bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Qualitative Study of Breast Reconstruction Decision-Making among Asian Immigrant Women Living in the United States
Authors: Fu Rose , Chang Michelle Milee , Chen Margaret , Rohde Christine Hsu 
Published: February 2017

Background:
Despite research supporting improved psychosocial well-being, quality of life, and survival for patients undergoing postmastectomy breast reconstruction, Asian patients remain one-fifth as likely as Caucasians to choose reconstruction. This study investigates cultural factors, values, and perceptions held by Asian women that might impact breast reconstruction rates.

Methods:
The authors conducted semistructured interviews of immigrant East Asian women treated for breast cancer in the New York metropolitan area, investigating social structure, culture, attitudes toward surgery, and body image. Three investigators independently coded transcribed interviews, and then collectively evaluated them through axial coding of recurring themes.

Results:
Thirty-five immigrant East Asian women who underwent surgical treatment for breast cancer were interviewed. Emerging themes include functionality, age, perceptions of plastic surgery, inconvenience, community/family, fear of implants, language, and information. Patients spoke about breasts as a function of their roles as a wife or mother, eliminating the need for breasts when these roles were fulfilled. Many addressed the fear of multiple operations. Quality and quantity of information, and communication with practitioners, impacted perceptions about treatment. Reconstructive surgery was often viewed as cosmetic. Community and family played a significant role in decision-making.

Conclusions:
Asian women are statistically less likely than Caucasians to pursue breast reconstruction. This is the first study to investigate culture-specific perceptions of breast reconstruction. Results from this study can be used to improve cultural competency in addressing patient concerns. Improving access to information regarding treatment options and surgical outcomes may improve informed decision-making among immigrant Asian women.
Prepectoral Implant-Based Breast Reconstruction: Rationale, Indications, and Preliminary Results
Authors: Sigalove Steven , Maxwell G. Patrick , Sigalove Noemi M. , Storm-Dickerson Toni L. , Pope Nicole , Rice Jami , Gabriel Allen 
Published: February 2017

Summary:
Implant-based breast reconstruction is currently performed with placement of the implant in a subpectoral pocket beneath the pectoralis major muscle, by means of the dual-plane approach. Although the safety and breast aesthetics of this approach are well recognized, it is not without concerns. Animation deformities and accompanying patient discomfort, which are direct consequences of muscle elevation, can be severe in some patients. Moving the implant prepectorally may eliminate these concerns. For a successful prepectoral approach, the authors advocate use of their bioengineered breast concept, which was detailed in a previous publication. In this report, the authors discuss the rationale for prepectoral implant reconstruction, its indications/contraindications, and preliminary results from over 350 reconstructions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Single Implantable FK506 Disk Prevents Rejection in Vascularized Composite Allotransplantation
Authors: Unadkat Jignesh V. , Schnider Jonas T. , Feturi Firuz G. , Tsuji Wakako , Bliley Jacqueline M. , Venkataramanan Raman , Solari Mario G. , Marra Kacey G. , Gorantla Vijay S. , Spiess Alexander M. 
Published: February 2017

Background:
In vascularized composite allotransplantation, medication nonadherence leads to increased acute rejections. Improving medication adherence would improve overall allograft survival. Regionally delivered immunosuppression, targeted to sites of allorecognition, may reduce or eliminate the need for daily systemic immunosuppression.

Methods:
The authors developed biodegradable FK disks containing FK506-loaded double-walled microspheres and tested their efficacy at preventing rejection in a Brown-Norway–to-Lewis rat hindlimb transplantation model. In some experimental group animals, one FK disk was implanted subcutaneously either in native nontransplanted leg or in a transplanted allograft. Regular blood FK506 levels were measured. The endpoint was 180-day allograft survival or grade 3 rejection. At the endpoint, tissue FK506 levels were measured and mixed lymphocytic reaction was performed.

