Eplasty最新文献

Background: The number of resident positions in integrated plastic surgery residencies are relatively few and highly sought after. Medical students interested in plastic surgery as a career are faced with the challenge of deciding where to apply for these highly competitive spots. This sense of keen competition means students are often applying to almost all available programs across the country with the idea of increasing their chance of successfully matching. Previous research has shown that exposure to specialty programs in medical school portends enhanced success in residency matches. This study focuses on medical students who come from schools without plastic surgery residencies-orphans-and the characteristics of those who successfully matched into integrated plastic surgery programs.

Methods: This study evaluated trends in successfully matched applicants in integrated plastic surgery residencies from 2016-2021 by looking at applicants' medical school type, presence of plastic surgery residency associated with the medical school, and geographic region. Geographic region of residency programs, medical school of applicants, and national quality ranking of medical schools were correlated with applicant demographics. The data were tabulated and analyzed utilizing chi-square analysis.

Results: Orphans who graduated from allopathic medical schools without an affiliated integrated plastic surgery residency program comprised 24.4% of successfully matched applicants, whereas those with affiliated integrated residency programs comprised 72.2%. However, at the top quartile of prestige-rated residency programs, these orphan applicants only comprised 17.4% of residents. Of all medical school applicants, 18.2% matched at a residency program affiliated with their medical school (P = 0.04). Annually, 1 to 3 osteopathic medical school graduates and 3 to 9 international medical graduates matched, representing less than 1 and 4%, respectively, of all matched applicants; these applicants had the least successful match rates.

Conclusions: There continues to be a modest number of successfully matched integrated plastic surgery residents who are graduates of allopathic medical schools with no affiliated residency program but disproportionately fewer at the top quartile institutions. There are also very few osteopathic and international medical school graduates who match, which has seen no significant change over the last 6 years.

Background: In an initial trauma evaluation, computed tomography of the head (CTH) is performed to assess for life-threatening intracranial injury. Given the high incidence of concomitant facial injuries, many facial fractures are diagnosed incidentally during this evaluation. Although maxillofacial CT (CTMF) is widely accepted as the most sensitive method for evaluating facial fractures, it is often excluded from the initial survey. Failure to obtain dedicated imaging can lead to increased costs related to a missed or delayed facial fracture diagnosis. Our study investigates the location and type of missed facial fractures on CTH by reviewing imaging data from patients who presented at a level 1 trauma center and underwent both CTH and CTMF.

Methods: A retrospective review of all facial fractures diagnosed at a single institution from 2002 through 2016 was conducted. Inclusion criteria included adults aged 18 years or older who received CTH and then subsequent CTMF. Patients who had either CTH or CTMF only or combined CTH/CTMF were excluded. The facial fractures were further subdivided by location.

Results: There were 501 patients with 1743 total facial fractures. CTH successfully identified 788 (45.21%) fractures, versus 1743 (100%) for CTMF. The most common fractures, in both cohorts, were nasal bone (15.7%) and orbital floor (12.8%) fractures. Using CTMF to identify missed fractures on CTH, significant differences were noted in the following locations: anterior table frontal sinus, medial/lateral pterygoid, maxillary sinus, lateral orbital wall, zygomatic arch, palate, and all types of mandible fractures excluding the mandibular condyle.

Conclusions: CTH for initial trauma evaluation often misses facial fractures. CTH alone was only sufficient in detecting posterior frontal sinus, orbital (excluding lateral wall), and mandibular condyle fractures. In patients with suspected facial injury, dedicated imaging should be performed to detect the location and extent of injury because CTH inadequately identifies most facial fractures.

Background: The COVID-19 pandemic has affected the entire world tremendously. Particularly during the second wave in India, a dangerous complication followed in the form of COVID-19-associated mucormycosis. On June 7th, 2021, the Indian Union Health Minister stated that 28,252 cases of mucormycosis were reported from 28 states/Union territories in the country.

