Publications

BACKGROUND: Decreased nipple sensation following reduction mammoplasty can negatively affect a variety of patient-centered outcomes. This observational study examined the impact of dermoglandular pedicle type on subjective postoperative nipple sensation.

METHODS: A total of 178 women who underwent a bilateral reduction mammoplasty at a single institution from 2017 to 2023 and completed an 11-item survey assessing subjective postoperative nipple sensitivity across various tactile modalities were included. Patient-reported nipple sensations were compared across pedicle type and subgrouped by resection volume.

RESULTS: Of the included survey respondents, 72% (128) underwent reduction with an inferior pedicle and 28% (50) with a superior or superomedial pedicle. Over 92% of patients reported the preservation of postoperative nipple sensation. Compared to the inferior pedicle, the superior pedicle cohort reported decreased nipple sensitivity to light touch (56% vs 30%, respectively) and temperature (30% vs 15%). In resection weights greater than 500 grams, the superior pedicle cohort was less satisfied with postoperative nipple sensation (84% vs. 58%), reported decreased sensation in light touch (58% vs 24%), pressure (50% vs 21%), and experienced more numbness and tingling (17% vs 1.4%) (all p-values ≤0.05).

CONCLUSION: The majority of patients maintain some sensation after reduction mammoplasty; however, approximately 10% reported a relative decrease in subjective nipple sensation. Pedicle choice did not significantly affect sensory recovery in resection weights of less than 500 grams. When a greater resection weight is anticipated, the inferior pedicle may be associated with more favorable nipple sensation outcomes.

LEVEL OF EVIDENCE III: 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 .

Heparin is frequently used to mitigate the risk of thrombosis in microsurgical free tissue transfer. Although rare, heparin-induced thrombocytopenia (HIT) is a severe, life-threatening complication that can arise in patients exposed to heparin products. This systematic review aims to examine patterns in demographics, flap characteristics, diagnostic approaches, and treatment protocols for HIT following free flap reconstruction.A systematic search was conducted across PubMed, MEDLINE, and Web of Science, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Search terms included "heparin-induced thrombocytopenia," "HIT syndrome," "free flaps," "microsurgery," "plastic surgery," and "reconstructive surgery." Case reports or series written in English that presented patients developing HIT following free flap procedures were included. Eligibility criteria are accessible on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42025650125).A total of 15 articles were included, encompassing a total of 23 free flap reconstruction cases. The median patient age was 52 years, with male predominance (69.6). Lower extremity reconstruction was most common (47.8%), primarily using anterolateral thigh flaps (39.1%). Median 4T score was 6, median time to HIT diagnosis was 6 days, and median nadir platelet count was 72 × 103/μL. Thrombotic complications were common, with venous thrombosis (34.8%) predominating. Argatroban (26.1%) was the most frequently used alternative anticoagulant, while warfarin (30.4%) was the most common discharge medication. Overall flap survival was 43.5%. Meta-analysis revealed no significant difference in flap survival between anticoagulation strategies (95% CI: 0.38-2.63, p = 1.000).HIT represents a rare but devastating complication in free flap reconstruction, with approximately half of the affected flaps failing despite intervention. Although no single anticoagulation strategy demonstrated superior outcomes, expeditious diagnosis and treatment may improve flap salvage rates. This review provides a foundation for developing standardized protocols for HIT management in microsurgical patients.

Introduction: The current literature exploring the association between facial and intracranial injuries is limited, as it primarily focuses on the association with facial fractures. This study aims to broaden the epidemiologic association between facial and intracranial trauma by expanding the scope of studied facial injuries. The secondary aim of this study will be to identify the most common setting of injury, diagnosis, and mechanism of injury. Methods: The National Electronic Injury Surveillance System database, which captures consumer goods-related injuries, was queried from 2019 to 2021. Inclusion criteria included encounters with cranial, facial, and both cranial and facial injuries. Outcome variables included the number of encounters, diagnosis, location of injury, associated consumer products, and patient disposition. Predictor variables included patient demographic information. Descriptive analyses were conducted, and all analyses were done on weighted national estimates. Results: A total of 10 939 340 weighted encounters were analyzed. Facial injuries had concurrent cranial injuries in approximately 1 in 4 encounters, and cranial injuries had concurrent facial injuries in approximately 1 in 6 encounters. Intracranial head injuries occurred with lower acuity facial injuries and without facial fractures in 91.1% of the encounters. The most common location across all groups was at home (66.9%), and building structures (28.8%) were the most common products resulting in injury. Conclusion: There is an understudied burden of associated intracranial injuries with lower acuity facial trauma across all ages, specifically in the home setting. Thus, in evaluating facial trauma, providers should consistently assess for potential head trauma, even when not immediately evident.

BACKGROUND:  Postoperative free tissue transfer reexploration procedures are relatively infrequent but associated with increased overall failure rates. This study examines the differences between flaps requiring takeback versus no takeback, as well as trends in reexploration techniques that may increase the odds of successful salvage.