Results:
A single FK disk maintained systemic blood FK506 levels between 5 and 15 ng/ml for 146 ± 11.1 days. After that, the levels declined to less than 5 ng/ml through the endpoint. There was significantly increased FK506 concentration in groin lymph nodes draining the implanted FK disk. Compared with other groups, animals with an FK disk in the transplanted allograft had 100 percent allograft survival to more than 180 days despite subtherapeutic levels below 5 ng/ml. In these animals, significant T-cell hyporesponsiveness was seen in groin lymph nodes draining the FK disk compared with robust splenic T-cell proliferation.

Conclusions:
Sustained regional immunosuppression (with a single FK506 disk) maintained the allograft by means of a high regional concentration of FK506. Notably, this was achieved at subtherapeutic blood concentrations of FK506, without any further systemic FK506 administration.
The Severity of Deformity in Metopic Craniosynostosis Is Correlated with the Degree of Neurologic Dysfunction
Authors: Yang Jenny F. , Brooks Eric D. , Hashim Peter W. , Reuman Hannah S. , Travieso Roberto , Terner Jordan , Mayes Linda C. , Steinbacher Derek M. , Persing John A. , McPartland James C. 
Published: February 2017

Background:
In recent years, metopic synostosis has represented up to 25 percent of all nonsyndromic craniosynostosis cases, manifesting with varying degrees of trigonocephaly. It is unknown whether the degree of severity of anterior dysmorphology is proportionate to neurologic dysfunction. This knowledge is essential to guide future surgical treatment recommendations. Given the reported correlation of abnormal auditory processing with future language dysfunction and poorer academic performance in craniosynostosis patients, the present study aims to evaluate auditory processing in preoperative patients with moderate and severe metopic synostosis, and in control infants, to discern the neurologic risk carried by different severities of trigonocephaly.

Methods:
Thirty-eight infants underwent evaluation of auditory processing: nine patients with severe metopic synostosis, seven with moderate metopic synostosis, and 22 controls. Brain activity was recorded by electroencephalography while the participants listened to language-based stimuli. Electroencephalographic data were analyzed to extract event-related potentials evoked by the speech sounds.

Results:
Severe metopic synostosis patients demonstrated significantly attenuated event-related potential responses in the left frontal scalp region overlying the left frontal lobe compared with controls (p < 0.05). The moderate metopic synostosis patients did not show significantly different language processing compared to the control infants or the severe metopic synostosis patients in the frontal scalp region.

Conclusions:
The results of this study suggest that untreated severe metopic synostosis is associated with reduced language response in the frontal cortex. Less severe (moderate) forms are indeterminate, and mild forms do not show calculable irregularity by the event-related potential method of analysis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Worldwide Testing of the eFACE Facial Nerve Clinician-Graded Scale
Authors: Banks Caroline A. , Jowett Nathan , Azizzadeh Babak , Beurskens Carien , Bhama Prabhat , Borschel Gregory , Coombs Christopher , Coulson Susan , Croxon Glen , Diels Jaqueline , Fattah Adel , Frey Manfred , Gavilan Javier , Henstrom Douglas , Hohman Marc , Kim Jennifer , Marres Henri , Redett Richard , Snyder-Warwick Alison , Hadlock Tessa 
Published: February 2017

Background:
The electronic, clinician-graded facial function scale (eFACE) is a potentially useful tool for assessing facial function. Beneficial features include its digital nature, use of visual analogue scales, and provision of graphic outputs and scores. The authors introduced the instrument to experienced facial nerve clinicians for feedback, and examined the effect of viewing a video tutorial on score agreement.

Methods:
Videos of 30 patients with facial palsy were embedded in an Apple eFACE application. Facial nerve clinicians were invited to perform eFACE video rating and tutorial observation. Participants downloaded the application, viewed the clips, and applied the scoring. They then viewed the tutorial and rescored the clips. Analysis of mean, standard deviation, and confidence interval were performed. Values were compared before and after tutorial viewing, and against scores obtained by an experienced eFACE user.

