Publications by authors named "Francesco M Egro"

47 Publications

The impact of autologous versus implant-based breast reconstruction on body mass index in breast cancer patients.

Breast J 2021 Mar 3. Epub 2021 Mar 3.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1111/tbj.14214DOI Listing
March 2021

A Randomized Controlled Trial to Assess the Use of a Virtual Decisional Aid to Improve Knowledge and Patient Satisfaction in Women Considering Breast Reconstruction Following Mastectomy.

Cureus 2020 Dec 10;12(12):e12018. Epub 2020 Dec 10.

Plastic Surgery, University of Pittsburgh, Pittsburgh, USA.

Background The decisional process of navigating breast reconstruction surgery is very challenging for patients with a breast cancer diagnosis. This study aims to assess the impact of a virtual breast reconstruction decision aid program on the decision-making process of breast cancer patients considering breast reconstruction.  Methods A two-arm, randomized, controlled trial was conducted at the University of Pittsburgh. Patients were blindly assigned to one of two arms: Emmi Decide (Emmi Solutions LLC, Chicago, IL) program prior to traditional consultation (intervention) and traditional consultation alone (control). All patients completed a baseline pre- and post-intervention questionnaire to evaluate knowledge, patient satisfaction, and psychological status. Surgeons' satisfaction and consultation time were also recorded. Results A total of 26 patients participated in the study (n=13 in each arm). Patients in the intervention group reported a greater BREAST-Q reconstruction module score (control=47.9±8.2, intervention=56.8±4.2, =0.0017), lower decisional conflict scale score (control=30.2±11.8, intervention=14.5±8.8, =0.017), and improved patient knowledge (control=70.8±15.5%, intervention=83.1±13.8%, =0.018). No difference was noted in consultation time (control=51.0±7.8 min, intervention=47.8±13.7 min, =0.46) and psychological testing (control=49.7±16.0, intervention=44.6±15.2, =0.26). However, surgeons reported greater satisfaction with their consultations with interventional group participants (control=3.4±0.7, intervention=4.8±0.4, =0.000056). Conclusions The use of a virtual decisional aid program to assist the decision-making of breast reconstruction patients was shown to significantly benefit both patients and surgeons, by improving patient knowledge and satisfaction without placing an additional psychological burden on them. This supports the notion that this resource is a promising tool that can improve the difficult process of breast reconstruction in the vulnerable population of breast cancer patients.
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http://dx.doi.org/10.7759/cureus.12018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797415PMC
December 2020

Characteristics and Academic Productivity Among Pediatric Plastic Surgeons in the United States.

Cleft Palate Craniofac J 2020 Dec 30:1055665620982783. Epub 2020 Dec 30.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Background: The characteristics that predispose plastic surgeons to a career in pediatric plastic surgery remain unclear. Therefore, the aim of this study is to analyze the characteristics of current pediatric plastic surgeons and to determine their academic productivity.

Methods: Pediatric plastic surgeons were identified through an internet search of all academic children's hospitals affiliated with an Accreditation Council for Graduate Medical Education-accredited integrated or independent plastic surgery program. Demographics, training background, institutional and leadership positions, and academic productivity were determined.

Results: A total of 304 pediatric plastic surgeons were identified. The majority of pediatric plastic surgeons were white (n = 217, 71.8%) males (n = 235, 77.6%). Clinical fellowships were completed by 86.8% (n = 263) of the cohort, with craniofacial (n = 181, 59.7%) being the most common followed by hand (n = 54, 17.8%); 41.1% had clinical fellowship training at 10 institutions, with the top 3 most represented programs being University of Pennsylvania (n = 19, 6.2%), University of California-Los Angeles (n = 16, 5.3%), and Harvard University (n = 15, 4.9%); 25.7% (n = 78) held leadership positions within their institutions. A significant higher academic productivity was found among research fellowship-trained surgeons, chiefs of pediatric plastic surgery, fellowship directors, and members of departments of plastic surgery. Those who completed an independent residency had a significant higher H-index and number of citations.

Conclusion: Pediatric plastic surgery is represented by surgeons of diverse training background. An elite cohort of programs has trained the most pediatric plastic surgeons. Lastly, high academic productivity was found to be correlated with certain demographic and leadership variables highlighting its impact on career advancement.
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http://dx.doi.org/10.1177/1055665620982783DOI Listing
December 2020

Influence of Residency Training on Research Productivity and Plastic Surgery Career.

Ann Plast Surg 2020 12;85(6):672-676

From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.

Background: The impact of residency training on academic productivity and a career in academic plastic surgery remains uncertain. Previous literature has explored the influence of training institutions on academic careers in surgery. The aims of the study were to assess research productivity during plastic surgery residency training and to illustrate how differences in training programs impact resident research productivity.

Methods: Academic plastic surgery faculty that graduated in the past 10 years were identified through an Internet search of all Accreditation Council for Graduate Medical Education-accredited residency and fellowship training programs. Research productivity was compared based on h-index, number, and quality of peer-reviewed articles published during residency.

