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Background: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is quickly becoming a routine and effective means by which to treat degenerated bioprosthetic valves. A known complication of ViV-TAVI is patient-prosthesis mismatch, which substantially affects survival. Bioprosthetic valve fracture is a method by which to reduce the risk of patient-prosthesis mismatch and post–ViV-TAVI transvalvular gradients. This study sought to determine the safety and efficacy of post–ViV-TAVI bioprosthetic valve fracture. Methods: Patients with a history of surgical aortic valve replacement undergoing ViV-TAVI bioprosthetic valve fracture (N = 25) at the corresponding institution from 2015 to 2022 were cataloged for a retrospective analysis. The implanted transcatheter valves were Medtronic Evolut R, Evolut PRO, and Evolut PRO+. Gradients were assessed before and after implantation and after fracturing using transthoracic echocardiogram. Results: The mean left ventricular ejection fraction of patients who underwent fracturing was 55.04%. The average (SD) peak and mean (SD) transvalvular gradients before the intervention were 68.17 (19.09) mm Hg and 38.98 (14.37) mm Hg, respectively. After ViV-TAVI, the same gradients were reduced to 27.25 (12.27) mm Hg and 15.63 (6.47) mm Hg, respectively. After bioprosthetic valve fracture, the gradients further decreased to 17.59 (7.93) mm Hg and 8.860 (3.334) mm Hg, respectively. The average reduction in peak gradient associated with fracturing was 12.07 mm Hg (95% CI, 5.73-18.41 mm Hg; P = .001). The average reduction in mean gradient associated with valve fracturing was 6.97 mm Hg (95% CI, 3.99-9.74 mm Hg; P < .001). Conclusion: Bioprosthetic valve fracture is a viable option for reducing residual transvalvular gradients after ViV-TAVI and should be considered in patients with elevated gradients (>20 mm Hg) or with concern for patient-prosthesis mismatch in patients who have an unacceptable risk for a redo sternotomy and surgical aortic valve replacement.

Background:. With marijuana use on the rise, its influence on surgical outcomes, particularly for breast reduction, warrants investigation. This study aims to clarify marijuana’s effects on breast reduction surgery outcomes, given its limited research focus despite potential perioperative implications. Methods:. A retrospective review was conducted from 2016 to 2022 of patients with/without marijuana use undergoing breast reduction. Propensity score-matching considered age, body mass index, ptosis, and breast tissue mass. Patient demographics, clinical attributes, and postoperative details were analyzed. Quality-of-life (QoL) changes were gauged using pre- and postoperative BREAST-Q. Results:. Of 415 patients who underwent breast reduction, 140 patients documented marijuana use. After propensity matching, a total of 108 patients (54 marijuana users versus 54 nonusers) were analyzed. The average age was 39 years ± 12 and body mass index 30.1 kg/m2 ± 5.3. There were no differences between the 2 groups in comorbidities, breast symmetry, excision patterns, pedicle use, or drain count (P > 0.05). Furthermore, surgical outcomes including surgical site occurrences, scarring, pain levels, hypersensitivity, or sensation loss were comparable between the groups (P > 0.05). There were also no differences in number of readmissions, reoperations, or emergency department visits (P > 0.05). Both groups showed enhanced postoperative QoL, regardless of marijuana usage. Conclusions:. This study indicates that marijuana use does not significantly impact breast reduction surgery outcomes. Comparable surgical results and postoperative QoL improvements were observed in both marijuana users and nonusers. This study provides surgeons with the knowledge to offer more informed patient counseling regarding the implications of marijuana use in relation to breast reduction procedures.