Results:
eFACE feedback was positive; participants reported eagerness to apply the instrument in clinical practice. Standard deviation decreased significantly in only two of the 16 categories after tutorial viewing. Subscores for static, dynamic, and synkinesis all demonstrated stable standard deviations, suggesting that the instrument is intuitive. Participants achieved posttutorial scores closer to the experienced eFACE user in 14 of 16 scores, although only a single score, nasolabial fold orientation with smiling, achieved statistically significant improvement.

Conclusions:
The eFACE may be a suitable, cross-platform, digital instrument for facial function assessment, and was well received by facial nerve experts. Tutorial viewing does not appear to be necessary to achieve agreement, although it does mildly improve agreement between occasional and frequent eFACE users.
The Evolution of Surgical Simulation: The Current State and Future Avenues for Plastic Surgery Education
Authors: Kazan Roy , Cyr Shantale , Hemmerling Thomas M. , Lin Samuel J. , Gilardino Mirko S. 
Published: February 2017

Summary:
Alongside the ongoing evolution of surgical training toward a competency-based paradigm has come the need to reevaluate the role of surgical simulation in residency. Simulators offer the ability for trainees to acquire specific skills and for educators to objectively assess the progressive development of these skills. In this article, the authors discuss the historical evolution of surgical simulation, with a particular focus on its past and present role in plastic surgery education. The authors also discuss the future steps required to further advance plastic surgery simulation in an effort to continue to train highly competent plastic surgery graduates.
The Association between Smoking and Plastic Surgery Outcomes in 40,465 Patients: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program Data Sets
Authors: Goltsman David , Munabi Naikhoba C. O. , Ascherman Jeffrey A. 
Published: February 2017

Background:
Smoking is known to negatively impact postoperative wound healing and increase infection risk. However, few studies have investigated whether the negative effects of smoking are similar for different procedures. The authors examined the association between smoking and postoperative outcomes for a diverse range of plastic surgery procedures.

Methods:
Using the American College of Surgeons National Surgical Quality Improvement Program data set, demographics and outcomes were examined for patients who underwent plastic surgery between 2007 and 2012. Multivariable logistic regression models assessed the relationship between smoking status and a range of postoperative outcomes, including medical and surgical complications and impaired wound healing. Patients were also evaluated for length of inpatient hospitalization while controlling for multiple demographic factors and type of procedure.

Results:
Forty thousand four hundred sixty-five patients were identified from the data set, including patients who had undergone breast, upper and lower extremity, abdominal, and craniofacial procedures. Current smokers constituted 15.7 percent of the cohort. Smokers had a higher likelihood of surgical (OR, 1.37; p < 0.0001) and medical complications (OR, 1.24; p = 0.0323) and increased odds for wound complications (OR, 1.49; p < 0.0001) and wound dehiscence (OR, 1.84; p < 0.0001). Smokers were also found to have increased odds of these complications even when subgroup analysis was performed according to major Current Procedural Terminology categories. Smoking also increased the odds of superficial wound infections (OR, 1.40; p < 0.0001). No difference was observed in hospital length of stay between smokers and nonsmokers.

Conclusions:
Smoking increases a multitude of postoperative complications after plastic surgery procedures. The effects of smoking on plastic surgery outcomes should be used to guide patients in preoperative smoking cessation and to evaluate protocols for managing patients who smoke.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Cosmetic Professionals’ Awareness of Body Dysmorphic Disorder
Authors: Bouman Theo K. , Mulkens Sandra , van der Lei Berend 
Published: February 2017

Background:
Preoccupation with a perceived appearance flaw is the main feature of body dysmorphic disorder. The majority of these patients seek and often receive some sort of cosmetic procedure, although this condition is considered to be a contraindication. This study evaluates cosmetic professionals’ recognition of body dysmorphic disorder and the way they act on this.

Method:
Members of Dutch professional associations for aesthetic plastic surgery, dermatology, and cosmetic medicine received an online survey by means of their association’s digital mailing lists; the survey was completed by 173 respondents.