Results: Three hundred seventy-five academic plastic surgeons were identified and produced 2487 publications during residency. The 10 most productive training institutions were Johns Hopkins, Georgetown, University of Michigan, Stanford, University of California Los Angeles, Northwestern, Harvard, New York University, University of Pennsylvania, and Baylor. Academic productivity was higher among integrated residents (integrated = 8.68 publications, independent = 5.49 publications, P < 0.0001). The number of publications positively correlated to faculty size (r = 0.167, P = 0.0013), National Institute of Health (NIH) funding (r = 0.249, P < 0.0001), residency graduation year (r = 0.211, P < 0.0001), and negatively correlated with Doximity ranking (r = -0.294, P < 0.0001). H-index was positively correlated with number of publications (r = 0.622, P < 0.0001), faculty size (r = 0.295, P < 0.0001), and NIH funding (r = 0.256, P < 0.0001) and negatively correlated with Doximity ranking (r = -0.405, P < 0.0001) and residency graduation year (r = -0.163, P < 0.0001).

Conclusions: Our study has found that there is an elite cohort of programs that are the most productive research institutions. Resident research productivity is higher among integrated residents, recent graduates, and programs that are larger in size, with a higher Doximity ranking and NIH funding. This study can guide medical students and future applicants who are interested in a career in academic plastic surgery in the selection of programs that match their career aspirations.
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http://dx.doi.org/10.1097/SAP.0000000000002514DOI Listing
December 2020

A Systematic Review on Airbag-Induced Burns.

J Burn Care Res 2020 Oct 22. Epub 2020 Oct 22.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Background: Airbags significantly reduce fatalities and injuries in automobile crashes, but they have been found to be associated with burns. Specifically, airbags can cause burns through thermal or chemical mechanisms and commonly affect the arms, hands, face, and eyes. While most airbag-induced burns are minor, some may cause unfavorable outcomes. Our study aimed to systematically review airbag-induced burns to assess etiology, type and treatment of these injuries.

Methods: A systematic review of case reports pertaining to airbag-induced cutaneous and ocular burns was conducted. Data reviewed included type/location of burns, severity of burn, total number of patients, treatment, complications, and outcome after treatment.

Results: We identified 21 case reports that met our inclusion criteria with a total of 24 patients reported in the studies. Of the studies identified, 38% were chemical burns and 25% were thermal burns. Most commonly the upper extremities were burned in 42% of cases, followed by eyes (25%) and face (21%). Most burns identified were superficial partial-thickness (58%). Treatment outcomes were good for cutaneous burns, with 95% healing without complication. However, ocular injuries lead to permanent impaired eye function in 71% of cases.

Conclusion: In our systematic review, we highlighted the common risk factors, prognosis, and treatment for thermal, chemical, and ocular burns. Airbag-induced burns have a relatively good prognosis but must be recognized and treated immediately to reduce the risk of serious sequelae.
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http://dx.doi.org/10.1093/jbcr/iraa186DOI Listing
October 2020

Interdisciplinary Representation of Burn Surgery Journal and Society Leadership.

J Burn Care Res 2020 Oct 22. Epub 2020 Oct 22.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Background: Burn care is a complex craft that requires an interdisciplinary approach. It includes a diverse array of specialty providers to provide holistic, specialized care to burn victims. This study aims to evaluate the diverse array of subspecialties involved in burn surgery journal and society leadership.

Methods: A cross-sectional study was conducted in July 2019 by examining characteristics of society and journal leaders. Current governance and committee members of the American Burn Association (ABA) and International Society of Burn Injuries (ISBI) were determined, as well as the editors of five major burn journals. Information gathered included occupation, advanced degrees obtained, and type of residency training.

Results: Of 384 editorial board members identified, 76% were physicians (n=291), with specialties including burn surgery (n=208, 54%) and anesthesiology (n=22, 6%). Among non-physicians (n=78, 20%), 76% were medical researchers (n=59), 8% physical therapists (n=6), and 5% nurses (n=4). Looking at ABA and ISBI governance (n=29), 82% were physicians (n=24). Non-physician ABA and ISBI leaders were nurses (n=2, 7%) and occupational therapists (n=2, 7%). Of 467 identified ABA and ISBI committee members, half were physicians (n=244, 52%). There was a wide array of non-physician occupations among committee members, from nurses (n=99, 21%), to occupational therapists (n=25, 5%), and even fire fighters (n=6, 1%).

Conclusion: Burn surgery journal and society leadership reflects the interdisciplinary nature of burn care by including an array of subspecialities. Yet, physicians tend to dominate academic burn leadership in comparison to other disciplines, highlighting the need for more non-physician representation in leadership positions.
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http://dx.doi.org/10.1093/jbcr/iraa185DOI Listing
October 2020

The Relationship of Residency and Fellowship Sites to Academic Faculty and Leadership Positions.

Ann Plast Surg 2020 07;85(S1 Suppl 1):S114-S117

From the Department of Plastic Surgery University of Pittsburgh Medical Center, Pittsburgh, PA.

Background: After completion of training, a physician's training institution has a lasting and meaningful impact on career trajectory. Training program influence on first job placement and academic promotions remain uncertain in academic plastic surgery. The aim of this study was to determine the impact of training and internal bias in academic plastic surgery employment and promotion.

Methods: Academic plastic surgery faculty were identified through an internet search of all Accreditation Council for Graduate Medical Education-accredited residency training programs. Faculty demographics, training background, employment, and leadership status were gathered. The analysis examined the impact of internal recruitment bias on first job employment, the impact of training history on institutional leadership promotion (chair/chief, residency director, or fellowship director), and the impact of alumni effect on academic employment.