Background:. Few dedicated, funded clinical research fellowship positions exist in plastic surgery. This study provides insights from an established clinical research fellowship, highlighting its educational impact and confirming the impact of positive institutional support and a collaborative-first approach. Methods:. All research fellows within the program from 2008 to 2020 were examined during their year of employment and subsequent 2 years. Internal and external collaboration trends were assessed using PubMed affiliations. Correlation between external collaborations and research impact were examined. Research impact was characterized by publication count, journal impact factor, and journal diversity. Results:. Thirty-one research fellows were identified, with a 100% match rate. Four phases of development were identified, and a three-period cycle of productivity was noted to occur every 3 years. A shift toward more external collaborations occurred after 2016 (P = 0.008). A positive correlation was observed between external collaborations and academic output (r = 0.72, P = 0.004), journal diversity (r = 0.74, P = 0.004), and journal impact (r = 0.63, P < 0.05). Significant growth was observed in the collaborative networks (P = 0.002), publications (P = 0.003), journal diversity (P < 0.001), and research personnel (P = 0.002). Conclusions:. As a result of our strategic decision to engage collaborators across multiple disciplines, there is discernible improvement in measurable impact, contributing to the growth of our program. Dedicating resources to foster deeper collaborations can enrich the field of plastic surgery research, recognizing that this investment fuels the cycle of productivity, offering promising returns to the future.

Background:. Studies comparing carpal tunnel release with ultrasound guidance (CTR-US) to mini-open CTR (mOCTR) are limited. This randomized trial compared the efficacy and safety of these techniques. Methods:. In this multicenter randomized trial, patients were randomized (2:1) to unilateral CTR-US or mOCTR. Outcomes included Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), numeric pain scale (0–10), EuroQoL-5 Dimension 5-Level (EQ-5D-5L), scar outcomes, and complications over 1 year. Results:. Patients received CTR-US (n = 94) via wrist incision (mean 6 mm) or mOCTR (n = 28) via palmar incision (mean 22 mm). Comparing CTR-US with mOCTR, the mean changes in BCTQ-SSS (−1.8 versus -1.8; P = 0.96), BCTQ-FSS (−1.0 versus −1.0; P = 0.75), numeric pain scale (−3.9 versus −3.8; P = 0.74), and EQ-5D-5L (0.13 versus 0.12; P = 0.79) over 1 year were comparable between groups. Freedom from scar sensitivity or pain favored CTR-US (95% versus 74%; P = 0.005). Complications occurred in 2.1% versus 3.6% of patients (P = 0.55), all within 3 weeks postprocedure. There was one revision surgery in the CTR-US group, and no revisions for persistent or recurrent symptoms in either group. Conclusions:. CTR-US and mOCTR demonstrated similar improvement in carpal tunnel syndrome symptoms and quality of life with comparable low complication rates over 1 year of follow-up. CTR-US was performed with a smaller incision and associated with less scar discomfort.

Background:. Dermal scaffolds have created a paradigm shift for burn and wound management by providing improved healing and less scarring, while improving cosmesis and functionality. Dermal regeneration template (DRT) is a bilayer membrane for dermal regeneration developed by Yannas and Burke in the 1980s. The aim of this review is to summarize clinical evidence for dermal scaffolds focusing on DRT for the management and reconstruction of burn injuries and complex wounds. Methods:. A comprehensive search of PubMed was performed from the start of indexing through November 2022. Articles reporting on DRT use in patients with burns, limb salvage, and wound reconstruction were included with focus on high-level clinical evidence. Results:. DRT has become an established alternative option for the treatment of full-thickness and deep partial-thickness burns, with improved outcomes in areas where cosmesis and functionality are important. In the management of diabetic foot ulcers, use of DRT is associated with high rates of complete wound healing with a low risk of adverse outcomes. DRT has been successfully used in traumatic and surgical wounds, showing particular benefit in deep wounds and in the reconstruction of numerous anatomical sites. Conclusions:. Considerable clinical experience has accrued with the use of DRT beyond its original application for thermal injury. A growing body of evidence from clinical studies reports the successful use of DRT to improve clinical outcomes and quality of life across clinical indications at a number of anatomical sites.

