bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Functional Influence of Breast Implant Outer Shell Morphology on Bacterial Attachment and Growth
Authors: Jones Phoebe , Mempin Maria , Hu Honghua , Chowdhury Durdana , Foley Matthew , Cooter Rodney , Adams William P. , Vickery Karen , Deva Anand K. 
Published: September 2018

Background:
The introduction of texture to the outer shell of breast implants was aimed at increasing tissue incorporation and reducing capsular contracture. It has also been shown that textured surfaces promote a higher growth of bacteria and are linked to the development of breast implant–associated anaplastic large cell lymphoma.

Methods:
The authors aimed to measure the surface area and surface roughness of 11 available implants. In addition, the authors aimed to subject these implant shells to an in vitro bacterial attachment assay with four bacterial pathogens (Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, and Ralstonia pickettii) and study the relationship among surface area, surface roughness, and bacterial growth.

Results:
Surface area measurement showed grouping of implants into high, intermediate, low, and minimal. Surface roughness showed a correlation with surface area. The in vitro assay showed a significant linear relationship between surface area and bacterial attachment/growth. The high surface area/roughness implant texture grew significantly more bacteria at 24 hours, whereas the minimal surface area/roughness implant textures grew significantly fewer bacteria of all types at 24 hours. For implants with intermediate and low surface areas, some species differences were observed, indicating possible affinity of specific bacterial species to surface morphology.

Conclusions:
Implant shells should be reclassified using surface area/roughness into four categories (high, intermediate, low, and minimal). This classification is superior to the use of descriptive terms such as macrotexture, microtexture, and nanotexture, which are not well correlated with objective measurement and/or functional outcomes.
Defining the Aesthetic Units of the Male Chest and How They Relate to Gynecomastia Based on 635 Patients
Authors: Caridi Robert C. 
Published: September 2018

Summary:
Gynecomastia awareness and treatment have increased significantly. Treatment of gynecomastia is now one of the most popular procedures requested by men. There are many gynecomastia classification systems that have been described. The usefulness of these classifications in the diagnosis and treatment of modern gynecomastia is unknown and has fostered confusion among surgeons and patients. This article elucidates the topographic pattern consistently seen in gynecomastia patients and relates this to the diagnosis and treatment of gynecomastia. The proposed gynecomastia zone classification is a simple and objective method to clinically describe gynecomastia and direct appropriate treatment.
The Price of Medical Tourism: The Legal Implications of Surgery Abroad
Authors: Davison Steven P. , Hayes Kylie D. , LaBove Gabrielle , Shaffer Peter 
Published: September 2018

Summary:
Medical tourism, or traveling abroad to obtain medical services, has evolved into a global health care phenomenon, with over 15 million U.S. patients each year seeking medical care internationally, representing a $50 billion dollar industry in 2017. Speculation and media fascination about the growing industry, diverse destinations, and rationale behind the medical tourists is rampant; however, the legal implications of tourism medicine, particularly when it goes wrong, are often unclear. On the international stage, accreditation agencies are limited in scope and practice, legal jurisdiction is difficult to establish, and the enforcement of rulings is nearly impossible. Patients seeking tourism medicine have little legal recourse and shoulder all the legal burden.
Autologous Fat Grafting to the Chin: A Useful Adjunct in Complete Aesthetic Facial Rejuvenation
Authors: Rohrich Rod J. , Sanniec Kyle , Afrooz Paul N. 
Published: September 2018

Summary:
The chin makes up the central unit of the face and neck, and is a significant factor in facial harmony and aesthetics. Historically, correction of microgenia required surgical intervention with a sliding genioplasty, or placement of a permanent implant. However, these techniques require more extensive surgical intervention, prolonged downtime, with higher costs and complications. Furthermore, chin rhytides and descent of chin fat lead to an aged appearance of the chin and lower face that is difficult to correct with a chin implant alone. Autologous fat grafting in facial rejuvenation has expanded in its application and can serve as an effective technique to correct and enhance chin aesthetics, including lateral chin hollowing, asymmetry, mild microgenia, and correction of deep labiomental sulcus or a bifid chin. This article and accompanying video demonstrate the authors’ technique for chin augmentation and refinement with autologous fat.
Incision Choices in Nipple-Sparing Mastectomy: A Comparative Analysis of Outcomes and Evolution of a Clinical Algorithm
Authors: Frey Jordan D. , Salibian Ara A. , Levine Jamie P. , Karp Nolan S. , Choi Mihye 
Published: September 2018

