
Published: January 2021

Abstract
Pancreatic cystic tumors (PCTs) comprise a heterogeneous group of entities, accounting for 2% to 10% of pancreatic lesions. The most common types are intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasm (MCN), and serous cystic neoplasm (SCN), which account for approximately 90% of PCTs. This review discusses updates in pathologic features, malignant transformation, biologic behavior, and molecular evolution of PCTs. IPMN includes main duct and branch duct types. These can also be classified into 4 histologic subtypes based on cell lineages of differentiation, and may be associated with different tumorigenic pathways and clinicopathologic characteristics. The gastric type is the most common and is rarely associated with carcinomas, whereas the pancreatobiliary type is significantly more associated with invasive carcinoma. MCN is a mucinous cystic lesion with the presence of ovarian-type pericystic stroma. Prognosis of the resected non-invasive MCN is excellent, but the long-term survival of MCNs with invasive carcinoma may be poor. SCN includes microcystic adenoma, macrocystic adenoma, and solid variant serous adenoma. Serous cystadenocarcinoma is defined by the presence of distant metastases, which is rare in literature. Intraductal tubulopapillary neoplasm is characterized by uniformly high-grade dysplasia and ductal differentiation without overt production of mucin, with high risk for developing invasion. Acinar cell cystadenoma is a rare benign lesion with acinar differentiation. In addition, some pancreatic neuroendocrine tumors may assume a cystic configuration, sometimes referred to as cystic pancreatic endocrine neoplasm tumor, with a lower pathologic stage. Solid pseudopapillary tumor is composed of poorly cohesive monomorphic epithelial cells forming solid and pseudopapillary structures, with excellent prognosis.
The Milan System for Reporting Salivary Gland Cytopathology: Benefits and Cautions
Authors: van Zante Annemieke , Ha Patrick , Pusztaszeri Marc Philippe 
Published: January 2021

AbstractFine-needle aspiration (FNA) is a well-established procedure for the diagnosis and management of salivary gland lesions despite challenges imposed by their diversity, complexity, and cytomorphological overlap. Until recently, the reporting of salivary gland FNA specimens was inconsistent among different institutions throughout the world, leading to diagnostic confusion among pathologists and clinicians. In 2015, an international group of pathologists initiated the development of an evidence-based tiered classification system for reporting salivary gland FNA specimens, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). A corresponding MSRSGC Atlas was published in February 2018. The MSRSGC consists of 6 diagnostic categories that incorporate the morphologic heterogeneity and overlap among various nonneoplastic, benign, and malignant lesions of the salivary glands. In addition, each diagnostic category is associated with a risk of malignancy and management recommendations. The main goal of the MSRSGC is to improve communication between cytopathologists and treating clinicians, while also facilitating cytologic-histologic correlation, quality improvement, and sharing of data from different laboratories for research. Herein, we review the benefits and the limitations of the MSRSGC, as well as the challenges of implementing this new reporting system in routine practice.
Physical Medicine and Rehabilitation Program Directors’ Perspectives on US Medical Licensing Examination Step 1 Scoring Changes
Authors: Chator Areeb A. , Ganesh Kumar Nishant , Drolet Brian C. , Sullivan William J. , Kennedy David J. 
Published: January 2021

Abstract
In response to increasing dependence on US Medical Licensing Examination Step 1 scores for resident selection, and to improve medical student well-being and education, the Federation of State Medical Boards and the National Board of Medical Examiners announced that no sooner than 2022, Step 1 score reporting would change from numeric to pass/fail. To gauge the impact that this change will have on the residency application process in physical medicine and rehabilitation, an anonymous survey was electronically distributed to program directors of all accredited physical medicine and rehabilitation residency programs in the United States. A response rate of 49% was obtained. In total, 13% of program directors agreed that the scoring change was a good idea. Eighty percent of program directors felt that the change would increase emphasis on Step 2 clinical knowledge in the application process and that it will be more difficult to objectively compare applicants. Among free-text responses to the survey, 70% disapproved, 10% approved, and the remaining 20% were neutral to the change. The results of this survey show that many physical medicine and rehabilitation program directors are concerned about the implications of the Step 1 score reporting change. These data can serve as a helpful guide to program directors and students preparing for a pass/fail Step 1.
Design and conduct of confirmatory chronic pain clinical trials
Authors: Katz Nathaniel 
Published: January 2021

