bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Third-attempt Breast Reconstruction Following Infection-Associated Failure of Secondary Implant-Based Reconstruction
Authors: Hassan Abbas M. , Tran Jacquelynn , Asaad Malke , Slovacek Cedar , Liu Jun , Butler Charles E. 
Published: February 2023

Background:
Implant-based reconstruction is the most common method of breast reconstruction in the United States. Despite ongoing advancements, periprosthetic infection is a serious problem that often results in device explantation. The objective of this study was to evaluate the outcomes of third-attempt reconstruction in patients in whom secondary implant-based reconstruction failed owing to infection.

Methods:
The authors performed a retrospective review of patients who underwent mastectomy followed by implant-based reconstruction from 2000 to 2019. The outcomes of patients who had failed secondary implant-based reconstruction due to infection and ultimately underwent third-attempt breast reconstruction were analyzed.

Results:
Of 6,093 patients who underwent primary implant-based reconstruction, 13 patients had third-attempt breast reconstruction following infection-related explantation (median age, 52 [51-56] years; median body mass index, 23 [22-31] kg/m2; median follow-up of 46 [16-62] months). Nine patients (70%) had implant-based reconstruction, two (15%) had implant-based reconstruction combined with pedicled latissimus dorsi flap, and two (15%) had abdominal-based free tissue transfer. Third-attempt breast reconstruction was immediate in 46% of patients and delayed in 54%. The success rate was 78% in the implant-based reconstruction group, with a 23% complication rate. The success rate for autologous breast reconstruction was 100%, with one patient developing venous congestion necessitating return to the operating room.

Conclusion:
Third-attempt breast reconstruction following infection-associated failed secondary implant-based reconstruction is a safe and feasible option. Although the risk of failure is higher than that for primary implant-based reconstruction, a third attempt after secondary IBR infection had a surprisingly high 78% success rate.
Otoplasty: The Belfast Experience - A Ten Year Review of 2333 Ear Outcomes.
Authors: McGarry Kevin M. , Khadim Muhammad F. , McBride Michael , Martin Serena , Moorehead Andrew , Rashid Abid , Hill Chris , Fogarty Brendan 
Published: February 2023

Introduction:
“Prominent ear,” remains one of the most common referrals to pediatric plastic surgery. Correction of the perceived deformity has been carried out via a multitude of techniques for over a century and significant variation in practice still exists. Recent studies suggesting cartilage scoring techniques are associated with more major complications than suture techniques may have led to an adverse international perception of the technique. Thus, waning use of anterior scoring prominent ear correction appears to be occurring. In our center, for appropriate cases, we have used anterior scoring for over twenty years with high patient satisfaction and low complication rates. We thus present a review of all cases and outcomes from 2005-2015. We believe this is the largest case series of anterior scoring otoplasty published to date.

Methods:
All pediatric cases undergoing prominent ear correction from 2005 – 2015 were included in this retrospective case note analysis and follow up study. Patient demographics, operative details including early and late complications along with postoperative results were analyzed.

Results:
Over a 10 year period 1199 otoplasties were performed, of which 1134 were bilateral and 65 unilateral. This equates to a total of 2333 ear corrections. 1575 ears were corrected using the anterior scoring technique. The remaining cases underwent correction via suture only, cartilage reduction or combination techniques. There was a significantly lower all cause reoperation rate for anterior scoring compared to suture only techniques (p-value .0039. Significant at p < .025). There were no reported cases of cartilage necrosis in our series.

Conclusion:
This study demonstrates that in appropriately selected patients, anterior scoring otoplasty is a low morbidity procedure. In our institution, when compared to suture techniques, it was associated with a lower rate of complications and reoperation rate than suture only techniques.
Centralizing the Umbilicus in an Abdominoplasty: Eccentric Versus Concentric Fascial Plication in Addition to Medializing at the Skin
Authors: Vavra Jessica M. , Kachare Swapnil D. , Vivace Bradley J. , Choo Joshua , Wilhelmi Bradon J. 
Published: February 2023

Background:
The umbilicus is often not a midline structure. Centralization of the umbilicus during an abdominoplasty is routinely performed at the level of the skin; however, this is associated with a high rate of postoperative reversion. We propose using an eccentric fascial plication centered on the true midline in order to maintain postoperative centralization of the umbilicus in addition to correction at the skin level.

