bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Surgical Timing and Neurocognitive Development Among Patients with Craniosynostosis: Analysis of Confounding Variables and Selection Bias.”
Authors: Lynn Jeremy V. , Buchman Lauren K. , Breuler Christopher J. , Buchman Steven R. 
Published: February 2023

Background:
In 1988, Renier and Marchac asserted that children with craniosynostosis who undergo cranial vault remodeling (CVR) after 12 months of age experience delayed neurocognitive development compared to children who undergo CVR before 12 months of age. The purpose of this study is to identify factors potentially confounding this cause-and-effect relationship. We hypothesize that children with socioeconomic disadvantages or comorbid conditions are more likely to undergo CVR after 12 months and may represent a selection bias toward delayed neurocognitive development.

Methods:
Patients with non-syndromic single-suture craniosynostosis who underwent CVR between 2009 and 2020 at Michigan Medicine were included (n=227). Sociodemographic and clinical variables were documented. The sample was dichotomized to compare patients who underwent CVR before (Early) and after (Late) 12 months of age. Statistical analysis was performed at p<0.05 significance.

Results:
The Early and Late groups contained 157 patients and 70 patients, respectively. Compared to the Early group, the Late group contained a larger proportion of patients who identified as non-white (p=0.03), qualified for need-based financial assistance (p=0.03), were born preterm (p<0.01), or had a comorbid condition (p<0.01). Based on pre-operative testing, the Late group contained a larger proportion of patients with baseline cognitive (p<0.001) and language (p=0.008) delays relative to the Early group.

Conclusion:
This study demonstrates that socioeconomic disadvantages and comorbid conditions are prevalent among patients who undergo delayed CVR and may represent a selection bias toward delayed neurocognitive development. Future studies evaluating the relationship between surgical timing and neurocognitive development must control for these factors.
“Case Control Analysis of Genital Hypoplasia Prior to Gender Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?”
Authors: Blasdel Gaines , Kloer Carmen , Parker Augustus C. , Shakir Nabeel , Zhao Lee C. , Bluebond-Langner Rachel 
Published: February 2023

Background:
Insufficient genital tissue has been reported as a barrier to achieving depth in gender affirming vaginoplasty. We sought to characterize vaginal depth and revision outcomes in patients with genital hypoplasia undergoing robotic peritoneal flap vaginoplasty.

Methods:
Retrospective case control analysis of patients undergoing robotic peritoneal vaginoplasty between 9/2017 and 8/2020 was utilized. All 43 patients identified as having genital hypoplasia (genital length <7 cm) were included with 49 random controls from the remaining patients with >7 cm genital length. Baseline clinical characteristics and perioperative variables were recorded to identify potential confounders. Outcomes measured included vaginal size reported at last visit and undergoing revision surgery for depth or for vulvar appearance.

Results:
Patients were well matched other than median body mass index at time of surgery, which was greater in the hypoplasia cohort by 3.6 kg/m2 (p <.0001). Patients had a median of one year of follow up, with a minimum follow up of 90 days. No significant differences in outcomes were observed, with a median vaginal depth of 14.5 cm (interquartile range 13.3- 14.5), and median width of dilator used 3.8 cm (3.8- 3.8). No depth revisions were observed, and an 11% (n = 10) rate of external revision occurred.

Conclusions:
Patients with genital hypoplasia had equivalent dilation outcomes in a case control analysis with consistent follow up past 90 days. The robotic peritoneal flap vaginoplasty technique provides vaginal depth of 14cm or greater regardless of genital tissue prior to surgery. Further investigation with patient-reported outcome measures is warranted.
Prognostic factors of Marjolin’s ulcers: A Meta-analysis and Systemic Review Assisted with Machine Learning Techniques
Authors: Cheng Kai-Yuan , Yu Jiaxin , Liu En-Wei , Hu Kai-Chieh , Lee Jian-Jr 
Published: February 2023

Background:
Marjolin’s ulcers are malignant tumors arising from previously injured skin, including burn wounds, scars, chronic ulcers, etc. They have a potentially long latent period. We aimed to establish the prognostic factors for recurrence, metastasis, and disease-specific death related to Marjolin’s ulcers.

Methods:
We performed a comprehensive search of PubMed, EMBASE, and the Cochrane Library. After assessing the methodological quality of case series, we performed a meta-analysis and systematic review. Furthermore, we employed machine learning to predict the patients’ survival time.

