bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Impact of Completing Face-Q Craniofacial Module Scales on Children and Young Adults with Facial Differences: An International Study”
Authors: Gallo Lucas , Kamran Rakhshan , Rae Charlene , Deibert Shelby , Voineskos Sophocles H. , Wong Riff Karen W.Y. , Klassen Anne F. 
Published: February 2023

BACKGROUND:
The FACE-Q Craniofacial module measures outcomes that matter to patients with diverse craniofacial conditions. However, it is not known whether completing a patient reported outcome measure (PROM) has a negative impact on patients, particularly children. This study aims to investigate the impact of completing the FACE-Q Craniofacial module and identify factors associated with a negative impact.

METHODS:
Participants were aged 8-29 years, with a facial difference, who completed at least one module of the FACE-Q Craniofacial module as part of the international field-test study between December 2016-2019. Participants were asked three questions: ‘Did you like or dislike answering this questionnaire?’; ‘Did answering these questions change how you feel about how you look?’; and ‘Did answering this questionnaire make you feel unhappy or happy?’ Univariate and multivariable logistic regression analyses were used to evaluate variables associated with a negative response.

RESULTS:
The sample included 927 participants. Most patients responded neutrally to all impact questions: 42.7% neither disliked nor liked the questionnaire; 76.6% felt the same about how they looked; and 72.7% felt neither unhappy/happy after completion. Negative responses represented a small proportion of patients across all three impact questions (<13.2%). Increased craniofacial severity, more scales completed, and lower scores on all FACE-Q scales were associated with negative responses for all three impact questions (p<0.01).

CONCLUSION:
This study provides evidence that the FACE-Q Craniofacial module is acceptable for most participants. Clinicians and study investigators should follow up with patients after completing this PROM to address areas of concern in scale scores.
“Direct-to-Implant, Prepectroal Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Years of Follow-Up”
Authors: Safran Tyler , Abi-Rafeh Jad , Viezel-Mathieu Alex , Vorstenbosch Joshua , Dionisopoulos Tassos 
Published: February 2023

BACKGROUND:
Prepectoral breast reconstruction has recently experienced a resurgence in popularity. However, in direct-to-implant (DTI) reconstruction, there is no opportunity for capsular modifications prior to final implant insertion. Implant pocket and breast shape are thus maintained, initially, solely by the mastectomy skin flaps, and eventually, by attachments of the peri-prosthetic capsule. The present study aims to quantify changes in breast geometric measurements over time following DTI prepectoral breast reconstruction.

METHODS:
A retrospective chart review was performed for patients who underwent bilateral prepectoral DTI reconstruction by a single surgeon from June 2016 to January 2018. Patients followed for >2 years were included. Yearly standardized frontal photographs were analyzed, and nipple-midline, sternal notch-nipple, and mid-clavicle-lower pole measurements were obtained. Patient demographics, operative details and complications were documented.

RESULTS:
A total of 72 breasts (38 women) undergoing direct-to-implant, prepectoral breast reconstruction were included in the final analysis. Acellular-dermal matrix was used in 78.9% (n=56) of breasts only for anterior coverage. The average change in nipple-midline distance after two years decreased by 0.41cm (range: -2.00, 2.97), sternal-notch to nipple decreased by 0.62cm (range: -4.98, 5.4), and mid clavicle to lower pole decreased 0.10cm superiorly (Range: -6.07, 3.6). In breasts that underwent post-mastectomy radiation therapy, the average changes were -0.08cm, -0.43cm and -0.56cm respectively. No patient in this cohort had severe malposition requiring further surgery.

CONCLUSIONS:
The present study provides insight on geometric breast measurements following prepectoral breast reconstruction at two-years of follow-up. The minimal breast shape changes observed demonstrate the feasibility of prepectoral DTI reconstruction with or without the use of ADM.
Accessory Lymphatic Drainage Pathways on Indocyanine Green Lymphography in Patients with Breast-Cancer Related Lymphedema
Authors: Kim Leslie N. , Mehrara Babak , Dayan Joseph , McGrath Leslie , Coriddi Michelle 
Published: February 2023

Introduction:
Current predictive models of lymphedema risk cannot predict with 100% certainty which patients will go on to develop lymphedema and which will not. Patient-specific anatomical and physiologic differences may be the missing part. We hypothesize that patients with accessory lymphatic pathways may have improved lymphatic drainage, resulting in smaller limb volumes.

