bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Impact of ACAPS Coordinated Interview Release Policy: Applicant and Program Attitudes, Adherence and Interview Trends”
Authors: Davis Greta L. , Reghunathan Meera , Dean Riley A. , Cronin Brendan J. , Weber Robert A. , Gosman Amanda A. 
Published: February 2023

Background:
This study describes the impact of a new, coordinated interview release date for integrated plastic surgery residencies.

Methods & Results:
A cross-sectional study of all 2020 integrated plastic surgery residencies and applicants was performed. Voluntary, anonymous surveys were administered following implementation of the interview policy.
Program response rate was 55.6% (initial survey) and 57.1% (follow-up survey). Programs released an average of 2.1 (95% CI: 1.8, 2.4) rounds of interview invitations and invited 39.0 (95% CI: 35.3, 42.6) applicants to interview. Policy adherence was high (91.1%). Most programs believed the interview policy was an improvement for applicants (46.5% “yes”, 9.1% “no”) and programs (41.9% “yes”, 27.0% “no”). National Residency Match Program (NRMP) data revealed that no integrated plastic surgery residency positions went unfilled following the 2020 Match.1 Median rank of matched candidates was 13, and 55.1% of programs matched candidates within the top quartile of their rank order list.
Applicant response rate was 54.3%. The average candidate applied to 72 programs, attended 11 interviews, and ranked 12 programs. Interview distribution was bimodal, with peaks at 6 and 15 total interview invitations. The top 5th, 10th, and 15th percentile of applicants, ranked according to number of interviews received, disproportionately accounted for 15.3%, 26.6% and 36.5%, respectively, of all invitations. Regarding interview policy experience, applicants ranked the following Likert items favorably (1 = strongly disagree, 5 = strongly agree): overall impression (mean score 4.04), improved travel planning (3.96), improved scheduling (3.73), and cost savings (3.55). Applicants were somewhat dissatisfied with interview distribution (2.84).

Conclusions:
A coordinated interview release date is facile to adopt and does not adversely impact program interview trends or match rates. Applicants benefit from improved scheduling, travel planning, and cost savings, yet interview distribution continues to favor top-tier candidates.
Efficacy of Vascularized Submental Lymph Node Transfer Combined With Preoperative Decongestive Therapy and Antibiotics for Early-Stage Lower Limb Filarial Lymphedema
Authors: De Santis Giorgio , Saxena Bharat , Starnoni Marta , Pappalardo Marco , Jacob Vinay 
Published: February 2023

SUMMARY:
Filarial lymphedema (FLE) is the commonest cause of secondary lymphedema with endemic prevalence in developing countries. This has been traditionally managed with antibiotics and decongestive therapy (DCT) in early-stage or excisional surgery at late-stage. Results of vascularized lymph node transfer (VLNT) in post-oncological lymphedema have been encouraging, and it is currently a widely accepted surgical treatment. We advocate that the combined treatment of antibiotics, DCT, and VLNT could produce objective and subjective improvement of early-stage lower limbs FLE. Between January 2019 and January 2020, patients with early-stage lower-limb FLE who underwent VLNT were retrospectively reviewed. VLNT was harvested from the submental region in all patients. Outcomes were assessed using volume improvement, frequency of cellulitis, and lymphoscintigraphy, along with subjective scoring questionnaire. Three males and one female with an average age of 27(range 25-29) years were included. Two patients presented bilateral lymphedema. One patient was lost at three months follow-up and not included in the analysis. Patients showed an initial decrease in circumferential measurements post-antibiotics/DCT of 2074±471cc (39±9%). At a mean follow-up of 12.3±6.2 months, further improvement of limb volume of 2389±576cc (45±10%) was achieved following VSLN transfer. Lymphoscintigraphy demonstrated dye uptake by the VLNT with reduced dermal backflow, and none of the patients had episodes of postoperative cellulitis. Patients gave an excellent outcome on subjective scoring (average score 9±1), returning to their daily activities without wearing compression garments. Our early experience showed that VSLN transfer may represent an effective treatment option in the multi-modality approach to early-stage lower limb FLE.
“Landmark Plastic Surgeon Advocacy within the Federal Government: Four Case Studies”
Authors: Moss Whitney , Pires Giovanna , Reed Evelyn , Crombie Courtney , Janis Jeffrey E. , Tenzel Paul 
Published: February 2023

Background:
Throughout history, plastic surgeons have advocated for the protection of the specialty and for better care for their patients. Whether through efforts to support and move legislation through Congress or through preventative advocacy in the form of lobbying against legislation, plastic surgeons have often used their expertise in the political sphere to shape patientcare. We hope to inspire current and future plastic surgeons to be politically active and to devise ways in which their expertise can be used within the legislative system to better care for their patients.

