bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the Role of Partner Satisfaction in Predicting Patient Satisfaction Regarding Post-mastectomy Breast Reconstruction
Authors: Cimaroli Sawyer , LoGiudice John A. , Doren Erin L. 
Published: January 2021

Background:
Qualitative studies have suggested that perceived partner satisfaction is an important predictor of patient satisfaction in post-mastectomy breast reconstruction. To better characterize these relationships, a couple-based study employing a quantitative analysis was conducted.

Methods:
BREAST-Q and a novel partner survey were used to assess relationships among patient satisfaction, perceived partner satisfaction, and reported partner satisfaction in 11 couples. Breast reconstruction patients completed the postoperative BREAST-Q, and their partners completed a survey designed to assess satisfaction with their emotional relationship, partner’s breasts, partner’s medical care, and sexual relationship.

Results:
The majority of patients were married. Seventy-three percent of women had an implant-based reconstruction, while 27% had an abdominal-based reconstruction. The majority (82%) of patients reported no complications with reconstructive procedures. The mean patient BREAST-Q score was 86 (range, 48–97), and the mean partner score was 87 (64–98). There was a correlation of 0.85 between reported partner satisfaction and patient satisfaction. Fifty-eight percent of partners reported being afraid to touch their partner’s reconstructed breasts out of fear of causing pain; 7% of patients reported experiencing pain in the area of their reconstructed breasts.

Conclusions:
This study reveals that partner satisfaction with breast reconstruction correlates with patient satisfaction. With this knowledge, we will be able to formulate suggestions on how preoperative consultations could be conducted as to optimize patient and partner satisfaction and bridge the gap between patient and partner knowledge of postoperative pain.
Composite Cutaneous Anterolateral Thigh Flap with Rolled Fascia Lata for Tibialis Anterior Tendon Reconstruction
Authors: Bekeny Jenna C. , Zolper Elizabeth G. , Fan Kenneth L. , Evans Karen K. 
Published: January 2021

Background:
Rupture of the tibialis anterior tendon (TAT) is a rare phenomenon with limited therapeutic options derived from sparse case reports. Without proper anchoring of the tibialis anterior, dorsiflexion and inversion of the foot become impaired, disrupting patient’s gait. Reported techniques for repair fall into nonoperative (ankle-foot orthosis) or operative (primary closure, tendon transfer, free gracilis) modalities, depending on patient factors, mechanism of injury, and extent of defect. In this report, we outline a novel method of tendon repair and soft tissue coverage for a large defect.

Methods:
We present a unique case of traumatic TAT rupture with a failed primary closure yielding a large (>15 cm) defect. The patient presented with a defect spanning the entire anterior compartment of the leg, limiting options for coverage and functional restoration.

Results:
The patient’s large, chronic defect was successfully repaired via a composite cutaneous anterolateral thigh and a rolled fascia lata free flap. The patient had robust return to function and is able to dorsiflex and invert the foot and ambulate.

Conclusions:
The use of this donor site offers a novel, advantageous option for TAT repair. It should be considered for patients with large defects that make other repair methods unfeasible.
Temporary Use of Acellular Dermal Matrix in Upper Extremity Salvage
Authors: Ali Barkat , Wu Jeffrey , Borah Gregory , Wu Eugene 
Published: January 2021

Summary:
Wound coverage of exposed vascular bypasses after acute limb revascularization may not be immediately possible, while delay may create a hostile environment for the bypass graft. The use of negative-pressure wound therapy may not be possible because of extrinsic compression. Temporary use of acellular dermal matrix can help salvage upper extremity. We present 2 patients with brachial artery transection secondary to blunt trauma, who had revascularization with interposition saphenous vein grafts. We used acellular dermal matrix as temporary coverage for the exposed arterial bypass grafts to allow for patient stabilization, serial debridement, and demarcation of the surrounding tissues before definitive coverage. Additionally, the use of negative-pressure wound therapy caused diminished pulses in the bypass graft, creating the need for reliable temporary coverage. The acellular dermal matrix dressing was left in place until definitive closure was possible. Both patients underwent successful wound coverage with fasciocutaneous flaps without disruption, thrombosis, or infection of the bypass grafts. Follow-up at 6 months demonstrated good healing and excellent function. The use of the acellular dermal matrix provides temporary coverage of vital structures until definitive reconstruction can be performed.
Benchmarking Residual Limb Pain and Phantom Limb Pain in Amputees through a Patient-reported Outcomes Survey
Authors: Mioton Lauren M. , Dumanian Gregory A. , Fracol Megan E. , Apkarian A. Vania , Valerio Ian L. , Souza Jason M. , Potter Benjamin K. , Tintle Scott M. , Nanos George P. , Ertl William J. , Ko Jason H. , Jordan Sumanas W. 
Published: January 2021