Purpose: Technological progress of machine learning and natural language processing has led to the development of large language models (LLMs), capable of producing well-formed text responses and providing natural language access to knowledge. Modern conversational LLMs such as ChatGPT have shown remarkable capabilities across a variety of fields, including medicine. These models may assess even highly specialized medical knowledge within specific disciplines, such as radiation therapy. We conducted an exploratory study to examine the capabilities of ChatGPT to answer questions in radiation therapy. Methods and Materials: A set of multiple-choice questions about clinical, physics, and biology general knowledge in radiation oncology as well as a set of open-ended questions were created. These were given as prompts to the LLM ChatGPT, and the answers were collected and analyzed. For the multiple-choice questions, it was checked how many of the answers of the model could be clearly assigned to one of the allowed multiple-choice-answers, and the proportion of correct answers was determined. For the open-ended questions, independent blinded radiation oncologists evaluated the quality of the answers regarding correctness and usefulness on a 5-point Likert scale. Furthermore, the evaluators were asked to provide suggestions for improving the quality of the answers. Results: For 70 multiple-choice questions, ChatGPT gave valid answers in 66 cases (94.3%). In 60.61% of the valid answers, the selected answer was correct (50.0% of clinical questions, 78.6% of physics questions, and 58.3% of biology questions). For 25 open-ended questions, 12 answers of ChatGPT were considered as “acceptable,” “good,” or “very good” regarding both correctness and helpfulness by all 6 participating radiation oncologists. Overall, the answers were considered “very good” in 29.3% and 28%, “good” in 28% and 29.3%, “acceptable” in 19.3% and 19.3%, “bad” in 9.3% and 9.3%, and “very bad” in 14% and 14% regarding correctness/helpfulness. Conclusions: Modern conversational LLMs such as ChatGPT can provide satisfying answers to many relevant questions in radiation therapy. As they still fall short of consistently providing correct information, it is problematic to use them for obtaining medical information. As LLMs will further improve in the future, they are expected to have an increasing impact not only on general society, but also on clinical practice, including radiation oncology.

Peliosis hepatis remains a rare focal liver lesion with inconclusive imaging features. The unknown pathogenesis represents a wide possible range of etiologies including the breakdown of the sinusoidal borders, a potential hepatic outflow obstruction or dilatation of the central vein of a hepatic lobule. In histopathology, a blood-filled cystlike appearance with sinusoidal dilatation was reported. On ultrasound, B-mode features are not specific demonstrating a irregular, moreover hypoechogenic focal liver lesions. Postcontrast imaging features on Contrast-Enhanced-Ultrasound may mimic a malignant lesion with irregular contrast inflow and washout during late phase. Our case demonstrates a peliosis hepatis with malignant image features on contrast-enhanced ultrasound, ruled out by PET-CT and core needle biopsy with corresponding histopathological workup.

Background:. Despite efforts to promote gender equity in medicine, gender disparities persist in various medical specialties, including plastic surgery. This study aimed to investigate the representation of female physicians in leadership positions in German plastic surgery departments. Methods:. This cross-sectional study collected data about the physician workforce in the German plastic surgery field. The primary outcome was the proportion of female physicians in plastic surgery departments. Data were collected from 94 departments. The physician workforce was stratified based on gender and leadership. Results:. We included 812 physicians working in different German plastic surgery departments. Of those, 76.8% were in leadership positions, and 35.1% were women. There was a significant association between being male sex and holding a leadership position (n = 158/188, 84% versus n = 30/188, 16%, P

