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Ann Plast Surg 2022 Jun;88(6):674-678

General Surgery.

Background: The aims of this study were to investigate if recipient artery choice in right lobe living donor liver transplant affects postoperative complications and discuss solutions accordingly.

Methods: Three hundred fourteen right lobe living donor liver transplantation patients were divided into 2 groups: 163 patients using right hepatic artery as the recipient vessel and 151 patients using left hepatic artery as the recipient vessel. Cases involving 2 recipient blood vessels or the use of other blood vessels as recipient vessels were excluded. Read More

Ann Plast Surg 2022 Jun 18;88(6):e13-e19. Epub 2022 Feb 18.

Department of Surgery, University of Medical Branch, Galveston, TX.

Background: As the cost of healthcare rises, it is imperative to assess value delivered to patients and impact on the economic viability of institutions. We aimed to characterize plastic surgery operative time management and identified areas for efficiency improvement.

Methods: Procedures from a US academic plastic surgery division from September 2017 to August 2018 were reviewed. Read More

Ann Plast Surg 2022 Jun 18;88(6):606-611. Epub 2022 Feb 18.

From the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, Xi'an, Shaanxi, China.

Background: Fifty percent of Asians are born without a supratarsal fold (also called single eyelid), and double eyelid blepharoplasty is one of the most commonly performed and most popular facial cosmetic surgeries in the Asian population. However, patients with single eyelid frequently present with concomitant mild blepharoptosis (degree of ptosis, ≤2 mm), which often fails to cause the attention of surgeons and misses correction.

Methods: A retrospective study of all patients who underwent double eyelid blepharoplasty and blepharoptosis correction simultaneously with the modified levator aponeurosis plication technique was performed from June of 2017 to June of 2020. Read More

Ann Plast Surg 2022 Jun 1;88(6):599-605. Epub 2021 Nov 1.

From the Division of Plastic Surgery, Department of General Surgery.

Purpose: Integrated plastic surgery residency programs have increased their social media presence to educate and recruit prospective residents. This study aims to understand the impact of integrated plastic surgery residency program social media on the 2020 to 2021 applicants' evaluation of prospective programs, particularly during the coronavirus disease 2019 pandemic.

Materials And Methods: An optional 20-item online survey was sent to integrated plastic surgery residency applicants applying to the authors' program. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S309-S313

Department of Orthopaedic Surgery, University of Pennsylvania.

Background: Although occupational exposure to radiation has been previously studied in the hand surgery literature, there is a paucity of studies looking at radiation exposure to the patient during fluoroscopy-guided hand surgery. We aimed to describe the level of radiation experienced by patients undergoing common hand and wrist fracture fixation and to identify risk factors for increased radiation exposure.

Methods: We performed a retrospective review of patients at a single institution who underwent fracture fixation of the hand, wrist, or forearm requiring mini c-arm fluoroscopic guidance from 2016 to 2020. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S302-S308

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York.

Background: Nipple reconstruction is widely regarded as the final step in postmastectomy breast reconstruction. While grafts, local flaps, or combination approaches have been used in nipple reconstruction, none has been able to achieve reliable long-term projection preservation. In response, we have sought to bioengineer neonipples in situ via the implantation of processed, decellularized cartilage xenografts placed within 3-dimensional-printed polylactic acid (PLA) scaffolds. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S296-S301

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York.

Background: Reconstruction of cartilaginous deformities is a well-established surgical challenge with high levels of unpredictability and complication. Because of the morbidity associated with autologous cartilage grafting, combined with its limited supply and the significant expense of commercially decellularized allografts, increasing efforts have sought to produce an acellular, nonimmunogenic cartilage xenograft. We have developed and validated a novel protocol for high throughput decellularization of ovine costal cartilage with immediate translational potential for preclinical investigation of novel strategies for cartilaginous reconstruction. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S293-S295

From the Division of Plastic Surgery, Department of Surgery.

Objective: Dedicated research time is a component of certain plastic surgery programs, and yet, there is limited research examining its impact on academic productivity and career outcomes. This study aimed to assess the effect of dedicated research time on the academic productivity of residents and the likelihood of pursuing an academic career.

Methods: We conducted a cross-sectional study that examined bibliometric indices of integrated plastic surgery residency graduates from 2010 to 2020. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S288-S292

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, The Pennsylvania State University.

