Publications

BACKGROUND: The nasal cavity's natural bacterial flora poses a risk for postoperative infections, prompting surgeons to administer prophylactic antibiotics during septorhinoplasty. However, this practice's effectiveness is debated due to concerns about antibiotic resistance and variability in practice. This study leverages a large nationwide database to evaluate the impact of perioperative antibiotics on infection, cellulitis, and sepsis rates following septorhinoplasty.

METHODS: A retrospective cohort study was conducted to identify patients undergoing septorhinoplasty using the TriNetX network, querying 133 million US medical records over 20 years. Outcomes up to three months post-surgery were compared between those administered antibiotics within one day before or on the day of surgery and those that were not. Antibiotics included cefazolin, amoxicillin, clindamycin, azithromycin, clarithromycin, and cephalexin. Propensity score matching was performed on demographics, tobacco use, and other immune-related comorbidities (diabetes mellitus, human immunodeficiency virus, systemic lupus erythematosus, rheumatoid arthritis, liver cirrhosis, chronic kidney disease, chronic systemic steroids, and chemotherapy status). Infection, cellulitis, and sepsis risks were compared across cohorts.

RESULTS: 14,760 septorhinoplasty patients were identified who received perioperative antibiotics, and 4,640 patients that did not. After propensity score matching, 4,086 patients remained in each cohort. There was no significant difference in infection risk (RR 1.110, p = 0.812) or cellulitis (RR 1.180, p = 0.565). No cases of sepsis were reported in either cohort.

CONCLUSION: Prophylactic antibiotics did not significantly reduce the risk of infection, cellulitis, or sepsis in septorhinoplasty patients. Future research is required to optimize evidence-based guidelines on antibiotic use in elective nasal surgeries.

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 .

BACKGROUND: Cauliflower ear is a deformity caused by trauma, leading to a thickened external ear with indistinct cartilaginous features. Historically perceived as a "badge of honor" by athletes, it may also cause significant cosmetic, functional, and psychosocial challenges. This study aims to elucidate the functional and psychosocial burden of cauliflower ear and evaluate awareness and interest in reconstruction.

METHODS: An anonymous survey was distributed by e-mail via REDCap to members of the National Wrestling Coaches Association (NWCA). Demographic information, history of cauliflower ear, psychological and functional experience with cauliflower ear, and history of reconstruction for cauliflower ear were collected.

RESULTS: A total of 1,338 responses were analyzed. The mean age of respondents was 45.2, and 3% were female. Of those surveyed, 910 (69%) reported having a history of cauliflower ear. Of those affected, 15% reported feeling self-conscious or embarrassed by their ears in social interactions. 19% believe their cauliflower ear has played a role in relationships. 12% reported issues with hearing, 59% have experienced pain, 30% had issues with sleeping, and 5% reported medical complications. 57% were not aware or somewhat aware of surgical options to treat their cauliflower ear(s). 100 respondents (11%) reported that they are currently or have previously considered surgical treatment of their ears.

CONCLUSIONS: Cauliflower ear imposes significant functional and psychosocial challenges, with many affected individuals expressing interest in reconstruction. However, awareness of surgical options remains low. This highlights the need for greater patient education and outreach by plastic surgeons to address this unmet need.

LEVEL OF EVIDENCE IV: 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 .

INTRODUCTION: Oncoplastic breast surgery (OBS) has gained attention for improving breast cancer patients' satisfaction and quality of life. This study aims to address the readability of online English and Spanish language patient education materials (PEMs) in oncoplastic breast surgery.

METHODS: A de-identified online search using the terms "oncoplastic breast surgery" or "cirugía oncoplástica de seno" was performed. English and Spanish websites were selected and categorized by academic or private centers. Readability scores were generated using established tests: Simple Measure of Gobbledygook (SMOG), Fry Graph, Patient Education Materials Assessment Tool (PEMAT) for Understandability and Actionability, and Cultural Sensitivity and Assessment Tool (CSAT). Fisher's exact tests assessed group differences.