Summary: Background: Recurrent graft fibrosis after liver transplantation can threaten both graft and patient survival. Therefore, early detection of fibrosis is essential to avoid disease progression and the need for retransplantation. Non-invasive blood-based biomarkers of fibrosis are limited by moderate accuracy and high cost. We aimed to evaluate the accuracy of machine learning algorithms in detecting graft fibrosis using longitudinal clinical and laboratory data. Methods: In this retrospective, longitudinal study, we trained machine learning algorithms, including our novel weighted long short-term memory (LSTM) model, to predict the risk of significant fibrosis using follow-up data from 1893 adults who had a liver transplantation between Feb 1, 1987, and Dec 30, 2019, with at least one liver biopsy post transplantation. Liver biopsy samples with indefinitive fibrosis stage and those from patients with multiple transplantations were excluded. Longitudinal clinical variables were collected from transplantation to the date of last available liver biopsy. Deep learning models were trained on 70% of the patients as the training set and 30% of the patients as the test set. The algorithms were also separately tested on longitudinal data from patients in a subgroup of patients (n=149) who had transient elastography within 1 year before or after the date of liver biopsy. Weighted LSTM model performance for diagnosing significant fibrosis was compared against LSTM, other deep learning models (recurrent neural network and temporal convolutional network), and machine learning models (Random Forest, Support vector machines, Logistic regression, Lasso regression, and Ridge regression) and aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), and transient elastography. Findings: 1893 people who had a liver transplantation (1261 [67%] men and 632 [33%] women) with at least one liver biopsy between Jan 1, 1992, and June 30, 2020, were included in the study (591 [31%] cases and 1302 [69%] controls). The median age at liver transplantation was 53·7 years (IQR 47·3–59·0) for cases and 55·3 years (48·0 to 61·2) for controls. The median time interval between transplant and liver biopsy was 21 months (5 to 71). The weighted LSTM model (area under the curve 0·798 [95% CI 0·790 to 0·810]) consistently outperformed other methods, including unweighted LSTM (0·761 [0·750 to 0·769]; p=0·031) Recurrent Neural Network (0·736 [0·721 to 0·744]), Temporal Convolutional Networks (0·700 [0·662 to 0·747], and Random Forest 0·679 [0·652 to 0·707]), FIB-4 (0·650 [0·636 to 0·663]) and APRI (0·682 [0·671 to 0·694]) when diagnosing F2 or worse stage fibrosis. In a subgroup of patients with transient elastography results, weighted LSTM was not significantly better at detecting fibrosis (≥F2; 0·705 [0·687 to 0·724]) than transient elastography (0·685 [0·662 to 0·704]). The top ten variables predictive for significant fibrosis were recipient age, primary indication for transplantation, donor age, and longitudinal data for creatinine, alanine aminotransferase, aspartate aminotransferase, total bilirubin, platelets, white blood cell count, and weight. Interpretation: Deep learning algorithms, particularly weighted LSTM, outperform other routinely used non-invasive modalities and could help with the earlier diagnosis of graft fibrosis using longitudinal clinical and laboratory variables. The list of most important predictive variables for the development of fibrosis will enable clinicians to modify their management accordingly to prevent onset of graft cirrhosis. Funding: Canadian Institute of Health Research, American Society of Transplantation, Toronto General and Western Hospital Foundation, and Paladin Labs.

Background:. This study aimed to analyze the association between completion of research training and career success in American plastic surgery faculty to aid trainees in their decisions to perform research fellowships. Methods:. A cross-sectional analysis of attending academic plastic surgeons in the United States was conducted. Outcomes were compared between faculty who completed research training (research fellowship, PhD, or MPH) and those who did not. Outcomes included promotion to full professor and/or department chair, h-index, and attainment of National Institutes of Health funding. Outcomes were analyzed using chi-squared tests, t tests, and multivariable regressions. Results:. A total of 949 plastic surgery faculty members were included, and of those, 185 (19.5%) completed dedicated research training, including 13.7% (n = 130) who completed a research fellowship. Surgeons who completed dedicated research training were significantly more likely to achieve full professorship (31.4% versus 24.1%, P = 0.01), obtain National Institutes of Health funding (18.4% versus 6.5%, P < 0.001), and have a higher mean h-index (15.6 versus 11.6, P < 0.001). Dedicated research fellowships were independently predictive of achieving full professorship (OR = 2.12, P = 0.002), increased h-index (β = 4.86, P < 0.001), and attainment of National Institutes of Health funding (OR = 5.06, P = 0.01). Completion of dedicated research training did not predict an increased likelihood of becoming department chair. Conclusion:. The performance of dedicated research training was predictive of improved markers of career success in plastic surgery and should be considered beneficial in both the short and long term.

