bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Impact of Health Insurance Contract Timing on Breast Reconstruction Completion”
Authors: Jones Kaitlin D. , Wen Yuan E. , Teotia Sumeet S. , Haddock Nicholas T. 
Published: February 2023

Introduction:
Cost of breast reconstruction can create a substantial burden for patients. As patients hope to maximize insurance plan benefits, it is crucial to receive efficient, cost-reducing care. This study analyzes the impact of insurance cycle (calendar-based insurance (CBI) vs. non-calendar-based insurance (NCBI)) on breast reconstruction.

Methods:
Between January 2014-2018, patients undergoing post-mastectomy breast reconstruction by two senior surgeons at a single academic institution (N.T.H. and S.S.T.) were retrospectively evaluated. Data were collected on Insurance Contract Timing (CBI vs. NCBI) and Insurance payor.

Result:
A total of 514 patients were included: 136 patients on NCBI and 378 patients on CBI. Individuals enrolled in CBI were more likely than NCBI patients to have their last surgery towards the end of the calendar year (p<0.0005). Additionally, individuals on private CBI’s are more likely to have their last surgery closer to the end of the year than those on public CBI’s (p<0.0001). Individuals enrolled in CBI were less likely to receive autologous reconstruction than individuals on NCBI (p=0.011). Among patients on private CBI’s, patients with all major revisions were more likely to start their reconstructive journey earlier in the year than patients that did not finish major revisions (p=0.011). Lastly, individuals on private insurance also receive more revisionary procedures than those on public insurance (p< 0.0001).

Conclusions:
Insurance contract cycle and payor impact the timing of breast reconstruction. This study emphasizes the importance of both patient and provider working towards maximizing health insurance plan benefits.
D.a.C.i. (Double asymmetric Circular incision), a new skin-sparing mastectomy technique: results and outcomes of first 46 procedures.
Authors: Casella Donato , Cassetti Dario , Marcasciano Marco , Lo Torto Federico , Fusario Daniele , Miccoli Simone , Fausto Alfonso , Restaino Valeria , Ribuffo Diego , Neri Alessandro 
Published: February 2023

SUMMARY:
Skin-sparing mastectomy (SSM) is a surgical technique that preserves as much of the breast skin as possible. D.a.C.i. - Double asymmetric Circular incision is a novel immediate breast reconstruction technique for immediate prepectoral implant placement using a titanium-coated polypropylene mesh.
The aim of this technique is to optimize the cosmetic benefits of smaller incisions, preserve breast anatomy, avoid breast deformities and reduce negative psychological impact on the patient without increasing local recurrence risk.
D.a.C.i. SSM uses a double circular incision: the external drawing contains the nipple-areola complex (NAC), while the inner circular skin island will be used to provide the skin for the new areola.
We performed D.a.C.i. SSM in patients with tumors located within 2 cm of the NAC, or in cases of patients with multicentric lesions involving areolar tissue.
Forty-six patients underwent D.a.C.i. SSM at the authors’ institutions between February 2014 and July 2019. Two patients developed hematoma and one patient developed seroma. No implant loss was observed. Skin flap necrosis rate was 0%. The BREAST-Q patient-reported outcomes measure was routinely used at our institution and recorded good aesthetic outcomes and high patient satisfaction.
This new technique appears to be safe and easily reproducible in patients with small- to medium-sized breasts and with little to moderate ptosis (up to Regnault classification grade II).
“The Use of Endonasal Spreader Grafts in Preservation Rhinoplasty”
Authors: Go Beatrice C , Frost Ariel S , Friedman Oren 
Published: February 2023

Summary:
Rhinoplasty is a complicated procedure that requires surgical finesse and precision to sculpt a framework that suits each patient’s unique anatomical needs. Extensive resection may lead to nasal valve incompetence, causing obstructive symptoms associated with reduced quality of life. Numerous techniques have been described to help preserve and open the nasal airway, thereby mitigating valvular obstructive problems. In particular, the endonasal spreader graft is a common technique used to widen the internal nasal valve cross-sectional area while limiting external incisions and preserving local nasal structures. Preservation rhinoplasty is a variation of the traditional rhinoplasty that can lower the nasal dorsum without causing major disruption to the nasal keystone area, the junction between the middle and upper thirds of the nose. This study describes the successful and safe combination of these two surgical operations, demonstrating 3 case examples, who all reported improved post-operative nasal obstruction symptoms. Using endonasal spreader grafts in preservation rhinoplasty allows providers to manage the nasal valve and nasal dorsum similarly to the external approach without extensive deconstruction and reconstruction.
“Natural History of Metacarpal Subsidence Following Trapeziectomy with Ligament Reconstruction and Tendon Interposition and Its Relationship to Clinical Outcomes”
Authors: Meyers Abigail , Krebs Jillian P , Rampazzo Antonio , Bassiri Gharb Bahar 
Published: February 2023

