bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Anterior Neck Aging without a Submental Approach: Lateral Skin-Platysma Displacement, a New and Proven Technique for Platysma Bands and Skin Laxity
Authors: Pelle-Ceravolo Mario , Angelini Matteo , Silvi Erminia 
Published: February 2017

Background:
A high rate of recurrence of anterior platysma bands and anterior skin laxity was reported at the 1-year follow-up of 150 patients who underwent complete neck undermining and full-width platysma transection for neck rejuvenation. The authors propose a new technique—lateral skin-platysma displacement—to treat these two aesthetic problems using only a lateral approach to avoid “opening” the anterior neck. The authors’ objective was to compare outcomes following full-width platysma transection technique and lateral skin-platysma displacement technique in terms of patient satisfaction, complications, and long-term effectiveness in the treatment of bands and anterior skin laxity.

Methods:
A prospective study was carried out on 100 patients. All patients were operated on by the senior surgeon (M.P.C.). Patient questionnaires were used to assess their levels of satisfaction.

Results:
Patient satisfaction was extremely high following both techniques. Successful correction of bands at 1 year was observed in 83.5 percent of the lateral skin-platysma displacement patients and 56 percent of the full platysma section patients. Regarding recurrent skin laxity, 68 percent of those who underwent lateral skin-platysma displacement did not show any obvious recurrence of excess skin at 1 year compared with 52 percent of the full platysma section group. Prolonged edema was the main complication and was considerably more frequent in the patients undergoing complete neck undermining.

Conclusions:
The 1-year patient satisfaction ratings were higher for those treated with the lateral skin-platysma displacement technique. The lateral skin-platysma displacement technique has proved to have a much shorter recovery and better outcomes in the correction of platysma bands and of the anterior neck skin laxity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Evidence-Based Recipes for Venous Thromboembolism Prophylaxis: A Practical Safety Guide
Authors: Pannucci Christopher J. 
Published: February 2017

Learning Objectives:
After studying this article and viewing the videos, the participant should be able to: 1. Demonstrate an understanding of risk stratification for venous thromboembolism in surgical patients. 2. Calculate and interpret a 2005 Caprini score. 3. Give examples of modifiable risk factors for perioperative venous thromboembolism. 4. Propose a venous thromboembolism risk reduction strategy using mechanical and/or chemoprophylaxis and justify the risks and benefits of the proposed strategy.

Summary:
This CME article provides an evidence-based summary of venous thromboembolism in plastic and reconstructive surgery patients, with a focus on current knowledge surrounding risk stratification, risk modification, and risk reduction.
Traditional Methods versus Quantitative Sensory Testing of the Feet at Risk: Results from the Rotterdam Diabetic Foot Study
Authors: Rinkel Willem D. , Castro Cabezas Manuel , Setyo Jonathan H. , Van Neck Johan W. , Coert J. Henk 
Published: February 2017

Background:
Diabetic sensorimotor polyneuropathy is one of the greatest risk factors for foot ulceration. The current study investigated the measurement properties of the Pressure-Specified Sensory Device in comparison with traditional threshold screening instruments, in several categories of sensory loss. Knowledge of these values may help to identify diabetics at risk for ulceration more reliably.

Methods:
A partially cross-sectional cohort study was carried out in patients with diabetes. Traditional instruments classified each patient into groups representing severity of diabetic sensorimotor polyneuropathy. Demographic characteristics, laboratory measures, and Pressure-Specified Sensory Device measurements were compared between groups. The Bland-Altman method was used to characterize reliability of the Pressure-Specified Sensory Device, and construct validity was determined by comparison with Semmes-Weinstein monofilaments.

Results:
One hundred fifty-five diabetic patients were measured. Fifteen patients had a diabetic ulcer in their medical history, seven patients were insensate to the 10-g monofilament and had diminished vibration sense (group 1), 34 patients had diminished vibration sense but no elevated cutaneous threshold (group 2), and 99 patients acted as controls (no elevated cutaneous threshold or diminished vibration sense, group 3). The Pressure-Specified Sensory Device distinguished these groups with one-point static cutaneous thresholds alone. Semmes-Weinstein monofilament and Pressure-Specified Sensory Device measurements were not interchangeable. Spatial discrimination (two-point static and two-point moving discrimination) by the Pressure-Specified Sensory Device was more reliable compared with one-point static discrimination. Semmes-Weinstein monofilament (force in grams and pressure in grams per square millimeter) correlations with Pressure-Specified Sensory Device measurements differed between groups.