Background:
Nipple-sparing mastectomy allows for preservation of the entire nipple-areola complex using various incision patterns. Reconstructive trends and overall risk associated with these diverse nipple-sparing mastectomy incisions have yet to be fully elucidated.

Methods:
All nipple-sparing mastectomies from 2006 to 2017 were identified; outcomes were stratified by type of mastectomy incision: lateral or vertical radial, inframammary fold, Wise pattern, previous, and periareolar.

Results:
A total of 1207 nipple-sparing mastectomies were included for final analysis. Of these, 638 (52.9 percent) used an inframammary fold incision, 294 (24.4 percent) used a lateral radial incision, 161 (13.3 percent) used a vertical radial incision, 60 (5.0) used a Wise pattern incision, 35 (2.9 percent) used a previous incision, and 19 (1.6 percent) used a periareolar incision. The groups were heterogeneous and differed significantly with regard to various factors, including age (p < 0.001), body mass index (p < 0.001), reconstruction modality (p < 0.001), and others. In crude multivariate logistic regression analysis, vertical radial (16.1 percent) and inframammary fold incisions (21.0 percent) were associated with lower overall complication rates. In a reduced multivariate logistic regression model, inframammary fold incisions (p = 0.001) emerged as significantly protective of overall complications after controlling all variables.

Conclusions:
Nipple-sparing mastectomy may be safely performed using various mastectomy incisions, each with unique advantages and limitations. Overall, inframammary fold incisions appear to be associated with the lowest risk, whereas Wise pattern incisions may increase risk.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Development of the BODY-Q Chest Module Evaluating Outcomes following Chest Contouring Surgery
Authors: Klassen Anne F. , Kaur Manraj , Poulsen Lotte , Fielding Craig , Geerards Daan , van de Grift Tim C. , Hoogbergen Maarten , Juhl Claus Bogh , Lorenzen Mike Mikkelsen , McEvenue Giancarlo , McLean Hugh , Moliver Clayton , Mullender Margriet G. , Panchapakesan Vivek , Repo Jussi P. , Rose Michael , Sørensen Jens Ahm , Støving René Klinkby , Pusic Andrea L. 
Published: September 2018

Background:
Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome instrument designed for weight loss and/or body contouring. In this article, the authors describe the development of a new module for masculinizing chest contouring surgery.

Methods:
Qualitative methods were used to develop the BODY-Q Chest Module, which was subsequently field-tested in Canada, the United States, The Netherlands, and Denmark between June of 2016 and June of 2017. Participants were aged 16 years or older and seen for gynecomastia, weight loss, or transman chest surgery. Data were collected using either a Web-based application or paper questionnaire. Rasch measurement theory analysis was performed.

Results:
The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, and 341 gender-affirming). Rasch measurement theory analysis refined a 10-item chest scale and a five-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability [i.e., person separation index and Cronbach alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale), respectively]. Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean scores for the chest and nipple scales were significantly higher (p < 0.001 on independent samples t tests) in participants who were postoperative compared with preoperative.

Conclusion:
This new BODY-Q Chest Module is a clinically meaningful and scientifically sound patient-reported outcome instrument that can be used to measure outcomes for masculinizing chest contouring surgery.
Identifying Predictors of Time to Soft-Tissue Reconstruction following Open Tibia Fractures
Authors: Shammas Ronnie L. , Mundy Lily R. , Truong Tracy , Weber Jeremy M. , Grier A. Jordan , Cho Eugenia H. , Peskoe Sarah B. , Gage Mark J. , Hollenbeck Scott T. 
Published: September 2018

Background:
Controversy remains regarding the optimal timing of soft-tissue coverage following severe lower extremity trauma. This study identifies nationwide practice patterns and factors associated with discrepancies in time to first flap surgery following open tibia fractures.

