bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of Free Versus Local Flaps on Time to Union in Open Tibia Fractures
Authors: Zelenski Nicole A. , Archual Anthony , Tangtiphaiboontana Jennifer , Kuruoglu Doga , Yan Maria , Bustos-Hemer Samyd , Moran Steven L. 
Published: February 2023

Background:
Early soft tissue reconstruction of open fractures has been shown to decrease infection rates and improve rates of bony union. The purpose of this study was to compare the rates and time to union of open tibia fractures that underwent soft tissue coverage.

METHODS:
A retrospective chart review of 118 patients with open tibia fractures requiring soft tissue reconstruction treated at a single level 1 trauma center was performed. Demographic data as well as flap type were collected. Union status was determined using radiographic union scale in tibia fractures (modified RUST) score >11.

RESULTS:
Limb salvage was achieved in 90% of patients. The overall rate of nonunion was 33%. Flap type significantly affected time to union with local fasciocutaneous and keystone flaps having significantly longer time to union (202 SD 120.3 days) than all other flap groups (p=0.01). Free flaps had significantly shorter time to union than local flaps (115 SD 49.6 vs. 149 SD 75.4 days p=0.02). Muscle flaps had significantly shorter time to union than fasciocutaneous flaps (123 days SD 52.4 vs. 165 SD 104.1 days, p=0.04). This remained true after controlling for fracture location, age of patient, need for second flap and fixation method (p=0.037). Patients who underwent an initial soft tissue reconstruction with a local muscle flap were more likely to require a second flap to achieve wound closure (OR=3.7, p=0.008) and needing a second flap significantly increased time to union (162 SD95.9 vs. 122 SD 51.9 days p=0.03).

CONCLUSIONS:
Flap type affects time to union but not nonunion rate in open tibia fractures.
The use of recanalized vessels for diabetic foot reconstruction: Pushing the boundaries of reconstruction in vasculopathic lower extremity:
Authors: Suh Hyunsuk P , Kedar Daniel J , Lee Yeon Hoon , Lee Pil Hyung , Lee Seung-Whan , Hong Joon Pio 
Published: February 2023

Background:
Free flap after lower extremity revascularization may enable limb salvage in defects following critical limb ischemia. This study examined the outcomes of reconstruction of ischemic diabetic foot according to the severity of the vessel occlusion and assessed whether recanalized vessels may serve as a reliable recipient vessel.

Methods:
Total of 62 patients who underwent diabetic foot reconstruction with free flaps after successful percutaneous transluminal angioplasty (PTA) from February 2010 to February 2016 were identified and divided into three groups; Group 1: used non-occluded vessels as recipient (n=11), Group 2: used recanalized artery after PTA for partially occluded artery (n=30), Group 3: used recanalized artery after PTA for completely occluded artery (n=21).

Results:
Flap survival was statistically higher for Group 2 (90%) compared to Group 3 (67%) (P<0.05). Subsequent major amputation was significantly lower in Groups 1 and 2 (0/7, 0% and 1/30, 3.3%) compared to Group 3 (5/21, 23.8%) (P<0.05). The patient survival and limb salvage rate was 90.9% at one and three years in Group 1, 89.8% at one year and 86.3% at three and five years in Group 2, and 76.2% at one, three, and five years in Group 3. This difference was not statistically significant (p = 0.485)

Conclusions:
The use of recanalized vessels after PTA can be safe for partially occluded arteries but require caution for complete occluded arteries. Nevertheless, one can push the limit of using completely occluded vessels after PTA when other options are not available and achieve a 76% chance of limb salvage.
“Disparities in Telemedicine Literacy and Access in the United States”
Authors: Harris Andrew , Jain Amit , Dhanjani Suraj A. , Wu Catherine A. , Helliwell Lydia , Mesfin Addisu , Menga Emmanuel , Aggarwal Shruti , Pusic Andrea , Ranganathan Kavitha 
Published: February 2023

Background:
Due to the expansion of telehealth services through the 2020 CARES Act, telemedicine’s potential in plastic surgery has gained visibility. This study aims to identify populations who may suffer from limited access to telemedicine.

Methods:
We created a telemedicine literacy index (TLI), using a multivariate regression model and data from United States Census and Pew Research Institute survey. A multivariate regression model was created using backwards elimination, with TLI as the dependent variable and demographics as independent variables. The resulting regression coefficients were applied to data from the 2018 United States Census at the county level to create a county-specific Technological Literacy Index (cTLI). Significance was set at p<0.05.