Conclusions:
The Pressure-Specified Sensory Device is able to distinguish between categories of sensory loss. The Pressure-Specified Sensory Device is valid in measuring cutaneous thresholds and can reliably measure spatial discrimination at the feet.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Diagnostic, II.
Predicting Complications in Immediate Alloplastic Breast Reconstruction: How Useful Is the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator?
Authors: O’Neill Anne C. , Murphy Blake , Bagher Shaghayegh , Al Qahtani Saad , Hofer Stefan O. P. , Zhong Toni 
Published: February 2017

Background:
Complications following immediate breast reconstruction can have significant consequences for the delivery of postoperative chemotherapy and radiation therapy. Identifying patients at higher risk of complications would ensure that immediate breast reconstruction does not compromise oncologic treatment. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator is an online tool in the public domain that offers individualized preoperative risk prediction for a wide range of surgical procedures, including alloplastic breast reconstruction. This study evaluates the usefulness of this tool in patients undergoing immediate breast reconstruction with tissue expanders at a single institution.

Methods:
Details of 278 patients who underwent immediate breast reconstruction with tissue expander placement were entered into the calculator to determine the predicted complication rate. This was compared to the rate of observed complications on chart review. The predictive model was evaluated for calibration and discrimination using the statistical measures used in the original development of the calculator.

Results:
The predicted rate of complications (5.2 percent) was significantly lower that the observed rate (16.2 percent; p < 0.01). The Hosmer-Lemeshow test confirmed lack of fit of the model. The C statistic was 0.62 and the Brier score was 0.173, indicating that the model had poor predictive power and could not discriminate between those who were at risk for complications and those who were not.

Conclusions:
The American College of Surgeons National Surgical Quality Improvement Program universal Surgical Risk Calculator underestimated the proportion of patients that would develop complications in this cohort. In addition, it was unable to effectively identify individual patients at increased risk, suggesting that this tool would not make a useful contribution to preoperative decision-making in this patient group.
Multivariate Preoperative and Intraoperative Predictors of Postmastectomy Radiation Therapy in Patients for Whom Immediate Breast Reconstruction Is Planned
Authors: Chao Albert H. , Martinez Juan Carlos , Wobb Jessica , Povoski Stephen P. 
Published: February 2017

Background:
Postmastectomy radiation therapy often impacts decision-making and outcomes of breast reconstruction. However, plastic surgeons typically have limited information regarding the likelihood of radiation therapy when decisions about immediate breast reconstruction are made. The study objective was to examine whether commonly available information can be used to predict the probability of radiation therapy.

Methods:
A retrospective review was performed of patients undergoing mastectomy and sentinel lymph node biopsy. Multivariate logistic regression analysis of variables available in greater than 95 percent of patients was performed in relation to predicting radiation therapy.

Results:
A total of 322 patients were reviewed, of whom 55 (17.1 percent) received radiation therapy, which was indicated for patients having four or more positive axillary lymph nodes in all cases. Multivariate logistic regression identified the intraoperative sentinel lymph node frozen section results (OR, 27.3), tumor size (OR, 1.7), and age (OR, 0.96) as significant predictors. The sentinel lymph node frozen section exhibited negative and positive predictive values for radiation therapy of 95.4 percent and 54.3 percent, respectively. When sentinel lymph node frozen section was combined with tumor size greater than or equal to 2.0 cm, the positive predictive value increased to 80.5 percent.