Results: A significant proportion of recent graduates (38.6%) are practicing at the same institution as where they received residency or fellowship training. Of the 229 institutional leaders, 31.5% of chairs/chiefs, 39.6% of residency directors, and 37.5% of fellowship directors were internal hires. Overall, 34% of plastic surgery faculty in the United States share a common training program with at least 1 colleague. The top 5 programs that have the most faculty who trained at their hiring institution are Harvard (30 faculty), University of Southern California (15 faculty), University of California Los Angeles (12 faculty), University of Michigan (12 faculty), and Albert Einstein (12 faculty). Overall, 54% of plastic surgery departments employ 2 or more faculty who share a common external training program. The top 5 programs that have the most faculty who share an external training program are (1) Methodist Houston, 8 faculty who trained at Baylor; (2) Hofstra, 7 faculty who trained at New York University; (3) Stanford, 6 faculty who trained at University of California, Los Angeles; (4) Wisconsin, 5 faculty who trained at University of Pittsburgh Medical Center; and (5) University of Southern California, 4 faculty who trained at New York University.

Conclusions: The study highlights that an internal bias exists in the recruitment for first jobs and leadership promotions. However, a clear bias of internal hiring exists at several institutions. In addition, an alumni effect was identified, where some programs have a bias of hiring faculty who trained at the same external institution.
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http://dx.doi.org/10.1097/SAP.0000000000002336DOI Listing
July 2020

A Nomogram for the Rapid Prediction of Hematocrit Following Blood Loss and Fluid Shifts in Neonates, Infants, and Adults.

Cureus 2020 Apr 22;12(4):e7780. Epub 2020 Apr 22.

Plastic Surgery, University of Pittsburgh, Pittsburgh, USA.

Introduction There is often a need for a simple means of predicting hematocrit (Hct) following blood loss, administration of intravenous fluids, or fluid shifts. The aim of this study is to introduce a nomogram for the rapid prediction of blood volume and packed red cell volume appropriate for a given patient's body weight and Hct in both the pediatric and adult populations. Methods A nomogram for prediction of Hct was created using the following variables: 1) blood volume determined from bodyweight, 2) estimated blood loss, and 3) initial Hct. Results Hct was calculated after blood loss, administration of intravenous fluids, or fluid shifts using the pediatric and adult nomograms. Alternatively, the nomograms can be used to back-calculate blood or fluid loss if Hct is known. The nomogram allows for adjustment for measured and insensible fluid losses and fluid administration. Conclusions  The nomogram helps to predict the Hct and fluid requirements in neonates, children, and adults with blood loss, fluid administration, and rehydration following dehydration. It allows for the calculation of Hct after fluid shifts in a simple, fast, and portable manner. We believe it can be a useful adjunct to monitor the fluid balance in all patients, especially in resource-limited settings where laboratory equipment may not be available.
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http://dx.doi.org/10.7759/cureus.7780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243637PMC
April 2020

Microsurgery fellowship representation in the United States.

Microsurgery 2020 07 22;40(5):624. Epub 2020 Apr 22.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

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http://dx.doi.org/10.1002/micr.30582DOI Listing
July 2020

Clinical Evaluation of an Off-the-Shelf Allogeneic Adipose Matrix for Soft Tissue Reconstruction.

Plast Reconstr Surg Glob Open 2020 Jan 27;8(1):e2574. Epub 2020 Jan 27.

Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa.

Biomaterials derived from human adipose extracellular matrix have shown promise in vitro and in animal studies as an off-the-shelf adipogenic matrix for sustained volume replacement. Herein, we report the results of a randomized prospective study conducted with allograft adipose matrix (AAM) grafted into the pannus of presurgical abdominoplasty patients 3 or 6 months before scheduled surgery. This is the first report of a longitudinal histologic analysis of AAM in clinical use.

Methods: Ten healthy patients undergoing elective abdominoplasty were recruited to receive AAM before surgery. Enrolled subjects were randomized into either a 3-month follow-up cohort or a 6-month follow-up cohort. Subjects were monitored for adverse events associated with AAM grafting in addition to undergoing serial biopsy. Following surgical excision of the pannus, representative samples from the AAM surgical sites were stained and evaluated with hematoxylin and eosin for tissue morphology, Masson's trichrome for collagen, and perilipin for adipocytes.

Results: All subjects tolerated AAM with no severe adverse events reported. At 3 months following implantation, AAM remained visible within the confines of the subjects' native surrounding adipose tissue with sparse adipocytes apparent within the matrix. By 6 months, AAM had remodeled and was primarily composed of perilipin-positive adipocytes. Histologic analysis confirmed tissue remodeling (hematoxylin and eosin), adipogenesis (perilipin), and angiogenesis (Masson's trichrome) occurred with the presence of AAM.

Conclusions: AAM is a safe, allogeneic, off-the-shelf regenerative matrix that is adipogenic and noninflammatory and promotes angiogenesis.
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http://dx.doi.org/10.1097/GOX.0000000000002574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015604PMC
January 2020

Reduction Mammaplasty in Adolescents: A Comparison of Wise and Vertical Incision Patterns.

Plast Reconstr Surg Glob Open 2019 Dec 31;7(12):e2516. Epub 2019 Dec 31.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.

