Publications by authors named "Irene A Chang"

14 Publications

  • Page 1 of 1

Dual Fluorescent Tracers for Surgical Guidance: Preventing Donor-site Lymphedema in Vascularized Lymph Node Transfer.

Plast Reconstr Surg Glob Open 2022 Jun 21;10(6):e4390. Epub 2022 Jun 21.

Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.

Introduction: Vascularized lymph node transfer (VLNT) restores physiological lymphatic function. Although effective, postoperative impairment of donor-site lymphatic function and iatrogenic lymphedema following lymph node transfer remains a pressing concern.

Methods: Prospective analysis of VLNT patients undergoing dual fluorescent tracers-assisted harvest was performed at our institution from September 2013 to April 2022. Reverse lymphatic mapping of the lower extremity was performed with indocyanine green (ICG). Blue dye was utilized in both white light and near-infrared spectra for visualization of donor-site lymphatic structures. Demographics, intraoperative details, and surgical outcomes were recorded.

Results: Twenty-five patients were included. Median age was 52.9 years with a body mass index of 29.1 kg/m and mean follow-up of 44 months (range 24 to 90 months). Lymphedema stage ranged from Campisi 2 to 4. Inguinal VLNT was performed in 13 patients, and 12 patients received combined VLNT and free flap breast reconstruction. No patients required change in lymph node donor site intraoperatively. All ICG stained nodes were preserved in situ. No cases of iatrogenic lower extremity lymphedema were observed. Postoperative bioimpedance spectroscopy, circumferential, and volumetric measurements of the donor-site limb did not show evidence of subclinical or clinical lymphedema. The donor site healed appropriately in 92% of patients; one patient developed methylene blue-induced skin necrosis.

Conclusion: Reverse lymphatic mapping and surgical guidance with dual ICG and blue dye fluorescent tracers provides surgeons with real-time surgical guidance without radioisotope, improves surgical visualization in both white light and near-infrared spectra, and avoids iatrogenic lymphatic dysfunction in the donor limb.
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http://dx.doi.org/10.1097/GOX.0000000000004390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9278919PMC
June 2022

The Hairline Brow Lift.

Clin Plast Surg 2022 Jul 13;49(3):349-356. Epub 2022 May 13.

Cleveland Clinic Department of Plastic Surgery, 9500 Euclid Avenue, Cleveland, OH 44195-0001, USA; Section of Cosmetic Surgery, Cleveland Clinic Plastic Surgery, 9500 Euclid Avenue, Cleveland, OH 44195-0001, USA. Electronic address:

Effective rejuvenation of the upper face results when effective brow repositioning is combined with maintenance or improvement of brow shape. Endoscopic brow lift techniques have increased in popularity as surgeons have investigated less invasive surgical procedures. This article provides a comparison of hairline brow lift with other open and endoscopic techniques used for improving brow position. It includes a detailed description of hairline brow lift with videos illustrating the authors' preferred technique. It also provides a description of ideal candidates including indications and contraindications to procedure, and common modifications to technique used in select patient populations.
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http://dx.doi.org/10.1016/j.cps.2022.01.004DOI Listing
July 2022

Analysis of TikTok's Most Viewed #PlasticSurgery Content: An Opportunity for Educational Outreach.

Plast Reconstr Surg 2022 06 25;149(6):1271e-1273e. Epub 2022 Apr 25.

Department of Plastic Surgery, Cleveland Clinic, Akron General Hospital, Akron, Ohio.

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http://dx.doi.org/10.1097/PRS.0000000000009113DOI Listing
June 2022

The Makings of a Positive Patient Experience: A Comprehensive Analysis of Plastic Surgery Online Reviews.

Aesthet Surg J 2022 Apr 13. Epub 2022 Apr 13.

Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA.

Background: Subjective online physician evaluation is an important component of patient decision-making. Understanding reviews may improve satisfaction and build positive online reputation.

Objectives: Our objective was to analyze and compare the top predictive factors driving patient satisfaction across the most popular plastic surgery procedures.

Methods: Online reviews were analyzed from RealSelf, Yelp, and Google for the five highest-rated plastic surgeons of the six metropolitan areas. Blank, non-English, consultation, duplicate, and unrelated reviews were excluded. Data from free-text reviews included physician rating, patient-reported reasons for rating, procedure, and complications. Univariate analysis was performed to compare predictive factors of online ratings.

Results: 11,078 reviews were included. RealSelf the highest average rating (4.77), while Yelp had the lowest (4.66). Reviews in Miami, Philadelphia, New York City, and Chicago were mostly published on RealSelf, while Houston and Los Angeles most used Google and Yelp, respectively. Reconstructive procedures were rated significantly higher than cosmetic procedures (p = 0.035). Aesthetic appearance was the strongest predictor of rating across all procedures. Buccal fat removal (98.8%) and abdominoplasty (98.1%) had highest satisfaction, while Brazilian butt lift had the lowest (88.2%) (p < 0.001). Additional significant contributors included staff interaction, bedside manner, health outcomes, complications, and postoperative care (p < 0.001).