Methods:
A retrospective study was conducted of all patients between 2015-2019 who underwent abdominoplasty with either skin only (concentric plication) versus fascial (eccentric plication) umbilical centralization. Fisher’s exact test and Student’s t test were used to compare the two groups and assess differences in rates of umbilical reversion.

Results:
71 patients were included in the study; the majority was female (n=69, 97%) and Caucasian (n=50, 70%). There were 28 (39%) patients who underwent concentric plication and 43 (61%) had eccentric plication. Mean BMI in the concentric and eccentric groups were 32 kg/m2 and 28.5 kg/m2, respectively. Average follow up was 51.6 months for concentric plication and 27.8 months for eccentric plication. Of those who received concentric plication, ten patients (36%), had their umbilicus revert to the preoperative position, while none in the eccentric plication group reverted, (p<0.0001).

Conclusion:
Midline placement of the umbilicus during an abdominoplasty is important in providing symmetry to optimize aesthetics. Eccentric fascial plication maintains the centralization of the umbilicus when compared to concentric fascial plication with skin-only centralization.
Effectiveness of high intensity micro-focused ultrasound (HIFU) therapy for non- surgical facial and body contouring: A systematic review of Prospective and Experimental Studies.
Authors: Kumar Vaibhav , Jain Anuj , Vadera Sapna , Shome Debraj , Kapoor Rinky 
Published: February 2023

Introduction:
The most common body sculpting surgical procedure known today is liposuction. Its use is however associated with the risk of numerous complications. Hence, the choice has shifted to more safer and non-invasive type of modalities. One amongst them is the use of high-intensity focused ultrasonography (HIFU) lasers which work on the principle of selectively damaging fat tissue through apoptosis or necrosis induction of fat cells. The present systematic review is designed to identify the effectiveness of HIFU for non-surgical facial and body contouring.

Methodology:
An exhaustive literature search was conducted over electronic databases like PubMed/Medline, Cochrane Central, Scopus and EBSCO from a period of November 2005 to July 2020. Full text of the selected articles was reviewed for possible inclusion in the study and the articles fulfilling the inclusion criteria were recruited in the study. The characteristics of the included studies were noted and the outcomes were assessed. Quality assessment and Risk of Bias was done for all the studies using the RevMan tool and MINORS methodological index.

Results:
The initial search revealed a total of 4584 citations, out of which only 11 were included in the present review. Out of them, 9 studies used HIFU for recontouring of abdomen and only two studies used HIFU over face and neck. Studies either evaluated the efficacy of HIFU or the safety with its use. The average total energy ranged from 140 J/cm2 to 248 J/cm2 for abdominal region and 0.3 J/cm2 to 1.2 J/cm2 for face and neck. The focal depth ranged from 1.1 – 1.8 cm among the included studies. All the studies showed promising results with the use of HIFU.

Conclusion:
The HIFU therapy is safe, effective and minimally invasive with predictable results when used for body and facial recontouring.
Hairline correction by hair transplantation for reducing apparent face length in long face females
Authors: Park Jae Hyun , Suh Bum Sin 
Published: February 2023

Background:
The long face morphology is associated with esthetic concerns, and surgery is often necessary to correct excess length in the frontal plane, in upper, middle, and lower thirds of the face. However, correcting midline facial length in the frontal plane, alone, does not provide facial harmony. This study introduces a novel approach to correcting long face morphology using measurements in the frontal, oblique, and lateral views, and reducing hairline measurements using hair transplants.

Methods:
83 patients were enrolled in the study. We measured the midline facial length in the frontal plane and the lengths of the upper, middle, and lower thirds of the face. We also measured four additional measurements in the oblique and lateral views, including the distance from the infratemporal hairline to the chin and from the sideburn to the chin. The patients’ midfrontal hairlines were lowered, and the measurements from the infratemporal hairline to the chin and from the sideburn to the chin were also shortened. The results were evaluated by patients and the surgeon using a 5-point Likert scale.

