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While the novel Coronavirus 2019 disease’s (COVID-19) impact on the practice of orthopaedics has been readily apparent, the effects of COVID-19 on the orthopaedic literature has not been studied. The objective of this paper is to analyze the COVID-19 pandemic’s impact on peer-reviewed articles published in the orthopaedic surgery literature. Using the Journal Citation Reports, twenty orthopaedic surgery journals with the highest impact factor in 2019 were selected and articles within those journals were sorted by mention of COVID-19. The Altmetric Attention Score (AAS) and citation count were collected and compared for COVID-19 versus non-COVID-19 related articles using the Mann-Whitney U test. Furthermore, within COVID-19 related articles, AAS and citation count were compared using Kruskal-Wallis test between sub specialty of orthopaedics, type of article, study type, and quarter of publication. The average AAS of COVID-19 articles was significantly higher than non-COVID articles (15 vs. 6, p=0.019). Within COVID-19 articles, those pertaining to spine and trauma had a significantly lower AAS than those pertaining to orthopaedics as a whole (20 & 6 vs 51, p Orthopaedic articles related to COVID-19 demonstrated a greater influence, dissemination, and impact than articles not related to COVID-19 as demonstrated by AAS and citations accrued.

Purpose: Early onset of minor suture fusion in syndromic craniosynostosis is associated with midface dysplasia and is a common indication for craniofacial surgery. However, the potential effects of fusion severity on craniofacial growth patterns are not well understood. This study seeks to describe the impact of minor suture fusion severity on midface morphology in Crouzon syndrome. Methods: Pre-operative computed tomography images (CT) of 63 patients with Crouzon syndrome and 63 normocepahlic controls were included. Degree of suture fusion was assessed for the frontosphenoidal, sphenethmoidal, sphenosquamosal, sphenopetrosal, spheno-occipital synchondrosis, frontoethmoidal, and zygomaticosphenoidal sutures. Each suture was graded on a 5-point scale. The sella (S), nasion (N), A point (A), basion (BA), and anterior nasal spine (ANS) landmarks were used to calculate the SNA angle, BA-ANS length of the lower midface, and N-S length of the upper midface. Multiple linear regressions were used to analyze data. Results: The mean age was 43 months and 44% were female. The control group was significantly older ( P Conclusion: The severity of sheno-occipital synchondrosis fusion in Crouzon syndrome contributes to midface hypoplasia. Similarly, all anterior skull base sutures limited lower midface growth to a greater degree than the upper midface.

Background: Cephalic index (CI) is an objective measure of head shape used by craniofacial surgeons to support a diagnosis of head shape abnormality. However, the consensus on what values correspond to a normal head shape are changing following the Back to Sleep campaign. Recent work has shown an increase in mean CI from 74 to 84. Following this shift, no study has been undertaken to evaluate whether the perception of normal head shape has changed as well. Methods: About 1020 subjects, 18 or older, were recruited through Amazon Turk crowdsourcing platform. Subjects were asked to select the head shapes they considered most normal in a series of questions identifying ideal head shape in children 6 months or younger. Demographic information was recorded for study participants to identify differing ethnic perceptions of head shape. Results: The mean cephalic index preferred by a crowdsourced population was 81.84 (SD 2.48). There was a difference in mean preferred CI between people who identified as black (CI = 82.875) and people who identified as white (CI = 81.500; P = .00062). There was no difference in mean preferred CI between males and females. Education level, age healthcare occupation status, medical literacy, and work involving children did not affect preference. Conclusions: The typical head shape has changed following the Back to Sleep campaign and the current perception of head shape aligns with the newly described norm as opposed to the historic population data. Criteria for intervention and outcome goals should be adjusted accordingly.

Forty percent of physicians anticipate becoming parents during residency. This often occurs in the absence of clear parental leave and breastfeeding policies, which may adversely impact parental and child health or jeopardize residents' board eligibility, fellowship, and job prospects. This study reports on the current status of parental leave and breastfeeding policies across all specialties.Twenty-six specialties recognized by the Accreditation Council for Graduate Medical Education were included. The maximum leave allowed in 2020 and breastfeeding accommodations during board examinations were collected for each specialty. Change in leave since 2006, 2018, and breastfeeding accommodations were analyzed by specialty.In 2020, the median time allowed for parental leave without the extension of training was 5 weeks, and there was no significant difference between 2006, 2018, and 2020 ( p = 0.58). In 2020, plastic surgery and obstetrics/gynecology provided the longest parental leave at 12 weeks. Surgical specialties provided 1 additional week of leave as compared to medical specialties after adjusting for year ( p = 0.02). Twenty-one specialties (81 percent) allowed additional time for lactation during board examinations; however, only seven (27 percent) guaranteed a private location to pump.There has been little improvement in parental leave allowances since 2006, and the current median, 5 weeks, falls short of guidelines recommending 6 to 12 weeks following the birth of a child. Starting in July of 2021, the Accreditation Council for Graduate Medical Education will require medical boards to provide a minimum of 6 weeks of leave. Ongoing improvement in culture and policy are needed to support residents and their families.