Conclusions: While aesthetic outcome is an important predictor of satisfaction, other aspects of care, such as bedside manner and staff interaction, provide an important foundation of support. Excellent patient-surgeon communication and postoperative care may mitigate patient dissatisfaction and elicit high-satisfaction online patient reviews.
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http://dx.doi.org/10.1093/asj/sjac092DOI Listing
April 2022

Labiaplasty: Analysis of the National Surgical Quality Improvement Program Database.

Aesthet Surg J 2022 06;42(7):771-780

Division of Plastic Surgery, Department of Surgery, Stanford University, Stanford, CA, USA.

Background: Labiaplasty is an increasingly popular procedure performed for both cosmetic and pathologic etiologies. Questions have been raised regarding the efficacy of the procedure, especially for cosmetic etiologies.

Objectives: The aim of this study was to examine the complication profiles of labiaplasties for both cosmetic and pathologic etiologies.

Methods: The 2005 to 2017 National Surgical Quality Improvement Program database was analyzed for patients who, according to the relevant Current Procedural Terminology code, had undergone labiaplasties. Our cohort was further separated into cosmetic and pathologic groups based on International Classification of Diseases codes. Information was collected on patient demographic characteristics, patient comorbidities, and operative variables. Outcomes of interest included surgical complications and delayed length of stay (DLOS). A univariate analysis and multivariate logistic regression were applied to determine statistically significant predictors of our outcomes of interest for both etiologies.

Results: There were 640 patients in the cosmetic cohort and 1919 patients in the pathologic cohort. There were no significant differences in rates of surgical complications between the 2 groups, but there was a statistically significant increase in length of stay for the pathologic group. Univariate analysis revealed operative time and plastic surgeon specialty to be predictive of DLOS in the cosmetic cohort. No covariates were implicated with multivariate analysis for either surgical complications or for DLOS in the cosmetic cohort.

Conclusions: Our findings suggest that cosmetic labiaplasty is a safe and efficacious procedure with low complication rates and no predictors of adverse outcomes.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjac045DOI Listing
June 2022

A Multimetric Readability Analysis of Online Patient Educational Materials for Submental Fat Reduction.

Aesthetic Plast Surg 2022 04 17;46(2):712-718. Epub 2022 Jan 17.

Department Chair, Department of Plastic Surgery, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue- A60, Cleveland, OH, 44195, USA.

Background: Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction.

Methods: Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales.

Results: Analysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8-59.2), representing a "difficult" level of reading. Mean readability grade levels (range 9-13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health.

Conclusions: Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266.
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http://dx.doi.org/10.1007/s00266-021-02675-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8761512PMC
April 2022

Readability of online patient educational materials for transgender dermatologic care.

J Am Acad Dermatol 2022 Jan 5. Epub 2022 Jan 5.

Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio.

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http://dx.doi.org/10.1016/j.jaad.2021.12.041DOI Listing
January 2022

"Twitter and plastic surgery: Reconstructing traditional concepts of mentorship in the digital age".

J Plast Reconstr Aesthet Surg 2022 Feb 1;75(2):893-939. Epub 2021 Dec 1.

Department of Plastic Surgery, Cleveland Clinic Akron, Akron, OH, USA.

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http://dx.doi.org/10.1016/j.bjps.2021.11.096DOI Listing
February 2022

A Longitudinal, Geographical, and Descriptive Analysis of Political Contributions of Plastic Surgeons.

Aesthetic Plast Surg 2021 Dec 2. Epub 2021 Dec 2.

Department of Plastic Surgery, Cleveland Clinic Akron General, Akron, Ohio, USA.

Background: Political contributions from healthcare providers are essential to shaping healthcare policy and allow physicians to expand their influence on a national level. Political Action Committees in particular provide a useful avenue for unifying contributions for the interest of a specific community. This study examined the geographical distribution, temporal pattern, and overall nature of the political contributions made by plastic surgeons.

Methods: The Federal Election Commission was analyzed for political contributions made by plastic surgeons from 2003 to 2021 using the search terms "plastic surgeon," "microsurgeon," and "craniofacial" as well as physician contributions to PlastyPAC. Contributions were categorized based on political parties (Democratic, Republican, and independent parties), and further analyzed based on state distribution and year of contribution. Spatial distribution data were then visualized using heatmaps for each state.