METHODS:  A retrospective review was conducted on all free tissue transfers performed at our institution from 2011 to 2022. Patients who underwent flap reexploration within 30 days of the original procedure were compared with a randomly selected control group who underwent free flap procedures without reexploration (1:2 cases to controls). Univariate and multivariate logistic regression analyses were performed.

RESULTS:  From 1,213 free tissue transfers performed in the study period, 187 patients were included in the analysis. Of the total flaps performed, 62 (0.05%) required takeback, and 125 were randomly selected as a control group. Free flap indication, flap type, reconstruction location, and number of venous anastomoses differed significantly between the two groups. Among the reexplored flaps, 8 (4.3% of the total) had a subsequent failure while 54 (87.10%) were salvaged, with significant differences in cause of initial flap failure, affected vessel type, and salvage technique.

CONCLUSION:  Free tissue transfers least prone to reexploration involved breast reconstruction in patients without predisposition to hypercoagulability or reconstruction history. When takeback operations were required, salvage was more likely in those without microvascular compromise or with an isolated venous injury who required a single exploratory operation.

ObjectiveThe incidence of lipedema is poorly described due to its confusion with lymphedema. Patient education is crucial for treatment and prevention strategies but also for improving healthcare outcomes. This study assessed and compared the quality of English and Spanish online resources for patients suffering from lipedema using a multimetric approach.MethodsA deidentified Google search using the terms "lipedema" and "lipedema español" was conducted. The first 10 academic/organizational websites in each language were selected. Quality assessment was performed using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), Simple Measure of Gobbledygook (SMOG), and facticity criteria to evaluate understandability and actionability, cultural sensitivity, readability, and factual quality, respectively.ResultsEnglish webpages scored 73.70% for understandability and 35.0% for actionability, while Spanish webpages scored 75.05% and 21.0%, respectively; no significant differences were found between languages in understandability (p = .970) and actionability (p = .895). A significantly higher proportion of Spanish resources was found to be culturally sensible than English resources (90% vs 70%; p < .001). However, no significant differences were found in the cultural sensitivity score (English 2.87 vs Spanish 3.01; p = .677). The grade reading level for Spanish materials was significantly lower compared to English materials (11.08 vs 13.45; p = .006). Factual quality was low across both languages according to the facticity framework, though English materials scored higher than Spanish (2.20 vs 1.00; p = .051).ConclusionOur results suggest that online English and Spanish materials on lipedema have inadequate actionability, facticity, and reading grade levels for patients. Nonetheless, the levels of understandability and cultural sensitivity are acceptable. Enhancing the quality of online health literature for lipedema patients presents an opportunity to alleviate psychosocial burdens and address misconceptions.

The purpose of this study was to evaluate epidemiologic characteristics and postoperative complications among nonbinary, transgender, and cisgender adults undergoing mastectomy or breast augmentation. Comparable postoperative complication rates were observed between gender modality cohorts undergoing breast augmentation, but higher complication rates were observed among cisgender patients following mastectomy, likely due to variations in clinical indications and technique. These results underscore the safety of chest surgery for gender-diverse patients.

INTRODUCTION: The parascapular free flap (PFF), primarily harvested as a fasciocutaneous flap, is perfused by the parascapular branch of the circumflex scapular artery. Its anatomy enables modification and combination with other flaps. However, its use in reconstructive microsurgery has not been comprehensively characterized. This systematic review and meta-analysis aim to assess the key features and outcomes of the PFF.

METHODS: The study protocol followed the PRISMA guidelines. Multiple online databases were used to identify articles published through 2024. Studies including patients who underwent PFF procedures were eligible. A two-stage screening process was conducted for study selection. Data extraction focused on the primary outcome (failure rate), secondary outcomes (other complications), and additional information. An analysis of pooled data was performed to evaluate rates of complications.

RESULTS: Eighty-four articles were included in this review. A total of 647 patients and 664 PFFs were identified; among these, 57.38% were harvested solely as PFFs, while 42.62% involved combinations with other free flaps. The predominant recipient site was the head and neck, accounting for 72.52% of cases. The leading indications were malignancy (28.64%), post-burn scarring (17.35%), and trauma (13.26%). Meta-analysis of the primary outcome revealed no heterogeneity across the studies (I2 = 0.00%; Q statistic 17.50, p = 0.56), with a pooled failure rate of 0.99% (95% CI: 0%-2.63%). Other complication rates included partial necrosis (2.09%, 95% CI: 0%-5.45%), hematoma (5.18%, 95% CI: 1.34%-10.63%), wound dehiscence (5.98%, 95% CI: 0.38%-15.47%), infection (0.86%, 95% CI: 0.00%-3.97%), and venous thrombosis (1.57%, 95% CI: 0.00%-4.95%).