Methods:
A retrospective analysis was performed on the National Trauma Databank from 2008 to 2015 to identify patients who presented with an open tibia fracture and underwent subsequent flap reconstruction. A least absolute shrinkage and selection operator algorithm was performed, revealing those factors most significantly associated with differences in time to flap surgery from hospitalization.

Results:
A total of 3297 patients were included in the analysis. Mean ± SD and median times to first flap surgery were 230.1 ± 246.7 hours and 169.1 hours, respectively. Older age, nonwhite race, treatment in the South, and non–private insurance status were all independently associated with an increased time to flap surgery. In addition, more surgical débridements; a higher Injury Severity Score and/or Abbreviated Injury Scale score; and a nerve, vascular, and/or crush injury were independent predictors of an increased time to flap surgery.

Conclusions:
Most patients who present with open tibia fractures requiring soft-tissue coverage undergo flap reconstruction after the historical 72-hour window. Specific sociodemographic and clinical factors were independently predictive of an increased time to flap surgery. These findings suggest that not all patients in the United States are receiving the same level of care in lower extremity trauma reconstruction, emphasizing the need to develop more explicit national standards.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of Lymphatic Vessel Detection Rates on 840 Surgical Fields in Lower Extremity Lymphedema Patients
Authors: Yamamoto Takumi , Yamamoto Nana , Fuse Yuma , Narushima Mitsunaga , Koshima Isao 
Published: September 2018

Background:
Supermicrosurgical lymphaticovenular anastomosis is becoming a useful treatment option for progressive lower extremity lymphedema because of its minimal invasiveness. Finding a lymphatic vessel is a minimum requirement for lymphaticovenular anastomosis surgery, but no study has reported comprehensive analysis on factors associated with lymphatic vessel detection.

Methods:
One hundred thirty-four female secondary lower extremity lymphedema patients who underwent indocyanine green lymphography and lymphaticovenular anastomosis without a history of lymphedema surgery were included. Medical charts were reviewed to obtain clinical, indocyanine green lymphographic, and intraoperative findings. Lymphatic vessel detection was defined as positive when one or more lymphatic vessels were found in a surgical field of lymphaticovenular anastomosis. Logistic regression analysis was used to identify independent factors associated with lymphatic vessel detection.

Results:
Patient age ranged from 36 to 81 years, duration of edema ranged from 3 to 324 months, and body mass index ranged from 16.2 to 33.3 kg/m2. Forty-eight patients (35.8 percent) had a history of radiation therapy, and 76 patients (56.7 percent) had a history of cellulitis. Lymphaticovenular anastomoses were performed in 840 surgical fields, among which lymphatic vessel detection was positive in 807 fields; the overall lymphatic vessel detection rate was 96.1 percent. Multivariate analysis revealed inverse associations in higher body mass index (OR, 0.323; p = 0.008) and the S-region/D-region on indocyanine green lymphography compared with the L-region (OR, 1.049 × 10–8/1.724 × 10–9; p < 0.001/p < 0.001).

Conclusions:
Independent factors associated with lymphatic vessel detection were clarified. Lower body mass index and L-region on indocyanine green lymphography are favorable conditions for finding lymphatic vessels in lower extremity lymphedema patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Toward the Assessment of Core Procedural Competencies among Canadian Plastic Surgery Residents
Authors: Shih Jessica G. , Knox Aaron D. C. , Zhygan Nick , Courtemanche Douglas J. , Fish Joel S. , Brown Mitchell H. 
Published: September 2018

Background:
Plastic surgery residency training programs are working toward integrating competency-based education into program curriculum and training, a key component of which involves establishing core procedural competencies. This study aims to determine the exposure of graduating Canadian plastic surgery residents to established core procedural competencies.