The coronavirus disease-19 (COVID-19) pandemic dramatically changed the delivery of breast cancer care. The objective of this study was to quantify the effect of the pandemic on breast cancer screening, treatment, and reconstruction at a single institution in New York City.A retrospective chart review was conducted to determine the number of mammograms, lumpectomies, mastectomies, and breast reconstruction operations performed between January 1, 2019 and June 30, 2021. Outcomes analyzed included changes in mammography, oncologic surgery, and breast reconstruction surgery volume before, during and after the start of the pandemic.Mammography volume declined by 11% in March-May of 2020. Oncologic breast surgeries and reconstructive surgeries similarly declined by 6.8% and 11%, respectively, in 2020 compared with 2019, reaching their lowest levels in April 2020. The volume of all procedures increased during the summer of 2020. Mammography volumes in June and July 2020 were found to be at pre-COVID levels, and in October-December 2020 were 15% higher than in 2019. Oncologic breast surgeries saw a similar rebound in May 2020, with 24.6% more cases performed compared with May 2019. Breast reconstruction volumes increased, though changes in the types of reconstruction were noted. Oncoplastic closures were more common during the pandemic, while two-stage implant reconstruction and immediate autologous reconstruction decreased by 27% and 43%, respectively. All procedures are on track to increase in volume in 2021 compared to that in 2020.The COVID-19 pandemic reduced the volume of breast cancer surveillance, surgical treatment, and reconstruction procedures. While it is reassuring that volumes have rebounded in 2021, efforts must be made to emphasize screening and treatment procedures in the face of subsequent surges, such as that recently attributable to the Delta and Omicron variants.

Goals/Purpose Breast aesthetics are a highly discussed topic within plastic surgery. However, there is a paucity of literature examining how preferences differ amongst various demographic groups. The objective of this study was to assess how perceptions of the ideal breast differ between respondents stratified by self-identified race. Methods/Technique A cohort of 25 patients from the senior surgeons’ practices presenting for aesthetic or reconstructive breast surgery was assembled. This cohort was selected with the aim of choosing a sample that maximized diversity on the basis of breast size and shape, skin tone, and nipple-areola complex size and position. Pre-operative anteroposterior photographs from these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents’ impressions of “breast attractiveness.” Respondents were asked to rate breasts on a Likert scale of 1 to 5, with 1 being not at all attractive and 5 being most attractive. Survey responses were analyzed for differences in breast aesthetic preferences by race using ANOVA and t-tests where appropriate. Results/Complications A total of 1,021 survey responses were collected. The majority of survey respondents identified as White or Caucasian (73%). A total of 18% of individuals self-identified as Black or African-American, while 5% identified as Asian. The remaining 3% of respondents identified as Other, Native American, or selected multiple categories and groups were too small for cross-group comparison and were thus excluded. On average, individuals in the White or Caucasian group rated any given pair of breasts 8% more attractive than Black or African-American individuals and 14% more attractive than Asian individuals. ANOVA testing revealed significant differences amongst groups (p=0.014). Subgroup comparison revealed a significant difference between ratings of breast attractiveness between White or Caucasian individuals and Asian respondents (2.61 vs 2.25; p=0.002). Comparisons between White or Caucasian respondents and Black or African-American individuals were not significant (2.61 vs 2.40; p=0.06) as was the analysis between Black or African-American respondents and Asian individuals (2.40 vs 2.25; p=0.08). While these intergroup comparisons did not reach significance in the current sample, perhaps with a larger sample size a difference between these groups might be elucidated. Despite these racial discrepancies in breast attractiveness, regression analysis revealed that the ratings amongst each of the groups were highly correlated with one another: White or Caucasian and Black and African-American (R=0.68; R2=0.46; p Conclusion In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by race. On average, White or Caucasian respondents rated a given pair of breasts as more aesthetically pleasing than Black or African-American and Asian counterparts. While this difference was observed, it is important to note that ratings amongst racial groups were highly correlated with one another across all photographs presented. In other words, while Black or African-American and Asians rated breasts lower than their White or Caucasian counterparts, relative attractiveness for the breasts amongst groups paralleled one another. While self-identified racial groups rated the breasts similar relative to one another, there were distinct differences in numerical ratings that may be reflective of broader, more generalized sentiments and preferences that were not able to be captured by our survey instrument. These findings merit further investigation to understand these trends and observations. Doing so will enable plastic surgeons to have a better understanding of patient preferences and expectations when seeking reconstructive or aesthetic breast surgery and thereby improve patient satisfaction.