Results:
Most participants indicated being more or less familiar with the diagnostic criteria and clinical picture of body dysmorphic disorder. Approximately two-thirds of the participants reported that they had encountered between one and five of these patients in their practice over the past year, a percentage that is significantly lower than the estimated prevalence of body dysmorphic disorder. The majority of professionals sometimes or often address body image problems during consultation, most of them collaborate with psychologists or psychiatrists when encountering a patient with body dysmorphic disorder, and approximately 70 percent had refused to perform a procedure in such a patient.

Conclusions:
Our results converge with those of previous studies, showing that most cosmetic professionals have some degree of awareness of body dysmorphic disorder, although the number they report encountering in clinical practice departs from prevalence figures. When a patient is identified as having body dysmorphic disorder, the professionals use this knowledge to guide their decision to perform a cosmetic procedure.
What Is the Lobular Branch of the Great Auricular Nerve? Anatomical Description and Significance in Rhytidectomy
Authors: Sharma Vicki S. , Stephens Robert E. , Wright Barth W. , Surek Christopher C. 
Published: February 2017

Background:
Current literature suggests that preserving the lobular branch of the great auricular nerve has greater impact on sensory function of the auricle than preservation of the posterior branch during rhytidectomy. However, no methodology exists to efficiently and accurately determine the topographic location of the lobular branch. This study describes the branching characteristics of the lobular branch and algorithmic surface markings to assist surgeons in preservation of the great auricular nerve during rhytidectomy flap elevation.

Methods:
The lobular branch was dissected in 50 cadaveric necks. Measurements were taken from the lobular branch to conchal cartilage, tragus, and antitragus. The anterior branch was measured to its superficial musculoaponeurotic system insertion, and the posterior branch was measured to the mastoid process. The McKinney point was marked and the great auricular nerve diameter was recorded. Branching pattern and location of branches within the Ozturk 30-degree angle were documented. Basic statistics were performed.

Results:
The lobular branch was present in all specimens and distributed to three regions. In 85 percent of specimens, the lobular branch resided directly inferior to the antitragus; in the remaining specimens, it was located directly inferior to the tragus. Preoperative markings consisting of two vertical lines from the tragus and antitragus to the McKinney point can be used to outline the predicted location of the lobular branch.

Conclusions:
This study delineates the location of the lobular branch of the great auricular nerve. The authors translate these findings into a quick and simple intraoperative marking, which can assist surgeons in avoiding lobular branch injury during rhytidectomy dissection.
Comparison of a Small Central versus a Large Peripheral Perforator in a Rat Model of Extended Dorsal Three–Vascular Territory Perforator Flap
Authors: Ding Jian , Feng Xiaoliang , Gao Weiyang , Yan Hede , Tao Xianyao , Wang Long , Tang Maolin 
Published: February 2017

Background:
Selection of suitable perforators is critical for satisfactory postreconstructive surgery outcome. This study aims to compare a small central versus a large peripheral perforator flap in a rat extended dorsal three–vascular territory perforator flap model.

Methods:
An extended intercostal artery perforator flap with three vascular territories was used to model a small central perforator flap. An extended deep circumflex iliac artery flap with three vascular territories was used to model a large peripheral perforator flap. Flap viability, angiography, and perfusion were compared.

Results:
Intercostal artery flaps showed significantly higher relative viable area than deep circumflex iliac artery flaps (98.5 ± 3.2 percent versus 87.1 ± 7.3 percent; p < 0.01). Angiography revealed that the anatomical and the first adjacent territories were perfused successfully in both types of flap, but the second adjacent territory of deep circumflex iliac artery flaps was not perfused sufficiently, thus ultimately leading to flap necrosis. Perfusion at the anatomical and the first adjacent territories of both types of flap increased significantly for 3 days (p < 0.05) and became stable 5 to 7 days after surgery. Perfusion at the second adjacent territory of deep circumflex iliac artery flaps diminished continuously.