Results:
The mean patient Likert score was 4.5(range: 3-5), and the mean surgeon Likert score was 4.9(range: 3-5). No patients experienced adverse events. Three patients required touch-up surgery at the recipient sites to increase the hair density.

Conclusions:
This novel approach to correcting long face morphology using hair transplants to decrease hairline measurements provided excellent facial harmony and symmetry.

Level of Evidence:
Level IV
Evaluation of Prepectoral Breast Tissue Expander Reconstruction Intraoperative Fill: Air or Saline
Authors: Bamba Ravinder , Christopher Laura , Mailey Brian A. , Mercho Raphael , Dawson Steven E. , Hadad Ivan , Lester Mary E. , Hassanein Aladdin H. 
Published: February 2023

Introduction:
Staged implant-based breast reconstruction with immediate tissue expanders is the most common method of breast reconstruction after mastectomy. Tissue expanders traditionally are filled with saline for expansion. Some surgeons have advocated initial intraoperative fill of the tissue expander with air to avoid excess pressure on ischemic mastectomy skin flaps. The purpose of the study was to compare intraoperative air versus saline tissue fills.

Methods:
All patients who underwent prepectoral tissue expander reconstruction after mastectomy from 2017-2019 were reviewed. The primary predictive variable was whether saline or air used for initial tissue expansion. Outcome variables included mastectomy skin necrosis, nipple necrosis, infection, number of expansions, hematoma, and explant.

Results:
A total of 53 patients(88 tissue expanders) were included in the study: 28 patients(44 tissue expanders) who underwent initial intraoperative fill with air and 25 patients(44 tissue expanders) who underwent an initial saline fill were assessed. There were no significant differences in complication rates between initial TE fill with saline versus air including nipple necrosis, wound dehiscence, cellulitis, abscess, or TE removal(p=1.0). The number of postoperative tissue expander fills in the initial air fill group was 3.2 compared to 2.7 in the initial saline fill(p=0.27).

Conclusions:
Prepectoral tissue expander initial fill with air has similar postoperative outcomes compared to initial saline fill. We found no benefit to initially filling prepectoral tissue expanders with air intraoperatively. Given the additional effort of exchanging air for saline during the first postoperative fill, there was no clinical advantage of filling prepectoral tissue expanders with air.
Top 100 Highly Cited Articles on Rhinoplasty Between 2001 and 2020: A Bibliometric and Visualized Analysis
Authors: Zhou Yu C. , Zhu Yuan L. , Cai Zhen , Chen Zai H. , Cui Wei , You Xiao B. , Wang Jian X. 
Published: February 2023

Background:
We performed a bibliometric and visualized analysis of the top 100 highly cited articles in rhinoplasty published between 2001 and 2020, to provide researchers with the present research status and the potential directions.

Methods:
We obtained data from the Web of Science (WoS) Core Collection on April 7, 2021. Quantitative and qualitative analyses were performed using the WoS. Collaboration and keyword analyses were performed using VOSviewer software.

Results:
The top 100 highly cited articles included 86 original research and 14 reviews. The average total citations was 77 (ranging 50-202). The article with 202 citations was published by Toriumi DM in 2006 and the most influential reference. The most common level of evidence was the level IV (n =24). Only five articles had a level of evidence of I. The top 100 articles were published in 24 journals. The Plastic and Reconstructive Surgery (PRS) published 49 papers with 4,013 citations. The USA published most highly cited articles. The University of Texas System published 16 articles with 1,166 citations. Rohrich RJ published 14 papers with 1,025 total citations. Cleft lip and palate, FACE-Q, FROI-17, NOSE scale, quality of life, questionnaire, and RHINO scale were the most common keywords.

Conclusions:

PRS was the most influential journal, and most research was reported from the USA, and the University of Texas System published the most highly cited article. Rohrich RJ, Daniel RK, and Guyuron B were the most prolific and influential authors. Global cooperation in rhinoplasty requires further strengthening.
Terminal Schwann cells are essential for neuromuscular junction function and recovery after nerve injury
Authors: Jablonka-Shariff Albina , Balta Eric , Santosa Katherine , Lu Chuieng-Yi , Snyder-Warwick Alison K. 
Published: February 2023

Background–
Terminal Schwann cells (tSCs), non-myelinating glial cells at the neuromuscular junction (NMJ), are integral to NMJ development, function, remodeling, and response to injury. It is essential to understand their requirement for NMJ function. In this study, we assessed consequences of immune-mediated tSC ablation in adult S100-GFP mice of both sexes in homeostasis and after nerve injury.

