Publications

BACKGROUND: The opioid epidemic, which cost over $1.02 trillion in 2017, continues to be a major public health concern. To improve postoperative pain control and reduce opioid misuse, our team implemented tumescent local anesthesia with bupivacaine (TLA) in DIEP flap breast reconstructions at both breast and abdominal donor sites.

METHODS: We conducted a retrospective study of DIEP flap reconstructions from 2019-2023, comparing patients who received TLA (tumescent fluid with bupivacaine as TAP, intercostal, and local blocks) to those who received the standard TAP block alone. Unpaired t-tests and Fisher's Exact tests assessed group differences; multivariable regression models evaluated postoperative complications.

RESULTS: A total of 481 patients were included: 271 (56.3%) in the TLA group and 210 (43.7%) in the control group. Patients receiving TLA were younger (50.3 vs. 53.7 years; p=0.025), while hormonal therapy (43.8% vs. 34.7%; p=0.047) and prior radiation (52.9% vs. 39.1%; p=0.003) were more common in controls. TLA patients had lower breast hematoma rates (2.2% vs. 6.2%; p=0.033). Linear regression showed reduced inpatient opioid use (29.4 MME lower; 95% CI: -45.29 to -13.45; p<0.001), discharge opioid prescriptions (36.1 MME lower; 95% CI: -58.27 to -13.98; p=0.001), and shorter hospital stays (3.4 vs. 3.9 days; p<0.001).

CONCLUSIONS: TLA significantly reduces inpatient and discharge opioid use and hospital stay length without compromising pain control. Further study is needed to evaluate long-term opioid use and refill rates post-discharge.

Lactoferrin (LF) is a natural glycoprotein. Its diverse biological roles include immune modulation and osteogenesis. Evidence shows that LF promotes collagen synthesis and fibroblast activity, thereby accelerating wound healing. This study investigates the role LF plays in wound healing and potential future applications. A systematic review was conducted in accordance with PRISMA guidelines. Articles were sourced from MEDLINE, Embase, Web of Science, and the Cochrane Central Register. Studies published before September 2025 were eligible. The primary outcome of interest was wound healing rate, while secondary outcomes included collagen synthesis and fibroblast migration associated with LF exposure. An NIH quality assessment was performed to score the quality of the papers. Comparative analyses and descriptive statistics were performed to synthesise the findings. Of the 261 screened articles, 17 studies met the inclusion criteria. Twelve studies reported that LF accelerated wound healing compared to controls, 12 demonstrated increased collagen synthesis, and 9 showed enhanced fibroblast migration. All included studies were preclinical, comprising human in vitro or animal models. Most originated from Japan (n = 6), followed by China (n = 3) and Russia (n = 2), and were published within the last 20 years. This review highlights consistent preclinical evidence linking LF to enhanced wound healing. These findings provide a strong rationale for future clinical trials investigating LF as a therapeutic agent for wound healing. To date, no human studies have directly evaluated LF in wound repair, further emphasising the need for well-designed clinical trials.

BACKGROUND: Postoperative octreotide is known to reduce lymphorrhea after axillary node dissection in breast cancer and other gynecological malignancies with varying efficacy. However, the effect of octreotide on the development of lymphedema after axillary node dissection has not been explored. We sought to evaluate the role of octreotide in preventing lymphedema in patients who underwent axillary lymphadenectomy.

METHODS: This retrospective review of the TriNetX Analytics Network queried the Global Collaborative Network with over 170 million patients to identify patients undergoing complete axillary lymphadenectomy or radical, modified radical, or partial mastectomy with axillary node dissection. Then, the patients who received octreotide after surgery were identified. Patients with a history of octreotide use prior to surgery or hereditary lymphedema were excluded. Patients were identified using diagnosis and procedure codes. Occurrence of postoperative lymphedema was compared between 1:1 propensity score matched cohorts. Patients were matched for age, body mass index (BMI), gender, race, radiation therapy, and smoking among others. Risk ratios, t-tests, and Z-tests were used to compare outcomes.