RESULTS: The most common location of origin of online resources was the United States (53%), followed by Europe (23%). The specialties performing OBS included breast surgery (48%), plastic surgery (44%), and obstetric and gynecological surgery (8%). All PEMs failed to meet the recommended readability levels. The average Simplified Measure of Gobbledygook and Spanish Orthographic Length reading level corresponded to that of a university freshman for both academic and private materials, with English websites being more difficult to read than Spanish resources. The average understandability score was slightly higher for academic centers compared to private institutions (63% versus. 61%; P = 0.661). The average actionability score was significantly higher for English websites compared to their Spanish counterparts (35% versus 21%; P < 0.001).

CONCLUSIONS: Patient information found through an online search for OBS is too difficult for the average American adult to read. As patient interest in OBS grows, access to appropriately written educational material is crucial to support informed decision-making, enhance patient satisfaction, reduce decisional regret, and ultimately promote equity in health care.

PURPOSE: A recent TikTok trend of users reporting nasal size reduction after oral isotretinoin has conflated this acne medication as a nonsurgical rhinoplasty option, termed "Accutane rhinoplasty". We conducted a systematic review of studies reporting outcomes of rhinoplasty and oral isotretinoin and analyzed TikTok reels published under this emerging aesthetic trend.

METHODS: A comprehensive systematic literature search was conducted in December 2024 using the MEDLINE, Web of Science, and EMBASE databases following PRISMA guidelines. Studies reporting outcomes of rhinoplasty patients treated with oral isotretinoin were included. TikTok Scraper extracted details of English-language TikTok reels posted up to September 2024 under three hashtags: #accutanenosejob, #accutanenose, and #accutanenosejobcheck.

RESULTS: Five articles met inclusion criteria. Studies included a median of 24 patients, with isotretinoin administered postoperatively in all studies and preoperatively in two studies. Two of three prospective studies reported positive findings, including lower frequency of facial acne, reduced facial skin thickness, and higher patient satisfaction. Retrospective studies reported mixed findings, including improved nasal skin appearance, increased rhinoplasty complications, and isotretinoin side effects. TikTok hashtags have 68.5 million views, and 100 reels were included for review. Self-reported physicians represented 10% (10/100) of reels and self-reported patients reporting nasal size reduction after isotretinoin represented 90% (90/100) of reels.

CONCLUSIONS: Current evidence on isotretinoin use in rhinoplasty patients is limited, with small sample sizes and mixed findings. While some studies suggest potential benefits in patients with thick nasal skin or severe acne, the long-term effects and safety profile remain unclear. The popularity of "Accutane rhinoplasty" on TikTok contrasts with the scarcity of rigorous clinical data, underscoring the need for further high-quality studies and greater clinician engagement in online discussions.

LEVEL OF EVIDENCE II: Therapeutic study. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

[This corrects the article DOI: 10.1097/GOX.0000000000007207.].

BACKGROUND: Mastectomy and breast reconstruction aim to restore aesthetics and psychological well-being in breast cancer patients. However, postoperative shoulder pain and stiffness are common, with varying incidence rates across studies. This study assesses the incidence and risk factors for shoulder morbidity following breast reconstruction.

METHODS: A single-institution retrospective review was conducted from January 2015 to November 2023. Female patients who underwent mastectomy followed by reconstruction were included. Data on demographics, surgical details, therapies, and shoulder outcomes were collected. Unpaired t-tests, Fisher's Exact tests, and multivariable logistic regression models identified risk factors for shoulder impairment.

RESULTS: Among 773 patients, 192 (24.8%) reported shoulder impairment, associated with neoadjuvant chemotherapy (p=0.004), radiation (p=0.003), right-sided (p=0.001), and oncologic mastectomies (p<0.001). Axillary lymph node dissection (p<0.001) and lymphedema (p<0.001) were also linked. Shoulder impairment occurred, on average, 244.8 days post-surgery, lasting 293.4 days. Multivariable analysis identified prior shoulder impairment (OR 2.287; p=0.049), axillary lymph node dissection (OR 2.556; p=0.049), lymphedema (OR 5.677; p=0.003), and Hispanic race (OR 9.049; p=0.019) as significant predictors. Age and private insurance were protective factors.

CONCLUSION: Shoulder impairment is a prevalent complication after mastectomy and breast reconstruction, associated with previous shoulder issues and lymph node dissection. Early identification of these risk factors may inform targeted interventions to reduce shoulder morbidity and improve outcomes. Prospective studies are needed to refine prevention strategies for shoulder impairment in breast cancer survivors.

