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Uterine transplant (UTx) is performed to address absolute uterine infertility in the presence of uterine agenesis, a non-functional uterus, or following a prior hysterectomy. Following the initial success of UTx resulting in a livebirth (2014) in Sweden, there are over 70 reported UTx surgeries resulting in more than 40 livebirths worldwide. Currently, UTx has been performed in over 10 countries. As UTx is transitioning from an "experimental procedure" to a clinical option, an increasing number of centers may contemplate a UTx program. This article discusses essential steps for establishment of a successful UTx program. These principles may be implemented in cis- and transgender UTx candidates.

Background The coronavirus disease 2019 pandemic has disrupted the delivery of safe surgical care worldwide. One specific aspect of global surgical care that has been severely limited is the ability for physicians and trainees to participate in global surgical outreach programs in low- and middle-income countries. Methods A narrative review of the literature regarding global surgical outreach programs during the coronavirus disease 2019 pandemic was performed. Factors that must be considered in the reinstatement of global surgical outreach programs were identified, and suggestions to address them were provided based on the available literature and the experiences of the senior authors. Results As global surgical outreach programs were canceled at the start of the pandemic, many academic surgeons turned to digital solutions to continue to engage with low- and middle-income country partners. With the advent of coronavirus disease 2019 vaccines and improved access to testing and treatment worldwide, the recommencement of global surgical outreach programs may begin to be considered. Important considerations before initiation include vaccine and testing availability for visiting providers, local staff, and patients, local hospital capacity, staff and equipment shortages, and the characteristics of the patient population and visiting providers. Region- and country-specific factors, including local infection rates and concomitant health crises, must also be taken into account. Expansion of digital collaborative efforts may further deepen international connections and promote sustainable models of care. Conclusion With careful consideration, global surgical outreach programs may begin to be safely restarted in the near future. The current article evaluates individual factors that must be considered to safely restart global surgical outreach programs as the coronavirus disease 2019 pandemic is better controlled.

Direct neurotization is a method that involves direct implantation of nerve fascicles into a target tissue, that is, muscle fibers, skin, cornea, and so on, with the goal of restoring aesthetic, sensation and or functional capacity. This technique has been implemented since the early 1900s, with numerous experimental and clinical reports of success. Applications have included both sensory and motor neurotization of muscle, as well as protective sensory provision for other organs. These techniques have been used to restore corneal sensation, repair brachial plexus injuries, reestablish tongue movement and function through direct tongue neurotization, and reinnervate multiple facial muscles in patients with facial paralysis. Most recently, these methods have even been used in conjunction with acellular cadaveric nerve grafts to directly neurotize skin. Indications for direct neurotization remain limited, including those in which neural coaptation is not feasible (ie, surgical or traumatic damage to neuromuscular junction, severe avulsion injuries of the distal nerve); however, the success and wide-range application of direct neurotization shows its potential to be implemented as an adjunct treatment in contrast to views that it should solely be used as a salvage therapy. The purpose of the following review is to detail the historic and current applications of direct neurotization and describe the future areas of investigation and development of this technique.

Background Botulinum toxin (BT), a potent neurotoxin, has been used in clinical medicine since the 1970s for cosmetic and therapeutic purposes. Studies have consistently shown positive outcomes with a very limited adverse effect profile and a conventional understanding that results dissipate after 3 to 5 months. However, more recent evidence suggests that changes in muscle composition, function, and appearance persist for much longer, even years. To examine the potential implications of these findings on cosmetic use of BT injections in reduction of skin lines and wrinkles, we first needed to further our understanding of the current literature on long-term outcomes after repeated BT injections. Methods A comprehensive review of the literature on long-term outcomes after repeated BT injections for cosmetic indications was performed. We evaluated the study designs, and results were compared. Results A total of 22 publications met our inclusion criteria, of which 14 were clinical trials. Few studies extended outcome measurement past 6 months postinjection, and many were funded or supported by industry. However, the studies that extended follow-up saw persistent changes after BT injection, in some cases as far as 4 years postinjection. Conclusion The current body of knowledge on the long-term results after repeated cosmetic BT injections is very limited, and the available literature provides insufficient evidence on how prolonged effects could alter clinical use of BT. Further clinical studies with extended follow-up periods with inclusion of both subjective and objective measured outcomes of appearance and muscle function are required to better understand the long-term impacts of repeated BT injections.