Methods–
We examined NMJ morphology and function in the extensor digitorum longus (EDL) muscle during homeostasis at post-tSC ablation days (PAD) 3, 14 and 42, and after peroneal nerve transection and immediate repair at 3 and 6 weeks post-nerve injury and tSC ablation (post-injury and ablation, PIA).

Results–
Terminal Schwann cell ablation resulted in significant decreases (p<0.05) in tSC numbers per NMJ and endplate fragmentation. NMJ innervation and EDL tetanic force significantly decreased at PAD14 (p<0.05), and tSCs re-established their NMJ coverage at PAD42. After nerve injury, motor endplate fragmentation increased (p<0.01) with tSC ablation compared with injured control mice. NMJ reinnervation and EDL tetanic force were significantly reduced (p<0.001), even at 6 weeks PIA, compared to control mice.

Conclusions–
These results add to the understanding that tSCs, with their pro-regenerative potential, help maintain NMJ integrity in homeostasis and are necessary for NMJ reinnervation following peripheral nerve injury.

Clinical Relevance Statement–
Terminal Schwann cells are integral for efficient NMJ recovery after nerve injury. This cell population may provide a novel therapeutic target to improve outcomes for patients with nerve injuries; additional investigation is warranted.
Morphometric Outcomes of Non-Syndromic Sagittal Synostosis following Open Middle and Posterior Cranial Vault Expansion
Authors: Massenburg Benjamin B. , Mercan Ezgi , Shepard Elizabeth , Birgfeld Craig B. , Susarla Srinivas M. , Lee Amy , Ellenbogen Richard G. , Hopper Richard A. 
Published: February 2023

PURPOSE:
This study aims to quantify the change in three-dimensional skull morphometrics for patients with sagittal synostosis (SS) at presentation, after surgery, and at two-year follow-up.

METHODS:
CT scans from 91 patients with isolated SS were age, gender, and race-matched to 273 controls. We performed vector analysis with linear regressions to model the impact of open middle and posterior cranial vault remodeling on cranial shape and growth.

RESULTS:
Anterior cranial volume, bossing angle and frontal shape were not changed by surgery but normalized without surgical intervention by 2 years. Biparietal narrowing and middle cranial volume were corrected after surgery and maintained at 2 years. Occipital protuberance was improved after surgery and normalized at 2 years. Posterior cranial volume was decreased by the occipital remodeling and remained slightly lower than control volumes at 2 years whereas middle vault volume was larger than controls. Residual deformities that persisted at 2 years were decreased superolateral width at the level of opisthion, and increased anterosuperior height (vertex bulge). Linear models suggested older age at surgery resulted in more scaphocephaly and enlarged posterior cranial vault volumes at two years but did not impact other volume outcomes. Preoperative severity was the variable most predictive of 2-year morphometrics.

CONCLUSION:
Initial severity of SS deformity was the best predictor of 2-year morphometric outcomes. Upper posterior cranial width decreases with time after surgery and an anterior vertex bulge can persist after open surgery, but frontal dysmorphology self-corrects without surgical intervention.

LEVEL OF EVIDENCE: III
Assessing the Validity and Reliability of the Zwisch Scale in Plastic Surgery Residency
Authors: Almufarrej Faisal , Shahait Awni , Nava Guillermina 
Published: February 2023

Background:
The Zwisch scale is a recognized model for assessing surgical skills competency and autonomy, with paucity of its application in plastic surgery field. We look to assess the validity of utilizing this model for plastic surgery residency programs.

Methods:
This 6-month pilot study was a prospective study with attending surgeons from 3 different teaching hospitals. Two samples were obtained. The first sample contained all procedures performed by a participating faculty member and resident during a specified time period. The second sample was a subset of the first consisting of 15 procedures. The procedures were observed in person by 2 additional surgeons who rated the resident’s performance leveraging the Zwisch scores. A third surgeon utilized the operative skill assessment tool- Ottawa Surgical Competency OR Evaluation (O-SCORE) to provide ratings. All ratings were confidential.