Results:
Marjolin’s ulcer on the upper limbs, head, and neck had a higher risk of recurrence. Contrastingly, lower-grade lesions, absence of lymph node metastasis, and a tumor diameter of <10 cm were associated with lower recurrence risk. The risks were unrelated to age and latent period. Additionally, patients without lymph node metastasis had a lower risk of developing distant metastasis. Furthermore, the risk of disease-specific death was lower in patients with a lower tumor grade, absent lymph node metastasis, small tumor diameter (<10 cm), and tumors located in regions other than the head and neck. Correlation analysis showed that the age at initial injury was negatively correlated with the latent period of Marjolin’s ulcer.

Conclusions:
We found that tumor grade, tumor site, lymph node status, and tumor size are important predictors of a worse prognosis. To integrate these predictors, we created an equation to predict the survival time for individual patients via machine learning processes. Moreover, we found that Marjolin’s ulcer developed more quickly in older individuals with injuries.
A high-fat diet in the absence of obesity increases lymphangiogenesis by inducing VEGF-C in a murine lymphedema model
Authors: Choi Jaehoon , Kim Jaehoon , kim Junhyung , Jeong Woonhyeok , Jo Taehee , Lee Hyoun Wook , Park Young Sook , Park Sang Woo 
Published: February 2023

Background:
Many researchers have attempted to induce lymphangiogenesis for the treatment of lymphedema. However, most previous studies had limited clinical usefulness. A high-fat diet (HFD) increases serum β-hydroxybutyrate (β-OHB) levels, which can stimulate lymphangiogenesis. The authors hypothesized that a HFD will ameliorate lymphedema through enhanced lymphangiogenesis.

Methods:
The effects of β-OHB on the lymphangiogenic process in human dermal lymphatic endothelial cells (HDLECs) were analyzed. A mouse tail lymphedema model was used to evaluate the effects of a HFD on lymphedema. Experimental mice were fed a HFD (45% kcal as fat, 20% as protein and 35% as carbohydrates) for 4 weeks. Tail volume was measured using the truncated cone formula. Biopsies were taken six weeks after surgical induction of lymphedema.

Results:
In HDLECs, treatment with 20 mM β-OHB increased cell viability (p = 0.008), cell migration (p = 0.011), tube formation (p = 0.005), and VEGF-C mRNA and protein expression (p < 0.001) compared with controls. HFD feeding decreased tail volume by 14.3% and fibrosis by 15.8% (p = 0.027), and increased the lymphatic vessel density (p = 0.022) and VEGF-C protein expression (p = 0.005) compared with those of operated, standard chow diet-fed mice.

Conclusion:
Our findings demonstrated that β-OHB promoted lymphatic endothelial cell function and increased VEGF-C mRNA and protein expression. When mice with tail lymphedema were fed a HFD, volume and fibrosis of the tail decreased. Therefore, our findings suggest that a HFD can be a successful novel dietary approach to treating lymphedema.

Clinical Relevance Statement:
Lymphatic regeneration after vascularized lymph node transfer can be augmented when high-fat diet is used in conjunction with vascularized lymph node transfer.
Abandoning the SIEA flap for the “Dual-Plane” DIEP Reduces Fat Necrosis and Flap Failure
Authors: Hembd Austin , Liu Yulun , Haddock Nicholas T. , Teotia Sumeet S. 
Published: February 2023

Purpose:
Despite its limitations in abdominally based breast reconstruction, utilizing the superficial inferior epigastric artery (SIEA) flap or system can be advantageous in specific clinical scenarios. To optimize outcomes in these cases, we performed a retrospective review of our flap series to advocate a new algorithm to use the superficial system.

Methods:
A retrospective analysis was performed on 1700 consecutive free abdominal flaps for presence of a dominant superficial system or poor deep inferior epigastric artery perforators (DIEP) on clinical exam or angiography. In this setting, we analyzed the primary outcome measures of fat necrosis and flap failure with utilizing the superficial system alone versus a “dual-plane DIEP”, where there was an intra-flap anastomosis performed between the DIEP pedicle and SIEA pedicle. A multivariable analysis was performed with 21 other potentially confounding variables and compared to outcomes with traditionally perfused DIEP flaps.