OBJECTIVE Surgery lacks women and racial minorities that are underrepresented in medicine (UIM). This systematic review evaluates interventions used to promote diversity in surgery. DESIGN The PubMed (MEDLINE), EMBASE, and Cochrane databases were searched for studies (1) describing interventions for increasing UIM and gender diversity, (2) within surgery, and (3) targeting any learner prior to residency. SETTING Nine surgical specialties were searched: general, neurosurgery, plastics, orthopedics, otolaryngology, urology, cardiothoracic, vascular, and ophthalmology. RESULTS Of the 982 studies identified, 16 were included. Awards, clerkships, and workshops were each described by three studies; awards funded research or travel to national meetings, clerkships referred to a third- or fourth-year rotation that provided exposure to surgery, and workshops were hands-on skills sessions for learners. Two studies proposed a holistic review of residency applications, which involves emphasizing an individual's attributes and life experiences rather than strictly academics. Two studies detailed a longitudinal mentoring program comprised of mentorship throughout medical school plus opportunities for research, lectures, and workshops. One study described a combination of interventions and the remaining 2 presented interventions that were characterized as “other.” Longitudinal mentoring programs significantly increased the likelihood of women and UIM applying to surgical residency, while holistic review significantly increased the numbers of women and UIM being interviewed and ranked by residency programs. One award increased the number of female residents matriculating into surgical residency. Clerkships significantly increased the number of women applying to surgical residency. The mere mention of diversity initiatives on a program's website was associated with more female surgical residents, but not UIM residents. Workshops led to a higher, but not statistically significant, proportion of women applying to surgery. CONCLUSION Holistic review and longitudinal mentoring programs are the most effective interventions for increasing UIM and female representation among surgical trainees.

Background: The novel coronavirus disease (COVID-19) has had a significant impact on orthopedic surgery practice, but there has been little investigation of the effects of COVID-19 on the orthopedic surgery literature. Additionally, because orthopedic research plays a vital role in physician education, changes to the characteristics and content of published literature can have lasting impacts on future teaching and learning. This paper represents the first known analysis of the COVID-19 pandemic's impact on peer-reviewed articles published in orthopedic surgery journals. Methods: The 20 orthopedic journals with the highest impact factors in 2019, according to the Journal Citation Reports, were included in this study. Using PubMed and COVID-19 related keywords as well as manual screening, a final count of 199 articles were assessed for this study and subsequently sorted by country of origin, orthopedic subspecialty, article type, and general theme. Kruskal Wallis and Pearson's Chi-squared tests were used to analyze continuous and categorical variables, respectively. Results: Fourteen journals published articles relating to COVID-19, representing 26 countries with the United States (37%) and United Kingdom (13%) publishing the greatest proportion of all COVID-19 articles. Sixty percent of publications discussed COVID-19's impact on the overall field of orthopedic surgery, with the remainder focusing on specific subspecialties. Forty-seven percent of publications were original research articles while 46% were editorials or commentaries. The median time to publication for all COVID-19 related articles was 24.5 days, compared to the 129 days reported for orthopedic journals prior to the COVID-19 pandemic (p