Results:
Six residents and 5 attendings participated with a total number of 126 encounters for 184 procedures. The association between the Q1 (complexity of procedure- easiest, average, hardest) and Q2 (Zwisch level) was estimated with Spearman’s correlation and tested using Chi-square test. ICC and Spearman’s rank correlation coefficient demonstrated validity of the Zwisch scores in plastic surgery procedures with good reliability amongst attending surgeons with resident self-rating decreased score reliability (ICC Without self-rating 0.817, with self-rating 0.752).

Conclusion:
Plastic surgery cases are often more complex and have longer operative times making it difficult to evaluate residents. This research substantiates developing a specifically modified Zwisch scoring system for plastic surgery.
Effective Strategies to Patent Plastic Surgery Ideas and Intellectual Property
Authors: Xu Hong Hao , Kazan Roy , Zammit Dino , Reece Edward , Jowett Nate , Gilardino Mirko S. , Vorstenbosch Joshua 
Published: February 2023

Summary:
Patents are of great importance to plastic surgery, a field fueled by constant innovation. Familiarity with the patent process, in turn, could promote further innovation by plastic surgeons. By granting proprietary rights to inventors in exchange for publication of their inventions, patents incentivize creativity and innovation while simultaneously promoting diffusion and transfer of technology. The task of securing patent protection, however, is complex, and begins well before the patent application. Inventors must familiarize themselves with regulations to ensure that their inventions satisfy the criteria for patentability, which can differ between countries. Patents regarding surgical methods should undergo additional ethical deliberation given their potential interference with medical altruism. The patent application must be thoroughly devised and written as it needs to withstand meticulous examination by patent offices and potential third-party opposition—professional assistance in doing so should thus be sought. Filing of the application calls for intricate procedural and timing requirements that bear major benefits if well understood and respected by applicants. Given that patent rights only cover the issuing country’s territorial scope, further endeavors must be pursued when seeking patent protection in additional countries. In this regard, two options exist, and the ultimate decision should be tailored to each inventor’s personal needs. At every step of the patenting process, financial readiness is key as costs can be unpredictable and quickly escalate. In this manuscript, we propose effective strategies directed at plastic surgeons to facilitate patenting of their ideas and protection of their intellectual property.
Lateral Thoracic Vessel as a Recipient Vessel in Immediate Breast Reconstruction after Nipple/Skin-Sparing Mastectomy: Clinical Experience of 270 Perforator Flaps
Authors: Muto Mayu , Satake Toshihiko , Tsunoda Yui , Koike Tomoyuki , Narui Kazutaka , Ishikawa Takashi , Maegawa Jiro 
Published: February 2023

Background:
The selection of recipient vessels for free-flap breast reconstruction is important for the success of the surgery and the esthetics of the breast mound. The thoracodorsal artery and vein (TDA/V) allow reconstruction without noticeable scars from the anterior view, but TDA/V exposure is an invasive and time-consuming process on sentinel node biopsy. This study aimed to determine the effectiveness of the lateral thoracic artery and vein (LTA/V) as recipient vessels by comparing them with the TDA/V.

Methods:
This study included 270 flaps that underwent immediate free-flap breast reconstruction after nipple/skin-sparing mastectomy by lateral incision. The patients were categorized into two groups (LTA and TDA) based on the recipient vessel selected.

Results:
The LTA and TDA groups comprised 78 and 192 flaps, respectively. Among the 131 short and small pedicle flaps, such as gluteal artery perforator flap and profunda artery perforator flap, 65 (50%) used LTA as the recipient vessel. The external diameters of the LTA/LTV (median, 1.2 mm/1.5 mm) were significantly lower than those of the TDA/TDV (median, 1.65 mm/2.0 mm). LTV was present in 94% and the second vein was present in 49% of cases with anastomosis. No significant differences in flap-related complications were observed between the two groups.

Conclusions:
LTA/V can be used as recipient vessels for immediate free-flap reconstruction. Because of their superficial location and small caliber, they are easily accessible and suitable for short and small pedicle flaps.