Methods:
We reviewed indocyanine green (ICG) lymphography images of all patients who presented to our institution for evaluation of breast cancer-related lymphedema. Patients with unilateral upper extremity lymphedema, a full set of bilateral limb measurements, and ICG images of both limbs were included. Other variables of interest included patient demographics and length of follow up. Patients with accessory pathways were determined independently and conflicts were resolved with discussion. Abnormal images were also evaluated for common drainage pathways.

Results:
Thirty patients were identified as having accessory lymphatic drainage pathways. These patients had significantly smaller limb volume differences (8.19% (11.22)) compared to patients who did not exhibit these pathways (20.74% (19.76)) (p<0.001). The most common pathway was absence or re-routing of the radial bundle to the ulnar and/or volar bundles (n=16).

Conclusions:
The ability to create accessory lymphatic drainage pathways may be associated with improved lymphatic drainage, resulting in smaller limb volumes. Furthermore, certain drainage pathways appear to be more common than others. Description of these pathways should be considered for inclusion in ICG lymphography image grading criteria. Further study is needed clarify the nature of these pathways, and whether these pathways affect subjective symptomology and patient quality of life.
Rejuvenation of the lower eyelid and midface with deep nasolabial fat lift in East Asians
Authors: Lee Tae-Yul , Cha Ji-Hwan , Ko Han-Woong 
Published: February 2023

Background:
Correcting infraorbital hollowness is an important procedure for midface rejuvenation. Suborbicularis oculi fat (SOOF) lift is a commonly used method. However, adipose tissue, which has been thought of as SOOF, has recently been controversial. The objective of our study was to introduce a method of midface rejuvenation using deep nasolabial fat lift (MRDN) via lower blepharoplasty and to compare surgical outcomes between MRDN and lower blepharoplasty with fat transposition (LBF).

Methods:
The medical records of patients who had undergone midface rejuvenation with lower blepharoplasty between 2013 and 2020 were retrospectively reviewed. Questionnaires, digital photographs, and charts were used to evaluate the surgical outcomes and complications. The degree of aging was graded as mild, moderate, or severe. LBF and MRDN were used for mild and severe grades, respectively. For the moderate grade, the preferred surgical method of the two methods was selected and surgical outcomes were compared. The MRDN technique included LBF.

Results:
Postoperative satisfaction was significantly higher (p<0.001), recurrence rate for tear trough (p=0.046) and fat bulging (p=0.005) was significantly lower, duration of swelling (p<0.001) was significantly longer, and incidence of chemosis (p=0.024) was significantly higher in the MRDN group than in the LBF group. Regarding lid malposition, transient retraction was higher in the LBF group, while cicatricial ectropion was higher in the MRDN group; however, these differences were not significant.

Conclusions:
MRDN is associated with higher patient satisfaction and surgical longevity without serious complications than LBF.
Precision in Midfacial Volumization using Ultrasound-assisted Cannula Injections
Authors: Schelke Leonie , Velthuis Peter J. , Lowry Natalia , Rohrich Rod J. , Swift Arthur , Alfertshofer Michael , Frank Konstantin , Gotkin Robert H. , Cotofana Sebastian 
Published: February 2023

Background:
Soft tissue filler injections performed with a cannula are perceived to be less precise due to the length of the instrument and due to the blunt tip, which can deviate in any direction. Midfacial needle injections are favored despite the increased risk for intra-arterial product placement.

Objectives:
The objective of this study is to demonstrate that ultrasound-assisted cannula injections of the midface result in precise, safe and effective volumization procedures.

Methods:
Midfacial injections with a 22 G cannula were performed in 188 midfaces of 94 healthy volunteers, (86 females; 53.05 (9.9) years; 23.63 (2.1) kg/m2) under ultrasound-assisted guidance. Precision ̶ the administration of product in the same plane as the location of the cannula tip, safety ̶ the rate of adverse events ̶ and aesthetic outcome ‒ rated by the patient and the treating physician ‒ were assessed.