Background:
More than 75% of major limb amputees experience chronic pain; however, data on severity and experience of pain are inconsistent. Without a benchmark using quantitative patient-reported outcomes, it is difficult to critically assess the efficacy of novel treatment strategies. Our primary objective is to report quantitative pain parameters for a large sample of amputees using the validated Patient-reported Outcomes Measurement System (PROMIS). Secondarily, we hypothesize that certain patient factors will be associated with worse pain.

Methods:
PROMIS and Numerical Rating Scales for residual limb pain (RLP) and phantom limb pain (PLP) were obtained from a cross-sectional survey of upper and lower extremity amputees recruited throughout North America via amputee clinics and websites. Demographics (gender, age, race, and education) and clinical information (cause, amputation level, and time since amputation) were collected. Regression modeling identified factors associated with worse pain scores (P < 0.05).

Results:
Seven hundred twenty-seven surveys were analyzed, in which 73.4% reported RLP and 70.4% reported PLP. Median residual PROMIS scores were 46.6 [interquartile range (IQR), 41–52] for RLP Intensity, 56.7 (IQR, 51–61) for RLP Behavior, and 55.9 (IQR, 41–63) for RLP Interference. Similar scores were calculated for PLP parameters: 46.8 (IQR, 41–54) for PLP Intensity, 56.2 (IQR, 50–61) for PLP Behavior, and 54.6 (IQR, 41–62) for PLP Interference. Female sex, lower education, trauma-related amputation, more proximal amputation, and closer to time of amputation increased odds of PLP. Female sex, lower education, and infection/ischemia-related amputation increased odds of RLP.

Conclusion:
This survey-based analysis provides quantitative benchmark data regarding RLP and PLP in amputees with more granularity than has previously been reported.
Use of Single-recipient Vessels for Cross-chest Abdominal Flap–based Breast Augmentation as an Outpatient
Authors: Deramo Paul , Martinez Carlos A. , Boutros Sean G. 
Published: January 2021

Background:
Breast reconstruction with autologous tissue following mastectomy for breast cancer has become the standard of care. Microvascular breast augmentation is an alternative for patients with failed breast prostheses, including painful capsular contractures or poor cosmetic outcomes. We present a series of 4 patients who underwent microvascular breast augmentation with cross-chest flap recipient vessels.

Methods:
We perform a bilateral DIEP flap reconstruction in an outpatient setting following a modified recovery protocol, focused on decreasing postoperative pain and narcotic requirements, allowing early ambulation and discharge. This includes harvest of the flap via abdominal microfascial incisions and rib-sparing vessel dissection. Cosmetic microvascular augmentation of the contralateral breast was performed via cross-chest flap recipient vessel anastomoses, where the pedicle was tunneled across the chest and anastomosed to the primary flap.

Results:
Four patients underwent flap-based breast augmentation with cross-chest recipient vessels. Two patients underwent immediate DIEP flap breast reconstruction of the affected side and contralateral flap-based augmentation, while 2 patients underwent bilateral breast augmentation with DIEP flaps for cosmetic purposes due to undesired cosmetic results following implant-based augmentations. No intraoperative complications were reported, and all patients were discharged within 23 hours without signs of flap compromise or need for operative take-backs. Mean follow-up was 23 weeks.