Obesity and lower-extremity arthritis are challenging problems to address as they are often mutually exacerbating. Due to the known perioperative risk of morbid obesity, the modality and timing of weight loss prior to arthroplasty is debated. We present a case of a 55-year-old nonambulatory female patient with an initial body mass index of 80.3 kg/m2. This individual underwent a staged bariatric and joint replacement surgical pathway employing personnel of differing treatment disciplines. Our patient successfully lost a substantial amount of weight and has been able to ambulate, exercise, and engage in new, strenuous physical activities. In the care of the nonambulatory bariatric patient, employing a multidisciplinary treatment plan can produce successful results.

Cryopreserved vein allografts are used as alternative conduits for infrainguinal bypass but are prone to aneurysmal degeneration. A 60-year-old man presented with a pulsatile, tender right groin mass 2 years after thrombosis of a cryopreserved vein jump graft emanating from a prosthetic axillary to profunda bypass. Intraoperatively, the aneurysm was consistent with isolated dilatation of the hood of the thrombosed cryopreserved vein graft. This was excised and repaired with bovine pericardial patch angioplasty. The patient recovered with no recurrence for 2 years. Aneurysmal degeneration of the cryopreserved vein allograft can occur even after graft thrombosis.

A 60-year-old man presented with chest pain and acute limb ischemia of the right leg. He was found to have a type B aortic dissection with a flap occluding the origin of the right common iliac artery. The dissection flap was fenestrated endovascularly with the placement of a covered stent in the right common iliac artery. After 10 years, the dissection remains stable with a minimal increase in the aorta size. The stent is patent with no lower extremity symptoms or reintervention. Fenestration and stenting of the obstructing flap can be a durable reperfusion strategy for patients with aortic dissection presenting with acute limb ischemia.

Lower urinary tract symptomatology is often difficult to categorize if history and investigation focus only on the urinary tract. Disease and dysfunction in organs more posteriorly can often cause or influence such bladder and urethral symptoms. Vulvovaginal skin diseases are an important but often missed influence on lower urinary tract symptomatology.

Background:. The introduction of mesh for reinforcement of ventral hernia repair (VHR) led to a significant reduction in hernia recurrence rates. However, it remains controversial whether synthetic or biologic mesh leads to superior outcomes. Recently, hybrid mesh consisting of reinforced biosynthetic ovine rumen (RBOR) has been developed and aims to combine the advantages of biologic and synthetic mesh; however, outcomes after VHR with RBOR have not yet been compared with the standard of care. Methods:. We performed a retrospective analysis on 109 patients, who underwent VHR with RBOR (n = 50) or synthetic polypropylene mesh (n = 59). Demographic characteristics, comorbidities, postoperative complications, and recurrence rates were analyzed and compared between the groups. Multivariate logistic regression models were fit to assess associations of mesh type with overall complications and surgical site occurrence (SSO). Results:. Patients who underwent VHR with RBOR were older (mean age 63.7 versus 58.8 years, P = 0.02) and had a higher rate of renal disease (28.0 versus 10.2%, P = 0.01) compared with patients with synthetic mesh. Despite an unfavorable risk profile, patients with RBOR had lower rates of SSO (16.0 versus 30.5%, P = 0.12) and similar hernia recurrence rates (4.0 versus 6.78%, P = 0.68) compared with patients with synthetic mesh. The use of synthetic mesh was significantly associated with higher odds for overall complications (3.78, P < 0.05) and SSO (3.87, P < 0.05). Conclusion:. Compared with synthetic polypropylene mesh, the use of RBOR for VHR mitigates SSO while maintaining low hernia recurrence rates at 30-month follow-up.

Antimicrobial stewardship programs seek to improve patient outcomes, reduce cost, and hinder development of antimicrobial resistance. Collection of inpatient antimicrobial use data is foundational to these programs, and decisions to initiate and discontinue antibiotics are potentially amenable to improvement. In order to better understand our current practices and with a view toward improved antimicrobial stewardship, we reviewed charts of previously healthy children to age 16 years hospitalized with fever (without an evident localized source) and/or other findings suggestive of serious bacterial infection. Of 105 patients (18% 0-2 months of age, 42% 3-12 months, 25% 2-5 years), 100 (95%) received antibiotics, 72% for more than 2 days. Of 98 patients with negative body fluid cultures, 23 received antibiotics for 2 days or less, and 70 received antimicrobial therapy for more than 2 days. Focusing on selective initiation and earlier discontinuation of antimicrobial therapy in hospitalized children might reduce unnecessary antibiotic use.