Methods:
The following manuscript highlights four historical examples of plastic surgeon led advocacy within the federal government: The U.S. Flammable Fabrics Act, ASPRS and the Federal Trade Commission -1979, the Women’s Health and Cancer Rights Act, and the Breast Cancer Patient Education Act.

Results:
We hope that plastic surgeons will – like Dr. Crikelair, Dr. Wider, and the members of ASPS/ASPRS – continue to play an active role in the shaping of the legislative system for our profession and ultimately our patients.

Conclusion:
To ensure the best care for their patients, plastic surgeons must continue to maintain their relationship with public health and legal professionals and legislators. Through relationships with patients and a firm understanding of their stories, plastic surgeons can make great impacts in all local, state, and national political spheres.
The Impact of Prepectoral Versus Subpectoral Tissue Expander Placement on Complications and Outcomes in Delayed-Immediate Autologous Patients Who Undergo PMRT
Authors: Teotia Sumeet S. , Amaya Joshua , Haddock Nicholas T. 
Published: February 2023

Background:
Delayed-immediate autologous (DIA) breast reconstruction is a safe and flexible operative strategy for patients undergoing post-mastectomy radiation therapy (PMRT). Traditionally, tissue expanders (TE) are placed in the subpectoral position, but the development of acellular dermal matrix material has led to increased use of prepectoral placement strategies. Our aim is to compare the outcomes of both TE placement strategies in DIA patients who underwent PMRT and determine if they experienced similar outcomes to non-PMRT patients.

Methods:
A retrospective analysis of 4 patient groups (314 total patients) who underwent DIA reconstruction from 2012 to 2019 was performed. 98 non-PMRT prepectoral (PP), 106 non-PMRT subpectoral (SP), 39 PMRT prepectoral (PMRT PP) and 71 PMRT subpectoral (PMRT SP) patients were compared. Demographics, TE complications, flap complications and the use of large inferior skin patches were analyzed.

Results:
A significantly lower percentage of the PMRT PP cohort required large inferior skin patches (30.6% vs 55.7%; p < 0.05) and multi-flap procedures (15.4% vs 47.9%; p < 0.001) than the PMRT SP cohort. PMRT (p < 0.0001), subpectoral placement (p < 0.05), BMI (p < 0.05), autoimmune diseases (p < 0.05), bilateral mastectomy (p < 0.001) were identified as factors predictive of patients requiring a large inferior patch via multivariable analysis. More SP patients experienced flap post-op breast complications compared to PP patients (35.8% vs 12.2%; p < 0.0001).

Conclusion:
DIA patients who undergo PMRT will require more skin and flaps if subpectoral TE placement is chosen over prepectoral TE placement.
Tranexamic acid use in breast surgery: a systematic review and meta-analysis
Authors: Liechti Rémy , van de Wall Bryan J. M. , Hug Urs , Fritsche Elmar , Franchi Alberto 
Published: February 2023

Background:
The perioperative use of tranexamic acid (TXA) has become popular among plastic surgeons for a variety of surgical procedures. The aim of this study is to perform a systematic review and meta-analysis on the results reported in literature regarding the effect of perioperative systemic TXA administration in breast surgery.

Methods:
PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR) with corresponding 95% confidence interval (95%CI).