Results:
On multivariable analysis, the following factors were found to be significantly associated with telemedicine literacy: age, gender, race, employment status, income level, marital status, educational attainment, and urban/rural classification. Counties in the lowest tertile had significantly lower median annual income levels ($43,613 vs. $60,418, p<0.001) and lower proportion of the population with at least a bachelor’s degree (16.7% vs. 26%, p<0.001). Rural areas were approximately 3 times more likely to be in the lowest cTLI compared to urban areas (p<0.001). Additional associations with low cTLI were black or African-American race (p=0.045), widowed marital status (p<0.001), less than high school education (p=0.005), and presence of a disability (p=0.01).

Conclusions:
These results highlight disadvantaged groups at-risk of being underserved with telehealth. Using these findings, key stakeholders may be able to target these communities for interventions to increase telemedicine literacy and access.
Revision Incidence after Immediate Direct-To-Implant Versus Two-Stage Implant-Based Breast Reconstruction: Results from a Nationwide Breast Implant Registry.
Authors: Becherer Babette E. , Heeg Erik , Young-Afat Danny A. , Vrancken Peeters Marie-Jeanne T.F.D. , Rakhorst Hinne A. , Mureau Marc A.M. ,   Dutch Breast Implant Registry (DBIR) group
Published: February 2023

Background.
In immediate implant-based breast reconstruction (IBBR), large variation is observed in current practices between a direct-to-implant and a two-stage approach (insertion of a breast implant after a tissue expander). This population-based study aimed to compare unplanned short- and long-term revision incidence between direct-to-implant and two-stage IBBR in the Netherlands.

Methods.
All patients with immediate IBBR following a mastectomy between 2015 and 2019 were selected from the nationwide Dutch Breast Implant Registry (DBIR). Short- and long-term unplanned revision incidences were studied per immediate IBBR, including revision indications and the total number of additional operations. Confounding by indication was limited using propensity score matching.

Results.
A total of 4512 breast implants (3948 women) were included, of which 2100 (47 percent) for direct-to-implant IBBR and 2412 (53 percent) for two-stage IBBR. Median (IQR) follow-up was 29 (16-45) months and 33 (21-47) months, respectively. Short-term revision incidence was 4.0 percent and 11.7 percent, respectively (conditional OR 0.31, 95 percent CI 0.23-0.42). Long-term revision incidence was 10.6 percent (95 percent CI 9.2-12.1) and 16.4 percent (95 percent CI 14.8-17.9), respectively. In the propensity score matched cohort, similar results were found. In the direct-to-implant group, more breasts were reconstructed within the planned number of operations than in the two-stage group.

Conclusion.
Unplanned revision surgery occurred less often after direct-to-implant IBBR, and more breasts were reconstructed within the planned number of operations compared to two-stage IBBR. These results, based on real-world data, are important for improving patient counseling and shared decision-making.
Paravertebral Blocks in Tissue Expander Breast Reconstruction: A Propensity-Matched Analysis of Perioperative Opioid Consumption and Patient-Reported Outcomes
Authors: Shamsunder Meghana G. , Chu Jacqueline J. , Taylor Erin , Polanco Thais O. , Allen Robert J. , Moo Tracy-Ann , Disa Joseph J. , Mehrara Babak J. , Tokita Hanae K. , Nelson Jonas A. 
Published: February 2023

Background:
The paravertebral block (PVB) is an adjunctive perioperative pain control method for breast reconstruction patients that may improve perioperative pain control and reduce narcotic use. This study determined the efficacy of preoperative PVBs for perioperative pain management in tissue expander breast reconstruction patients.

Methods:
A retrospective review was performed of patients who underwent tissue expander breast reconstruction from December 2017 to September 2019. Two PVB patients were matched using propensity scoring to one no-block patient. Perioperative analgesic use, pain severity scores on days 2-10 after discharge, and BREAST-Q Physical Wellbeing scores before surgery and at 2 weeks, 6 weeks, and 3 months after surgery were compared between the two groups.