Results:
In 100% of the cases, the product was applied into the desired deep midfacial fat compartment and the product did not migrate into more superficial layers during the injection process or at any follow-up visit. There was a statistically significantly (p<0.001) improvement in midfacial volume loss and the aesthetic outcome was rated as very much improved. No adverse events were reported throughout the follow-up of the study.

Conclusion:
Real-time imaging allows for visual feedback during cannula advancement and injection procedures in the midface and can help practitioners achieve safer aesthetic outcomes. It is hoped that practitioners decide to use a cannula more frequently for midfacial volumization based on the results presented herein.
Breast Reconstruction Outcomes With and without StratticE (BROWSE)- Long-term outcomes of a multi-centre study comparing Strattice TM immediate implant breast reconstruction with submuscular implant reconstruction.
Authors: Wilson Rebecca L , Kirwan Cliona C , Johnson Richard K , O’Donoghue Joe M , Linforth Richard A , Harvey James R 
Published: February 2023

Background:
Over half of immediate implant-based breast reconstructions (IBBR) are performed with an acellular dermal matrix (ADM), despite limited long-term outcome data.

Methods:
The Breast Reconstruction Outcomes With and without StratticE (BROWSE) (NCT02608593) study was a retrospective multicentre cohort study comparing consecutive patients who had undergone immediate StratticeTM IBBR with those who had undergone immediate IBBR with a submuscular technique between January 2009 and December 2015.

Results:
This study compared 553 StratticeTM reconstructions with 242 submuscular reconstructions, with a median follow-up of 4.3 years (range 2 - 9.3) and 5.7 years (range 2 - 8.1) respectively, demonstrating an equivalent total complication rate (Strattice TM 36.9% (n=204) vs. submuscular 31.8% (n=77),p=0.17) and implant loss rate (8.5% vs. 5.4%, p=0.12, respectively). Infection rates and wound dehiscence rates were higher in the StratticeTM cohort (20.6% (n=114) vs. 12.8% (n=31), p=0.009 and 16.3% (n=90) vs. 10.4% (n=25), p=0.03, respectively). Overall revision rates were comparable (46.7% (n=226) vs. 41.1% (n=79), p=0.2) but significantly less StratticeTM reconstructions required revision surgery for capsular contracture (5.3% vs. 15.6%, p<0.001).

Conclusions:
Although the risk of complications associated with StratticeTM reconstruction is numerically higher than that for submuscular coverage, the difference is small and not statistically significant, and likely outweighed by the clear reduced rate of revision surgery due to capsular contracture when Strattice TM is used.
“Functional Outcomes of Cubital Tunnel Release in Patients with Negative Electrodiagnostic Studies”
Authors: Townsend Clay B. , Katt Brian , Tawfik Amr , DeMarco Michael , Lutsky Kevin F. , Matzon Jonas L. , Rivlin Michael , Beredjiklian Pedro K. 
Published: February 2023

Background:
Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy of the upper extremity. Electrodiagnostic studies (EDS) are often used to confirm diagnosis. However, negative EDS can present a difficult clinical challenge. The purpose of this study was to determine the functional outcomes and symptom improvement for patients with a clinical diagnosis of CuTS, but with negative EDS, who are treated surgically.

Methods:
Patients who had EDS prior to ulnar nerve surgery were identified via database search. Chart review was performed on 867 cases to identify those with negative EDS. Twenty-five ulnar nerve surgeries in 23 patients were included in analysis. Chart review was performed to record preoperative and postoperative symptoms, physical exam findings, and outcome measures [Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Rated Ulnar Nerve Evaluation (PRUNE)].

Results:
At a mean follow up of 20.7 months (SD 14.9), 15/25 cases (60.0%) had complete resolution of all preoperative symptoms. All 10 cases that had residual symptoms endorsed improvement in their preoperative complaints. The median preoperative DASH score was 40.0 [IQR, 23.9 - 58.0], which significantly decreased to a median of 6.8 [IQR, 0 - 22.7] at final follow up (p<.01). The median postoperative PRUNE score was 9.5 [IQR, 1.5 - 19.5].