Results:
A total of 5 studies encompassing 1’139 patients undergoing mastectomy with or without immediate implant or free flap-based breast reconstruction or breast-conserving surgery with or without axillary lymph node dissection were included. Perioperative intravenous administration of TXA significantly reduced the risk for hematoma (7.3% versus 12.9%, OR 0.43, 95% CI 0.23 – 0.81) and seroma formation (11.5% versus 19.9%, OR 0.57, 95% CI 0.35 – 0.92) in comparison to the control group. In the studies measuring the postoperative drainage amount, the mean difference was 132ml (95% CI 220 – 44ml). No thromboembolic event occurred in either group. The weighted surgical site infection rate was higher in the control group (3.1 vs. 1.5%). However, these data were too sparse to perform comparative mata-analysis.

Conclusion:
Evidence of this study suggests that perioperative administration of TXA significantly reduces the risk for postoperative hematoma and seroma formation in breast surgery while the risk for thromboembolic events and postoperative infection is not increased.
New Insight into Glabellar Arteries: A 3D CT and Dissection Study
Authors: Liao Zhi-Feng , Cong Li-Yao , Luo Cheng-En , Zhan Wen-Feng , Luo Sheng-Kang 
Published: February 2023

Background:
Vascular complications from glabellar intravascular filler injections are major safety concerns. Filler injection into the glabella without precise knowledge of its vascular topography poses a risk of severe complications.

Methods:
Computed tomography was used to study 90 cadaveric heads after contrast agent and filler injection, and 15 cadaveric heads were dissected.

Results:
Central, paracentral and reverse dorsal nasal arteries (CAs, PCAs, and rDNAs) were found in 70 (38.9%), 58 (32.2%), and 16 (8.9%) of the 180 hemifaces, respectively. Based on the presence of CAs, PCAs and rDNAs between the bilateral supratrochlear arteries (STAs), glabellar arteries were categorized into two main patterns: in type 1 (without named arteries between the bilateral STAs) (22/90, 24.4%), the glabella was supplied by the bilateral STAs and their branches; in type 2 (with named arteries between the bilateral STAs) (68/90, 75.6%), the glabella was supplied by the bilateral STAs and CAs, PCAs and rDNAs. Type 2 could be further divided into three subtypes: in type 2a (45/90, 50.0%), the glabella was supplied by the bilateral STAs and one of the named arteries; in type 2b (21/90, 23.3%), the glabella was supplied by the bilateral STAs and two of the named arteries; and in type 2c (2/90, 2.3%), the glabella was supplied by the bilateral STAs and unilateral CA, PCA and rDNA.

Conclusion:
This study elucidated novel arterial systems and proposed considerations for glabellar filler injection.
Variations in Incidence of Trigger Finger and Response to Corticosteroid Injection after Aromatase Inhibitor Therapy for Breast Cancer
Authors: Hollins Andrew W , Hein Rachel , Atia Andrew , Zhang Gloria , Sergesketter Amanda , Darner Grant , Morris Miranda , Mithani Suhail K. 
Published: February 2023

Introduction:
Aromatase inhibitors (AI), such as letrozole and anastrozole, have been demonstrated to have significant musculoskeletal symptoms in patients. The purpose of this study was to evaluate specific AI medications effect on the incidence of trigger finger and independent factors affecting treatment outcomes within this population.

Methods:
A retrospective chart review was performed at our institution between the years 2014-2018 in patients with the diagnosis of breast cancer. This cohort was then sorted based on medication regimens, trigger finger diagnosis, steroid injections, and need for surgical release of trigger finger.

Results:
A total of 15, 144 patients were included for initial review. The overall rate of trigger finger diagnosis was 2.75% in entire breast cancer population and 4.5% for patients receiving AI therapy. Patients taking letrozole and anastrozole had an increased odds ratio of 2.0 and 1.7 respectively for developing trigger finger. Patients that switched between letrozole and anastrozole during treatment had a higher rate of failed steroid injection treatment (45.2% vs. 23.5%, p=.021). Among patients receiving AI treatment diagnosed with trigger finger, diabetics and a hemoglobin A1c greater than 6.5 were associated with significantly increased rates of failed steroid therapy.