Conclusion:
Immediate breast reconstruction patients who have negative intraoperative sentinel lymph node frozen section results have a less than 5 percent chance of radiation therapy, whereas patients with positive intraoperative sentinel lymph node frozen section results and tumor size greater than or equal to 2.0 cm have a greater than 80 percent chance of radiation therapy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Versatility of the Profunda Artery Perforator Flap: Creative Uses in Breast Reconstruction
Authors: Haddock Nicholas , Nagarkar Purushottam , Teotia Sumeet S. 
Published: February 2017

Background:
Flaps based on the profunda artery perforators were first used for reconstruction of pressure sores, burn contractures, and extremity wounds. Recently, a revised profunda artery perforator flap was introduced for breast reconstruction. However, the flap is rarely used despite interesting reports on its use. The authors present their experience with the profunda artery perforator flap, describing its versatile applications in breast reconstruction.

Methods:
The authors conducted a retrospective review of all patients of the lead author who underwent breast reconstruction with profunda artery perforator flaps before January of 2015. Patient demographics, perioperative data, and postoperative complications were recorded and analyzed.

Results:
Seventy-three consecutive profunda artery perforator flaps were used to reconstruct 71 breasts. In 21 breasts, a profunda artery perforator flap was used in conjunction with another flap—with a deep inferior epigastric perforator flap (n = 18), a superior gluteal artery perforator flap (n = 1), or as stacked profunda artery perforator flaps (n = 2). The flap failure rate was 2.7 percent. There was one case of clinically apparent fat necrosis. There were no other major flap complications. Donor-site complications included cellulitis in two thighs (2.7 percent) and minor wound dehiscence in six thighs (8.2 percent). All donor-site complications healed satisfactorily by secondary intention without any additional procedures.

Conclusions:
The profunda artery perforator flap is a safe and versatile option for breast reconstruction. It can be combined with other flaps when additional volume or skin requirements are present. Flap and donor-site complications are comparable to other free tissue breast reconstruction options.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Improved Recovery Experience Achieved for Women Undergoing Implant-Based Breast Reconstruction Using an Enhanced Recovery after Surgery Model
Authors: Dumestre Danielle O. , Webb Carmen E. , Temple-Oberle Claire 
Published: February 2017

Background:
Enhanced recovery after surgery was compared with traditional recovery after surgery for postmastectomy alloplastic breast reconstruction.

Methods:
Length of stay, emergency room visits, and complications within 30 days of surgery were compared among three groups: traditional recovery after surgery, transition (some elements of enhanced recovery protocol, not transitioned to outpatient care), and enhanced recovery after surgery (day surgery, provided with standardized perioperative education and multimodal analgesia). Prospective data collection allowed quality-of-recovery assessment using a validated questionnaire for enhanced recovery/transition groups. Results were statistically analyzed (analysis of variance/chi-square).

Results:
The traditional recovery, transition, and enhanced recovery cohorts comprised 29, 11, and 29 patients, respectively. No significant differences were present regarding age, smoking status, preoperative radiation, single stage direct-to-implant versus tissue expander, bilateral versus unilateral surgery, or immediate versus delayed reconstruction among groups. Average length of stay was 1.6 nights in both the traditional recovery and transition groups, compared with 0 nights in the enhanced recovery group (p < 0.001). Enhanced recovery patients had less severe pain (p = 0.02) and nausea (p = 0.01), and better enjoyed their food (p = 0.0002) and felt more rested (p = 0.02) than their transition counterparts. There were no differences in the number of emergency room visits among the three groups (p = 0.88). There was no difference in the rate of hematoma (p = 0.36), infection requiring intravenous antibiotics (p = 0.36), or infection requiring explantation (p = 0.36) among the three groups.

Conclusion:
An enhanced recovery protocol for alloplastic breast reconstruction treated patients safely, with improved patient satisfaction and same-day discharge and with no increase in complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
The Anterior Intercostal Artery Flap: Anatomical and Radiologic Study
Authors: Carrasco-López Cristian , Julian Ibañez Juan Francisco , Vilà Jordi , Rodriguez-Baeza Alfonso , Carrera-Burgaya Anna , Reina-de-la-Torre Francisco , Damaso-Margelí-Cervera Victor , Fernandez-Llamazares-Rodriguez Jaime , Higueras-Suñe Carmen 
Published: February 2017

Background:
Reconstruction of the anterior thorax is complex because of the presence of aesthetically important areas such as the breast, sternum, and upper abdomen. For this reason, a wide variety of pedicled perforator flaps have been described. The anterior intercostal perforator flap is one of these perforators flaps and is valuable for use in breast reconstruction surgery.