Background: Reduction mammaplasty was shown to ameliorate physical and psychological problems in adolescents suffering from macromastia. However, benefits of the Wise compared to the vertical incision pattern have not yet been established in this population. The aim of this study is to compare the outcomes of these 2 techniques in adolescents undergoing reduction mammaplasty.

Methods: A retrospective study of adolescents undergoing breast reduction by a single surgeon between 2011 and 2017 was conducted. Wise and vertical reduction techniques were compared based on demographics, surgical outcomes, patient satisfaction, and aesthetic outcomes. Patient satisfaction was determined using the validated BREAST-Q survey, and aesthetic outcomes using the validated ABNSW system.

Results: A total of 60 adolescents underwent reduction mammaplasty (Wise/inferior pedicle = 80.0%, Wise/superior medial pedicle = 1.7%, vertical/superior medial pedicle = 18.3%). Patients who reported preoperative pain (Wise = 95.9%, vertical = 72.7%, = 0.039) were more likely to undergo Wise reduction. Patients with Wise reductions also were more likely to undergo bilateral reduction (Wise = 93.9%; vertical = 63.6%, = 0.017). The major and minor complication rates were 1.7% (Wise = 2.0%, vertical = 0%, = NS) and 23.3% (Wise = 20.4%, vertical = 36.4%, = NS), respectively. Adolescents undergoing Wise incision demonstrated statistically significant improvement in NAC contour (Wise = 61%, vertical = 47%, = 0.028) and overall aesthetic outcome (Wise = 25%, vertical = 17%, = 0.008) with scarring not being a negative factor (Wise = -16%; vertical = -35%, = 0.004). Patient satisfaction was comparable in both groups.

Conclusions: Reduction mammaplasty is a safe, effective treatment for adolescent macromastia. The similarity in complication and satisfaction rates between Wise and vertical patterns suggests that both techniques can be safely performed in the adolescent population and allow for overall improvements in aesthetic outcomes.
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http://dx.doi.org/10.1097/GOX.0000000000002516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964923PMC
December 2019

Racial and Ethnic Disparities Among Burn Surgery Leadership.

J Burn Care Res 2020 05;41(3):714-721

University of Pittsburgh Medical Center Mercy Burn Center, Pittsburgh, Pennsylvania.

The underrepresentation of racial and ethnic minority groups has been well-documented in general and plastic surgery but not in burn surgery. The aim of this study is to evaluate current minority group disparities among burn surgery leadership. A cross-sectional analysis was performed. Burn surgeons included directors of American Burn Association-verified burn centers in the United States, past and current presidents of the American Burn Association, and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and Hirsch index (h-index). Among 71 burn center directors, 50 societal presidents, and 197 journal editors, minority groups represented 18.3, 2.0, and 34.5%, respectively. Among burn center directors, the group classified collectively as nonwhite was significantly younger (49 vs 56; P < .01), graduated more recently (2003 vs 1996; P < .01), and had a lower h-index (9.5 vs 17.4; P < .05). There were no significant differences in gender, type of residency training, advanced degrees obtained, fellowships, academic rank, and academic leadership positions between white and nonwhite groups. When compared with the 2018 U.S. National Census, burn unit directors had a 5.1% decrease in nonwhite representation. Disparities in representation of ethnic and racial minorities exist in burn surgery despite having similar qualifying factors.
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http://dx.doi.org/10.1093/jbcr/iraa026DOI Listing
May 2020

Gender Disparities Among Burn Surgery Leadership.

J Burn Care Res 2020 05;41(3):674-680

University of Pittsburgh Medical Center Mercy Burn Center, PA.

Gender disparities have been described in the plastic surgery and general surgery literature, but no data have been reported in burn surgery. The aim of this study is to determine gender disparities among burn surgery leadership. A cross-sectional study was performed. Burn surgeons included were directors of American Burn Association (ABA)-verified burn centers, past presidents of the ABA, and International Society for Burn Injuries (ISBI), and editors of the Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma. Training, age, H-index, and academic level and leadership position were compared among surgeons identified. Among the 69 ABA and ISBI past presidents, 203 burn journals' editorial board members, and 71 burn unit directors, females represented only 2.9%, 10.5%, and 17%, respectively. Among burn unit directors, females completed fellowship training more recently than males (female = 2006, male = 1999, P < .02), have lower H-indexes (female = 8.6, male = 17.3, P = .03), and are less represented as full professors (female = 8.3%, male = 42.4%, P = .026). There were no differences in age, residency, research fellowship, or number of fellowships. Gender disparities exist in burn surgery and are highlighted at the leadership level, even though female surgeons have a similar age, residency training, and other background factors. However, gender diversity in burn surgery may improve as females in junior faculty positions advance in their careers.
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http://dx.doi.org/10.1093/jbcr/iraa013DOI Listing
May 2020

Long-gap peripheral nerve repair through sustained release of a neurotrophic factor in nonhuman primates.

Sci Transl Med 2020 01;12(527)

Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.