Introduction: Ongoing recognition of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and its link with textured devices has brought a paradigm shift in prosthetic-based breast reconstruction. Many institutions no longer offer textured expansion devices for staged reconstruction. However, there is a paucity of data regarding the efficacy of smooth tissue expanders (TE). Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S284-S287

From the Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.

Introduction: Over the last several years, various social media platforms have been used to increase collaboration, education, and research internationally. The purpose of this study was to evaluate how plastic surgery residency programs use social media to promote global surgery education, research, and collaboration.

Methods: A full list of active integrated residency programs was obtained from the American College of Academic Plastic Surgeons website. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S279-S283

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

Background: Postmastectomy breast reconstruction (BR) has been shown to provide long-term quality of life and psychosocial benefits. Despite the policies initiated to improve access to BR, its delivery continues to be inequitable, suggesting that barriers to access have not been fully identified and/or addressed. The purpose of this study was to assess the influence of geographic location, socioeconomic status, and race in access to immediate BR (IBR). Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S274-S278

Fox Chase Cancer Center/Division of Plastic and Reconstructive Surgery, Temple University.

Background: Abdominoplasty complication rates are among the highest for cosmetic surgery. We sought to create a validated scoring system to predict the likelihood of wound complications after abdominoplasty using a national multi-institutional database.

Methods: Patients who underwent abdominoplasty in the American College of Surgeons National Surgical Quality Improvement Program 2007-2019 database were analyzed for surgical site complications, a composite outcome of wound disruption, and surgical site infections. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S257-S265

From the Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ.

Background: Increasing health care diversity is critical to overcoming disparities. Plastic surgery has been working to improve diversity through various efforts, including social media movements like Diversify PRS and #ilooklikeasurgeon. Because residency programs' social media sites serve as a public symbol of the programs' values and can attract potential applicants, we sought to analyze such platforms for content highlighting sex and ethnic diversity. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S250-S256

From the Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ.

Background: Burnout, "a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment", afflicts approximately one third of plastic surgery attending surgeons and residents. Burnout can be detrimental to resident training and patient outcomes. Therefore, cultivating wellness during residency is essential. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S239-S245

From the Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.

Background: Lymphedema is an edematous condition that afflicts the postmastectomy breast cancer population, with diminished quality of life with substantial financial costs. The factors predictive of postmastectomy lymphedema development in breast cancer patients are unknown. The objective was to evaluate the trends over time in lymphedema development and the risk factors predictive of lymphedema-related events within 2 years of mastectomy. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S235-S238

From the Department of Plastic and Reconstructive Surgery, NewYork-Presbyterian/Weill Cornell, New York, NY.

Purpose: Our previous rodent studies demonstrated significantly decreased full-thickness necrosis in pedicled dorsal skin flaps with topical tacrolimus as compared with petroleum jelly. Histologically, we found that topical tacrolimus was correlated with increased vascular growth in areas more susceptible to ischemic damage. The purpose of this study was to investigate the potential benefits of pretreatment with tacrolimus. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S229-S234

From the Division of Plastic Surgery, Weill Cornell Medical College, New York, NY.

In 2019, the plastic surgery residency match changed their method for inviting students to interview. Instead of offering interview invitations and scheduling interviews on a first come, first served basis, all plastic surgery residency programs sent out secured interview spots on the same day. This universal offer date was intended to remove student worry that surrounded not scheduling an interview fast enough, as well as cause students to more carefully select which interview invitations to accept, increasing the likelihood that residency programs could interview only those students most interested in matching at their institutions. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S224-S228

Orthopedic Surgery, Hospital for Special Surgery, Hospital for Special Surgery.

Background: Patients with transfemoral and transtibial amputations generally rely on socket-suspended (SS) prostheses for ambulation. The use of these aids can be complicated by poor fit, leading to tissue damage, pain at the socket-limb interface, and inability to ambulate. Osseointegrated implants (OIs) directly anchor a prosthesis to the patient's residual limb, eliminating these issues. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S219-S223

From the Plastic Surgery Department, Brown University, Providence, RI.

Background: Preoperative surgical risk assessment is a major component of clinical decision making. The ability to provide accurate, individualized risk estimates has become critical because of growing emphasis on quality metrics benchmarks. The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) Surgical Risk Calculator (SRC) was designed to quantify patient-specific risk across various surgeries. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S209-S213

From the Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.

Purpose: Nail bed injuries are commonly treated with nail plate removal and repair due to concern for future nail deformity. There is controversy whether this is necessary. We compared the outcomes for adult patients with simple nail bed lacerations who underwent either formal nail bed repair or nonoperative management. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S205-S208

From the Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY.