RESULTS: A total of 222 patients who underwent axillary lymphadenectomy and received octreotide postoperatively were matched to 222 patients who did not receive octreotide from an original pool of 69,955 patients. Prior to matching, the standardized mean difference between the two groups was greater than 0.1 for age, BMI, and several race categories. After matching, all standardized mean differences were less than 0.1. Patients who received octreotide were at significantly lesser risk of developing lymphedema (p<0.0001) when compared to patients who did not receive octreotide. Patients who received octreotide required fewer manual therapy techniques including lymphatic massage/drainage (p<0.05). Additionally, patients who received octreotide were less likely to undergo plastic surgical consultation or surgical correction of their lymphedema (p<0.05). Patients who received octreotide were not at increased risk of bradycardia (p>0.05) or hypothyroidism (p>0.05).

CONCLUSIONS: Patients who underwent axillary lymphadenectomy and received octreotide postoperatively were associated with significantly less risk of developing lymphedema and undergoing surgical lymphedema correction without increased risk of hypothyroidism or bradycardia. This study establishes the potential role of octreotide for lymphedema prevention in patients undergoing axillary lymphadenectomy.

BACKGROUND: The American Society of Plastic Surgeons (ASPS) created the Essentials of Leadership (EOL) program to foster leadership skills and networking among current and upcoming plastic surgery leaders. This study elucidates the program's impact on participants, its strengths and weaknesses, and the future of leadership in plastic surgery.

METHODS: A qualitative descriptive design was employed, utilizing semi-structured interviews to explore the experiences of plastic surgeons who participated in the program. The data was analyzed inductively, and codes were reviewed to identify overarching themes.

RESULTS: We interviewed 29 participants who completed EOL at an average of 8.3 years of practice, with an average of 15.5 years at the time of interview. Significant themes were identified, including motivations for joining, skills gained, and the program's impact. Many surgeons found themselves at a professional crossroads, seeking leadership skills and a broader network. Participants found that the following were most beneficial: 1) conflict resolution and negotiation, 2) understanding personality dynamics, and 3) effective meeting management. The program had a long-lasting impact on participants through two key outcomes: 1) enduring relationships and 2) increased confidence in pursuing career changes. Participants expressed hope that plastic surgery leaders will support greater leadership programming, increase diversity, and unite to innovate and protect their specialty.

CONCLUSION: The EOL program provides time for reflection, relationship building, and leadership development. Participants walk away with practical skills, meaningful connections, and renewed purpose, demonstrating the program's critical role as a catalyst for career advancement and long-term leadership in plastic surgery.

Cartilage regeneration remains a major clinical challenge because cartilage has limited healing capacity and must withstand substantial mechanical loading. Silk fibroin, a cocoon-derived biomaterial with tunable mechanical properties, has emerged as a promising scaffold material for cartilage tissue engineering. This systematic review evaluates the biomechanical performance, fabrication approaches, and regenerative potential of silk fibroin bioprinted scaffolds for cartilage repair. A systematic review was conducted according to PRISMA guidelines. Primary outcomes included scaffold mechanical properties relevant to cartilage function. Secondary outcomes included scaffold composition, fabrication methods, biological performance, clinical applications, and reported limitations. Of 918 identified records, 24 studies published between 2014 and 2025 met the inclusion criteria. Most were preclinical studies using silk fibroin-based hydrogels, often combined with hyaluronic acid, gelatin, collagen, or synthetic polymers. Mechanical properties varied according to scaffold composition and crosslinking methods. Reinforced scaffolds generally demonstrated improved stiffness, structural support, and load distribution. Silk fibroin scaffolds consistently supported chondrogenesis and cartilage-like tissue formation. However, challenges remain, including mechanical mismatch with native cartilage, construct instability, cell loss, and suboptimal degradation profiles. Overall, silk fibroin bioprinted scaffolds demonstrated support for chondrogenesis and cartilage-like tissue formation in preclinical studies for cartilage regeneration. Future research should focus on standardized biomechanical testing, long-term in vivo evaluation, and clinically relevant scaffold designs to facilitate translation toward functional cartilage repair.