Background: There is evidence that specific variants of scapular morphology are associated with dynamic and static posterior shoulder instability. To this date, observations regarding glenoid and/or acromial variants were analyzed independently, with two-dimensional imaging or without comparison with a healthy control group. Therefore, the purpose of this study was to analyze and describe the three-dimensional (3D) shape of the scapula in healthy and in shoulders with static or dynamic posterior instability using 3D surface models and 3D measurement methods. Methods: In this study, 30 patients with unidirectional posterior instability and 20 patients with static posterior humeral head subluxation (static posterior instability, Walch B1) were analyzed. Both cohorts were compared with a control group of 40 patients with stable, centered shoulders and without any clinical symptoms. 3D surface models were obtained through segmentation of computed tomography images and 3D measurements were performed for glenoid (version and inclination) and acromion (tilt, coverage, height). Results: Overall, the scapulae of patients with dynamic and static instability differed only marginally among themselves. Compared with the control group, the glenoid was 2.5° (P = .032), respectively, 5.7° (P = .001) more retroverted and 2.9° (P = .025), respectively, 3.7° (P = .014) more downward tilted in dynamic, respectively, static instability. The acromial roof of dynamic instability was significantly higher and on average 6.2° (P = .007) less posterior covering with an increased posterior acromial height of +4.8mm (P = .001). The acromial roof of static instability was on average 4.8° (P = .041) more externally rotated (axial tilt), 7.3° (P = .004) flatter (sagittal tilt), 8.3° (P = .001) less posterior covered with an increased posterior acromial height of +5.8 mm (0.001). Conclusion: The scapula of shoulders with dynamic and static posterior instability is characterized by an increased glenoid retroversion and an acromion that is shorter posterolaterally, higher, and more horizontal in the sagittal plane. All these deviations from the normal scapula values were more pronounced in static posterior instability.

Background:. The present study assesses training characteristics, scholastic achievements, and traditional career accomplishments of ethnically underrepresented in medicine (UIM) plastic and reconstructive surgery (PRS) faculty relative to non-UIM PRS faculty. Method:. A cross-sectional analysis of core PRS faculty appointed to accredited United States residency training programs (n = 99) was performed. Results:. Of the 949 US PRS faculty, a total of 51 (5.4%) were identified as UIM. Compared with non-UIM faculty, there were few differences when evaluating medical education, residency training, pursuit of advanced degrees, and attainment of subspecialty fellowship training. UIM faculty were more likely than non-UIM faculty to have graduated from a medical school outside the United States (25% versus 13%, P = 0.014). In addition, UIM faculty did not differ from non-UIM counterparts in traditional career accomplishments, including promotion to full professor, obtaining NIH funding, serving as program director, receiving an endowed professorship, appointment to a peer-reviewed editorial board, scholarly contributions (H-index and number of publications), and appointment to chief/chair of their division/department. Conclusions:. The historical lack of ethnic diversity that comprise US academic PRS faculty persists. This study reveals that those UIM faculty who are able to obtain faculty appointments are equally successful in achieving scholastic success and traditional career accomplishments as their non-UIM counterparts. As we strive toward increasing representation of UIM physicians in academic plastic surgery, the field will benefit from efforts that promote a pipeline for underrepresented groups who traditionally face barriers to entry.