Since its first introduction by Martin and colleagues (1993) and with further revisions by Sterne et al (1996), the submental artery flap (SMAF) has proven to be an effective, reliable, safe, and valuable option in head, neck, and facial reconstructive surgeries. The SMAF utilizes a long pedicle based on the submental artery, a branch of the facial artery, which provides good reach to the lower two-thirds of the face with excellent cosmetic outcomes. It also maintains a good skin color match for facial and cervical defects with a mostly hidden donor site scar (in the majority of cases the donor site can be primarily closed after raising the flap). Although the use of the SMAF is associated with high patient and surgeon satisfaction along with low rates of complications, disadvantages including flap thickness and the hair-bearing nature of the submental skin, which may be problematic for coverage of orofacial defects, especially in male patients. Although it has been almost 30 years since its introduction, and the SMAF has been successfully used in over 500 reported cases of pediatric and adult patients, a comprehensive review of the different aspects of the SMAF is lacking in the medical literature.

According to the Center for Disease Control (CDC)’s yearly Behavioral Risk Factor Surveillance System (BRFSS) report, approximately 25 million individuals worldwide, including 1–1.4 million adults ...

Gender dysphoria refers to the medical condition experienced by individuals whose physical anatomy is not consistent with their gender identity. Surgery is a safe and effective treatment for many individuals, yet the current demand for surgery exceeds the number of trained surgeons. This article reviews gender-affirming surgical procedures and emphasizes an individualized approach within the context of a multidisciplinary team. We review pre-, intra-, and postoperative care including the preoperative requirements for surgery.

The temporoparietal fascial flap (TPFF) is a versatile tool that can be used in the reconstruction of head and neck and distal upper and lower extremity defects. The TPFF may be harvested as a pedicle or free flap as well as with the temporalis muscle and/or adjacent calvarial bone as a composite flap. As a free flap, the TPFF has been used as a joint gliding surface with coverage of nerves and tendons, for extremity soft tissue repair, for tracheal and pharyngeal coverage and for defects of the nose, scalp, and auricle. This article focuses on the use of the free TPFF in the pediatric population through systemic review of the medical literature. Current perspectives on the use of this flap and microsurgery in general in pediatric patients are addressed.

The global pandemic of coronavirus 2019, or COVID-19, has undeniably impacted all facets of healthcare, affecting both its function and provision. Due to the cessation of all non-emergent surgical cases in the USA and worldwide, the professional lives and practices of many physicians have been negatively affected. However, among different physicians and specifically plastic surgeons, cosmetic/aesthetic plastic surgeons have been disproportionately affected by the COVID-19 pandemic as the majority of their cases are semi-elective and elective. The ability to perform semi-elective and elective cases is dependent on state and local authorities’ regulations, and it is currently uncertain when the ban, if ever, will be completely lifted. Financial constraints on patients and their future inability to pay for these procedures due to the COVID-19-related economic recession are things to consider. Overall, the goal of this unprecedented time for cosmetic/aesthetic plastic surgeons is for their medical practices to survive, to conserve cash flow although income is low to none, and to maintain their personal finances. In this paper, the authors review the financial impacts of the current COVID-19 pandemic on the practices of cosmetic plastic surgeons in the USA and worldwide, along with some potential approaches to maintain their practices and financial livelihoods. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Since its first introduction, autologous fat grafting (AFG) has undergone multiple refinements and has become a common treatment option within plastic surgery. It is a safe, quick, economical, and minimally invasive method for volume augmentation and is finding its own indications in the pediatric craniofacial surgery patients. Because there is currently a paucity of literature regarding the use of AFG in the pediatric population compared with the adults, the authors performed a systematic review of the literature using PubMed, Cochrane Library databases, and the Journal of Plastic and Reconstructive Surgery using the terms of fat grafting/lipofilling, fat grafting, and craniofacial surgery to include articles that contained pediatric patients. While reviewing AFG in the pediatric craniofacial patients, indications, technique, and challenges were specifically evaluated and an algorithm of approach was proposed. In current practice, the choice of microvascular free flap versus AFG is one of the surgeon preferences on a case-by-case basis. With the low complication rate and ease of use, selection of AFG for the repair of soft tissue defects in pediatric craniofacial patients is increasing and may come to surpass use of traditional invasive methods such as free flaps. It should also be considered as a useful adjunct to other concurrent invasive procedures, that is, bony adjustments.