Methods: A PubMed search was conducted for English-language studies published from 1988 through May 22, 2021 using the terms "reconstruction AND mucormycosis."

Results: The search yielded 102 results. After excluding the articles not describing reconstruction in mucormycosis, 53 abstracts were screened. Then 34 articles dealing with reconstruction in non-ROC regions were excluded. The full text of 16 articles was reviewed. Additionally, 3 articles were identified from the reference search. Due to the aggressive debridements, rhino-orbito-cerebral mucormycosis survivors may be left with complex tissue defects with significant functional and aesthetic impairments. It is essential to offer reconstructive solutions that improve their quality of life. As far as the timing of reconstruction is concerned, the consensus is in favor of delayed reconstruction after ensuring that the infection has been eliminated/controlled and that there are no recurrences. The most common defects encountered were the ones that resulted from orbital exenteration and excision of a varying extent of the involved contiguous bony and soft tissue structures. Reconstruction with pedicled flaps was preferred rather than free flaps, especially in the cases where the infection was not eliminated completely. Adjuvant antifungal therapy was used in most of the cases. Long-term follow-up was considered essential to detect and treat recurrences.

Conclusions: A multitude of options are available for reconstruction in rhino-orbito-cerebral mucormycosis including skin grafts, pedicled flaps, free flaps and in some cases implants and prosthetics. These can be utilized to give as much as functional and aesthetic restoration as possible to the patient.

Background: Pressure injuries remain among the most common problems faced by plastic surgeons and comprise a large portion of wound clinic practice. However, little is known about the overall morbidity related to the disease. This research sought to identify the burden related to the diagnosis of pressure injuries.

Methods: We used the Global Burden of Disease Study 2017 to extract information about incidence and disability-adjusted life years (DALYs) related to pressure injuries from 1990 to 2017. Descriptive statistics were used to identify changes in the outcomes of interest.

Results: A relative though not statistically significantly decrease in the incidence and burden of pressure injuries was observed between 1990 and 2017. Rates of incidence in the US appear higher than other higher socio-demographic index countries. No clinically and statistically significant changes were observed based on age or sex.

Conclusions: Pressure injury incidence and burden have remained relatively stable between 1990 and 2017 with no significant improvement noted. There is room for improvement on a national performance level, and further research is needed regarding inconsistencies in regional outcomes.

Background. The availability of corneal tissue is a major limiting factor in utilizing keratoplasty for correction of corneal blindness. Viable corneal tissue is typically difficult to obtain as posthumous donation is required to avoid significant morbidity and loss of vision in live patients. As a result, the possibility of obtaining viable corneal tissue from a living donor is rarely discussed. This report describes a case in which corneal donation was completed in a living patient undergoing exenteration for invasive squamous cell carcinoma of the maxillary sinus. Performing corneal donation in similar patients in the future should be considered by head and neck surgeons as an opportunity to increase the availability of corneal tissue.

Background: Soft tissue reconstruction of the lower third of the leg, the ankle, and the foot is challenging for reconstructive surgeons. The options for reconstruction are limited. Reverse sural flap is relatively easy to perform and considered a good option for reconstruction. The complication rates are variable in studies. This study aims to systemically review all available articles based on reverse sural flap focusing on complications of the flap. The overall complication of the flap helps to better understand the reliability of the flap.

Methods: A comprehensive literature search was performed using MEDLINE, EMBASE, and Google Scholar to identify cases of reverse sural artery flap.

Results: A pooled analysis of 89 articles was performed, which yielded 2575 patients (2592 flaps) over a period of 19 years. Most of the cases were performed in Asian countries (1540 flaps, 59.4%) with the majority being performed in China (746 flaps, 28.8%). The most common cause for reverse sural flap surgery was trauma/postsurgical (1785/2592) followed by burn/scarring. Flap complications were recorded in 653 of 2592 flaps (25.20%). The most common complication was partial flap loss, which was recorded in 204 flaps (7.85%) followed by venous congestion (79 flaps, 3.05%). Complete flap loss was observed only in 66 participants (2.5% of all the flaps performed).