Abstract:
The purpose of this article is to provide readers with a basis for understanding the emerging science of clinical trials and to provide a set of practical, evidence-based suggestions for designing and executing confirmatory clinical trials in a manner that minimizes measurement error. The most important step in creating a mindset of quality clinical research is to abandon the antiquated concept that clinical trials are a method for capturing data from clinical practice and shifting to a concept of the clinical trial as a measurement system, consisting of an interconnected set of processes, each of which must be in calibration for the trial to generate an accurate and reliable estimate of the efficacy (and safety) of a given treatment. The status quo of inaccurate, unreliable, and protracted clinical trials is unacceptable and unsustainable. This article gathers aspects of study design and conduct under a single broad umbrella of techniques available to improve the accuracy and reliability of confirmatory clinical trials across traditional domain boundaries.
Oncologic Considerations for Safe Gender-Affirming Mastectomy: Preoperative Imaging, Pathologic Evaluation, Counseling, and Long-Term Screening
Authors: Salibian Ara A. , Axelrod Deborah M. , Smith Julia A. , Fischer Beverly A. , Agarwal Cori , Bluebond-Langner Rachel 
Published: January 2021

Summary:
There remain significant gaps in the evidence-based care of patients undergoing gender-affirming mastectomy with regard to implications for breast cancer development and screening. The current clinical evidence does not demonstrate an increased risk of breast cancer secondary to testosterone therapy in transgender patients. Gender-affirmation mastectomy techniques vary significantly with regard to the amount of residual breast tissue left behind, which has unknown implications for the incidence of postoperative breast cancer and need for screening. Subcutaneous mastectomy should aim to remove all gross breast parenchyma, although this is limited in certain techniques. Tissue specimens should also be routinely sent for pathologic analysis. Several cases of incidental breast cancer after subcutaneous mastectomy have been described. There is little evidence on the need for or types of postoperative cancer screening. Chest awareness is an important concept for patients that have undergone subcutaneous mastectomies, as clinical examination remains the most common reported method of postmastectomy malignancy detection. In patients with greater known retained breast tissue, such as those with circumareolar or pedicled techniques, consideration may be given to alternative imaging modalities, although the efficacy and cost-utility of these techniques must still be proven. Preoperative patient counseling on the risk of breast cancer after gender-affirming mastectomy in addition to the unknown implications of residual breast tissue and long-term androgen exposure is critical. Patient awareness and education play an important role in shared decision-making, as further research is needed to define standards of medical and oncologic care in this population.
Topographic and Neural Anatomy of the Depressor Anguli Oris Muscle and Implications for Treatment of Synkinetic Facial Paralysis
Authors: Krag Andreas E. , Dumestre Danielle , Hembd Austin , Glick Samuel , Mohanty Ahneesh J. , Rozen Shai M. 
Published: January 2021

Background:
Synkinetic patients often fail to produce a satisfactory smile because of antagonistic action of a hypertonic depressor anguli oris muscle and concomitantly weak depressor labii inferioris muscle. This study investigated their neurovascular anatomy to partially explain this paradoxical depressor anguli oris hypertonicity and depressor labii inferioris hypotonicity and delineated consistent anatomical landmarks to assist in depressor anguli oris muscle injection and myectomy.

Methods:
Ten hemifaces from five fresh human cadavers were dissected to delineate the neurovascular supply of the depressor anguli oris and depressor labii inferioris muscles in addition to the depressor anguli oris muscle relation to consistent anatomical landmarks.

Results:
The depressor anguli oris muscle received innervation from both lower buccal and marginal mandibular facial nerve branches, whereas the depressor labii inferioris muscle was solely innervated by marginal mandibular branches. The mandibular depressor anguli oris origin was on average 39 mm wide, and its medial and lateral borders were located 17 mm from the symphysis and 41 mm from the mandibular angle, respectively. The depressor anguli oris fibers consistently passed anterior to the first mandibular molar toward their insertion into the modiolus, which was located 10 mm lateral and 10 mm caudal to the oral commissure.

Conclusions:
Depressor anguli oris muscle dual innervation versus depressor labii inferioris single innervation may explain why depressor anguli oris hypertonicity and depressor labii inferioris weakness are commonly observed concomitantly in synkinetic patients. Based on treatment goals, diagnostic percutaneous injection with lidocaine can be performed on the depressor anguli oris muscle along a cutaneous line from the modiolus to the mandibular first molar border, and an intraoral depressor anguli oris myectomy can be performed along that same transmucosal line.
The Business of Plastic Surgery: Employment Contracts
Authors: Johnson Debra J. , Adatto, J.D. Bradford E. , Byrd, J.D. Michael S. 
Published: January 2021

Summary:
Plastic surgeons are increasingly choosing to practice as employed physicians: either in an academic position, a single-specialty or multispecialty group, or within a franchise-type business. Employment offers advantages with regard to immediate income, minimal investment in practice start-up costs, and easier access to prospective patients. Surgeons considering such employment must perform due diligence to determine whether the position offered is a good fit. Once the decision is made to offer the plastic surgeon a position, an employment contract is negotiated. It is imperative that all parties understand the provisions of the contract, so that there are no misunderstandings between the employer and employee for the duration of the term. This article introduces physician recruitment offers and employment contracting. The key components of a contract are described, and compensation options are explained. Negotiation of the contract is critical so that all aspects are understood and agreed on, and the responsibilities of all parties are delineated.