Nurses caring for patients who contract coronavirus disease 2019 (COVID-19) have experienced significant traumas in the form of increased workloads, negative patient outcomes, and less social support system access. Nurses should be provided with information regarding early detection, coping skills and treatment for anxiety, depression, post-traumatic stress syndrome (PTSS)/post-traumatic stress disorder (PTSD), and other mental health disorders. Early intervention is important as mental health disorders can cause dysfunction, internal suffering, and in the most extreme situations, lead to death if not properly cared for. Healthcare corporations should consider providing coverage for mental health treatment for employees who experience COVID-19 traumas. With the implementation of healthy coping skills and therapeutic intervention, nurses will be able to let go of the negative impacts that the COVID-19 pandemic has caused and reintegrate into their roles as caring and entrusted health care providers. The current paper evaluates the mental health disorders encountered by nurses in the COVID-19 era based on the current medical literature and aims to provide practical coping strategies.

The temporoparietal fascial flap (TPFF) is a versatile tool used in head and neck reconstructive surgeries as well as distal upper and lower extremity reconstructions. Depending on the anatomical location and characteristics of the recipient site soft tissue defects, harvesting techniques for TPFF retrieval may include elevation as a pedicle or a free flap, inclusion of the temporalis muscle and/or adjacent calvarial bone as a composite flap. The TPFF as a free flap is not only used for soft tissue coverage of various defects, and it can be used as a joint gliding surface with coverage of nerve and tendons after repair or trauma. This article includes a systematic search of the medical literature for indications, historical background, techniques, current perspective, and complications along with the pros and cons of the free TPFF compared with other potential reconstructive options.

Surgical treatment of trigger finger involves release of A1 pulley. Some authors have theorized that the loss of A1 pulley can lead to ulnar subluxation of flexor tendons, which can be prevented by release of A1 pulley radially, even in a nonrheumatoid hand. However, there is no evidence in literature to either support or oppose this hypothesis. Occasionally, difficulty is encountered to precisely identify where A1 ends and A2 begins. While incomplete release of A1 can cause relapse of triggering, release of substantial A2 can cause bowstringing. Knowledge of the safe limit of concomitant A2 release is beneficial. The study was conducted in 12 cadaver upper extremity specimens. A1 pulleys of 48 fingers were divided at the radial (24 fingers) or ulnar (24 fingers) attachment. A 20lb traction force was applied on the flexor tendons. Any subluxation or bowstringing was noted. The experiment was repeated following serial release of the A2—initially 25%, followed by 50% and 100%. No bowstringing or subluxation was noted when A1 pulley was opened, either by radial or ulnar incision. The same was true for A1 + 25% A2 release. When A1 + 50% A2 pulley were released, bowstringing was observed in 3/48 fingers. When A1 + 100% of the A2 pulley were released, bowstringing occurred in all cases. The location of incision for release of the A1 pulley has no effect on bowstringing or tendon subluxation. Release of additional 25% of the A2 pulley can be performed safely, which corresponds to the level of palmar digital crease.

Mesenchymal stromal cells (MSCs) have demonstrated extensive capacity to modulate a catabolic microenvironment toward tissue repair. The fate, biodistribution, and dwell time of the in vivo delivered MSCs largely depend on the choice of the cell delivery route. Intramuscular (IM) delivery of MSCs is clinically safe and has been used for the effective treatment of local pathologies. Recent findings have shown that the secretome of the IM-delivered MSCs enters the circulation and provides systemic effects on distant organs. In addition, muscle tissue provides a safe residence for the delivered MSCs and an extended secretorily active dwell time compared with other delivery routes. There are, however, controversies concerning the fate of MSCs post IM-delivery and, specifically, into an injured site with proinflammatory cues. This review seeks to provide a brief overview of the fate and efficacy of IM-delivered MSCs and to identify the gaps that require further assessment for adoption of this promising route in the treatment of systemic disease. Stem Cells Translational Medicine 2019;8:456–465