PURPOSE Hematoma affects 10% to 13% of patients undergoing panniculectomy. Although elevated perioperative blood pressure has been associated with hematoma after rhytidectomy, this has not been established for panniculectomy. We sought to determine the impact of perioperative blood pressure on hematoma development in patients undergoing panniculectomy. METHODS A retrospective review was performed on patients undergoing isolated panniculectomy procedures. Blood pressure parameters recorded included systolic blood pressures (SBPs), diastolic blood pressures (DBPs), and mean arterial pressure. The mean, peak, and trough blood pressure values were recorded. Preoperative, intraoperative, and postoperative blood pressures were recorded, and differences between phases were calculated. Univariate and multivariate logistic regressions were performed. RESULTS One hundred forty-three patients were identified, which included 84% (n = 120) women and 17% (n = 23) men. A history of hypertension was present in 55% (n = 79) of patients, of which 91% (n = 72) were medically controlled. Preoperative antiplatelet or anticoagulation was used in 21% (n = 31) of patients. Seven patients (5%) developed a hematoma, of which 5 required operative drainage. Development of hematoma was not associated with patient, surgical, or postoperative pain variables. There was an association between hematoma and elevated postoperative blood pressures on univariate and multivariate analyses. The mean peak SBP in the hematoma group was 160 mm Hg in comparison to 141 mm Hg in the nonhematoma group. For each 10-mm Hg increase in postoperative peak SBP, the odds of a hematoma increased by 2.8 times. When comparing phases of care, hematoma patients had similar intraoperative and postoperative peak SBP, but their postoperative SBP was 19 mm Hg higher than preoperative baseline. Conversely, nonhematoma patients had a postoperative blood pressure that was similar to their preoperative baseline and 20 mm Hg lower than their intraoperative values. CONCLUSIONS Hematoma is associated with elevated postoperative blood pressures. A postoperative mean peak SBP of 160 mm Hg was associated with hematoma, and for each 10 mm Hg, the risk of hematomsa increased by 2.8 times. The risk of hematoma may be reduced by strict postoperative blood pressure control. We recommend a postoperative peak SBP goal of 140 mm Hg or less, with a value equal to or less than their preoperative baseline and 20 mm Hg lower than their intraoperative pressure.

Purpose: To assess a novel technique for classifying zygomaticomaxillary complex (ZMC) fractures by its ability to predict clinical outcomes and reoperations when compared to a well-established classification method. Methods: The investigators conducted a retrospective cohort study over a 7-year period composed of patients with unilateral and bilateral fractures of the ZMC. Fractures were graded according to the Zingg method and a CT-based comminution method. Outcomes were classified into 3 groups: orbital complications, facial complications, and reoperation. Orbital complications consisted of enophthalmos and diplopia. Facial complications consisted of lagophthalmos, ectropion, ptosis, facial motor weakness, trismus, and malar depression. Other variables included demographics, mechanism of injury, and preoperative symptoms. Results: A total of 159 patients were identified producing a total of 204 ZMC fractures. The mean age was 40.2 ± 16.5 years and the most common mechanism of injury was motor vehicle accidents in 49.7% of patients. By the Zingg classification, B-type fractures were the most common in 46% of patients. The average total comminution score was 2.9 ± 2.4. Univariate analysis showed an association between increased age and reoperation ( P = .01). After adjusting for demographic and clinical variables on multivariate analysis, total comminution score was a significant predictor of facial complications and reoperation. The Zingg method did not demonstrate significance as a predictor for facial complications or reoperation. Neither classification method was predictive of orbital complications. Conclusion: The results of this study suggest that total comminution scoring is a viable method for categorizing ZMC fractures to better predict clinical outcomes.

Background:. The zygomaticomaxillary complex (ZMC) can experience a multitude of deforming forces. There is limited understanding on which deformities alter patient outcomes. This study utilized an automated, three-dimensional analysis to elucidate which fracture patterns and rotational deformities are most prevalent and associated with postoperative complications. Methods:. This study was a 7-year retrospective review of patients with unilateral ZMC fractures who underwent surgical intervention. Patient demographics, injury mechanisms, presenting symptoms, and postoperative outcomes were collected. Segmentation was completed using Mimics software. The lateral-medial, superior-inferior, and anterior-posterior axes were manually identified on the zygoma and then displacement, rotational direction, and rotational degrees were automatically calculated using Geomagic software. Total displacement score was generated by summation of individual displacement scores at each of the five sutures. Results:. Eighty-one patients satisfied inclusion criteria. The most prevalent rotational pattern of the zygoma was medially-superiorly-posteriorly (P < 0.001). When comparing rotation along the three axes, the zygoma had the greatest rotation along the lateral-medial axis compared with the superior-inferior (P = 0.003) and anterior-posterior (P < 0.001) axes. Within each axis, the zygoma was more likely to rotate medially than laterally (P = 0.003) and posteriorly than anteriorly (P = 0.01). Multivariate analysis identified total displacement scores and degrees rotated along the lateral-medial axis as significant predictors of facial complications and reoperation. Conclusions:. This study suggests that patients with unilateral ZMC fractures who undergo surgical intervention are at an increased risk for adverse outcomes with greater rotation along the lateral-medial axis and higher total displacement scores. Additionally, the automated analysis method described can provide objective data to better characterize ZMC fractures.