Conclusions:
Patients with CuTS and normal EDS treated surgically can be expected to have favorable outcomes with respect symptoms and improvement in functional outcome scores. After ruling out confounding diagnoses, we continue to offer surgical intervention for these patients when non-operative treatment has failed.
Extended Duration Venous Thromboembolism Chemoprophylaxis Following Microsurgical Breast Reconstruction: Analysis of Trends in Postoperative Anticoagulation
Authors: Le Elliot L.H. , Saifee Jessica , Constantine Ryan , Tuaño Krystle , Yang Jerry , Kaoutzanis Christodoulos , Mathes David , Iorio Matthew L. 
Published: February 2023

Background:
Microsurgical breast reconstruction following mastectomy represents a high-risk patient group for venous thromboembolism (VTE), but there is limited consensus on postoperative prophylaxis duration. The aim of this study was to characterize the risk of VTE after microsurgical breast reconstruction, the risk reduction associated with postoperative outpatient VTE prophylaxis, the clinical factors associated with VTE events, and surgeon prescribing patterns regarding outpatient VTE prophylaxis.

Methods:
A commercially available database of 53 million unique patients, PearlDiver, was used to identify patients with breast cancer that underwent microsurgical breast reconstruction. Patients were grouped into those receiving any form of outpatient VTE prophylaxis at discharge and those who did not. Probability of VTE within 90 days was calculated for each group followed by absolute risk reduction and number needed to treat. A logistic regression, assuming binomial distribution, was performed to determine clinical factors associated with VTE events after surgery.

Results:
A total of 22,606 patients underwent microsurgical breast reconstruction from 2010 and 2020. Of these patients, 356 (1.6%) were discharged with VTE prophylaxis and 22,250 (98.4%) were discharged without. No patients developed a VTE in the prophylaxis group, and 403 (1.8%) developed a VTE in the group without prophylaxis. Number needed to prevent one VTE was 55.25 patients. Most VTE events occurred after post-operative day 10 (71.3%).

Conclusion:
Outpatient chemoprophylaxis following breast reconstruction is underutilized despite the majority of VTE events occurring after the acute postoperative period. Breast microsurgeons should consider routine outpatient chemoprophylaxis as part of their postoperative care pathway to optimize VTE prevention. ***

Level of evidence:
IV
Risk of Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) in Patients with Temporary Exposure to Textured Tissue Expanders: An Analysis of 3310 Patients
Authors: Nelson Jonas A. , McKernan Cayla D. , Rubenstein Robyn N. , Shamsunder Meghana G. , Poulton Ricky , Dabic Stefan , Mehrara Babak J , Disa Joseph J , Cordeiro Peter G. , McCarthy Colleen M. 
Published: February 2023

Background:
The association between textured implants and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is well established, but the risk of BIA-ALCL in patients with transient exposure to a textured tissue expander (TE) is not as well documented. The aim of this study was to assess the incidence and risk of BIA-ALCL in patients with temporary exposure to a textured TE with subsequent smooth implant placement.

Methods:
This single-institution retrospective cohort study included all female patients who underwent two-stage breast reconstruction with placement of a textured TE from 1995-2016 with subsequent exchange to a smooth permanent implant. Primary outcome of interest was development of BIA-ALCL. Patients with exposure to textured implants were excluded. Follow-up was determined by last documented visit. We calculated summary statistics for exposure time and follow-up intervals.

Results:
Overall, 3310 patients had temporary exposure to a textured TE with exchange to a smooth implant, totaling 5201 textured TEs. Average textured TE exposure time was 6.7 months (median 5.8 months). Average follow-up was 6.8 years (median 6.3 years), ranging from 3.7 months to 18 years. No cases of BIA-ALCL were identified.