The Pfizer-BioNTech, Moderna, and Johnson & Johnson COVID-19 vaccinations have been approved under “Emergency Use Authorization” by the United States Food and Drug Administration (FDA). Other vaccines, such as the Sputnik V and AstraZeneca vaccines, have begun to be distributed in other nations around the world after the publication of promising efficacy results. Multiple more vaccine candidates are likely to follow, which will still require safety and efficacy testing. As vaccines have been distributed in a tiered fashion to the public, there has been discussion and disagreement regarding the matter of vaccination of placebo groups from the past or upcoming trials (1). It has been argued that only trial participants (placebo group) who would be otherwise offered the vaccine outside of the trial [i.e., high risk participants or healthcare workers (HCWs)] should be unblinded and given the vaccine, while all other participants should remain blinded (2, 3). We argue that, once proven efficacious, vaccine makers and researchers have an ethical obligation to unblind the placebo groups of COVID-19 vaccine trials and offer them vaccine, based on the four principles of medical ethics.

Objective Chronic spontaneous urticaria (CSU) is defined as urticaria with an unknown etiology which persists for more than 6 weeks. CSU is an uncomfortable cutaneous condition that occurs due to an immune-mediated inflammatory reaction. Many studies have demonstrated that vitamin D deficiency and single-nucleotide polymorphisms in the vitamin D receptor (VDR) impact the immune response. In the current study, the frequency of the Taq1 polymorphism in the VDR gene were compared between patients with CSU and individuals without CSU. Methods In a case–control study, a group of CSU patients (n = 100) was compared with a group of healthy age- and gender-matched individuals as a control group (n =100) who visited our center between 2015 and 2017. After DNA extraction from EDTA-containing blood, polymerase chain reaction (PCR–RFLP) was used to determine the presence of the Taq1 polymorphism. Serum vitamin D levels were measured using ELISA method (Abcam, Cambridge, USA). Results Genotyping for Taq1 polymorphism showed that TT, Tt and tt genes frequency in the CSU group were 36%, 54%, and 10% respectively. The TT, Tt and tt genotypes had a distribution of 50%, 47% and 3% respectively in the control group. The mean serum vitamin D level in the CSU group was 19.88 ± 8.14 ng/ml, which was not significantly correlated with the Taq1 polymorphism (P = 0.841). There was a significant relationship between Taq1 gene polymorphism (tt genotype) and CSU (P = 0.038). Tt genotype increased the risk of CSU (odds ratio = 1.596), and inheritance of tt genotype increased the risk even further (odds ratio = 4.630). Conclusion The frequency of Taq1 genotype polymorphism in the VDR gene was significantly higher in patients with CSU compared to the control group. The tt genotype polymorphism may be a risk factor for CSU.

With multiple COVID-19 vaccine candidates in development and the United States Food and Drug Administration (FDA) approval of three vaccines, widespread availability may only be months away. As vac...

Tweetable abstract As vaginoplasties become increasingly prevalent, it is imperative to develop efficient techniques to achieve adequate postoperative pain control. Currently available pain management methods following vaginoplasties are briefly discussed.

Penile inversion vaginoplasty helps to alleviate gender dysphoria and improve quality of life in many transgender individuals. Overall, the procedure is associated with high post-operative satisfaction, even when complications occur. Adverse events related to vaginoplasty are commensurate with other genitourinary reconstructive procedures performed for other diagnoses (i.e. cancer or congenital issues). Here, we explore the incidence of complications following vaginoplasty, emphasizing the challenges in defining and managing these adverse events. In addition, outcome measures to assess patient satisfaction will be reviewed.