Conclusions:
The DIEP flap is recognized as an option for breast augmentation, although its limitations are several, including the pain and recovery associated with autologous tissue-based breast reconstruction. Enhanced recovery protocols help reduce this burden, making it more acceptable and feasible.
Nummular Headache and Its Surgical Treatment
Authors: Baldelli Ilaria , Lucia Mangialardi Maria , Salgarello Marzia , Raposio Edoardo 
Published: January 2021

Background:Nummular headache (NH) is an uncommon primary headache characterized by pain limited to a precise small area of the scalp. There is no global consensus on its pathogenesis, but its extracranial origin is the most accepted theory. Moreover, peripheral mechanism is supported by the overlapping symptomatology of secondary forms of NH and is well described in the literature. However, a standard effective treatment is still lacking.Methods:A literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted to evaluate surgical strategies for NH. Inclusion criteria were English language, diagnosis of primary NH according to International Classification of Headache Disorders, 3rd Edition, or of secondary NH, and follow-up at a minimum of 3 months. The treatment had to consist of peripheral surgery.Results:One hundred eighty-seven records were identified after duplicates were removed, 15 full-text articles were assessed for eligibility, and 4 records were selected for inclusion. A total of 53 patients were included in this review, 50 of whom were diagnosed with primary NH. The general positive response after surgery (>50% reduction in occipital migraine headaches) was about 70.0% for primary NH, while secondary NH always showed complete pain relief. However, many variations in patient selection and type of surgery were described.Conclusions:Neurovascular relationship in the extracranial tissues seems to be involved in the onset of NH. However, only limited data from meager literature and from few patients are currently available. Shared multicentric research protocols are badly required.
Microvascular Reconstruction of Complex Nasal Defects: Case Reports and Review of the Literature
Authors: Gasteratos Konstantinos , Spyropoulou Georgia-Alexandra , Chaiyasate Kongkrit 
Published: January 2021

Background:
The area of nasal reconstruction can be challenging for the microsurgeon, as the nose is a complex structure. A 3-dimensional understanding of the organ is a prerequisite for a successful outcome. A combination of procedures is usually necessary to completely repair subtotal or total nasal defects. Contouring and secondary revisions may ensue to enhance the postoperative functional and aesthetic outcome of the reconstruction. This study aimed to present a review of the various methods of microvascular reconstruction for complex nasal defects based on the radial forearm flap (RFF).

Methods:
Two independent reviewers screened the literature on PubMed according to the inclusion criteria. The keywords for the search were “microvascular,” “nasal reconstruction,” and “free flaps in nasal reconstruction.” Articles on locoregional flap reconstruction, experimental animal studies, letters to the editors, non-English literature, and articles without full text were excluded from the study. The protocol is registered at the International Prospective Register of Systematic Reviews (CRD42019146447) under the umbrella of the National Institute for Health Research, and it is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results:
Eighteen eligible studies were included in our articles. The infolding RFF, multiple skin paddles RFF, and prelaminated RFF were described. The results have been more than encouraging so far. Also, 3 clinical cases where the RFF provided intranasal lining and a forehead flap resurfaced the nose were presented.

Conclusion:
The RFF is a reliable technique for nasal reconstruction in expert hands.
Correcting Nipple Inversion Simultaneously with Implant Augmentation of the Breast, Using “Pirelli” Technique
Authors: Nara Kishen , Hodgkinson Darryl 
Published: January 2021

Background:
Most techniques of isolated nipple inversion correction are well published. Simultaneous breast augmentation with nipple inversion correction is less often found in the literature. Previously, nipple inversion correction was thought to be performed as a staged procedure after other breast operations. We present a study of 19 patients and 34 breasts who had concomitant breast augmentation and nipple inversion correction treated with a “Pirelli” technique to assess the complication rates and the rate of recurrence of inversion.

Methods:
The Pirelli technique was used, involving division of lactiferous ducts and deep closure of breast tissue before closure. An external “Pirelli tire” was then applied and secured circumferentially around the nipple–areolar complex, which helped to maintain eversion of the nipple after 1 week. Patients were then followed up with specific postoperative instructions to ensure wound healing and maintenance of eversion.

Results:
Nineteen patients were included where 34 breasts were involved. Eighteen patients had primary breast implants. The recurrence rate was 5.9%, involving 2 patients who had unilateral recurrences. These patients were managed with the same technique and had no further recurrences. Two patients successfully breastfed at a median time of 10 years postoperatively.