Methods:
A retrospective review of case log procedure data using three databases (T-Res, POWER, and New Innovations) from graduating residents at all 10 Canadian English-speaking plastic surgery training programs between 2004 and 2014 was completed. Case logs were coded according to 177 core procedural competencies identified as “core” by the Delphi method among an expert panel of Canadian plastic surgeons.

Results:
A total of 59,405 procedures were logged by 55 graduating residents across Canada between 2004 and 2014 (average, 1080 ± 352 procedures per resident). Of 13 plastic surgery domains, 44 percent of all procedures were within either hand, upper extremity, and peripheral nerve (28.3 percent) or nonaesthetic breast (16.1 percent). The most frequently performed core procedural competencies (average case logs per resident) included breast reduction (65.3 ± 33.9); open carpal tunnel release (46.7 ± 34.2); breast reconstruction, implant-based (39.6 ± 20.5); and wound management (35.7 ± 28.6). Sixty-two of 177 procedures were logged on average less than once in 5 years of residency, including escharotomy, temporal parietal fascia flap, Guyon canal release, and soft-tissue fillers.

Conclusion:
This study identifies areas of exposure and underexposure to plastic surgery core procedural competencies, and can help focus surgical education on areas of greater need for surgical skills training and acquisition.
A Simple Framework for Weighting Panels Across Primary Care Disciplines: Findings From a Large US Multidisciplinary Group Practice
Authors: Kamnetz Sandra , Trowbridge Elizabeth , Lochner Jennifer , Koslov Steven , Pandhi Nancy 
Published: September 2018

Background:
Health system redesign necessitates understanding patient population characteristics, yet many primary care physicians are unable to identify patients on their panel. Moreover, accounting for differential workload due to patient variation is challenging. We describe development and application of a utilization-based weighting system accounting for patient complexity using sociodemographic factors within primary care at a large multidisciplinary group practice.

Methods:
A retrospective observational study was conducted of 27 clinics across primary care serving more than 150 000 patients. Before and after implementation, we measured empanelment by comparing weighted to unweighted panel size and the number of physicians who could accept patients. Perceived access was measured by the number of patients strongly agreed that an appointment was available when needed.

Results:
After instituting weighting, the percentage of physicians with open panels decreased for family physicians and pediatricians, but increased for general internists; the number of active patients increased by 2%. One year after implementation, perceived access improved significantly in family and general internal medicine clinics (P < .05). There were no significant changes for general pediatric and adolescent medicine patients.

Conclusions:
The creation of a weighing system accounting for complexity resulted in changes in practice closure, increased total patients, and improved access.
Bile Collection Detected With BrIDA Scintigraphy in a Patient With Hepatocellular Carcinoma
Authors: Maccora Daria , Di Giuda Daniela , Ponziani Francesca Romana , Pompili Maurizio , Valenza Venanzio 
Published: September 2018

Abstract
A 47-year-old man, with a history of anabolic steroid abuse, developed hepatic adenomatosis and multifocal hepatocellular carcinoma. He underwent ultrasound and CT follow-up, showing multiple solid and fluid hepatic lesions. Consequently, hospitalization was required because of high fever (up to 39°C), weakness, and anorexia. An abdominal CT scan revealed an enlargement of one of the intrahepatic fluid collections. Biochemical and microbiological analyses of a fluid sample showed bilirubin and bile acids as well as Streptococcus cristatus and Enterobacter cloacae. Thus, the patient underwent 99mTc-trimethylbromo-iminodiacetic acid scintigraphy, demonstrating bile collection in the lesion with a flow from a bile duct.
Huge Abdominal Photopenic Area Due to Kidney Cyst Imaged by Bone Scintigraphy in a Prostate Cancer Patient
Authors: Sioka Chrissa , Gkika Evangelia , Paliouras Athanasios , Giannakis John , Fotopoulos Andreas 
Published: September 2018