Introduction:. The COVID-19 pandemic posed unique challenges for breast reconstruction. Many professional organizations initially placed restrictions on breast reconstruction, leading surgeons to conceive innovative protocols for offering breast reconstruction. This study reviewed the current evidence on breast reconstruction during the COVID-19 pandemic to provide guidance for surgeons facing future crises. Methods:. The MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were searched for studies (1) describing implant and autologous breast reconstruction following mastectomy and (2) occurring during or pertaining to the COVID-19 pandemic. Results:. Of the 1347 studies identified, 26 were included. Studies discussed type of reconstruction (18, 69%), complications (11, 42%), timing of reconstruction (10, 38%), protocols (10, 38%), COVID-19 screening (7, 27%), and length of hospital stay (7, 27%). The type of reconstruction varied depending on the stage of the pandemic: early on, autologous breast reconstruction was halted to preserve resources, but was later resumed. Within implant-based reconstruction, direct-to-implant was favored over serial tissue expansion. Several protocols were developed, with many emphasizing multidisciplinary collaborations for patient selection, use of specialized measures to reduce risk of COVID-19 transmission, and optimization of same-day discharge. Complication rates following breast reconstruction were similar to pre-pandemic rates. Conclusions:. The COVID-19 pandemic has forever changed the landscape of breast reconstruction by raising important questions about delivery of care, cost, and resource utilization. The findings of this review may inform surgeons as they plan for similar future crises or strive for improved patient care and efficacy even during nonpandemic times.

Background:. The COVID-19 pandemic created an unprecedented residency application cycle that required the use of virtual interviews. The inaugural class of applicants participating in virtual interviews were surveyed concerning their preferences and suggestions for future application cycles. Methods:. A survey was distributed to 349 individuals who applied for an integrated plastic surgery residency position at three institutions during the 2020–21 application cycle. Responses were analyzed to determine the most popular attributes of virtual interviews. Results:. Response rate was 44%. Eighty-six percent of applicants valued having time to consider their interview offers before scheduling; however, nearly one-third felt the instructions provided by programs lacked clarity and did not abide by the American Council of Academic Plastic Surgeons guidelines. Eighty-two percent of applicants valued having a preinterview social, and most preferred smaller breakout rooms organized by themes. A short interview day (less than three hours) was associated with less applicant familiarity with the program, its people, and its location when compared with medium (three to seven hours) and long (more than seven hours) interview days (P < 0.001 for all). Eighty percent of applicants preferred an interview day where they were placed into interview rooms by a program coordinator. Conclusions:. The virtual interview format can be optimized in many ways to benefit both applicants and programs. The data presented in this article provide suggestions for future iterations of virtual interviews.

Background:. Resident cosmetic clinics (RCCs) are the training modality of choice among both residents and faculty and are a mainstay at most residency programs.1–4 Despite this, knowledge of RCCs among plastic surgery consumers remains untested. We hypothesize that the public would be aware of and receptive to RCCs. Methods:. Participants with prior cosmetic procedures or interest in future cosmetic procedures were recruited using Amazon Mechanical Turk and asked to complete a survey in September 2020. First, prior awareness of RCCs was assessed. After a brief description of RCCs, perceptions of safety and preferences for care were assessed. Results:. After screening for quality, 815 responses were included. Forty-five percent of consumers were aware of RCCs. Seventy-six percent of consumers believed that RCCs were just as safe as attending clinics and 65% were comfortable receiving care from fourth-year residents or higher. Belief in RCC safety was associated with 4.8 times higher odds of feeling comfortable receiving care at an RCC [95% confidence interval (3.3–7.1), P < 0.001]. When given a hypothetical choice between residents and attendings in two scenarios, 46% of consumers chose residents for abdominoplasty and 60% chose residents for Botox injections. Belief in RCC safety was associated with choosing a resident or being indifferent in both scenarios. Conclusions:. Consumer preference regarding RCCs has largely been untested. This study shows that belief in RCC safety influences consumers’ perceived comfort with receiving care at an RCC. This knowledge can help guide RCC practice and maximize learning opportunities for surgeons-in-training.

Adolescents in sub-Saharan Africa encounter high risks associated with sexuality and reproduction, yet face numerous barriers in obtaining appropriate health services and information. Mobile phones...