Conclusions: Reverse sural flap is reliable flap for the reconstruction of lower leg, ankle, and foot. It can give a comparable outcome as free flap when meticulously performed and, in many cases, a better result.

What is breast implant illness? What is the proposed pathophysiology behind breast implant illness? What are the most common etiologies of fungal breast implant infections? What risks should patients undergoing breast augmentation be informed of?

Background: Medially positioned nipple areola complex (NAC) is an anatomic configuration common in women who have undergone significant weight loss. The superomedial pedicle (SMP) technique is thought to have excellent long-term outcomes but is considered unsafe in patients with a medially positioned NAC. In a patient with a medially positioned NAC, the SMP technique can be challenging to achieve sufficient arc of rotation of the NAC.

Methods: Medial canting of both vertical limbs of the Wise pattern as well as broadening the base of the pedicle are 2 key modifications to the standard SMP technique that create sufficient arc of rotation of the NAC. Demographics (age, body mass index), operative details (weight of tissue excised from each breast), and outcomes (perioperative complications, incidence of partial or total NAC loss, and aesthetics) were recorded for each patient. A modified superomedial pedicle breast procedure was performed on 8 women with medially positioned NAC (16 breasts); 6 underwent breast reduction, and 2 underwent mastopexy. Mean age was 38.0 years (range 21-50), mean BMI was 28.1 (range 23-35). The mean weight of tissue removed was 509 grams (range 245-889 grams) in patients undergoing a reduction and 105 grams (range 83-131 grams) in patients undergoing mastopexies.

Results: There was 1 perioperative complication (hematoma) and no instances of partial or complete NAC loss. All patients had satisfactory breast shape and NAC position.

Conclusions: Modifications to the standard SMP design that include medial canting of the vertical limbs and lateral extension of the base of the pedicle allow SMP breast reduction or mastopexy to be safely and successfully performed in women with medially positioned NAC.

Background: Hypersensitivity reaction in a tattoo secondary to red ink is a relatively rare complication, particularly as the biochemical composition of tattoo dye has been refined. Most hypersensitivity reactions are amenable to conservative management, but less common is the necessity for full surgical excision and reconstruction.

Methods: A 50-year-old female patient with a chronic tattoo granuloma causing excessive pruritus, erythema, and ulceration, refractory to conservative and minimally invasive techniques, underwent full surgical excision and skin-graft reconstruction of the areas affected by the red dye. Additionally, literature was reviewed for similar reports requiring excision.

Results: The patient reports complete symptomatic resolution and satisfaction with the result. The literature reveals a small set of cases reporting a necessity for surgical excision following red-ink hypersensitivity.

Conclusions: Tattoo hypersensitivity secondary to a red ink-induced allergic reaction is relatively rare. Most cases are amenable to conservative treatment; however, surgical excision and reconstruction provides a viable option in cases refractory to traditional and less invasive management.

Background: Part of the skull can be lost due to neurosurgical diseases or trauma. Skulls with partial defects can develop different fracture patterns from those of intact skulls. This study aims to clarify the differences.

Methods: A 3-dimensional skull model was produced by referring to the computer-tomography data of a 23-year-old intact male volunteer. We defined the model as Intact Model. Another model was produced by removing part of the frontal bone, which was defined as Defect Model. Dynamic simulations of impacts were performed varying the site and direction of impact. Fracture patterns caused by the impacts were calculated using dynamic analysis software (LS-DYNA; Livermore Software Technology Corp.) and were compared between the intact model and defect model.

Results: When Defect Model was impacted, fracture involved wider areas than when Intact Model was impacted. This finding was observed not only when Defect Model was impacted on its defect side but also when it was impacted on its intact side.

Conclusions: When a skull carrying a defect on one side is impacted, serious fracture occurs even when the non-defect side is impacted, meaning that a skull with a defect is vulnerable to impacts on the non-defect side. This finding should be taken into consideration in deciding indications of skull defect reconstruction.