Results:
Fat necrosis was present in 13% of 506 DIEP flaps, 34.1% of 41 SIEA system flaps, and 2.7% of 37 dual-plane DIEP flaps. Superficial system only flaps were independent predictors of fat necrosis (OR, 6.55; p < 0.001) and flap failure (OR, 9.82; p= 0.002) compared to dual-plane DIEP flaps when utilized for the same indications.

Conclusions:
In settings of superficial dominance or need to augment perfusion to lateral zones in abdominal free flaps, performing a dual-plane DIEP instead of utilizing the superficial system vasculature alone with an SIEA flap can decrease the odds of fat necrosis and flap failure to equal that of standard DIEP flap.
Autologous Platelet-Rich Plasma Treatment for Androgenic Alopecia: A Systematic Review and Meta-analysis of Clinical Trials on Patient Safety, Efficacy and Outcomes.
Authors: Papakonstantinou Menelaos , Siotos Charalampos , Gasteratos Konstantinos C. , Spyropoulou Georgia-Alexandra , Gentile Pietro 
Published: February 2023

Background:
Androgenic alopecia (AGA) is a common condition associated with hair loss both in men and women (female pattern hair loss, FPHL), causing considerable psychological distress. Ongoing research focuses on novel safe, cost-effective and efficient treatments with the best patient outcomes. Autologous platelet-rich plasma (PRP) has become increasingly popular in the treatment of AGA compared to hair transplantation techniques. The present study aims to evaluate the outcomes of PRP as a treatment for AGA/FPHL.

Methods:
A computerized literature search was conducted on PubMed, clinicaltrials.gov and Cochrane Library for articles published until November 2020. The online screening process was performed by two independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses), and it was registered at the International Prospective Register of Systematic Reviews (PROSPERO) of the National Institute for Health Research (NIHR). Meta-analyses were performed by employing the Random Effects Model using the RevMan software.

Results:
The initial search yielded 49 randomized controlled clinical trials (RCTs). Eleven RCTs were included in the study based on a priori criteria. PRP injections significantly increased the number of hair follicles, hair thickness and density compared to placebo interventions. Also, the patients reported high overall satisfaction with the PRP treatment. Only temporary minor side effects were noted, including localized pain, bleeding and itching.

Conclusion:
Autologous PRP significantly improves alopecia in select patients. Future research should focus on optimizing PRP treatment protocols and minimizing possible adverse reactions.
“Perioperative intermittent fasting protects ischemic musculocutaneous flap tissue from necrosis”
Authors: Weinzierl Andrea , Harder Yves , Menger Michael D. , Laschke Matthias W. 
Published: February 2023

Background:
Dietary restriction, such as intermittent fasting (IF), has previously been shown to protect various tissues from ischemia-induced necrosis. Based on this finding, we herein evaluated for the first time the tissue-protective effects of IF in musculocutaneous flaps.

Methods:
Male C57BL/6N mice were randomly assigned to an IF-group (n = 8) and a control group with unrestricted access to standard diet (n = 8). IF animals were put on a perioperative feeding schedule with 8 hours unrestricted access to standard diet per day starting 7 days before flap elevation up to 3 days after surgery. Random pattern musculocutaneous flaps were raised and mounted into a dorsal skinfold chamber. Intravital fluorescence microscopy was performed on days 1, 3, 5, 7 and 10 after surgery for the quantitative assessment of angiogenesis, nutritive blood perfusion and flap necrosis. After the in vivo observation period, the flaps were harvested for additional histological and immunohistochemical analyses.

Results:
We found that the IF-group exhibited more newly formed microvessels and a higher functional capillary density within the flap tissue when compared to controls. This was associated with a significantly lower rate of tissue necrosis. Immunohistochemical detection of different inflammatory cell subtypes revealed a markedly reduced number of invading myeloperoxidase positive neutrophilic granulocytes in the musculocutaneous tissue of IF-treated animals.

Conclusion:
Taken together, these findings indicate that IF prevents flap necrosis by maintaining nutritive tissue perfusion and suppressing ischemia-induced inflammation.
Preoperative Exam Is Not Associated with Postoperative Function following Radial Forearm Free Flap Harvest
Authors: Emanuelli Elisa , Egan Katie G , Bins Griffin , Nazir Niaman , Bur Andres M , Kakarala Kiran , Przylecki Wojciech , Endress Ryan 
Published: February 2023

Purpose:
There is debate on utility of preoperative Allen’s test or ultrasound prior to radial forearm flap harvest. This study sought to evaluate correlations between preoperative testing and donor site morbidity.