Results:
The propensity-matched cohort consisted of 471 patients (314 PVB and 157 no-block). The PVB group used significantly fewer morphine milligram equivalents than the no-block group (53.7 vs. 69.8; p < 0.001). Average daily postoperative pain severity scores were comparable, with a maximum difference of 0.3 points on a 0-4 scale. BREAST-Q Physical Wellbeing scores were significantly higher for the PVB group than the no-block group at 6 weeks after surgery (60.6 vs. 51.0, p = 0.015), but did not differ significantly at 2 weeks or 3 months after surgery.

Conclusions:
PVBs may help reducing peri-operative opioid requirements but did not reduce pain scores after discharge when used as part of an expander-based reconstruction perioperative pain management protocol. Continued research should examine additional or alternative regional block procedures, as well as financial cost and potential long-term impact of PVBs.
“Alpha Defensin-1 Biomarker Outperforms Culture in Diagnosing Breast Implant-Related Infection: Results from a Multicenter Prospective Study.”
Authors: Basta Marten N. , White-Dzuro Colin G. , Rao Vinay , Liu Paul Y. , Kwan Daniel , Breuing Karl H. , Sullivan Rachel , Mermel Leonard A. , Drolet Brian C. , Schmidt Scott 
Published: February 2023

BACKGROUND:
Prompt diagnosis of breast implant infection is critical to reducing morbidity. High incidence of false-negative microbial culture mandate superior testing modalities. Alpha defensin-1 (AD-1), an infection biomarker, has outperformed culture in diagnosing periprosthetic joint infection with sensitivity/specificity of 97%. After previously demonstrating its feasibility in breast implant-related infection (BIRI), this case-control study compares AD-1’s accuracy to microbial culture in suspected BIRI.

METHODS:
An IRB-approved, prospective multicenter study was conducted of adults with prior breast implant reconstruction undergoing surgery for suspected infection (cases-BIRI) or prosthetic exchange/revision (controls). Demographics, perioperative characteristics, antibiotic exposure, and implant pocket fluid was collected. Fluid samples underwent microbial culture, AD-1 assay, and adjunctive markers (CRP, lactate, cell differential); diagnostic performance was assessed via sensitivity, specificity, and accuracy from receiver operator curve (ROC) analysis with p<0.05 considered significant.

RESULTS:
53 implant pocket samples were included (Cases-20, Controls-33). All 20 patients with suspected BIRI exhibited cellulitis, 65% had abnormal drainage, and 55% were febrile. All suspected BIRIs were AD-1 positive (sensitivity=100%). Microbial culture failed to grow any microorganisms in 4 BIRIs (sensitivity=80%, p=0.046); gram stain was least accurate (sensitivity=25%, p<0.001). All tests demonstrated 100% specificity. ROC analyses yielded the following area under the curve (AUCs): AD-1 AUC=1.0, Microbial culture AUC=0.90 (p=0.029), gram stain AUC=0.62 (p<0.001). Adjunctive markers were significantly higher among infections versus controls (p<0.001).

CONCLUSIONS:
Study findings confirm AD-1’s accuracy in diagnosing BIRI and indicate superiority to microbial culture. While further study is warranted, AD-1 may facilitate perioperative decision-making in BIRI management in a resource-efficient manner.
Comparing the benefits and risks of immediate breast cancer reconstruction with or without acellular dermal matrix (ADM) or synthetic mesh support– A Systematic Review and Network Meta-analysis.
Authors: Murphy Donal , O’Donnell John P , Ryan Éanna J. , Lane O’Neill Billy , Boland Michael R , Lowery Aoife J , Kerin Michael J , Mc Inerney Niall M 
Published: February 2023

Introduction and Aims:
The use of acellular dermal matrices (ADM) and synthetic mesh as part of implant-based breast reconstruction (IBBR) has been widely adopted. Our aims were to investigate the clinical efficacy and safety of the use of human/allograft (HADM), xenograft (XADM) and synthetic mesh as part of IBBR in post-mastectomy patients as compared to previous standard implant reconstruction techniques using only a submuscular pocket for coverage.

Methods:
A systematic search for randomised control trials and observational studies was performed. A frequentist network meta-analysis was conducted using the R packages netmeta and Shiny.