Conclusion:
As no cases of BIA-ALCL were identified, the risk of BIA-ALCL with short exposure to textured TEs is likely lower than the risk from exposure to permanent textured implants. While longer follow-up is needed, these results can help counsel patients with previous exposure to textured TEs who are concerned about their risk of BIA-ALCL and can contribute to discussions on potential continued utility of textured TEs.
“Compound Effect of Hypoalbuminemia and Obesity on Complications after Autologous Breast Reconstruction”
Authors: Chiang Sarah N , Finnan Michael J , Skolnick Gary B , Westman Amanda M , Sacks Justin M , Christensen Joani M 
Published: February 2023

Background:
Obesity is among the risk factors identified which impair postoperative wound healing. Recently, malnutrition and sarcopenia have also been found to correlate with poor surgical outcomes; however, the effect of malnutrition in the setting of obesity is understudied, particularly in reconstructive surgery. We examine the ACS National Surgery Quality Improvement Program (NSQIP) database to determine the impact of obesity plus hypoalbuminemia on complications after autologous breast reconstruction.

Methods:
Autologous breast reconstruction procedures (pedicled and free flaps) were collected from the 2009-2019 NSQIP databases by CPT codes (n=23,690). Patients without height, weight, or preoperative serum albumin data (n=12,825) were excluded. Demographics and postoperative outcomes were compared in patients with obesity (BMI >30) and malnutrition (albumin <3.5 g/dL). Propensity score-matched cohorts with and without malnutrition were also compared.

Results:
A total of 10,865 procedures were included in analysis; 4,565 involved patients with obesity (42%). Obesity was associated with increased length of stay, reoperations, wound complications, and medical complications (all p<0.001). Among patients with obesity, 198 had malnutrition (4.3%). The combination of obesity and malnutrition was associated with a higher rate of wound complications (16%) over obesity alone (9.2%) or malnutrition alone (9.2%, both p<0.05). This difference is recapitulated in propensity score-matched analysis.

Conclusions:
Hypoalbuminemia, a marker of malnutrition, is underappreciated in obese patients and is associated with worse surgical outcomes after autologous breast reconstruction compared to obesity alone.
Enhanced Pain Control after Reduction Mammaplasty with Combination Bupivacaine and Dexamethasone Regional Block: A Double-Blind Randomized Controlled Trial (NCT04919317)
Authors: Taylor George A , Panichella Juliet C , Neusner Alex , Lo Alexis , Vazquez Daniella , Zhao Huaqing , Trehan Gaurav , Livelsberger Jon , Gassman Andrew A 
Published: February 2023

Background:
There are many approaches to pain control in reduction mammaplasty. Preoperative bupivacaine regional blocks control pain relatively inexpensively ($0.07/mL), but last only 8-hours. A liposomal bupivacaine formulation lasts 72-hours but can be costly ($17.21/mL). Orthopedic and thoracic surgeries have demonstrated that dexamethasone ($0.44/mL) plus bupivacaine can prolong analgesia. We conducted a double-blind, randomized controlled trial to determine if dexamethasone plus bupivacaine regional block improves postoperative pain control, reduces inpatient narcotic usage, and improves patient satisfaction (ClinicalTrials.gov NCT04919317).

Methods:
Female patients were randomized into control and experimental groups. Both groups received preoperative PECS2 blocks: bupivacaine plus saline (control) or bupivacaine plus dexamethasone (experimental). Postoperative pain regimens were standardized. Vital signs, pain scores, narcotic consumption, and anti-emetic usage were recorded throughout the hospitalization. Quality of life surveys were distributed at the first postoperative visit.

Results:
51 patients completed the study: 25 control and 26 experimental group patients. The experimental group averaged lower pain scores, although there was no statistically significant difference overall or at each 4-hour interval. Postoperative narcotic usage was significantly lower in the experimental group (mean 23.2 versus 36.6 oral morphine equivalents per patient, p=0.026). There were no differences in 4-hour interval vital signs, antiemetic usage, or length of stay. Survey results showed enhanced quality of life in the experimental group, but this was not statistically significant.

Conclusions:
The addition of dexamethasone to bupivacaine in the PECS2 block prior to bilateral reduction mammoplasty resulted in significantly less narcotic consumption in the hospital. This can be a cost-effective adjunct for postoperative pain control.