Introduction Despite the high risk for sexual dysfunction and pelvic organ prolapse after cystectomy and urinary diversion, a paucity of data and attention to these issues exists in women. This is in stark contrast to the attention paid to male sexual function undergoing similar urologic procedures. As survivorship from bladder cancer improves, appropriate assessment and treatment of these quality of life conditions are needed. Whereas consideration of surgical approach and technique on male outcomes is widespread, female outcomes are lacking in comparison. Aim This scoping review evaluates sexual function and postoperative vaginal support in women undergoing cystectomy for benign and malignant diseases of the bladder. Methods This article reviews current evidence regarding sexual function and pelvic organ prolapse in women undergoing cystectomy and the potential impact of choice of urinary diversion on these outcomes. Main Outcome Measure We conducted a systematic literature review of sexual dysfunction and pelvic organ prolapse after cystectomy and urinary diversion. Results 73 relevant articles were reviewed regarding sexual dysfunction and pelvic organ prolapse after cystectomy. This review discusses key quality-of-life outcomes, the role of surgical approach, the importance of evaluation and counseling, and future directions in the field. Conclusion Our internal review highlights the urgent need to raise awareness among providers regarding the adverse impact of cystectomy on these important quality-of-life issues. Voigt M, Hemal K, Matthews C. Influence of Simple and Radical Cystectomy on Sexual Function and Pelvic Organ Prolapse in Female Patients: A Scoping Review of the Literature. Sex Med Rev 2019;7:408–415.

Introduction:Flexible cystoscopy is routinely performed as an outpatient procedure. The use of disposable sheaths can increase cystoscope life span and reduce staff costs. The primary end p...

BACKGROUND: Although sex differences exist in the management of acute coronary syndromes, less is known about the management and outcomes of women and men with suspected coronary artery disease (CAD) being evaluated with non-invasive testing (NIT). METHODS: We investigated sex-based differences in NIT results and subsequent clinical management in 4720 women and 4246 men randomized to CT angiography vs stress testing in the PROMISE trial. Logistic regression models assessed relationships between sex and referral for catheterization, revascularization, and aspirin or statin use. Cox regression models assessed the relationship between sex and the composite of all-cause death, myocardial infarction, or unstable angina. RESULTS: Women more often had normal NITs than men (61.0% vs 49.6%, p

Dermal regeneration template and staged split-thickness skin grafting may mitigate the need for flap coverage of postoncologic scalp defects. This technique has been studied previously in small case series. We examine the effect of risk factors, surgical technique, irradiation, and dressing modalities on reconstructive outcomes in a highly comorbid patient cohort.Retrospective review.Academic medical center.Full- and partial-thickness extirpative scalp wounds reconstructed with dermal regeneration template and staged skin grafting were reviewed over a 14-year period. Stage 1 consisted of template application following burr craniectomy in cases lacking periosteum. Stage 2 consisted of skin grafting. Negative pressure wound therapy (NPWT) was variably used to support adherence.In total, 102 patients were analyzed (average age 74, mean follow-up 18 months). Eighty-one percent were American Society of Anesthesiologists class 3 or 4. Defect size averaged 56 cmDermal template and staged skin grafting is a reliable option for postcancer scalp reconstruction in poor flap candidates. Radiotherapy is associated with adverse outcomes. Negative pressure wound therapy simplifies postoperative wound care regimens and may accelerate healing.

Supplemental Digital Content is available in the text., Background: The COVID-19 global pandemic has impacted plastic surgery training in the United States, requiring unprecedented measures to prepare for potential surges in critically ill patients. This study investigates how plastic surgery programs responded to this crisis, as well as how successful these changes were, through a survey of program directors and of residents at academic training programs in the United States. Methods: Two separate anonymous online surveys were conducted via REDCap between April 16 and June 4, 2020. The first survey was distributed to program directors, and the second was distributed to plastic surgery residents. Resident responses were then subdivided for an analysis between geographic regions. Results: Of the 59 program director responses (43.7%), the majority of programs implemented a platoon approach for resident coverage. A minority did the same for attending coverage. In total, 92% transitioned to virtual didactics only. Plastic surgery residents covered alternative services at 25% of responding institutions, and an additional 68% had a plan in place for responding to personnel shortages. Overall, residents were satisfied with their program’s response in a variety of categories. When subdivided based on geographic region, respondents in the Northeast and Northwest were less satisfied with resident wellness, personal and loved ones’ safety, and program communication. Conclusions: With the possibility of a “second wave,” successful methods of academic programs adapting to the pandemic should be communicated to reduce the future impact. Increased frequency of communications between program directors and residents can improve mental health and wellness of the resident population.