Background:. Successful strategies to improve the representation of female and ethnically underrepresented in medicine (UIM) physicians among US plastic and reconstructive surgery (PRS) faculty have not been adequately explored. Accordingly, we aimed to identify programs that have had success, and in parallel gather PRS program directors’ and chiefs/chairs’ perspectives on diversity recruitment intentionality and strategies. Methods:. We conducted a cross-sectional analysis of the demographic composition of female and UIM faculty of PRS residency training programs. Separate lists of programs in the top quartile for female and UIM faculty representation were collated. Additionally, a 14-question survey was administered to program directors and chiefs/chairs of all 99 Accreditation Council for Graduate Medical Education-accredited PRS residency programs. The questions comprised three domains: (1) demographic information; (2) perceptions about diversity; and (3) recruitment strategies utilized to diversify faculty. Results:. Female and UIM faculty representation ranged from 0% to 63% and 0% to 50%, respectively. Survey responses were received from program directors and chiefs/chairs of 55 institutions (55% response rate). Twenty-five (43%) respondents felt their program was diverse. Fifty-one (80%) respondents felt diversity was important to the composition of PRS faculty. Active recruitment of diverse faculty and the implementation of a diversity, equity, and inclusion committee were among the most frequently cited strategies to establish a culturally sensitive and inclusive environment. Conclusions:. These findings reveal that female and UIM representation among US PRS faculty remains insufficient; however, some programs have had success through deliberate and intentional implementation of diversity, equity, and inclusion strategies.

Background:. Lack of female and ethnically underrepresented in medicine (UIM) surgeons remains concerning in academic plastic surgery. One barrier to inclusion may be unequal opportunity to publish research. This study evaluates the extent of this challenge for plastic surgery trainees and identifies potential solutions. Methods:. Data were collected on academic plastic surgeons' research productivity during training. Bivariate analysis compared publication measures between genders and race/ethnicities at different training stages (pre-residency/residency/clinical fellowship). Multivariate analysis determined training experiences independently associated with increased research productivity. Results:. Overall, women had fewer total publications than men during training (8.89 versus 12.46, P = 0.0394). Total publications were similar between genders before and during residency (P > 0.05 for both) but lower for women during fellowship (1.32 versus 2.48, P = 0.0042). Women had a similar number of first-author publications during training (3.97 versus 5.24, P = 0.1030) but fewer middle-author publications (4.70 versus 6.81, P = 0.0405). UIM and non-UIM individuals had similar productivity at all training stages and authorship positions (P > 0.05 for all). Research fellowship completion was associated with increased total, first-, and middle-author training publications (P < 0.001 for all). Conclusions:. Less research productivity for female plastic surgery trainees may reflect a disparity in opportunity to publish. Fewer middle-author publications could indicate challenges with network-building in a predominately male field. Despite comparable research productivity during training relative to non- UIM individuals, UIM individuals remain underrepresented in academic plastic surgery. Creating research fellowships for targeting underrepresented groups could help overcome these challenges.

Recanalization of a splenic artery aneurysm owing to incomplete transcatheter coil embolization is uncommon. In addition to the challenges of inherent vessel tortuosity, reintervention via catheterization of the main splenic artery presents unique difficulties in navigating across potentially obstructive preexisting coils. We describe here the application of a low-profile microembolization platform, most commonly used in neurovascular interventions, in the treatment of a tortuous, expanding splenic artery aneurysm that had previously undergone failed coil embolization.

Background: Patients who present at night following penetrating abdominal trauma are thought to have more severe injuries and increased risk for morbidity and mortality. The current literature is at odds regarding this belief. The purpose of this study was to evaluate time of day on outcomes following laparotomy for penetrating abdominal trauma. Methods: Patients undergoing laparotomy following penetrating abdominal trauma over a 12-month period at a level I trauma center were stratified by age, sex, severity of shock, injury, operative complexity, and time of day (DAY = 0700–1900, NIGHT = 1901–0659). Outcomes of damage control laparotomy, ventilator days, intensive care unit length of stay, hospital length of stay, morbidity, and mortality were compared between DAY and NIGHT. Results: A total of 210 patients were identified: 145 (69%) comprised NIGHT, and 65 (31%) comprised DAY. Overall mortality was 2.9%. Both injury severity and intraoperative transfusions were increased with NIGHT with no difference in morbidity (37% vs 40%, P = 0.63) or mortality (2.1% vs 4.6%, P = 0.31). Adjusting for sex, time of day, injury severity, and operative complexity, only abdominal abbreviated injury severity (odds ratio 1.46; 95% confidence interval 1.07–1.99, P = .019) and operative transfusions (odds ratio 1.18; 95% confidence interval 1.09–1.28, P

This article aims to give a brief outline of the pathogenesis and transmission of SARS-CoV-2 and how to safely navigate an arthroplasty practice during and after the pandemic.