Purpose:
Trapeziectomy is commonly performed for treatment of symptomatic trapeziometacarpal osteoarthritis. Proximal migration of the first metacarpal (subsidence) can occur following trapeziectomy. The aim of this study was to investigate the natural history of subsidence and its correlation with clinical outcomes.

Methods:
An IRB-approved retrospective review of patients who underwent trapeziectomy and ligament reconstruction and tendon interposition (LRTI) was conducted. Patient demographics, pain scores (VASp), grip strength, pinch strengths, and radial and palmar abduction were collected. The trapezial space ratio (TSR) was measured by the scaphometacarpal distance divided by the length of the capitate. Subsidence [(postoperative TSR-preoperative TSR)/preoperative TSR] was measured and classified as severe (≥70%) or mild-moderate (<70%). Median rate of subsidence increase was calculated. Conolly-Rath scores were used to evaluate the proportion of “good” outcomes in each group.

Results:
One hundred forty-one trapeziectomies-LRTI were included. Subsidence increased 6.7% [5.4-23.0%] per week, before 16 weeks, and 0.3% [0.1-0.8%] per week, thereafter. VASp was not significantly different between patients with severe and mild-moderate subsidence (p=0.25), 16 weeks after thumb mobilization.
The proportion of “good” outcomes was comparable among the two groups (p=0.12). There was no correlation between subsidence and pain (ρ=-0.20, p=0.24), grip (ρ=-0.02, p=0.93), key (ρ=-0.13, p=0.62), tripod (ρ=0.16, p=0.71), or index tip pinch strengths (ρ=-0.28, p=0.43), or radial (ρ=-0.03, p=0.92) or palmar (ρ=-0.15, p=0.61) abduction.

Conclusions:
Subsidence occurs in all patients following trapeziectomy and LRTI, stabilizing 16 weeks after mobilization. Degree of subsidence does not correlate with postoperative outcomes.
Transpalpebral “Eyelid” Approach for Supraorbital Frontal Craniotomy and Access to the Anterior Cranial Fossa
Authors: Morrison Kerry A. , Farber Scott J. , Riina Howard A. , Staffenberg David A. 
Published: February 2023

Summary:
The transpalpebral “eyelid” approach is an innovative alternative to the traditional incisions for exposure of the anterior cranial fossa for neurosurgery. Yet, there is a paucity of data on such a surgical technique in the plastic surgery literature for accessing the anterior cranial fossa. A retrospective review was performed of patients who underwent supraorbital frontal craniotomy using an anterior skull base approach with transpalpebral exposure over eight years by a single plastic surgeon (D.A.S.). Surgical techniques, medical co-morbidities, intra-operative complications, and long-term complications were assessed. Twenty patients (mean age 52±12 years, 55% male, 45% female) underwent supraorbital frontal craniotomy using an anterior skull base approach with upper transpalpebral exposure. Operative indications included: 75% had anterior communicating aneurysms with a mean aneurysm size of 5.36±1.91 mm, 10% had meningiomas, 10% had dural fistulas, and 5% had an orbital hemangioma. Notably, 60% had a smoking history. No intra-operative complications were encountered, and no cases required conversion to a traditional open approach. Mean length of hospital stay was 3.2±1.5 days. Post-operative imaging revealed no residual or recurrent pathology. Mean follow up time was 62.2±30.6 months. No long-term neurological or ophthalmologic complications or infections occurred. No forehead paresthesias, and no brow ptosis or brow paralysis were noted. The transpalpebral technique is an excellent, minimally invasive alternative to approach lesions of the anterior cranial fossa. Successful application may require appropriate management of the frontal sinus and supraorbital nerve. As described, this approach does not limit neurosurgical access or results, and led to no neurosurgical complications.
Y-Columellar Strut Graft: A Method for Reconstructing the Nasal Tip in Primary and Revision Rhinoplasty
Authors: Martino Carmine , Salzano Francesco Antonio , Martino Diletta , Ralli Massimo , Salzano Giovanni , De Vincentiis Marco , Brenner Michael J , Di Stadio Arianna 
Published: February 2023