Severe injuries to peripheral nerves are challenging to repair. Standard-of-care treatment for nerve gaps >2 to 3 centimeters is autografting; however, autografting can result in neuroma formation, loss of sensory function at the donor site, and increased operative time. To address the need for a synthetic nerve conduit to treat large nerve gaps, we investigated a biodegradable poly(caprolactone) (PCL) conduit with embedded double-walled polymeric microspheres encapsulating glial cell line-derived neurotrophic factor (GDNF) capable of providing a sustained release of GDNF for >50 days in a 5-centimeter nerve defect in a rhesus macaque model. The GDNF-eluting conduit (PCL/GDNF) was compared to a median nerve autograft and a PCL conduit containing empty microspheres (PCL/Empty). Functional testing demonstrated similar functional recovery between the PCL/GDNF-treated group (75.64 ± 10.28%) and the autograft-treated group (77.49 ± 19.28%); both groups were statistically improved compared to PCL/Empty-treated group (44.95 ± 26.94%). Nerve conduction velocity 1 year after surgery was increased in the PCL/GDNF-treated macaques (31.41 ± 15.34 meters/second) compared to autograft (25.45 ± 3.96 meters/second) and PCL/Empty (12.60 ± 3.89 meters/second) treatment. Histological analyses included assessment of Schwann cell presence, myelination of axons, nerve fiber density, and -ratio. PCL/GDNF group exhibited a statistically greater average area occupied by individual Schwann cells at the distal nerve (11.60 ± 33.01 μm) compared to autograft (4.62 ± 3.99 μm) and PCL/Empty (4.52 ± 5.16 μm) treatment groups. This study demonstrates the efficacious bridging of a long peripheral nerve gap in a nonhuman primate model using an acellular, biodegradable nerve conduit.
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http://dx.doi.org/10.1126/scitranslmed.aav7753DOI Listing
January 2020

An Evaluation of Race Disparities in Academic Plastic Surgery.

Plast Reconstr Surg 2020 01;145(1):268-277

From the Department of Plastic Surgery, University of Pittsburgh Medical Center.

Background: Academic plastic surgery has a history of underrepresentation of ethnic and racial minority groups. Recent policy shifts by national medical groups and plastic surgery societies have focused on reversing these inequalities. This study seeks to measure ethnic and racial representation at academic and leadership positions following recent changes.

Methods: A cross-sectional study was conducted in June of 2018, measuring ethnic and racial diversity of U.S. academic plastic surgery faculty. Among faculty, career qualifications, years of experience, faculty positions, and leadership ethnicity were compared.

Results: A total of 930 academic plastic surgeons were included in the study. Classified collectively as nonwhite, this group graduated more recently than other academic plastic surgeons (2006 versus 2001; p < 0.0001) and had greater rates of clinical fellowship attainment (OR, 1.62; 95 percent CI, 1.16 to 2.26). Nonwhite individuals were less likely to be employed in the full professor position compared with their white colleagues (OR, 0.6; 95 percent CI, 0.42 to 0.88; p = 0.0077). However, after adjustment for differences in years of postresidency experience, this disparity was no longer significant (OR, 1.06; 95 percent CI, 0.62 to 1.83; p = 0.82), indicating the importance of current cohort experience differences. Assessment of program leadership found that nonwhite chairs employed significantly more nonwhite faculty (42.5 percent versus 20.9 percent; p < 0.0001).

Conclusions: Academic plastic surgery continues to face disparities in representation of both ethnic and racial minorities. Current inequalities are most severe at senior academic positions and may be linked to cohort experience differences along with leadership and promotion biases.
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http://dx.doi.org/10.1097/PRS.0000000000006376DOI Listing
January 2020

Fat Grafting for Treatment of Secondary Facial Deformity.

Clin Plast Surg 2020 Jan;47(1):147-154

Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA. Electronic address:

Craniofacial deformities represent a great challenge for the patient and the plastic surgeon. Fat grafting has allowed a shift in paradigm for craniofacial reconstruction by providing a less invasive and safer alternative than traditional reconstructive options. Increasing evidence supports its use with optimal results. This article examines the evidence and practical aspects involved in the decision making and technique of fat grafting to treat secondary craniofacial deformities.
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http://dx.doi.org/10.1016/j.cps.2019.08.011DOI Listing
January 2020

Facial Fat Grafting: The Past, Present, and Future.

Clin Plast Surg 2020 Jan 21;47(1):1-6. Epub 2019 Oct 21.

Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, Pennsylvania 15261, USA. Electronic address:

Fat grafting has evolved over the past two centuries and has revolutionized regenerative medicine, aesthetic and reconstructive surgery. Fat grafting provides a safe and minimally invasive technique to improve signs of aging, sun damage, and congenital and acquired craniofacial deformities. The Coleman technique for harvesting, processing, and grafting provides a reliable strategy for consistent results. However, unanswered questions remain regarding the biology of fat grafting, survival mechanisms, and regenerative properties. The future of fat grafting is bright and includes cell-based therapy and extracellular matrix-based scaffolds. This article provides an overview of the past, present, and future of facial fat grafting.
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http://dx.doi.org/10.1016/j.cps.2019.08.004DOI Listing
January 2020

Change Is Happening: An Evaluation of Gender Disparities in Academic Plastic Surgery.

Plast Reconstr Surg 2019 10;144(4):1001-1009

From the Department of Plastic Surgery, University of Pittsburgh Medical Center.

Background: Gender disparities in academic plastic surgery are known; however, recently, professional societies have endorsed a culture of gender diversification. This study aims to evaluate the effects of these changes at faculty and leadership positions.

Methods: A cross-sectional study was conducted in June of 2018 to evaluate gender representation among U.S. academic plastic surgery faculty, and compare career qualifications, years of experience, and faculty positions.