“Drastic times call for drastic measures”—Hippocrates. The COVID-19 pandemic has had vast and lasting impacts on virtually every aspect of life. Without question, the sports world today looks very different than it looked a year ago. Professional sports leagues adapted to the pandemic by implementing bubbles and strict testing protocols (Dove et al., 2020), but college sports have been slower to adapt. All spring college athletes lost a full season of competition when National Collegiate Athletic Association (NCAA) leagues canceled sporting events in March 2020 and the same thing happened for some fall and winter athletes. With many gyms and other training facilities closed due to the regional lockdown regulations due to the pandemic around the country, it is difficult for college athletes to train on their own and be physically prepared for a collegiate season. More importantly, being separated from teammates has long term impacts on team culture and both mental and physical health. The question remains: how do college athletes stay connected with teammates and prepare for competitions despite being spread out across the country or even the world?

Genital reconstruction is performed for reconstruction of oncologic defects, traumatic injuries, congenital deformities, and gender-affirming surgery. There is an array of flap options, and the choice of flap is dependent upon the reconstructive requirements of the recipient site, as well as donor site tissue availability. Potential recipient vessels should be carefully considered when planning a free tissue transfer to the genital area. This chapter discusses the relevant anatomy, preoperative considerations, and recipient vessel exposure and harvest techniques. The advantages and disadvantages of these options are discussed, as are recommendations for optimizing operative outcomes.

The current COVID-19 pandemic has vastly impacted the health care system in the United States, and it is continuing to dictate its unprecedented influence on the education systems, especially the residency and fellowship training programs. The impact of COVID-19 on these training programs has not been uniform across the board, with plastic surgery residency and fellowship programs among the hardest hit specialties. Implementation of social distancing regulations has affected departmental educational activities, including preoperative, morbidity and mortality conferences and journal clubs; operating room educational activities; as well as the overall education of plastic surgery trainees in the United States. Almost all elective and semielective surgeries across the United States were suspended for a few months during the COVID-19 pandemic; this constitutes a significant portion of plastic surgery cases. Considering the current staged reopening policies, it may be a long time, if ever, before restrictions are completely lifted. In this paper, we review the multidimensional impact of the current COVID-19 pandemic on the training programs of plastic surgery residents and fellows in the United States and worldwide, along with some potential solutions on how to address existing challenges.

Since the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic, significant changes have occurred in the United States as the infection spread reached and passed its exponential phase. A stringent analysis of COVID-19 epidemiologic data requires time and would generally be expected to happen with significant delay after the exponential phase of the disease is over and when the focus of the health care system is diverted away from crisis management. Although much has been said about high-risk groups and the vulnerability of the elderly and patients with underlying comorbidities, the impact of race on the susceptibility of ethnic minorities living in indigent communities has not been discussed in detail worldwide and specifically in the United States. There are currently some data on disparities between African American and Caucasian populations for COVID-19 infection and mortality. While health care authorities are reorganizing resources and infrastructure to provide care for symptomatic COVID-19 patients, they should not shy away from protecting the general public as a whole and specifically the most vulnerable members of society, such as the elderly, ethnic minorities, and people with underlying comorbidities.

While free tissue transfer has long been established as a reliable microsurgical technique in the adult population, its application in pediatric reconstruction is a relatively recent phenomenon. Despite initial concerns regarding minute vessel diameters, increased propensity for vasospasm, and limited tissue availability, pediatric free tissue transfer is now a widely used technique that has demonstrated an acceptable level of donor and recipient site morbidity in children. Five flaps commonly used in the reconstruction of lower extremity trauma are discussed in this paper: the latissimus dorsi, rectus abdominis, anterolateral thigh, gracilis, and the subscapular and parascapular flaps. The indications, blood supply, advantages, and disadvantages of each are detailed. Incredible progress has been made in the application of microsurgical techniques to the pediatric population over the last several decades. With a healthy understanding of the anatomy and functionality of the donor site, the reconstructive surgeon can repair a variety of complex injuries with an acceptable morbidity and mortality rate.

In a recent viewpoint publication in the Journal of American Medical Association (JAMA), Onder, et al. provided insight into the coronavirus disease 2019 (COVID-19) outbreak in Italy along with an explanation of the Italian National Institute of Health (Istituto Superiore di Sanita [ISS]) surveillance system [1]. Onder calculated the overall attributed COVID-19 fatality rate of 7.2% in the Italian population, based on the data up to March 17th, 2020 (1625 deaths/22 512 cases) [1]. Onder and colleagues proposed the demographic characteristics of the Italian population (higher older age distribution in the population compared to some other nations) and the associated comorbidities, lack of clearly defined COVID-19 related deaths and the differences in calculation methods in Italy and internationally along with country-specific differences in testing strategies as possible explanations for the higher Italian case-fatality rate compared with some other nations (i.e. China) [1].