Methods:
A survey of plastic surgery and otolaryngology radial forearm flap patients was conducted at a midwestern academic center. The modified Cold Intolerance Symptom Severity (modCISS) and Quick Disabilities of the Arm, Shoulder and Hand (QDASH) were administered. A retrospective chart review was performed to assess perioperative factors.

Results:
Of 212 radial forearm flaps completed over seven years, 144 patients were contacted and 71 patients completed the survey (33% response rate). Preoperative Allen’s test was negative in 92% of patients (65/71). There was no statistical association between Allen’s test and duplex ultrasound findings (p=.19). Cold intolerance screening was positive on 20% of donor arms (14/71), with an average positive modCISS score of 39.0 (SD 14.7). Disability was reported on the QDASH by 76% of patients (54/71), with an average score of 21.0 (SD 22.3). There was no statistical correlation between preoperative Allen’s test or ultrasound classification and modCISS or QDASH score. There was a borderline positive correlation between modCISS and QDASH scores that did not reach statistical significance (r=0.22, p=.067). Operative characteristics also did not predict modCISS or QDASH scores.

Conclusions:
Following radial forearm flap harvest, donor extremity cold intolerance is reported in 20% of patients, and extremity related disability in the majority of patients. Preoperative ultrasound and physical exam findings are not predictive of morbidity.
An Evidence-Based and Case-Based Comparison of Modern Facelift Techniques
Authors: Avashia Yash J. , Stuzin James M. , Cason Roger W. , Savetsky Ira L. , Rohrich Rod J. 
Published: February 2023

Background:
Facial aging is a multifactorial process that affects each component of facial anatomy. The two general groups of facelift techniques are superficial musculoaponeurotic system (SMAS) elevation and SMAS manipulation. The purpose of this article is to describe and compare the advantages, disadvantages, and limitations of facelift techniques.

Methods:
A systematic review was performed to describe current outcomes evidence for facelift technique. A subcohort of articles were selected for case-based analysis based on designated facial assessment criteria. Analysis was performed to determine the advantages, disadvantages, and limitations of each respective technique.

Results:
A total of 65 articles were selected for systematic review of which 15 articles met criteria for case-based review. Patient satisfaction was found to be equivocal for various facelift techniques. Specific advantages and disadvantages for each facelift technique were dependent on the techniques’ approach to skin shift vector along with its degree of mobilizing superficial facial fat. Facial fat grafting was universally applicable for restoration of deep malar volume. Facial fat grafting was also used differently depending on the SMAS technique to address its specific limitations.

Conclusion:
Our review confirms that there are many methods to obtain excellent outcomes in facial rejuvenation. Experienced surgeons are able to obtain consistent results through a variety of techniques based on understanding the aesthetic needs of the individual patient, the quality of the soft tissues being manipulated, as well as how to vary a specific technique to reach desired aesthetic endpoints.
Turnover lengthening of the ECRB tendon does not alter the biomechanical strength of PT to ECRB tendon transfer
Authors: Weber Erin L. , Schmidt Elaine C. , Steinberger Zvi , Dardas Agnes Z. , Hast Michael W. , Levin L. Scott 
Published: February 2023

Background:
The pronator teres (PT) to extensor carpi radialis brevis (ECRB) tendon transfer reestablishes wrist extension. Occasionally, the PT periosteal extension is of suboptimal quality to support a strong transfer. In these instances, turnover lengthening techniques can increase usable tendon length. This study characterized the optimal length of tendon turnover and the effect of lengthening on transfer strength.

Methods:
Twenty-seven cadaveric extensor tendons were lengthened using the turnover lengthening technique with 1-3 centimeters of tendon overlap. PT to ECRB tendon transfers were performed with native or lengthened ECRB tendons. Tensile testing was used to evaluate stress-relaxation and load to failure.