Results:
A total of 31 studies of 2375 identified met the predefined inclusion criteria. Traditional submuscular placement (no ADM/mesh) had fewer overall complications compared to HADM (odds ratio [OR] 0.51; Credible interval [CrI]: 0.34 – 0.74), however there was no significant difference between no ADM/mesh and XADM (OR 0.63; CrI: 0.29-1.32) or synthetic mesh (OR 0.77; CrI: 0.44 – 1.30). No one treatment was superior with regards to implant loss. No ADM/mesh was associated with less infectious complications than HADM (OR 0.6; CrI 0.39 – 0.89). Both no ADM/mesh (OR 0.45; CrI 0.27 – 0.75) and XADM (OR 0.46; CrI 0.23 – 0.88) had reduced seroma compared with HADM.

Conclusion:
Selecting the appropriate IBBR should evaluate effectiveness, adverse events, and cost. While it is difficult to select a universal ideal IBBR, evaluation using this network analysis may help guide both physicians and patients in their choice of procedure, especially in the case of HADM, which in this study has shown to be significantly predisposed to complications of infection and seroma. Randomised data is required comparing XADM versus synthetic meshes given the similar risk profiles but significant cost discrepancy between the techniques.
High Definition Liposculpture's 18-year Evolution: Patient Safety and Aesthetic Outcomes
Authors: Hoyos Alfredo E. , Cala Laura C. , Perez Mauricio E. , Mogollon Ivan R. , Dominguez-Millan Rodrigo 
Published: February 2023

BACKGROUND:
High definition liposculpture (HDL) emerged as an innovative surgical technique that allowed plastic surgeons around the world to achieve higher aesthetic results by a natural and athletic appearance through minimal incisions and imperceptible scarring. Its ultimate targets are: High Aesthetic Standards and Patient Safety.

PURPOSE:
This manuscript summarizes the evolution of High Definition Liposculpture by showing the upgrades to the original technique and comparing the complications rate among them.

METHODS:
We retrospectively reviewed our records from 4 private medical centers (Evolution Medical Center, Santa Barbara Medical Center, and Dhara Clinic in Bogota; and FOSCAL in Bucaramanga – Colombia), looking for patients who underwent High Definition Liposculptures performed by the senior author over an 18-year period (2002 to 2019). Patients were classified into three groups: Suction-assisted lipoplasty (Period I), VASER-assisted HD lipo (Period II), and Dynamic Definition liposculpture (Period III).

RESULTS:
We established a cohort of 5,052 patients (4,300 women and 752 men). 923 in period I, 1272 in period II and 2857 in period III. Most common complications included seroma, bruising, hematoma, acute anemia, hyperchromia, wrinkled skin, wound dehiscence and local infections.

CONCLUSIONS:
High Definition and Dynamic Definition liposculpture procedures are safe and reproducible techniques in order to achieve not only an athletic and but also a natural body contour. Complication rates, especially those related to bleeding, did decrease as the technique evolved. These procedures have always been framed towards patient safety so as to provide them with higher aesthetic outcomes using extensive medical, anatomical, artistic, and technological knowledge.
“Preservation rhinoplasty for the twisted nose: management with unilateral or asymmetric wedge resection, the Modified “Push-Down & Let-Down” technique.
Authors: Jasso-Ramírez Elizabeth , Burgos-Páez Alan , Sánchezy Béjar Fernando , Friedman Oren , Kern Eugene , López-Ulloa Fausto 
Published: February 2023

Background:We present a retrospective, comparative, and analytical cohort study, which aimed to prove the utility of unilateral or asymmetrical bony wedge resection to straighten the twisted nose as applied in the “Let-Down” / “Push- Down” methods. The study involved objective angle measurements preoperatively and postoperatively on frontal view photographs.Patients and methods:Preoperative and postoperative angle measurements were made on frontal view photographs of 78 patients with twisted noses classified as Type- C and Type –I. Angles of deviation were obtained using Scion Image software, measured in degrees. Statistical analysis was performed using Excel v15.13.3.Results:42 patients had twisted nose Type- C and 28 patients had twisted nose Type –I. The mean age was 19 years old. There was 81% improvement ratio for twisted nose Type-C and 79% for twisted nose Type-I, and the angle correction for each type of nasal deformity was statistically significant (p< 0.01). The majority of postoperative results were classified as “excellent to good” except for four cases with “bad” outcomes, including 2 patients with Type-C and 2 with Type-I deviations.Conclusion:Unilateral or asymmetrical bony wedge resection is a modification of the “Let-Down” rhinoplasty technique. This study demonstrates statistically significant improvements in straightening twisted noses among patients with or without preoperative hump, while preserving the nasal dorsum. We found this modification better suited for Type- C deviations.
Negative Pressure Wound Therapy Induces Lymphangiogenesis in Murine Diabetic Wound Healing
Authors: Wu Mengfan , Liu Qinxin , Yu Zhen , Karvar Mehran , Aoki Shimpo , Hamaguchi Ryoko , Ma Chenhao , Orgill Dennis P. , Panayi Adriana C. 
Published: February 2023