Results: A total of 938 academic plastic surgeons were identified, of which only 19.8 percent were women. Female surgeons graduated more recently than men (2009 versus 2004; p < 0.0001) and predominantly from integrated residency programs (OR, 2.72; 95 percent CI, 1.87 to 3.96), were more likely to be an assistant professor (OR, 2.19; 95 percent CI, 1.58 to 3.05), and were less likely to be a full professor (OR, 0.20; 95 percent CI, 0.11 to 0.35) or program chair (OR, 0.32; 95 percent CI, 0.16 to 0.65). After adjustment for differences in years of postresidency experience, only disparities at the full professor position remained significant (OR, 0.34; 95 percent CI, 0.16 to 0.17), indicating that experience-independent gender inequality is prominent at the full professor level and that current differences in cohort experience are a significant contributor to many of the observed positional disparities. Lastly, programs led by a female chair employed significantly more female faculty (32.5 percent versus 18.2 percent; p = 0.016).

Conclusions: Gender diversity in academic plastic surgery remains a significant issue, but may see improvement as the disproportionately high number of junior female academics advance in their careers. However, leadership and promotion disparities between men and women still exist and must be addressed.
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http://dx.doi.org/10.1097/PRS.0000000000006086DOI Listing
October 2019

Dermatome-Induced Lacerations: An Unspoken Problem in Burn Surgery.

J Surg Res 2020 01 8;245:45-50. Epub 2019 Aug 8.

Department of Surgery, University of Pittsburgh Medical Center Mercy Burn Center, Pittsburgh, Pennsylvania.

Background: Dermatome-induced lacerations are a known complication; however, there is a paucity of literature discussing the incidence and predisposing factors. The aim of this study was to determine the incidence and risk factors to develop a preventive algorithm.

Methods: An 18-question survey was sent to all US and Canadian burn unit directors. Surgeons were queried about type and location of their practices, average annual caseload of skin graft harvesting, and number of dermatome-induced lacerations. The survey also asked about donor site location, harvesting technique and equipment, laceration severity, and causative factors. An algorithm was developed based on the results.

Results: Fifty-six responses (42% response rate) were received from the burn unit directors. They reported an estimated 133 lacerations over the past 5 y. The overall incidence of dermatome-induced lacerations was approximately 0.1% per year (1.3 per 1000 cases). The most commonly attributed causes were excessive pressure (25.0%) and patient factors (18.4%). Most lacerations occurred when using air dermatomes (73.0%) with a 4-inch guard (63.5%), 0.010- to 0.015-inch thickness (78.4%), and 30°-45° angulation (47.3%); the most common brand was Zimmer (71.6%). The dermatome was typically set up by a scrub tech or nurse (48.6%), whereas the skin harvesting was performed by residents (39.2%) or attendings (35.1%). Lacerations typically extended to subcutaneous tissue (70.3%), with no neurovascular injury (86.5%).

Conclusions: Our study showed that dermatome-induced lacerations are rare events and that certain factors predispose patients to injury. An algorithm was developed to provide guidance on risk factor identification and the set up and use of dermatomes.
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http://dx.doi.org/10.1016/j.jss.2019.07.022DOI Listing
January 2020

The Role of Fat Grafting in Alleviating Neuropathic Pain: A Critical Review of the Literature.

Plast Reconstr Surg Glob Open 2019 May 21;7(5):e2216. Epub 2019 May 21.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.

Background: Neuropathic pain is one of the more severe types of chronic pain and presents a great challenge as response to medical therapy remains often unpredictable. With the opioid epidemic and the search for ways to avoid narcotics, physicians are seeking other modalities to treat neuropathic pain. In recent years, surgeons have explored various surgical avenues to improve outcomes. The aim of this review was to evaluate the current clinical evidence regarding the efficacy of fat grafting for the treatment of neuropathic pain.

Methods: A critical review was conducted to examine the current clinical evidence of fat grafting as a therapy for neuropathic pain caused by neuromas, peripheral neuralgia, migraine and headaches, neuropathic scar pain, and postmastectomy pain syndrome.

Results: The precise mechanism role of fat grafting in modulating neuropathic pain remains unclear, but it appears to reduce pain levels through the anti-inflammatory effects of adipose-derived stem cells and mechanical cushioning by fat.

Conclusions: Fat grafting is an emerging therapy for chronic neuropathic pain of various etiologies. Although promising results have been reported, sample size and level of evidence of current studies are low. The encouraging results, however, are worthy of further clinical and scientific study. The minimally invasive nature of fat grafting and favorable risk profile make this an attractive therapy for neuropathic pain.
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http://dx.doi.org/10.1097/GOX.0000000000002216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571323PMC
May 2019

A Qualitative Survey Study of United States Burn Units: Pathways to a Career in Burn Surgery.

J Burn Care Res 2019 08;40(5):595-600

University of Pittsburgh Medical Center Mercy Burn Center, Pennsylvania.