Lymphadenectomy or lymph node dissection (LND) includes systematic dissection and biopsy of the regional lymph nodes. While LND is planned for staging purposes, it could also help with local control and systemic control of the cancers (prevention of other organs getting involved). The importance of the lymph node evaluation and surgical excision in the management of the cancers cannot be overemphasized. Due to its widespread list of possible early or late complications, LND is generally considered as a morbid procedure. Introduction of the sentinel lymph node biopsy (SLNB) in the last few years has been a wise attempt aiming in prevention of unnecessary morbidities associated with LND in the patients and at the same time trying to gain invaluable cancer staging data and even help in the local and systemic control of the cancers. Some of the consequences of these procedures (mostly LND but to a lesser degree SLNB) may take more than a decade to develop. Since its introduction, SLNB has been modified to help us in identification of the primary lymphatic drainage for skin and soft tissue malignancies. SLNB is supposed to give us regional information on cancerous lymph node involvement while avoiding the morbidity of the LND. The current chapter reviews the principles of the LND in simple terms with an overview of the lymph nodes regional anatomy. We will also discuss necessary preoperative evaluations, indications and the value of LND in the patients with different skin cancers, and possible complications of SLNB and LND.

Some authors have claimed that the mortality rate estimations for coronavirus disease 2019 (COVID-19) which are based on the number of deaths relative to the number of confirmed cases of infection are not representative of the actual death rate. As a matter of fact, the current mortality rate estimates (specially for calculations performed during the exponential phase of the virus spread) are an underestimation of the potential mortality of the symptomatic COVID-19 patients. Here we discuss some pitfalls of Baud and colleague’s innovative suggestion to re-estimate the COVID-19 mortality rate by dividing the number of deaths on a given time by the number of confirmed symptomatic COVID-19 patients at an earlier time (time from onset of symptom to death).

Summary:. The COVID-19 pandemic limited the ability of medical students to participate in plastic surgery sub-internships and to attend residency interviews in person during the 2020–2021 match cycle. A podcast and accompanying online directory were created to introduce integrated plastic surgery residency programs to medical students from the perspective of current residents. Since July 2020, a total of 49 plastic surgery residents representing 42 programs have participated in the podcast. Topics of discussion included program logistics, faculty leadership, and aspects of resident lifestyle of interest to medical students and future residency candidates. The podcast has had a total of 5072 downloads (mean 121 downloads per episode). The majority of listeners (90%) were in the United States. Twenty-five plastic surgery applicants who participated in the 2020–2021 National Resident Matching Program match cycle responded to a feedback survey. Listeners reported that the podcast was useful for preparing for interviews, making rank lists, and learning about programs that they otherwise would not have considered. Most listeners (90%) ranked the podcast as one of their top three resources for learning about plastic surgery programs during the application and interview process. Future directions include completion of episodes for all integrated plastic surgery programs and expansion to other surgical subspecialties and plastic surgery fellowships.

Summary:. Edwardsiella tarda (ET), a Gram-negative bacterium, causes an extremely uncommon, yet highly aggressive, soft tissue infection. Although plastic surgeons are frequently involved in the primary care, debridement, and secondary reconstruction of difficult soft tissue infections, infections caused by ET have received scant attention in the plastic surgery literature, perhaps because of the rarity of occurrence. We present a case of a 58-year-old man with alcohol abuse and hepatitis C who developed an upper extremity soft tissue infection after a catfish injury, which rapidly deteriorated to cause multiorgan failure and death within 5 days of admission. We will discuss the management of this rare but potentially lethal infection as well as the review of the current literature.

After weeks of speculation, WHO finally announced a "pandemic level" for COVID-19 distribution We agree with Watkins, that "catch and isolate" policy is of outmost importance in the current stage but suggest focusing more seriously on preparation and "plan for the worst" part of his suggestions