CONCLUSION: The PFF is a versatile and reliable option in reconstructive microsurgery, offering low failure rates and minimal complications. Its applicability across various anatomical regions and indications makes it an invaluable option for microsurgeons.

OBJECTIVE: An increasing number of women are choosing careers in the field of plastic and reconstructive surgery (PRS). These evolving surgeon demographics have highlighted the need for parental leave policies, lactation accommodations, and childcare services. Therefore, this study examines the reproductive and childbearing challenges that plastic and reconstructive surgeons encounter. Specific areas of focus include obstetric complications, parental leave, breastfeeding, childcare, and infertility.

METHODS: In September 2024, a scoping review was conducted across CINAHL, Google Scholar, MEDLINE, PubMed, and Scopus, following PRISMA-ScR guidelines. Randomized control trials, observational studies, surveys, and interviews that examined pregnancy, parental leave, or family planning in PRS trainees or attendings were included. Abstracts, commentaries, editorials, systematic reviews, and non-English studies were excluded.

RESULTS: Seventeen studies, consisting primarily of surgeon experience surveys (82.35%, n = 3,145), were examined. Infertility affected 19.6%-50.7% of surgeons, with 9.8%-19.6% utilizing assisted reproductive technology. Female surgeons were older at their first live births than the general population and faced stigma related to pregnancy. Between 39% and 56% experienced obstetric complications. Many reported a lack of lactation spaces and greater childcare burdens. Following the institution of a policy protecting parental leave by the American Board of Plastic Surgery (ABPS), trainees reported a positive affirmation in their selection of the surgical specialty.

CONCLUSIONS: The implementation of protected parental leave has positively influenced workplace culture in PRS. However, significant gender-related challenges remain, particularly stigmas surrounding pregnancy and parental leave.

BACKGROUND:  Plastic and reconstructive surgeons are often presented with reconstructive challenges as a sequela of complications in high-risk surgical patients, ranging from exposure of hardware, lymphedema, and chronic pain after amputation. These complications can result in significant morbidity, recovery time, resource utilization, and cost. Given the prevalence of surgical complications managed by plastic and reconstructive surgeons, developing novel preventative techniques to mitigate surgical risk is paramount.

METHODS:  Herein we aim to understand efforts supporting the nascent field of preventive surgery, including (1) enhanced risk stratification, (2) medical optimization and prehabilitation, (3) surgical mitigation techniques, and (4) advancements in postoperative care. Through an emphasis on four surgical cohorts who may benefit from preventive surgery, two of which are at high risk of morbidity from wound-related complications (patients undergoing sternotomy and spine procedures) and two at high risk of other morbidities, including lymphedema and neuropathic pain, we aim to provide a comprehensive and improved understanding of preventive surgery. Additionally, the role of risk analysis for these procedures and the relationship between microsurgery and prophylaxis is emphasized.

RESULTS:  Although multiple risk mitigation methods have demonstrated clear benefits, including prophylactic surgical procedures and earlier involvement of plastic surgery, their use is widely variable across institutions. Many current risk assessment tools are suboptimal for supporting more algorithmic approaches to reduce surgical risk.

CONCLUSION:  Reconstructive surgeons are ideally placed to lead efforts in the creation and validation of accurate risk assessment tools and to support algorithmic approaches to surgical risk mitigation. Through a paradigm shift, including universal promotion of the concept of "Preventive Surgery," major improvements in surgical outcomes may be achieved.

BACKGROUND: Filler injections are one of the most common minimally invasive cosmetic procedures. Some of the related adverse effects remain unexplored, such as kidney-related complications. This systematic review aims to summarize the cases of patients who developed kidney disease after filler injections.

METHODS: The study protocol followed the PRISMA guidelines. Multiple online databases were used in this review. Eligible studies included cases of patients who developed any kidney-related complication after filler injections. A two-stage screening process was conducted for study selection. Data extraction focused primarily on kidney complications.

RESULTS: Twenty-nine patients were identified, from 18 case reports and 4 case series. The most frequently injected anatomical site was the buttocks (72.41%, n=21). The three most identified fillers included silicone (51.72%, n=15), methacrylate (31.03%, n=9), and oil (17.24%, n=5). Notably, the status of the practitioner who administered the injections was reported as a non-medical professional in six articles. The most common reported kidney-related complication was chronic kidney disease (CKD), affecting 55.17% (n=16) of patients. Most patients received treatment through hydration (68.97%, n=20) and steroids (68.97%, n=20), while surgery was performed in 20.69% (n=6) of cases. After the renal complication, 37.93% (n=11) patients achieved remission, 20.69% (n=6) patients developed CKD, and 10.34% (n=3) patients died.

CONCLUSIONS: This study described 29 patients who developed renal complications after filler injections. The prevalence of unlicensed or unidentified practitioners performing these procedures could increase the risk of severe outcomes. This underscores the need for stringent regulations and education.

NO LEVEL ASSIGNED: 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 .