Background:
Several techniques have been proposed to modify tip shape and projection, both in congenital and acquired nasal tip deformities. We describe a novel technique, the Y-columellar strut graft (“Y-strut”), which uses auricular cartilage to increase tip projection and restore contour in primary or revision rhinoplasty.

Methods:
Thirty-seven patients with congenital, acquired, or iatrogenic nasal tip malformation were reconstructed with Y-strut using short or long upper limbs (“wings”). The short wings variant was employed to increase tip projection in primary rhinoplasty, and the long wings variant was used to corrected iatrogenic deformities of alar cartilages in revision rhinoplasty, improving contour and projection. Frontal, oblique, and lateral views before and after surgery were analyzed in blinded fashion at 1 year for tip shape and projection. Statistical analyses compared demographic characteristics, deformity type, and nasolabial angle before and after surgery to evaluate aesthetic outcome.

Results:
All patients demonstrated improved nasal tip position. The Y-strut increased the nasolabial angle, reflecting tip rotation, and findings were independent of type or location of deformity (p<0.00001). No statistically significant differences were observed in comparisons of the short versus long-wings techniques. Three patients with congenital nasal tip malformations showed mild tip deviation at 1-year follow-up, and one had mild dorsal irregularity unrelated to grafting; no negative outcomes were observed in revision rhinoplasty patients.

Conclusions:
The Y-columellar strut graft is a reliable and versatile rhinoplasty technique using paired, symmetrical grafts fashioned from auricular cartilage to correct tip deformities.
Level of evidence:IV
Abductor Digiti Minimi and Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer: The “Super-Turbocharge End to Side (STETS)” Transfer For Severe Ulnar Neuropathy
Authors: Peters Blair R. , Jacobson Lauren , Pripotnev Stahs , Mackinnon Susan E. 
Published: February 2023

Summary:
Anterior interosseous nerve (AIN) to ulnar motor nerve (UMN) supercharge end to side (SETS) nerve transfer to restore intrinsic function is a recently adopted nerve transfer in severe ulnar neuropathy. However, its success is predicated on the critical threshold number of axons innervating the intrinsic muscles. Given the relative expendability of the abductor digiti minimi (ADM) and the critical function of the other intrinsic muscles, we have modified our SETS transfer to redirect axons from the ADM to turbocharge the UMN to innervate the more critical intrinsic muscles, referring to this procedure as a super-turbocharge end to side (STETS) procedure. The ADM has been used previously as a muscle/tendon transfer for thumb opposition and more recently as a nerve transfer to reinnervate the thenar branch of the median nerve. While current methods of assessment of reinnervation are likely unable to differentiate between contributions from the AIN SETS versus ADM STETS transfer, this technique follows fundamentals of modern nerve surgery where directing the maximum number of nerve fibers in a timely fashion to the most critical target is paramount for the best functional recovery. Thus, we suggest the STETS technique may optimize outcomes in ulnar neuropathy without additional patient morbidity.
Gluteal Shape Framework for Augmentation Surgery: A Systematic Review of the Literature and Proposed Classification System
Authors: Dorfman Robert , Gupta Nisha , Saadat Sean , Delong Michael , Roostaeian Jason 
Published: February 2023

Purpose:
Gluteal augmentation is used to improve the size and shape of the buttocks. Unlike other anatomic areas, such as the breasts, where there are classification systems for size and projection, no standardized methods for classifying gluteal size and shape exists. Patients seeking augmentation rely on pictures to communicate their desired result to surgeons. Our study objectively reviews this topic and proposes a novel classification system for the buttocks that can provide an organized framework for patients and providers.

Methods:
A systematic of the literature was conducted on March 17, 2021, using various combinations of the following terms: “gluteal augmentation”, “classification”, “size”, “gluteoplasty”, and “Brazilian butt lift”. All eligible articles were included for analysis.