BACKGROUND: Extensor pollicis longus (EPL) rupture can be managed using several surgical techniques, with palmaris longus (PL) tendon graft reconstruction and extensor indicis proprius (EIP) transfer among the most commonly used options. Comparative clinical data between these techniques remain limited, particularly regarding functional outcomes and delayed reconstruction. This retrospective cohort study evaluated functional outcomes and complications following EPL reconstruction using a PL graft or EIP transfer in a single-institution cohort.

METHODS: This retrospective cohort study included demographic, surgical, and outcome data of all patients who presented to our institution with an EPL rupture between 2004 and 2020. Patients were identified using Current Procedural Terminology codes, International Classification of Diseases, Ninth/Tenth Revision codes, and operating room schedules. Group comparisons were performed using Fisher exact test, χ2 test, and t test, as appropriate; P < .05 was considered statistically significant.

RESULTS: A total of 38 patients with EPL rupture were identified, including 8 treated with PL grafts and 30 with EIP transfer. Both groups demonstrated improvement in Disabilities of the Arm, Shoulder, and Hand (DASH) scores. The PL graft group showed a larger mean reduction in DASH scores. Three patients in the EIP transfer group (11%) experienced index finger extensor lag or limited EPL function, whereas no such cases occurred in the PL graft group.

CONCLUSION: Both PL graft reconstruction and EIP transfer were associated with postoperative functional improvement in this cohort. Although the PL graft group demonstrated a larger mean reduction in DASH scores, the marked differences in baseline characteristics and surgeon-directed treatment selection preclude firm comparative conclusions. Delayed PL graft reconstruction was nevertheless associated with acceptable postoperative outcomes in this series.

BACKGROUND: Suzetrigine is a non-opioid, highly selective NaV1.8 pain-signal inhibitor of the voltage-gated sodium channel NaV1.8, with no addiction potential approved in the US for moderate-to-severe acute pain in January 2025.

METHODS: In this phase 4, single-arm study, suzetrigine was administered as part of multimodal therapy (MMT;100-mg preoperatively, then 50-mg q12h) for ≤14days. Patients underwent aesthetic/reconstructive surgeries wherein opioids are commonly used ≥72h postoperatively. Investigators determined MMT, with acetaminophen and/or ibuprofen recommended. The primary endpoint was proportion of patients reporting good/very good/excellent on a patient global assessment (PGA) for pain control at end of treatment. Opioid-rescue and safety were also evaluated.

RESULTS: Patients (N=99) underwent various procedures, the most common being aesthetic and reconstructive breast procedures (33.3% and 13.1%, respectively), abdominoplasty with liposuction (28.3%), and turbinoplasty (13.1%). Most patients (90.7%) rated suzetrigine as part of MMT as good/very good/excellent on a PGA for pain control at end of treatment, which was consistently high across surgeries. Most patients (90.9%) did not require opioid-rescue; those who did received 2.4 tablets (mean) after surgery (mean:2.0days). Most common MMT was suzetrigine with only acetaminophen and/or ibuprofen (78.8%), while 12.1% used suzetrigine alone. Suzetrigine was safe and well-tolerated. Adverse events were consistent with postoperative settings.

CONCLUSIONS: Suzetrigine demonstrated highly effective pain management and enabled opioid-free recovery for most patients (90.9%) when initiated preoperatively and as part of MMT in aesthetic and reconstructive surgeries wherein opioids are commonly used postoperatively; in contrast, in studies of mixed cosmetic procedures in the literature, <10% did not require opioids.