Results: The total sum of contributions between 2003 and 2021 from plastic surgeons was $5,306,605, with $1,737,178.51 for the Republican party, $962,773.26 for the Democratic party, and $2,604,149.86 for independent parties. Political funding of PlastyPAC consisted of 47.3% of the overall political contributions. There was no significant trend through the years in the overall contribution amount. The states with the most political contributions were California, New York, Florida, and Texas.

Conclusions: The temporal stagnation of total political contributions and decline in recent PlastyPAC funding from plastic surgeons support an increased political awareness for new plastic surgeons.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-021-02686-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8638794PMC
December 2021

"For the 'Gram: A Deconstruction of Influential Plastic Surgeon Instagram Posts".

Aesthetic Plast Surg 2022 04 29;46(2):1001-1003. Epub 2021 Nov 29.

Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alta, CA, USA.

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http://dx.doi.org/10.1007/s00266-021-02689-3DOI Listing
April 2022

Promoting applicant engagement via website development for transgender fellowship training programs in plastic surgery.

J Plast Reconstr Aesthet Surg 2022 Jan 14;75(1):439-488. Epub 2021 Nov 14.

Division of Plastic Surgery, Cleveland Clinic - Akron General, USA.

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http://dx.doi.org/10.1016/j.bjps.2021.11.047DOI Listing
January 2022

Repair Sequence and Management of the Premaxilla in Patients With Bilateral Cleft Lip and Palate: A Systematic Review of the Literature.

J Craniofac Surg 2022 Mar-Apr 01;33(2):421-425

Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH.

Background: Bilateral cleft lip and palate (BCLP) remains a difficult surgical problem due to the severely protruding premaxillary segment, with no consensus of optimal treatment sequence in older patients. A systematic review of the literature was performed to assess the current status of BCLP repair based on age.

Methods: A PRISMA systematic review of the PubMed, Web of Science, and Embase databases was performed using a series of search terms related to BCLP. Studies were categorized based on the age of presentation, repair sequence, and technique.

Results: The database search identified 381 articles. Of these, 72 manuscripts were ultimately included. The lip was repaired first in 1077 patients (86.0%), palate first in 161 patients (12.9%), and simultaneous lip and palate in 14 patients (1.1%). Patients less than 6 months old received lip repair first (n = 959, 98.6%), with complications of unaesthetic appearance (n = 86, 62.3%) and midface retrusion (n = 41, 34.1%) in younger patients and wound dehiscence (n = 8, 40%) in older patients. Primary lip repair was preceded by presurgical orthopedics (n = 760) or lip adhesion (n = 272) to reduce lip tension with nasoalveolar molding (n = 452, 62.9%) or the Latham device (n = 282, 37.1%). In older patients, the palate was repaired first or premaxillary setback (n = 222) was indicated in protruded premaxillae greater than 10 mm, but carried the risk of premaxilla mobility (n = 20, 37.7%) and midface retrusion (n = 10, 18.9%).

Conclusion: In younger patients, lip repair is performed first with preoperative orthopedics or lip adhesion. In older patients, the palate is more commonly repaired first compared with the lip; however, there is no difference in complication rate.
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http://dx.doi.org/10.1097/SCS.0000000000008184DOI Listing
April 2022

Vascularized Composite Allotransplantation-An Emerging Concept for Burn Reconstruction.

J Burn Care Res 2017 Nov/Dec;38(6):371-378

From the *Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School; and †Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Vascularized composite allotransplantation (VCA) has demonstrated utility in the reconstruction of extensive soft-tissue defects following severe burns. However, pre-VCA events such as multiple transfusions, previous transplantation and pregnancies, the use of skin allografts, and mechanical support devices may result in sensitization and ultimately exclude a burn patient, who may benefit most through VCA, from a hand or face transplant. The authors sought to identify the immunologic challenges involved. All reported VCA cases up to July 2016 were reviewed. Relevant data analyzed include patient demographics, burn etiology, type and extent of VCA performed, pretransplant panel reactive antibody (PRA) status, extent of human leukocyte antigen (HLA) mismatch between donor and recipient, and immunologic outcomes. Of the 142 known cases of VCA to date, 30 (mean age = 36 years) were performed for burn reconstruction (mean interval to surgery = 8.3 years). Thermal and electrical burns were most common and performed in 20 and 30% of all reported upper extremity and craniofacial VCA cases, respectively, despite highly variable pretransplant PRA (0-98%). HLA-matching statuses between donors and recipients varied from 2/6 to 6/6. No obvious relationship could be observed between the incidence and severity of acute rejection with the patient's PRA and HLA-matching statuses, although more extensive treatment was required to reverse rejection episodes in sensitized patients (PRA > 0%). Further development and refinement of clinically relevant immunomodulatory protocols is required to achieve immunosuppression minimization and/or successful transplantation tolerance to enable long-term survival of both the VCA itself and the patient.
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http://dx.doi.org/10.1097/BCR.0000000000000532DOI Listing
July 2018
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