With current changes in training requirements, it is important to understand the venues in the United States for a general surgery (GS) and plastic surgery (PS) resident interested in pursuing a burn surgery career. The study aims to evaluate the pathways to a career in burn surgery and the current state of leadership. A cross-sectional study was conducted between August and September 2017. A 12-question survey was sent to all burn unit directors in the United States, asking about their background, who manages various aspects of burn care and the hiring requirements. Responses were received from 55 burn unit directors (47% response rate). Burn units are lead most commonly by physicians who received GS training (69%), but the majority either did not undergo fellowship training (31%) or completed a burn surgery fellowship (29%). While surgical care (GS = 51%, PS = 42%) and wound care (GS = 51%, PS = 42%) were predominantly managed by GS- or PS-trained burn teams, management of other aspects of burn care varied depending on the institution, demonstrating that a shift in burn care management. The desired hiring characteristics, including GS (67%) or PS residency (44%) and a burn surgery (55%), trauma surgery (15%), or critical care (44%) fellowship. Directors' training significantly influenced their preferences for hiring requirements. While leadership in burn surgery is dominated by GS-trained physicians, the surgical and wound care responsibilities are shared among PS and GS. Although one third of current directors did not undergo fellowship training, aspiring surgeons are advised to obtain a burn surgery and/or critical care fellowship.
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http://dx.doi.org/10.1093/jbcr/irz071DOI Listing
August 2019

Subcutaneous drain-induced pressure sore following breast reconstruction.

Breast J 2019 01 4;25(1):149-150. Epub 2019 Jan 4.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

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http://dx.doi.org/10.1111/tbj.13173DOI Listing
January 2019

The "Wiser" oncoplastic reduction mammaplasty - An approach to challenging medial defects.

Breast J 2018 11 21;24(6):1051-1054. Epub 2018 Sep 21.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Medial defects created by breast-conservation surgery pose a significant challenge to oncoplastic reduction mammaplasty, especially with superficial tumors that necessitate resection of overlying skin. These tumors lie outside of the standard breast reduction excision pattern, and require modifications to the routine Wise approach. We present one modification - the "Wiser" oncoplastic reduction mammaplasty technique - that utilizes spared tissue along the lower pole, and a medial dermoglandular pedicle to address both skin and parenchymal defects created by the tumor resection.
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http://dx.doi.org/10.1111/tbj.13124DOI Listing
November 2018

Intramuscular Lipoma within a Free Myocutaneous Flap: Systematic Review and Management.

J Hand Microsurg 2018 Aug 20;10(2):101-104. Epub 2018 Mar 20.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.

Lipomas are a common finding often of little clinical significance, but they can pose a challenge to the microsurgeon if discovered during flap harvesting, especially if found within the muscle along the pedicle or perforators. Here the authors report a case in which a well-circumscribed intramuscular lipoma was discovered within the muscle of a free myocutaneous right anterolateral thigh (ALT) vastus lateralis free flap. To the authors' knowledge, the management of lipoma during flap harvesting has not been previously discussed in the literature. A systematic review was performed, and an approach for the management of myocutaneous flaps containing a lipoma was described. Underappreciated considerations including lipoma location, growth pattern, and proximity to pedicle and perforators must be taken into account when evaluating a lipoma during flap harvest.
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http://dx.doi.org/10.1055/s-0038-1626686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103749PMC
August 2018

Systematic Review of the Cost of Applying to Integrated Plastic Surgery Residency.

Plast Reconstr Surg 2018 11;142(5):820e-821e

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.

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http://dx.doi.org/10.1097/PRS.0000000000004913DOI Listing
November 2018

Longitudinal Data Highlighting the Inability to Maintain Medical Student Interest in Plastic Surgery.

Plast Reconstr Surg 2018 09;142(3):429e-430e

Division of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa.

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http://dx.doi.org/10.1097/PRS.0000000000004644DOI Listing
September 2018

Multicenter Randomized Controlled Trial to Assess an e-Learning on Acute Burns Management.

J Burn Care Res 2018 01;39(1):94-99

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pennsylvania.

An e-learning tutorial was developed to cover the basic aspects of acute burns management. The aim of this study was to provide objective educational evidence supporting the role of an e-learning on acute burns management ("basic burns management" or BBM) when compared with traditional teaching methods when introduced in different medical school settings around the world. A multicenter randomized controlled trial was conducted at the University of Pittsburgh, Peninsula College of Medicine and Dentistry, and St. George's University of London comparing the learning experience of medical students with the BBM e-learning tool (intervention) and a traditional lecture (control). A group of medical students was randomly allocated to the e-learning or lecture arms. Both groups were subjected to a 10-question pre-intervention and post-intervention tests assessing burns knowledge, and were asked to fill out a satisfaction survey. A total of 79 medical students of varying years of study participated. As a whole, students demonstrated a significant gain in knowledge after intervention (overall = 47.6%, P < .001), regardless of medical school year of study or interest in surgery. Participants undertaking the BBM e-learning had a greater exam score improvement and satisfaction compared with the traditional lecture even though they were not statistically significant. BBM e-learning is a free tool that provides comparable acute burn care learning opportunity and satisfaction outcomes to a traditional lecture, allowing convenient and standardized incorporation of burns teaching within an educational setting, regardless of geographical location, level of experience, or interest in surgery.
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http://dx.doi.org/10.1097/BCR.0000000000000528DOI Listing
January 2018

Primary Closure of Wide Fasciotomy and Surgical Wounds Using Rubber Band-Assisted External Tissue Expansion: A Simple, Safe, and Cost-effective Technique.

Ann Plast Surg 2018 09;81(3):344-352

From the Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.

Background: Although decompressive fasciotomy is a limb-saving procedure in the setting of acute compartment syndrome, it leaves a large wound defect with tissue edema and skin retraction that can preclude primary closure. Numerous techniques have been described to address the challenge of closing fasciotomy wounds. This study reports our experience with fasciotomy closure using rubber bands (RBs) for external tissue expansion.

