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Background:. Gunshot wounds (GSWs) create significant morbidity in the United States. Upper extremity (UE) GSWs are at high risk of combined injuries involving multiple organ systems and may require variable treatment strategies. This study details the epidemiology, management, and outcomes of civilian UE GSWs at an urban level 1 trauma center. Methods:. Using the University of Pennsylvania Trauma Registry, all adult patients with UE GSWs from 2015 to 2020 who were at least 6-months postinjury were studied for demographics, injury pattern, operative details, and postoperative outcomes. Fisher exact and Wilcoxon rank sum tests were used to determine differences in treatment modalities and outcomes. Results:. In 360 patients, the most common victim was young (x̄ = 29.5 y old), African American (89.4%), male (94.2%), and had multiple GSWs (70.3%). Soft tissue-only trauma (47.8%) and fractures (44.7%) predominated. Presence of fracture was independently predictive of neurologic, vascular, and tendinous injuries (P < 0.001). Most soft tissue-only injuries were managed nonoperatively (162/173), whereas fractures frequently required operative intervention (115 of 161, P < 0.001). Despite a prevalence of comminuted (84.6%) and open (43.6%) fractures, hardware complications (7.5%) and wound infection (1.1%) occurred infrequently. Conclusions:. Civilian GSWs to the UE with only soft tissue involvement can often be managed conservatively with antibiotic administration, bedside washout, and local wound care. Even with combined injuries and open fractures, single-stage operative debridement and fracture care with primary or secondary closure often prevail. As civilian ballistic trauma becomes more frequent in the United States, these data help inform patient expectations and guide management.

Background:. Academic advancement in plastic surgery necessitates creation of opportunities for rising faculty, which are pivotal for women in their efforts to close prominent gender gaps in higher ranks. We study positions of academic prestige that benefit from internal nomination as surrogates for opportunities afforded to men and women seeking leadership roles. Methods:. We collected the following datapoints: authors of invited discussions published in Plastic and Reconstructive Surgery from 2010 to 2019; current editorial board members of representative plastic surgery journals; recipients of society-sponsored traveling fellowships; and directors of the American Board of Plastic Surgery. Public profiles for all authors and surgeons were referenced to confirm gender identification. Results:. Seven-hundred ninety-seven plastic and reconstructive surgery discussions were included, 18% of which included female first or senior authorship. Seventy-one (9%) discussions listed a female senior author. Male and female senior authors were equally as likely to collaborate with a female first co-author (25% and 26%, respectively). Only 17% of invited authors contributed to 55% of discussion articles. Women occupied 19% of journal editorial board positions, though none were editors-in-chief. American Society of Reconstructive Microsurgery, American Society of Maxiliofacial Surgeons, American Society for Surgery of the Hand, and Plastic Surgery Foundation traveling fellowships were awarded to one (3%), four (7%), five (13%), and 141 (15%) female plastic surgeons, respectively. Women comprise 26% of directors of American Board of Plastic Surgery. Conclusions:. Female representation in plastic surgery is rising, but it is not mirrored across appointed positions in academia. We should strive to support advancements that allow selected prestigious positions to more accurately reflect the gender distribution within the plastic surgery community.