Methods:
The location and characteristics of the anterior intercostal perforators were evaluated both anatomically and radiologically. The anatomical study was conducted in a set of 14 hemitrunk cadavers, and the radiologic study was performed retrospectively from a randomly selected set of images obtained from 30 female patients who underwent thoracic computed tomographic angiography for other health problems at the authors’ institution during the year 2015. The findings were then compared.

Results:
A total of 60 perforators in 14 hemitrunks were identified and mapped. Perforators were found in all hemithoraces. The lateral third donor location was the most reliable zone, containing larger and more numerous perforators compared with the other donor regions. According to the radiologic study, a total of 164 perforators in 30 computed tomographic angiographs were identified and mapped. Perforators were found in all thoraxes.

Conclusions:
The authors found that the intercostal perforator flap has a consistent vascularization. Computed tomographic angiography is less reliable than dissection in identifying the number of perforators. The authors’ findings suggest that intercostal perforator flaps are reliable and consistent flaps for reconstruction of the upper trunk.
Gynecomastia Classification for Surgical Management: A Systematic Review and Novel Classification System
Authors: Waltho Daniel , Hatchell Alexandra , Thoma Achilleas 
Published: February 2017

Background:
Gynecomastia is a common deformity of the male breast, where certain cases warrant surgical management. There are several surgical options, which vary depending on the breast characteristics. To guide surgical management, several classification systems for gynecomastia have been proposed.

Methods:
A systematic review was performed to (1) identify all classification systems for the surgical management of gynecomastia, and (2) determine the adequacy of these classification systems to appropriately categorize the condition for surgical decision-making.

Results:
The search yielded 1012 articles, and 11 articles were included in the review. Eleven classification systems in total were ascertained, and a total of 10 unique features were identified: (1) breast size, (2) skin redundancy, (3) breast ptosis, (4) tissue predominance, (5) upper abdominal laxity, (6) breast tuberosity, (7) nipple malposition, (8) chest shape, (9) absence of sternal notch, and (10) breast skin elasticity. On average, classification systems included two or three of these features. Breast size and ptosis were the most commonly included features.

Conclusions:
Based on their review of the current classification systems, the authors believe the ideal classification system should be universal and cater to all causes of gynecomastia; be surgically useful and easy to use; and should include a comprehensive set of clinically appropriate patient-related features, such as breast size, breast ptosis, tissue predominance, and skin redundancy. None of the current classification systems appears to fulfill these criteria.
Topographic Analysis of the Supratrochlear Artery and the Supraorbital Artery: Implication for Improving the Safety of Forehead Augmentation
Authors: Cong Li-yao , Phothong Weeranut , Lee Sang-Hee , Wanitphakdeedecha Rungsima , Koh Iksoo , Tansatit Tanvaa , Kim Hee-Jin 
Published: February 2017

Background:
The supratrochlear and supraorbital artery branches from the ophthalmic artery are the primary suppliers of blood to the forehead. Filler injection into the forehead without precise knowledge of its vascular topography poses a risk of severe complications.

Methods:
Twenty hemifaces from 11 cadavers were dissected.

Results:
Based on the presence of the deep branch of the supratrochlear artery, two main arterial distribution patterns of the forehead were observed. Type I (deep branch of the supratrochlear artery–present pattern) was classified into two subtypes: type Ia, in which the layer superficial to the frontalis was supplied medially by the superficial branch of the supratrochlear artery and laterally by the superficial branch of the supraorbital artery, and the deep branch of the supratrochlear artery and the deep branch of the supraorbital artery were distributed deep to the frontalis; and type Ib, in which the layer superficial to the frontalis was supplied by the superficial branch of the supratrochlear artery and the superficial branch of the supraorbital artery in addition to the central artery or the paracentral artery, and the layer deep to the frontalis was supplied the same with type Ia. For type II (deep branch of the supratrochlear artery–absent pattern), the layer superficial to the frontalis was supplied the same with type Ia; only the deep branch of the supraorbital artery supplied the layer deep to the frontalis.