Abstract
Bone scintigraphy is a method of choice in evaluating metastatic disease in patients with prostatic cancer. We describe the case of a 77-year-old man who was subjected to bone scan for evaluation of secondary metastatic disease due to an elevated prostatic-specific antigen level (7.2). Bone scintigraphy demonstrated a huge photopenic area in the left upper abdominal area, as a result of a huge kidney cyst (15 × 13 cm).
Incidental Orbital Neuroendocrine Metastases on 111In-OctreoScan and MRI
Authors: Chen Yin Jie , Farwell Michael D. 
Published: September 2018

Abstract
Neuroendocrine tumors have a propensity to metastasize, but rarely to the orbits. A 69-year-old woman with history of neuroendocrine tumor of pancreatic primary underwent routine follow-up 111In-pentetreotide (OctreoScan) imaging, with 24-hour whole-body planar images showing subtle right periorbital tracer uptake that localized to extraocular muscles on subsequent SPECT/CT. Orbital MRI further defined the location of these highly suspicious orbital metastases, which were treated with external radiation, with follow-up MRI showing decreased size of the orbital metastases. Early identification and treatment of orbital metastases is critical to help preserve vision and quality of life.
Making Augmented and Virtual Reality Work for the Plastic Surgeon
Authors: Kanevsky Jonathan , Safran Tyler , Zammit Dino , Lin Samuel J. , Gilardino Mirko 
Published: September 2018

Abstract
Augmented and virtual reality is an evolving technology at the forefront of medicine. It can provide physicians with hands-free, real-time access to the vast resources of the Internet and electronic medical records, allowing simultaneously recording of clinical encounters or procedures. Mixed reality platforms can be applied as a clinical tool, educational resource, or as an aid in enhancing communication in health care. This article will explore how various augmented and virtual reality platforms have enabled real-time visualization of patient information, recording of surgical cases, point-of-view photography, and intraoperative consults—all while remaining sterile in the operating room. Although this technology is of potential value to a number of different surgical and medical specialties, plastic surgery is ideally suited to lead this charge.
Depressor Reanimation After Facial Nerve Paralysis
Authors: Bassilios Habre Samer , Googe Benjamin J. , Depew James B. , Wallace Robert D. , Konofaos Petros 
Published: September 2018

Abstract
Facial expressions play a fundamental role in interpersonal communication and interaction; consequently, facial palsy has profound effects on the quality of life of patients. Reanimation of lower lip depressors is rarely addressed during facial reanimation but is as important as treating the eye sphincter and the lip levators. Depressors of lower lip are vital for full denture smile and the expression of facial emotions. Static and dynamic techniques are used to reanimate the lower lip depressors. Static techniques provide stationary results either by weakening the contralateral normal side to achieve symmetry using botulinum toxin injection, depressor labi inferioris myectomy and marginal mandibular nerve neurectomy, or by creating static slings and tightening procedures on the affected side. Dynamic techniques provide functional results by reanimating the affected depressor complex using nerve transfers, muscle transfers, and direct muscle neurotization. The purpose of this article is to present an overview of the literature on the applications of these techniques in lower lip reanimation. Furthermore, preoperative evaluation and indications are also discussed.
Early Experiences With the Buttonhole Modification of the Double-Incision Technique for Gender-Affirming Mastectomies
Authors: Rothenberg Kara A. , Tong Winnie M. Y. , Yokoo Karen M. 
Published: September 2018

Background
Little has been published about transmasculine and nonbinary gender-affirming mastectomies, particularly for patients with skin excess who desire reliable vascularity and sensation to the nipple-areolar complex. In this case series, we describe our experiences with the “buttonhole technique.”

Methods
This was a retrospective case series of all consecutive patients who had a buttonhole mastectomy by a single surgeon. This technique maintains the nipple-areolar complex on a dermal pedicle rather than using a free nipple graft.

Results
Seventeen patients were included, with ages ranging from 21 to 49 years (median, 28 years). There were no major complications. Four patients had minor complications and/or required revision.

Conclusions
The buttonhole technique should be considered for transmasculine and nonbinary patients with skin excess who are concerned about nipple vascularity and sensation.