Results:
The PubMed/MEDLINE searches yielded 49 articles and abstracts. After review, 8 publications were chosen for analysis. All publications were found in plastic surgery journals, with the most common journals as follows: Aesthetic Surgery Journal (n=4), Clinics in Plastic Surgery (n=2), Annals of Plastic Surgery (n=1), and Plastic and Reconstructive Surgery (n=1). There are no articles in the plastic surgery literature that provide a standardized classification system for gluteal size determination.

Conclusion:
Our study revealed the need for a standardized classification system for gluteal size and shape. While the publications analyzed discussed various techniques for related procedures and provided ways to improve aesthetic outcomes, none presented a system for reproducibly classifying size and shape. By introducing a classification system, we hope to enable plastic surgeons to more accurately and efficiently discuss their patient’s goals.
Dermal Sensory Regenerative Peripheral Nerve Interface (DS-RPNI) for Re-establishing Sensory Nerve Feedback in Peripheral Afferents in the Rat
Authors: Sando Ian C. , Adidharma Widya , Nedic Andrej` , Ursu Daniel C. , Mays Elizabeth A , Hu Yaxi , Kubiak Carrie A. , Sugg Kristoffer B. , Kung Theodore A. , Cederna Paul S. , Gerling Gregory J. , Kemp Stephen W. P. , Urbanchek Melanie G. 
Published: February 2023

Background:
Without meaningful, intuitive sensory feedback, even the most advanced myoelectric devices require significant cognitive demand to control. The Dermal Sensory Regenerative Peripheral Nerve Interface (DS-RPNI) is a biologic interface designed to establish high-fidelity sensory feedback from prosthetic limbs.

Methods:
DS-RPNIs are constructed in rats by securing fascicles of residual sensory peripheral nerves into autologous dermal grafts. Our objectives are to confirm regeneration of sensory afferents within DS-RPNIs, and to establish the reliability of afferent neural response generation with either mechanical or electrical stimulation.

Results:
Two months after implantation, DS-RPNIs were healthy and displayed well-vascularized dermis with organized axonal collaterals throughout and no evidence of neuroma. Electrophysiological signals were recorded proximal from DS-RPNI’s sural nerve in response to both mechanical and electrical stimuli and compared to a) full-thickness skin, b) de-epithelialized skin, and c) transected sural nerves without DS-RPNI. Mechanical indentation of DS-RPNI’s evoked compound sensory nerve action potentials (CSNAPs) that were like those evoked during indentation of full-thickness skin. CSNAP firing rates and waveform amplitudes increased in a graded fashion with increased mechanical indentation. Electrical stimuli delivered to DS-RPNI’s reliably elicited CSNAPs at low current thresholds and CSNAPs gradually increased in amplitude with increasing stimulation current.

Conclusions:
These findings suggest that afferent nerve fibers successfully reinnervate DS-RPNI’s, and that graded stimuli applied to DS-RPNI’s produce proximal sensory afferent responses similar to those evoked from normal skin. This confirmation of graded afferent signal transduction through DS-RPNI neural interfaces validate DS-RPNI’s potential role of facilitating sensation in human-machine interfacing.
A Systematic Review and Meta-Analysis of Nerve Gap Repair: Comparative Effectiveness of Allografts, Autografts, and Conduits
Authors: Lans Jonathan , Eberlin Kyle , Evans Peter J. , Mercer Deana , Greenberg Jeffrey A. , Styron Joseph F. 
Published: February 2023