Conclusion:
Simultaneous breast mammoplasty with nipple inversion correction using the Pirelli technique is safe with low complication rates and high long-term patient satisfaction.
A Summary of Recommendations for Plastic Surgeons during the Coronavirus Disease 2019 Outbreak
Authors: Schoenbrunner Anna R. , Sarac Benjamin A. , Janis Jeffrey E. 
Published: January 2021

Background:
The coronavirus disease 2019 outbreak presents unique challenges to the healthcare system. The lack of unified guidelines on what constitutes elective surgery left plastic surgeons without a clear framework to guide their practices. More urgently, the ambiguity in defining elective surgery leaves plastic surgeons without clear guidance as states begin to phase in these procedures.

Methods:
Recommendations issued by state governing bodies as of April 28, 2020, were reviewed. National society and federal guidelines pertaining to postponement and resumption of elective surgeries affected by the coronavirus disease 2019 outbreak were also reviewed. Recommendations based on the above are collated for plastic surgeons.

Results:
Thirty-six states and the District of Columbia provide recommendations regarding elective surgery. Cosmetic surgery is considered an elective surgery and should be postponed; this may be among the first elective surgeries to safely resume. Societal guidelines provide disease-specific recommendations for cancer-related surgery and breast reconstruction. Trauma, other cancer-related reconstruction, and hand surgeries are considered nonelective if postponement threatens life or limb or if a patient is highly symptomatic. Postponement and resumption of oncology, trauma, and hand surgery cases depend on disease stage and complexity of reconstruction. Pediatric craniofacial surgery presents unique challenges due to the time-sensitive nature of the interventions.

Conclusions:
Guidance on elective surgery is vague for plastic surgeons. Government recommendations and societal guidelines provide a framework for plastic surgeons to assess the elective nature of a surgical intervention and safety of resumption; however, a nuanced assessment must be made on local disease transmission, supply availability, and hospital capacity.
Reconstruction of Bilateral Mandibular Condyles Using a Single Vascularized Fibula
Authors: Tiongco Rafael P. , Hui Amy , Stern-Buchbinder Zachary , Stalder Mark W. , St. Hilaire Hugo 
Published: January 2021

Summary:
Patients with end-stage temporomandibular joint (TMJ) pathology present with loss of vertical ramus height with resulting retrognathia, anterior open bite, and restricted jaw function requiring joint reconstruction. Costochondral grafts, long considered the gold standard for TMJ reconstruction, carry risks of bony ankylosis and resorption. Custom-made alloplastic TMJ prostheses show excellent objective and subjective outcomes but are also associated with complications such as infection or metal sensitivity, and necessitate hardware explantation in some cases. Revision surgeries are rare but present a real challenge. We present the case of a 50-year-old woman with longstanding TMJ arthritis, having undergone many surgical procedures to her TMJ, including explantation of failed alloplastic replacement, who presented with bilateral facial weakness as well as difficulty chewing and swallowing food. She had class II malocclusion with retrodisplacement of her mandible and anterior open bite, and moderate trismus with an inter-incisal opening of only 15 mm, consistent with fibrous ankylosis. After weighing all the reconstructive options, bilateral mandibular condyle and ramus reconstruction with a single fibula free flap (FFF) was planned with the use of preoperative virtual surgical planning (VSP) and 3D-printing of osteotomy and repositioning guides. A 2-team approach increases efficiency of the procedure and decreases operative time. The procedure and postoperative recovery were uncomplicated, and at her 2-month follow-up, she had increased range of motion and maintained the planned position of her mandible. Her masticatory function and deglutition were also improved due to the correction of her malocclusion and repair of her anterior open bite.
Preoperative Flap Surgery Simulation for a Case of Cryptotia Using a 3D Printer
Authors: Tsuge Takuya , Kuwahara Hiroaki , Akaishi Satoshi , Ogawa Rei 
Published: January 2021