Conclusion:
This study yielded novel arterial systems of the forehead and provided guidance for the safe forehead augmentation.
An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature
Authors: Frey Jordan D. , Poudrier Grace , Chiodo Michael V. , Hazen Alexes 
Published: February 2017

Summary:
Although many transgender individuals are able to realize their gender identity without surgical intervention, a significant and increasing portion of the trans population is seeking gender-confirming surgery (alternatively, gender reassignment surgery, sexual reassignment surgery, or gender-affirming surgery). This review presents a robust overview of genital reconstruction in the female-to-male transgender patient—an operation that, historically, was seldom performed and has remained less surgically feasible than its counterpart (male-to-female genital reconstruction). However, as the visibility and public awareness of the trans community continues to increase, the demand for plastic surgeons equipped to perform these reconstructions is rising. The “ideal” neophallus is aesthetic, maintains tactile and erogenous sensibility, permits sexual function and standing urination, and possesses minimal donor-site and operative morbidity. This article reviews current techniques for surgical construction, including metoidioplasty and phalloplasty, with both pedicled and free flaps. Emphasis is placed on the variety of techniques available for constructing a functional neophallus and neourethra. Preparative procedures (such as vaginectomy, hysterectomy, and oophorectomy) and adjunctive reconstructive procedures (including scrotoplasty and genital prosthesis insertion) are also discussed.
Learning How to Ask: Women and Negotiation
Authors: Fischer Lauren H. , Bajaj Anureet K. 
Published: February 2017

Summary:
Women are less likely to reach top-level leadership positions, and more likely to leave academic positions, than men, and are likely to earn less money than men. Women are also less likely to initiate a negotiation—a process that is crucial for professional advancement. This reluctance to ask hinders their advancement and can have long-lasting consequences—both financial and professional. The reasons that women do not ask are multifactorial. In this article, we will explore reasons why women are less likely to negotiate, the barriers they face when they do, and strategies that women can apply to improve their negotiation skills.
The Role of Bacterial Biofilm in Adverse Soft-Tissue Filler Reactions: A Combined Laboratory and Clinical Study
Authors: Saththianathan Mayuran , Johani Khalid , Taylor Alaina , Hu Hongua , Vickery Karen , Callan Peter , Deva Anand K. 
Published: February 2017

Background:
The development of chronic nodules and granulomatous inflammation after filler injections has been attributed to bacterial biofilm infection. The authors aimed to investigate the relationship between filler and bacterial biofilm using a combined in vitro and in vivo study.

Methods:
In vitro assays to investigate the ability of filler materials to support the growth of Staphylococcus epidermidis biofilm and the effect of multiple needle passes through a biofilm-contaminated surface were designed. Analysis of clinical biopsy specimens from patients presenting with chronic granulomas following filler administration using a number of laboratory tests for biofilm was performed.

Results:
All fillers (i.e., hyaluronic acid, polyacrylamide gel, and poly-l-lactic acid) supported the growth of S. epidermidis biofilm in vitro. Multiple needle passes through a biofilm-contaminated surface resulted in significantly increased contamination of filler material by a factor of 10,000 (p < 0.001). Six clinical samples from five patients all demonstrated bacterial biofilm. The mean number of bacteria was found to be 2.2 × 107 bacteria/mg tissue (range, 5.6 × 105 to 3.7 × 107 bacteria/mg tissue). Microbiome analysis detected a predominance of Pseudomonas, Staphylococcus, and Propionibacterium as present in these samples.

Conclusions:
Filler material can support the growth of bacterial biofilm in vitro. Multiple needle passes can significantly increase the risk of filler contamination. Biofilm appears to be associated with high numbers in clinical samples of patients presenting with chronic granulomatous inflammation. Strategies to reduce the risk of bacterial contamination need to be further studied and translated into clinical practice.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.