Background:Ideal nerve repair involves tensionless direct repair, which may not be possible after resection. Bridging materials include nerve autograft, allograft, or conduit. This study aimed to perform a systematic literature review and meta-analysis to compare the Meaningful Recovery (MR) rates and post-operative complications following autograft, allograft and conduit repairs in nerve gaps >5mm and <70mm. A secondary aim was to perform a comparison of procedure costs.Methods:The search was conducted in MEDLINE from January 1980 to March 2020, following PRISMA guidelines. Studies were included if they reported nerve injury type, repair type, gap length, and outcomes for MR rates. Thirty-five studies with 1,559 nerve repairs were identified.Results:Overall MR for sensory and motor function was not significantly different between autograft (n=670) and allograft (n=711) across both short and long gaps. However, MR rates for autograft (81.6%) and allograft (87.1%) repairs were significantly higher compared to conduits (62.2%) (p<0.05) in sensory short gap repairs. Complication rates were comparable for autograft and allograft but higher for conduit with regard to pain. Analysis of costs showed that total costs for allograft repair were less than autograft in the inpatient setting and were comparable in the outpatient setting.Conclusion:Literature showed comparable rates of MR between autograft and allograft, regardless of gap length or nerve type. Furthermore, the rates of MR were lower conduit repairs. In addition, the economic analysis performed demonstrates that allograft does not represent an increased economic burden compared to autograft.
“Maxillo-mandibular reconstruction with vascularized bone flaps using insourced virtual surgical planning and home-made CAD-CAM: A 5-year single-center evolution in 75 patients.”
Authors: Vranckx Jan Jeroen , Desmet Odille , Bila Michel , Wittesaele Winston , Wilssens Nicholas , Vander Poorten Vincent 
Published: February 2023

Background:
Virtual surgical planning (VSP) and computer-aided design (CAD) and manufacturing (CAM) of surgical guides and jigs have dramatically changed the predictability of bony reconstruction of the jaw. VSP craftmanship can lead to precision and enables the surgeon to complement the donor bone osteotomies with bony resection of the jaw. In recent years, immediate dental rehabilitation has become an integral part of VSP. However, outsourced CAD-CAM technology is expensive and may not be an option for many institutions worldwide.

Methods:
We present here a consecutive series of 75 maxillofacial reconstructions from 2015 till 2020. We established an insourced ‘in-house’ protocol for VSP and ‘home-made’ CAD-CAM for the reconstruction of the maxilla-mandibular defects with fibula, iliac crest, and scapular angle flaps. All patient files were retrospectively analyzed and relevant parameters influencing the reconstructive outcome were determined.

Results:
We went from a fibula-based protocol towards the selection of optimal vascularized bone for immediate placement of osteo-integrated implants. Bone flap survival was 94.7% after four months. The three-year patient survival is 77.6%. We show the multiple steps required for the routine use of in-house CAD-CAM and report the related financial balance.

Conclusion:
Insourced VSP and CAD-CAM has evolved into a valuable strategy in maxillomandibular reconstruction that promotes accuracy and precision and allows for occlusion-based planning with quality of life and aesthetic outcomes as essential parts of the reconstruction even in high-level oral cancers. Further reductions in the hardware and software acquisition costs may lead to widespread implementation of this innovative technology.

Clinical Question/Level of Evidence:

Therapeutic, IV
Role of autologous fat transplantation combined with negative-pressure wound therapy in the treatment of diabetic wounds in a rat model
Authors: Zhang Hao , Zhou Min , Wang Yu , Zhang Dong , Qi Baiwen , Yu Aixi 
Published: February 2023

Background:
Negative-pressure wound therapy (NPWT) and autologous fat transplantation (AFT) are two clinical modalities for plastic and reconstructive surgery. At present, there are few reports on the combination of these two methods in treating diabetic wounds. This study aimed to explore the effect of this combined therapy on diabetic wound healing.

Methods:
Full-thickness dorsal cutaneous wounds in rats with streptozotocin-induced diabetes were treated with either NPWT, AFT, or combined therapy. Rats covered with commercial dressings served as the control group. Macroscopic healing kinetics were examined. The levels of inflammation-related factors, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), Arginase-1, inducible NO synthase (iNOS) and angiogenesis related factors such as vascular endothelial growth factor (VEGF), were measured in the wound tissues on days 3, 7 and 14, and immunohistochemical staining for Arginase-1, iNOS, and CD-31 was performed on days 3, 7 and 14. The length of reepithelialization was investigated on day 14.

Results:
The combined therapy promoted faster wound healing than the other treatments. The expression levels of the proinflammatory factors IL-1β, IL-6, MCP-1, and iNOS were reduced, and Arginase-1 expression was increased compared with those in the other groups. The expression levels of VEGF and CD-31 in the NPWT combined with AFT group were significantly higher than those in the other groups. Reepithelialization was faster in the NPWT combined with AFT group (by day 14) than in the other groups.

Conclusion:
Combining NPWT and AFT can enhance diabetic wound healing by improving wound inflammation and increasing wound vascularization.