Methods: Patients were informed about RB closure and split-thickness skin graft options. Only patients who opted for RB closure and had wounds that could not be approximated using the pinch test underwent the procedure. Starting from the apex and progressively advancing, the RBs were applied to the skin edges at 3 to 4 mm intervals using staples. The RBs were advanced by twisting back-and-forth to create a criss-cross pattern. One week after application, fasciotomy wounds were closed primarily or underwent further RB application, based on clinical assessment of adequacy of skin advancement, compartment tension, and perfusion. Review of a prospectively maintained database was performed, including demographics, comorbidities, etiology, wound and operative details, hospital stay, and complications.

Results: Seventeen consecutive patients with 25 wounds (22 fasciotomy and 3 other surgical wounds) were treated using the RB technique. Average wound length and width measured 15.7 cm (range, 5-32 cm) and 5.2 cm (range, 1-12 cm), respectively. Locations of wounds included forearm (n = 12, 48.0%), leg (n = 7, 28.0%), hand (n = 4, 16.0%), elbow (n = 1, 4.0%), and hip (n = 1, 4.0%). Eighteen of 25 wounds (72.0%) were closed primarily after 1 RB application. Additional RB application was required for 5 wounds to achieve primary closure. Between stages, patients were discharged home if they did not have other conditions requiring in-hospital stay. No complications were observed, and no revision surgeries were required. Patient satisfaction was 100%, and all indicated that they would choose the RB technique over skin grafting.

Conclusions: The modified RB technique is a simple, safe, and cost-effective alternative for treating fasciotomy and other surgical defects resulting in high patient satisfaction and good cosmetic outcome, without the need for split-thickness skin graft or flap coverage.
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http://dx.doi.org/10.1097/SAP.0000000000001506DOI Listing
September 2018

Graphical Calculation of Estimated Energy Expenditure in Burn Patients.

Ann Plast Surg 2018 Mar;80(3):228-231

Background: Historically, estimated energy expenditure (EEE) has been related to the percent of body surface area burned. Subsequent evaluations of these estimates have indicated that the earlier formulas may overestimate the amount of caloric support necessary for burn-injured patients. Ireton-Jones et al derived 2 equations for determining the EEE required to support burn patients, 1 for ventilator-dependent patients and 1 for spontaneously breathing patients. Evidence has proved their reliability, but they remain challenging to apply in a clinical setting given the difficult and cumbersome mathematics involved. This study aims to introduce a graphical calculation of EEE in burn patients that can be easily used in the clinical setting.

Methods: The multivariant linear regression analysis from Ireton-Jones et al yielded equations that were rearranged into the form of a simple linear equation of the type y = mx + b. By choosing an energy expenditure and the age of the subject, the weight was calculated. The endpoints were then calculated, and a graph was mapped by means of Adobe FrameMaker.

Results: A graphical representation of Ireton-Jones et al's equations was obtained by plotting the weight (kg) on the y axis, the age (years) on the x axis, and a series of parallel lines representing the EEE in burn patients. The EEE has been displayed graphically on a grid to allow rapid determination of the EEE needed for a given patient of a designated weight and age. Two graphs were plotted: 1 for ventilator-dependent patients and 1 for spontaneously breathing patients. Correction factors for sex, the presence of additional trauma, and obesity are indicated on the graphical calculators.

Conclusions: We propose a graphical tool to calculate caloric requirements in a fast, easy, and portable manner.
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http://dx.doi.org/10.1097/SAP.0000000000001276DOI Listing
March 2018

Hand Surgery Fellowship Selection Criteria: A National Fellowship Director Survey.

Arch Plast Surg 2017 Sep 15;44(5):428-433. Epub 2017 Sep 15.

Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Background: Candidate characteristics for hand surgery fellowship training remains unknown, as very little data is available in the literature. This study aims to provide information on the criteria that are employed to select candidates for the hand surgery fellowship match.

Methods: A 38-question survey was sent in April 2015 to all Accreditation Council for Graduate Medical Education recognized hand surgery fellowship program directors (n=81) involved in the U.S. match. The survey investigated factors used for the selection of applicants, including medical school, residency training, research experience, fellowship interview, and candidate characteristics. A 5-point Likert scale was used to grade 33 factors from "not at all important" (1) to "essential in making my decision" (5); or for five controversial factors from "very negative impact" (1) to "very positive impact in making my decision" (5).

Results: A total of 52% (42 out of 81) of responses were received from hand surgery fellowship program directors. The most important influential factors were interactions with faculty during interview and visit (4.6±0.6), interpersonal skills (4.6±0.5), overall interview performance in the selection process (4.6±0.6), professionalism and ethics (4.6±0.7), and letters of recommendation from hand surgeons (4.5±0.7). Factors that have a negative impact on the selection process include visa requirement (2.1±1.2), graduate of non-plastic surgery residency program (2.4±1.3), and graduate of a foreign medical school (2.4±1.1).

Conclusions: This study provides data on hand surgery fellowship directors' perception on the criteria important for fellowship applicant selection, and showed that interview-related criteria and letters of recommendation are the important factors.
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http://dx.doi.org/10.5999/aps.2017.44.5.428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621811PMC
September 2017