Summary:
Cryptotia is a congenital auricular deformity. Common methods of surgical reconstruction involve creating an auricular temporal groove using local flaps and/or a skin graft. However, it can be difficult to determine which method is most suited to the unique 3-dimensional (3D) structure of each cryptotic ear. Here, we showed that creating 3D ear models of a cryptotic ear with a 3D camera and printer and using these models to simulate surgery with two different flap methods (cat’s-ear and square) allowed selection of a reconstruction method that led to good outcomes after the actual surgery. The patient was a 7-year-old girl with left cryptotia. A 3D camera was used to acquire 3D data for the ear. After structural analysis, a home 3D printer was used to print the data into 3D ear models using an elastic material. These models exhibited good plasticity. After subjecting the models to simulated cat’s-ear and square flap surgeries, the cat’s-ear flap method was considered to better reproduce the healthy side of the ear compared with the square flap method for this particular case. Ear morphology during and after the actual surgery closely resembled the model-ear morphology during and after the simulated cat’s-ear flap surgery. We successfully created a full-scale 3D model with good plasticity using a 3D camera and 3D printer. This allowed easy, noninvasive preoperative evaluation and identification of the most suitable operation for the specific case, facilitating easier, more successful surgery.
Hidden Costs in Resident Training: Financial Cohort Analysis of First Assistants in Reduction Mammaplasty
Authors: Malloy Shannon M. , Sanchez Karl , Cho Jonathan , Mulcahy Sarah E. , Labow Brian I. 
Published: January 2021

Background:
Graduate medical education (GME) programs are vital to developing future plastic surgeons. However, their cost-efficiency has yet to be contextualized. This cohort quality improvement (QI) project aimed to measure the indirect costs an institution assumes in training surgical residents, by comparing the differences in operative time and procedural charges between a resident and a physician assistant (PA) first-assisting during adolescent reduction mammaplasty.

Methods:
From 2013 to 2019, adolescent bilateral reduction mammaplasty procedures first-assisted by either a resident or physician assistant were considered for analysis. Financial data, including all hospital and physician expenditures and operation duration, patient demographics, and outcomes data were retrospectively collected.

Results:
A total of 49 reduction mammaplasty cases were included for analysis. Residents had an average of 5.9 ± 1.5 years of post-graduate surgical training, whereas the PA had 2 years of surgical experience. Procedures first-assisted by a surgical resident took a mean/median of 34 minutes longer and were $3750 more expensive, respectively, than cases first-assisted by a PA (P < 0.01, both).

Conclusions:
Reduction mammaplasty procedures were longer and accrued higher charges when first-assisted by a surgical resident than by a PA. Although Graduate Medical Education programs are necessary to train the next generation of surgeons, they may result in unintended opportunity costs for teaching hospitals. Federal support to academic medical centers aims to cushion the cost of residential training, but is insufficient to compensate for resident inefficiency. Hospitals may consider incorporating PAs into the Graduate Medical Education paradigm to alleviate administrative burden, lower operational charges, and enhance resident training curricula.
Impact on Abdominal Skin Perfusion following Abdominoplasty
Authors: Nergård Solveig , Mercer James B. , de Weerd Louis 
Published: January 2021

Background:
Wound healing problems following abdominoplasty may be a result of impaired tissue perfusion. This study evaluated the impact a standard abdominoplasty may have on abdominal skin perfusion.

Methods:
A standard abdominoplasty was performed in 16 patients. Dynamic infrared thermography (DIRT) using a mild and a stronger cold challenge was performed pre-, intra-, and postoperatively on day 1, 2, and in week 6. The abdomen was divided into Huger’s vascular zones. A two-tailed t test was used to evaluate differences in mean temperature between zones. Statistical significance was defined as P < 0.05.

Results:
Two patients suffered wound healing problems. Abdominal skin perfusion showed a hyperaemic state on day 1, day 2, and week 6, postoperatively. Hotspots in zones I and II had all disappeared at the end of surgery and on day 1, except in the cranial part of zone I. Hotspots reappeared in zones I and II during day 2. A statistically significant difference between zones I and II was seen on day 1 and 2, with zone II being cooler. This difference had disappeared in week 6 for the mild cold challenge but not for the stronger cold challenge.

Conclusions:
A standard abdominoplasty has a significant impact on abdominal skin perfusion. The skin perfusion is a dynamic process with a gradual improvement over time. The strongest effect was seen in zone II near the lower transverse incision line, where skin perfusion was the least. Such may contribute to impaired wound healing at this site.