Results:
The median maximum load to failure increased with increasing overlap length, measuring 35.6 N (Q1 30.2, Q3 38.6) for 1 cm, 66.0 N (59.1, 74.7) for 2 cm, and 96.6 N (85.9, 114.9) for 3 cm of overlap (p<0.05). Failure occurred most frequently at the junction of the central overlap and native tendon. Tendons lengthened with 2 and 3 cm of overlap displayed greater stiffness than with 1 cm (p<0.05). Lengthening the ECRB tendon with 2 or 3 cm of overlap did not disrupt the strength or stiffness of subsequent PT to ECRB tendon transfers.

Conclusions:
Turnover tendon lengthening does not detrimentally affect PT to ECRB tendon transfer.
Greater overlap lengthening distance confers greater stiffness and resistance to rupture. When the periosteal extension of the PT tendon avulses or is poor quality, the ECRB tendon can be lengthened using the turnover tendon lengthening technique to facilitate a robust transfer.
TikTok: Is it Time to Start Trending with #PlasticSurgery?
Authors: Long Emily A. , Shiah Eric , Lin Samuel J. 
Published: February 2023

Background:
TikTok is a short-form video social media platform created in 2016 that has rapidly grown in popularity. The aim of this study was to examine trending plastic surgery videos on TikTok and to understand the dynamics of the #PlasticSurgery conversation on this relatively new social media platform.

Methods:
A prospective analysis of TikTok videos identified by directly querying the platform using #PlasticSurgery was performed during November 2020. Top trending videos at time of data collection, defined as having greater than 100,000 likes, were included. Videos were analyzed for user credentials, video engagement (number of views, likes, shares, and comments), associated hashtags, and video purpose and content.

Results:
The top 376 trending videos were viewed a total of 1,680,910,700 times at time of analysis. Videos made by board-certified plastic surgeons on average were more popular than videos made by non-plastic surgeons (490.4 vs. 378.6 million likes, p=0.006; 5.1 vs. 3.8 billion views, p=0.046). The most popular procedures featured were augmentation mammoplasty (531,143,800 views; 42,825,400 likes), followed by body contouring procedures such as liposuction and abdominoplasty (276,810,500 views; 22,362,000 likes), and rhinoplasty (243,724,100 views; 27,588,200 likes). Educational videos on average had significantly higher levels of engagement than entertainment-focused videos (549,336 vs. 340,163 likes, p=0.002; 6.3 vs. 2.9 million views, p<0.001).

Conclusions:
Videos about plastic surgery, particularly educational videos by board-certified plastic surgeons, perform exceptionally well on the TikTok platform. TikTok presents an opportunity for plastic surgeons to educate patients about plastic surgery procedures and to present themselves as board-certified plastic surgeons.
Analysis of Contralateral Perfusion in the DIEP Flap Using a Response Surface Methodology: Role of the Location of the Perforator, Umbilicus, and Midline Crossing-over Vessel
Authors: Min Kyunghyun , Oh So Min , Kim Eun Key , Eom Jin Sup , Han Hyun Ho 
Published: February 2023

Background:
During breast reconstruction, predicting contralateral perfusion of the deep inferior epigastric artery perforator (DIEP) flap can help minimize tissue necrosis. This study aimed to quantify the area of contralateral perfusion and identify the factors affecting it.

Methods:
A retrospective study was conducted on unilateral breast reconstructions with a single perforator-based DIEP flap, for the period 2017–2019. Data on the distance between the perforator and the umbilicus, and the grade of the midline crossing-over vessel (G0: no vessel, G1: suspicious vessel, G2: definite vessel) were collected. Contralateral perfusion was estimated using intraoperative indocyanine green angiography, and the degree of contralateral circulation based on perforator location was assessed using a response surface methodology (RSM) analysis.

Results:
The study included 143 patients (G0: 62, G1: 45, G2: 36). The average length of transverse contralateral flap perfusion (contralateral circulation area / vertical height of the flap) increased as the crossing-over vessel grade increased (G0: 62.96 ± 20.33 mm, G1: 71.69 ± 20.66 mm, G2: 81.1 ± 19.32 mm; p = 0.0002). In the RSM analysis, contralateral perfusion was the least when the perforator was located near the umbilicus (G0: within a 10 mm radius, G1: less than 10 mm transverse distance; 16 mm to 22 mm vertical distance, G2: within a 20 mm radius).

Conclusions:
The umbilicus can interfere with contralateral perfusion; thus, a definite presence of a midline crossing-over vessel ensures robust contralateral perfusion. The results of this study would help surgeons select the optimal single perforator prior to surgery.