Introduction: Acellular dermal matrix (ADM) is frequently used during prepectoral tissue expander-based breast reconstruction. However, there has been a paucity of literature describing the experience of prepectoral reconstruction without the accompanying use of ADM. We seek to highlight our institutional experience with immediate prepectoral tissue expander placement without the use of ADM in breast reconstruction. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S201-S204

From the New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY.

Introduction: Patients with Ehlers-Danlos syndrome (EDS) are at elevated risk for soft tissue complications when undergoing decompression with or without fusion of the craniocervical junction. We have previously shown that muscle flap closure can decrease reoperative rates. This study investigated whether myofascial flap closure improved clinical outcomes after simple or complex surgery of the craniocervical junction in EDS patients specifically. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S197-S200

From the Department of Surgery, Temple University Hospital, Philadelphia, PA.

Background: Sternal wound infections are a rare but life-threatening complication of cardiothoracic surgery. Prior literature has supported the use of negative pressure wound therapy to decrease sternal wound infections and promote healing. This study sought to determine whether closed incision negative pressure therapy reduced wound infection and improved outcomes in cardiothoracic surgery. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S194-S196

General Surgery, Waterbury Hospital, Waterbury CT.

Background: Keloid formation occurs with increased incidence in African Americans and Afro-Caribbeans when compared with other ethnic populations. Although surgical management and nonsurgical management of keloids are mainstays of treatment, there are significant variations within studies comparing the efficacy of intraoperative steroid injection, postoperative radiotherapy, or a combination of both modalities. The purpose of our study is to evaluate the efficacy of different treatment modalities used for treatment of keloids and to determine their recurrence in a select Afro-Caribbean population. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S190-S193

Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.

Background: Sternal wound (SW) infection and dehiscence after median sternotomy from cardiac surgery remain challenging complications with high morbidity. Knowledge of common pathogen types and variance with time from cardiac surgery can simplify the choice of antibiotics while awaiting definitive culture results.

Methods: Records of 505 patients undergoing SW reconstruction by the senior author from 1996 to 2018 at a high-volume cardiac surgery center were reviewed. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S174-S178

From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital.

Background: Despite the lack of clear indications for the use of intra-arterial lines (IALs) for intraoperative hemodynamic monitoring, they are often used in a variety of settings. In this retrospective review of patients undergoing free tissue transfer (FTT) for lower extremity (LE) reconstruction, we sought to (1) identify patient factors associated with IAL placement, (2) compare hemodynamic measurements obtained via IAL versus noninvasive blood pressure (NIBP) monitoring, and (3) investigate whether method of hemodynamic monitoring affected intraoperative administration of blood pressure-altering medications.

Methods: Patients undergoing LE FTT from January 2017 through June 2020 were retrospectively reviewed. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S163-S169

From the Divisions of Plastic and Reconstructive Surgery.

Abstract: Upper extremity infections (UEIs), commonly caused by intravenous drug use and direct trauma to the hand, can be devastating. Many studies support hand therapy postoperatively to improve outcomes. This population of patients often experience increased returns to the emergency department (ED) for treatment, repeat surgery, poor function, and increased hospital expenditure. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S156-S162

Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester.

Introduction: The use of an inferiorly based dermal flap (IBDF) with implant insertion allows for 1-step reconstruction of a ptotic breast after mastectomy. An IBDF allows for secondary protection of the inferior pole and provides a vascularized pocket for implant insertion. Previous literature has demonstrated the use of this surgical approach for optimal patient satisfaction and higher patient-reported outcomes. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S152-S155

From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.

Introduction: Velopharyngeal insufficiency (VPI), a stigmatizing hallmark of palatal dysfunction, occurs in a wide spectrum of pediatric craniofacial conditions. The mainstays for surgical correction include palate repair and/or pharyngeal surgery. However, primary pharyngoplasty has a failure rate of 15% to 20%. Read More

Ann Plast Surg 2022 05;88(3 Suppl 3):S148-S151

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

Background: Chest masculinization surgeries are one of the most common gender-affirming procedures performed. There is a need for better understanding of the risk of breast cancer and postsurgical screening in female to male (FtM) individuals. This study aimed to evaluate the incidence of high-risk pathologic findings in FtM transgender patients undergoing gender-affirming chest reconstructive surgery. Read More