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Objective In the current healthcare climate, there is increased focus on medical errors, patient outcomes, and the influence of resident participation on these metrics. Other studies have examined the influence of resident involvement on surgical outcomes, but the arena of microsurgery, with added complexity and learning curve, has yet to be investigated. Design A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed to find patients undergoing procedures with free tissue transfer by screening for Current Procedural Terminology codes. Primary outcomes measured include flap failure, wound, infectious, and major and minor complications. Setting This study was conducted at the Methodist Hospital, an academic hospital located in Houston, Texas. Participants Patients in the National Surgical Quality Improvement Program database between the years 2005 and 2012 undergoing microsurgical procedures were included in this analysis. Results A total of 1466 patients met inclusion criteria. There was a statistically significant association of major complications with age, peripheral vascular disease, American Society of Anesthesiologists (ASA) classification of 3 or greater, total operative time, and year of operation. Multivariate analysis on minor complications demonstrated significant association with ASA class of 3 or 4. Resident involvement was not a significant factor among any outcome measures including major complications, minor complications, flap failure, wound complications, infectious complications, bleeding requiring transfusion, and unexpected reoperation rates within 30 days. Conclusions This study provides further evidence in support of the claim that resident involvement in microsurgery is safe and effective, with similar rates of major complications, minor complications, flap failure, and unexpected reoperation. High ASA classification and history of peripheral vascular disease were strong predictors of major complications and should be optimized preoperatively before free tissue transfer. Later years were associated with decreased major complication rates, which may be reflective of enhanced supervision standards.

The Drosophila eye disc is a sac of single layer epithelium with two opposing sides, the peripodial membrane (PM) and the disc proper (DP). Retinal morphogenesis is organized by Notch signaling at the dorsoventral (DV) boundary in the DP. Functions of the PM in coordinating growth and patterning of the DP are unknown. We show that the secreted proteins, Hedgehog, Wingless, and Decapentaplegic, are expressed in the PM, yet they control DP expression of Notch ligands, Delta and Serrate. Peripodial clones expressing Hedgehog induce Serrate in the DP while loss of peripodial Hedgehog disrupts disc growth. Furthermore, PM cells extend cellular processes to the DP. Therefore, peripodial signaling is critical for eye pattern formation and may be mediated by peripodial processes.

Purpose Infectious complications associated with left ventricular assist devices (LVADs) significantly reduce the quality and length of life while increasing costs and prolonging hospital stays. LVAD pocket infections are associated with a 40-50% mortality rate. There is no widely recognized method for effectively treating such infections other than device removal. Methods and Materials This study is a single-institution, retrospective review of 25 patients with LVAD-associated infections from 2010-2012. Incision and drainage and antibiotic impregnated polymethylmethacrylate (PMMA) beads were implanted in all 25 patients for local antibiotic delivery. Antibiotic beads were exchanged at 1 week intervals until the infected pocket was culture negative. Once the infection was cleared, the infected pocket was revised by repositioning the driveline or covering the pump with a flap. Results Infections were cleared in 16/25 patients (64%), while 9/25 patients (36%) continued to have positive bacterial cultures. Of the 16 patients whose infections were cleared by antibiotic beads, 50% had LVAD pocket infections, and 50% had driveline infections. Rate of re-infection in this group was 3/16 (19%), and overall mortality in the “cleared” group was 19% over the study period. The mortality rate among patients in whom antibiotic beads did not clear the infection was 88% (8/9 patients). There were no significant morbidity differences between the patients whose infections were successfully treated using antibiotic beads and those that were not. Conclusions Compared to other methods, debridement and placement and exchange of antibiotic impregnated beads may be an effective way to manage LVAD device-associated infections. Predicting which patients in whom this technique will successfully clear infections is difficult based upon this case series. However, improved patient survival may result from use of antibiotic beads before internal LVAD infection occurs.