Conclusion:
Patients receiving AI therapy have an increased incidence of trigger finger. The outcomes of treatment is equivalent between AI and non-AI trigger finger populations. However, patients that require switching of regimens due to significant musculoskeletal symptoms are more likely to fail steroid therapy. Poorly controlled diabetes was also an independent factor for compromised steroid treatment of trigger finger.
Comparison of Ischemic Complications with Direct-to-Implant versus Immediate Free Flap Reconstruction After Nipple Sparing Mastectomy: A Propensity-Score Matched Analysis
Authors: Abdou Salma A. , Sharif-Askary Banafsheh , Perez-Alvarez Idanis , Lavin Christopher V. , Bartholomew Alex J. , Sosin Michael , Tousimis Eleni , Fan Kenneth L. , Song David H. 
Published: February 2023

Background:
Both direct-to-implant (DTI) and immediate free flap (FF) breast reconstruction following nipple sparing mastectomy (NSM) have been described in the literature. However, there is a paucity of comparative studies between these two techniques. Furthermore, existing studies do not control for factors influencing ischemic complications.

Methods:
A retrospective review of all NSMs performed at a single institution between January 2014 and January 2020 was performed. Immediate FF reconstructions were propensity score matched using probit regression to identify a comparable DTI cohort based on mastectomy weight, smoking, age, and history of prior radiotherapy. Primary outcomes of interest were 30-day ischemic complications.

Results:
108 NSMs performed in 79 patients were included. Average age was 45.7 ± 10.5 years old and mean BMI was 27.1 ± 4.8 kg/m2. There were 54 breasts in both the DTI group and the immediate FF group. Median mastectomy weight in the DTI group was 508 (264 IQR) grams as compared to 473 (303 IQR) in the FF group [(p=0.792). There was no significant difference in the rate of partial nipple-areola complex (NAC) necrosis in the DTI and FF groups (5.6 percent versus 3.7 percent, respectively; p=0.500) or mastectomy flap necrosis (5.6 percent versus 11.1 percent; p= 0.297). Both the DTI and FF groups had a total NAC necrosis rate of 1.9 percent (p= 0.752).

Conclusion:
Both DTI and immediate FF reconstruction can be safely offered to patients undergoing NSM while providing the benefit of a single reconstructive procedure.
“A Two-Flap Combination for Auricular elevation in Microtia Reconstruction”
Authors: Quang Ly Xuan , Linh Tran Ngoc Tuong , Ha Van Thi Hai , Quyen Le Van Vinh , Ngoc Tran Le Hong , Dung Nguyen Tan , Nga Nguyen Thi Thuy , Chen Yen-Chun , Hung Shih-Han , Dang Luong Huu 
Published: February 2023

Objective:
The aims of this study were to describe and evaluate the effectiveness of combined flaps, a modification of Nagata's technique, for providing a reasonable projection for reconstructed auricles.

Method:
The authors modified Nagata's method for covering the cartilage block by introducing a new combined flap technique, including the temporoparietal skin flap and retroauricular flap. We compared the shape, size, and position of the reconstructed ear to the opposite ear, and we evaluated postoperative complications and patient satisfaction levels. We verified the effectiveness of the combined flap by assessing flap necrosis, skin color, thickness, hair in the auricular area and scars.

Results:
A total of 38 consecutive patients (39 ears) with microtia aged ranging from 6 to 34 years old were reconstructed using the modified method and followed for 33.6 months on average. The reconstructed auricle's shape was well defined, with 41.0% having good and 15.4% having excellent results. Most cases achieved good and acceptable levels in size, position, medial longitudinal axis angle and auriculo-cephalic angles, and 79.9% of patients/their families were satisfied. We observed no cases of flap necrosis or hypertrophic scarring, and there were low rates of flap complications, such as unmatched skin color (7.7%), unacceptable thickness (5.1%), or hair and stretch marks (10.3%).

Conclusion:
The modified method's reconstructed ear achieved stable projection, symmetrical appearance, and obvious anatomic landmarks with high patient satisfaction. The combined flap method showed certain advantages: high survival rate, less skin contrast, no hypertrophic scars, and fewer complications.