Background
Decreased lymphangiogenesis contributes to impaired diabetic wound healing. Although Negative Pressure Wound Therapy (NPWT) has been shown to be effective in the treatment of recalcitrant wounds, its impact on lymphangiogenesis remains to be elucidated. Here, we investigate the mechanisms of lymphangiogenesis following NPWT treatment of diabetic murine wound healing.

Methods
1×1 cm2 full thickness dorsal skin wounds were excised on 30 db/db mice. The mice were either treated with occlusive covering (Control, n=15), or received a 7-day treatment of continuous NPWT at -125 mmHg (NPWT, n=15). The wounds were photographed on days 0, 7, 10, 14, 21 and 28. Wound tissue was harvested on day 10, 14, 21 and 28 for quantitative analysis. Functional analysis of lymphatic drainage was performed on day 14 and 28 with Evans Blue dye tracing.

Results
Lymphatic density and diameter, as visualized through podoplanin (PDPN)-probing, was significantly higher in the NPWT group compared to the Control group (p<0.001). NPWT up-regulated the expression of lymphatic vessel endothelial hyaluronan receptor 1 (LYVE-1) at the protein level (p=0.04) and significant differences were noted in lymphatic density as assessed by LYVE-1 staining (p=0.001). Leucocyte infiltration was significantly higher in the NPWT group (p=0.01). A higher speed of wound closure (p<0.0001) and greater wound bed thickness (p<0.0001) were noted in the NPWT group compared to the Control group.

Conclusion
NPWT increased the lymphatic vessel density and diameter with LYVE-1 upregulation. NPWT therefore plays a positive role in lymphangiogenesis in diabetic wound healing.
Long-term Outcomes Following Free Vascularized Fibula Physeal Transfer for Proximal Humerus Oncologic Reconstruction in Children: An International Multi-Institutional Study
Authors: Azoury Saïd C. , Shammas Ronnie L. , Othman Sammy , Sergesketter Amanda , Brigman Brian E. , Nguyen Jie C. , Arkader Alexandre , Weber Kristy L. , Erdmann Detlev , Levin L. Scott , Kovach Stephen J. , Innocenti Marco 
Published: February 2023

BACKGROUND:
Vascularized fibula epiphyseal flap was first described in 1998 for proximal humeral reconstruction in children/infants. The authors aim to review their international, multi-institutional long-term outcomes.

METHODS:
An international, multi-institutional review (2004-2020) was conducted of patients <18 years of age undergoing free vascularized fibula epiphyseal transfer for proximal humeral reconstruction. Donor/recipient site complications, pain, and final ambulatory status were reviewed. Growth of the transferred bone was assessed under the guidance of a pediatric musculoskeletal radiologist.

RESULTS:
Twenty-seven patients were included with a median age of 7 years (range 2-13 years). Average follow-up was 120 ± 87.4 months. There were two flap failures (7.4%). Recipient site complications included fracture (n=11, 40.7%), avascular necrosis of the fibula head (n=1, 3.7%), fibular head avulsion (n=1, 3.7%), infection (n=1, 3.7%), hardware failure (n=1, 3.7%). Operative fixation was necessary in one patient with a fracture. The case of infection necessitated fibula explantation 2 years post-operatively, and ultimately prosthetic reconstruction. Sixteen patients suffered peroneal nerve palsy (59.3%): thirteen of these cases resolved within a year (81% recovery), and 3 were permanent (11.1%). One patient (3.7%) complained of upper extremity pain. Longitudinal growth was confirmed in all but 3 cases (n=24, 88.9%) at an average rate of 0.83 ± 0.25 cm/year.

CONCLUSIONS:
The vascularized fibula epiphysis for proximal humerus reconstruction in children preserves the potential for future growth and an articular surface for motion. Peroneal nerve palsy is common following harvest, although this is often transient. Future efforts should be geared towards reducing post-operative morbidity.