Background: There is a need for improvement in informed medical consent to address the lack of standardization and to increase patient engagement. Objective: To investigate the use of a video to aid informed consent for Mohs micrographic surgery and evaluate patient understanding, satisfaction, anxiety, and time savings relative to verbal consent. Methods: A 2-armed randomized controlled trial involving 102 patients compared video-assisted consent with a control group who underwent consent in the standard verbal manner. All participants underwent questionnaire-based testing of knowledge, satisfaction, and anxiety, and the time of each consultation was measured. Results: Patients who watched the video performed significantly better in the knowledge questionnaire compared with the control group (P = .02), were more satisfied with their understanding of the risks of Mohs micrographic surgery (P = .013), and spent less time with their physician (P = .008). Additionally, 78.4% of video group patients reported that they preferred seeing the video before speaking with their physician. Limitations: The study design may not replicate day-to-day clinical practice. Conclusion: Video-assisted consent for Mohs micrographic surgery improves patient knowledge, leads to a better understanding of the risks, and saves physicians time without compromising patient satisfaction and anxiety levels in this study setting.

Background:. The use of biologic mesh to reinforce the abdominal wall in ventral hernia repair has been proposed as a viable alternative to synthetic mesh, particularly for high-risk patients and in contaminated settings. However, a comparison of clinical outcomes between the currently available biologic mesh types has yet to be performed. Methods:. We performed a retrospective analysis of 141 patients who had undergone ventral hernia repair with biologic mesh, including noncross-linked porcine ADM (NC-PADM) (n = 51), cross-linked porcine ADM (C-PADM) (n = 17), reinforced biologic ovine rumen (RBOR) (n = 36), and bovine ADM (BADM) (n = 37) at the Stanford University Medical Center between 2002 and 2020. Postoperative donor site complications and rates of hernia recurrence were compared between patients with different biologic mesh types. Results:. Abdominal complications occurred in 47.1% of patients with NC-PADM, 52.9% of patients with C-PADM, 16.7% of patients with RBOR, and 43.2% of patients with BADM (P = 0.015). Relative risk for overall complications was higher in patients who had received NC-PADM (RR = 2.64, P = 0.0182), C-PADM (RR = 3.19, P = 0.0127), and BADM (RR = 2.11, P = 0.0773) compared with those who had received RBOR. Furthermore, relative risk for hernia recurrence was also higher in all other mesh types compared with RBOR. Conclusion:. Our data indicate that RBOR decreases abdominal complications and recurrence rates after ventral hernia repair compared with NC-PADM, C-PADM, and BADM.

Summary:. Randomized controlled trials, though considered the gold standard in clinical research, are often not feasible in plastic surgery research. Instead, researchers rely heavily on observational studies, leading to potential issues with confounding and selection bias. Propensity scoring—a statistical technique that estimates a patient’s likelihood of having received the exposure of interest—can improve the comparability of study groups by either guiding the selection of study participants or generating a covariate that can be adjusted for in multivariate analyses. In this study, we conducted a comprehensive review of research articles published in three major plastic surgery journals (Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive, & Aesthetic Surgery, and Annals of Plastic Surgery) to determine the utilization of propensity scoring methods in plastic surgery research from August 2018 to August 2020. We found that propensity scoring was used in only eight (0.8%) of 971 research articles, none of which fully reported all components of their propensity scoring methodology. We provide a brief overview of propensity score techniques and recommend guidelines for accurate reporting of propensity scoring methods for plastic surgery research. Improved understanding of propensity scoring may encourage plastic surgery researchers to incorporate the method in their own work and improve plastic surgeons’ ability to understand and analyze future research studies that utilize propensity score methods.