Clinical question/level of evidence:
Therapeutic, III
Free functional platysma transfer for restoration of spontaneous eye closure in facial paralysis: an analysis of anatomy, imaging, and clinical outcomes
Authors: Leckenby Jonathan I. , Patel Alap U. , Patel Swapnil , Rahman Akm A. , Haque Shameem , Grobbelaar AO 
Published: February 2023

Background:
Facial palsy patients suffer an array of problems ranging from functional to psychological issues. With regard to the eye, lacrimation, lagophthalmos and the inability to spontaneously blink are the main symptoms and if left untreated can compromise the cornea and vision. This paper reports the outcomes of 23 free functional vascularized platysma transfers used for reanimation of the eye in unilateral facial paralysis.

Methods:
Data was collected prospectively for all patients undergoing reanimation of the paralyzed eye using free functional platysma transfer. The only exclusion criterium was that a minimum of a two-year follow up was required. Patients were assessed pre- and post-operatively and scored using the eFACE tool focusing on eye-symmetry with documentation of blink reflex.

Results:
A total of 26 free functional platysma transfer were completed between 2011 and 2018; three patients were excluded due to inadequate follow up. The mean age was 9.1 years (SD 7.1) and a ratio of 12 males to 11 females. Pre-operatively no patients had evidence of a blink reflex in comparison to 22 patients at two-year follow up. There was a statistically significant improvement in palpebral fissure (p < 0.001) and full eye closure (p < 0.001) scores at two-year follow up however, there was no statistically significant difference in gentle eye closure (p = 0.15).

Conclusions:
This is the first report of free functional platysma long-term outcomes in eye reanimation. The results demonstrate that successful restoration of the blink reflex can be achieved and full eye closure is obtainable following surgery.
Simultaneous Scalp, Skull, Kidney, and Pancreas Transplant from a Single Donor:Insights from a Five Year Follow-Up
Authors: Jozaghi Yelda , Chang Edward I , Clemens Mark W , Hanasono Matthew M , Klebuc Michael , Yu Peirong , Gaber A Osama , Selber Jesse C 
Published: February 2023

Summary:
This report provides a 5-year follow-up on the first reported simultaneous scalp, calvarium, kidney, and pancreas transplant. The previously published case report represented both the first composite calvarial-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation. Over the ensuing 5 years, the patient underwent a single episode of acute scalp rejection successfully managed with intravenous solumedrol, one resection of a basal cell carcinoma on the native scalp, and hardware removal and bony contouring. In addition, the patient developed seizures secondary to delayed, post-radiation cerebral necrosis requiring craniotomy and resection. His seizures were ultimately controlled. Currently, more than 5 years following his multi-organ transplant, the patient continues to have excellent allograft function and a very satisfactory aesthetic outcome, demonstrating that in certain cases, combined vascularized composite allotransplantation with solid organ transplant can be performed safely without compromising the solid organ transplant.
“Zygomatico-Orbital Artery: A Re-Evaluation of the Temporal Blood Vessels.”
Authors: Chen Chun-Lin , Zhou Yu-Hao , Luo Cheng-En , Wang Hai-Bin , Luo Sheng-Kang 
Published: February 2023

Background:
The current anatomical description of the zygomatico-orbital artery (ZOA) is mainly based on cadaver head studies and do not accurately reflect the complete anatomical information of the ZOA.

Objective:
The purpose of this study was to reveal the anatomical characteristics of the ZOA and to provide an anatomical basis for relevant operations in the temporal area.

Methods:
Computed tomography (CT) scans and autopsies were performed on 78 cadaver heads perfused with lead oxide. Mimics software was used to construct a three-dimensional image based on the bilateral intertragic notches and the right inferior orbital margin for a detailed analysis of the ZOA.

Results:
The occurrence rate of ZOA in the 101 qualified hemisectioned cadaver heads was 86.14% (87/101). According to our observations, 52.87% (46/87) originated from the superficial temporal artery above the zygomatic arch, 26.44% (23/87) from the superficial temporal artery under the zygomatic arch, and 20.69% (18/87) from the frontal branch of the superficial temporal artery. The ZOA communicates with the deep and superficial arches of the supraorbital artery, transverse facial artery, and ophthalmic artery.

Conclusion:
This study describes the anatomical characteristics of the ZOA. Moreover, these findings may guide skin flap transplantation and prevent associated injection complications.