Conclusions:
A small central perforator may supply a larger vascular territory than a large peripheral perforator. Both the size and the location of a perforator should be considered for optimizing the design of an extended perforator flap.
Advanced Imaging Techniques for Investigation of Acellular Dermal Matrix Biointegration
Authors: DeGeorge Brent R. , Ning Bo , Salopek Lisa S. , Pineros-Fernandez Angela , Rodeheaver George T. , Peirce-Cottler Shayn , Hu Song , Cottler Patrick S. , Campbell Christopher A. 
Published: February 2017

Background:
Biointegration, a concept involving a dynamic interplay among three processes—inflammation, cellular infiltration, and angiogenesis—is key to understanding the interaction between acellular dermal matrices and the host. The current standard for evaluating acellular dermal matrix biointegration involves histologic analysis at fixed time points; however, the authors’ approach uses advanced imaging techniques to serially assess biointegration in real time.

Methods:
The authors have adapted two advanced imaging techniques—two-photon microscopy and photoacoustic microscopy—to investigate biointegration in a murine deepithelialized dorsal skin-fold window chamber model, specifically engineered to recapitulate the host microenvironment of acellular dermal matrix–assisted breast reconstruction. Four mice per group were assessed. Two-photon imaging of dual-transgenic mice allows for detection of fluorescently labeled perivascular cells, and macrophage lineage cells. Photoacoustic microscopy noninvasively assesses oxygen and hemoglobin concentration in living tissues, generating high-resolution, three-dimensional mapping of the nascent acellular dermal matrix–associated microvasculature and metabolic consumption of oxygen. These outcomes were corroborated by confirmatory histologic analysis at the terminal time point.

Results:
The acellular dermal matrix/host interface is characterized by robust inflammation (0 to 3 days), increased oxygen consumption and neoangiogenesis in the matrix border zone (10 to 14 days), and vascular and inflammatory cell penetration into the center of the matrix (>21 days).

Conclusion:
The data broaden the core knowledge of acellular dermal matrix biology, and serve as a potential template for elucidating the key differences among various commercially available and developmental products to guide the reconstructive surgeon to better select a reconstructive adjunct that meets their specific needs.
Perforator-Based Interposition Flaps Perform Better Than Full-Thickness Grafts for the Release of Burn Scar Contractures: A Multicenter Randomized Controlled Trial
Authors: Stekelenburg Carlijn M. , Jaspers Mariëlle E. H. , Jongen Sandra J. M. , Baas Dominique C. , Gardien Kim L. M. , Hiddingh Jakob , van Zuijlen Paul P. M. 
Published: February 2017

Background:
Burn scar contractures remain a significant problem for the severely burned patient. Reconstructive surgery is often indicated to improve function and quality of life. Skin grafts (preferably full-thickness grafts) are frequently used to cover the defect that remains after scar release. Local flaps are also used for this purpose and provide healthy skin subcutaneous tissue. The vascularization and versatility of local flaps can be further improved by enclosing a perforator at the base of the flap. Until now, no randomized controlled trial has been performed to determine which technique has the best effectiveness in burn scar contracture releasing procedures.

Methods:
A multicenter randomized controlled trial was performed to compare the effectiveness of perforator-based interposition flaps to full-thickness skin grafts for the treatment of burn scar contractures. The primary outcome parameter was change in the surface area of the flap or full-thickness skin graft. Secondary outcome parameters were width, elasticity, color, Patient and Observer Scar Assessment Scale score, and range of motion. Measurements were performed after 3 and 12 months.

Results:
The mean surface area between flaps (n = 16) and full-thickness skin grafts (n = 14) differed statistically significantly at 3 months (123 percent versus 87 percent; p < 0.001) and 12 months (142 percent versus 92 percent; p < 0.001). In terms of the secondary outcome parameters (specifically, the Patient and Observer Scar Assessment Scale observer score and color), interposition flaps showed superior results compared with full-thickness skin grafts.

Conclusion:
Perforator-based interposition flaps result in a more effective scar contracture release than full-thickness skin grafts and should therefore be preferred over full-thickness skin grafts when possible.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, I.