The superficial circumflex iliac perforator flap (SCIP-f) is a thinned adaptation of the superficial circumflex iliac artery flap (SCIA-f) that may have superior use flexibility, smaller scar burden, and lesser need for revision, advantages well-suited to pediatric patients. Despite documented success in adults, the safety and utility of SCIP and SCIA-f are underexplored in pediatric populations.A systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases identified 93 articles reporting SCIP/SCIA-f outcomes in patients ≤ 17 years of age. Patient demographics, clinical characteristics, and postoperative outcomes were collected. Cohorts were stratified by SCIP/SCIA and age group. Mann-Whitney U tests compared cohort outcomes.Thirty-one studies were included, constituting 107 SCIA-f and 57 SCIP-f, with ages 10 weeks to 17 years. Most cases were congenital or traumatic defects in upper/lower extremities. Compared with SCIA-f, SCIP-f demonstrated significantly lower rates of all-cause complications, total flap loss, major and minor complications, and debulking (p < 0.05). All-cause complication rates were also significantly lower across age groups (p < 0.001).This meta-analysis demonstrates favorable efficacy and safety of SCIP-f in children with congenital and traumatic defects, especially of the extremities. SCIP-f may be considered a reliable option for pediatric reconstruction. Additionally, fewer subsequent procedures for contouring may be required.

BACKGROUND: Improving diversity within plastic and reconstructive surgery (PRS) trainees is a crucial step to reduce inequities at the provider level. Trends in minority representation among independent program match applicants are understudied. We analyzed gender, racial, and ethnic demographic trends among independent PRS match applicants.

METHODS: With the approval of the American Council of Educators in Plastic Surgery, the San Francisco Match provided data for the independent PRS match from 2013 to 2023. Trends in the independent PRS match were reviewed, and a Cochran-Armitage test was conducted to evaluate the significance of match trends in minority applicants (Female, Black, Asian, Other Race, Hispanic ethnicity) over time.

RESULTS: A total of 1000 applicants participated in the independent plastic surgery match during the study period, of whom 735 matched. A 31% decrease in the number of independent PRS programs was observed. The match rate decreased from 86% to 60%. Statistical analysis by race (White, Black, Asian, Other) and match outcomes revealed significant differences in racial distributions between applicants and matched participants in 2014 (p = 0.002) and 2018 (p = 0.042). The proportion of female applicants and Hispanic applicants correlated yearly to the number of matched females and Hispanics, respectively (p > 0.05). Cochran-Armitage tests showed a significant increase in match trends among female participants over time (p = 0.004).

CONCLUSIONS: We show a significant increase in female representation in the independent PRS match in the last decade. However, representation of racial and ethnic minorities has shown minimal change over the years. Ongoing efforts are needed to identify barriers and reduce inequities.

BACKGROUND: Autologous nasoseptal cartilage grafts are used to correct nasal asymmetry and deviation in rhinoplasty, but patients who have undergone multiple operations may have limited autologous cartilage tissue available. L-strut implants created on a 3-dimensional (3D) printer may address these challenges in the future, but their mechanical strength is understudied. Silk fibroin-gelatin (SFG), polycaprolactone (PCL), and polylactide (PLA) are bioinks known for their strength. The authors present finite element analysis (FEA) models comparing the mechanical strength of 3D-printed SFG, PCL, and PLA implants with nasoseptal cartilage grafts when autologous or allografts are not available.

METHODS: FEA models compared the stress and deformation responses of 3D-printed solid and scaffold implant replacements to cartilage. To simulate a daily force from overlying soft tissue, a unidirectional load was applied at the "keystone" region given its structural role and compared with native cartilaginous properties.

RESULTS: The 3D-printed solid SFG, PCL, and PLA and scaffold PCL and PLA models demonstrated lower deformations compared with cartilage. Solid SFG balanced strength and flexibility. The maximum stress was below all materials' yield stresses, suggesting that their deformations are unlikely permanent under a daily load.

CONCLUSIONS: The authors' FEA models suggest that 3D-printed L-strut implants carry promising mechanical strength. Solid SFG results mimicked cartilage's mechanical behavior. Thus, scaffold SFG merits further geometric optimization for potential use for cartilage substitution. The 3D-printed septal cartilage replacement implants can potentially enhance surgical management of patients who lack available donor cartilage in select settings.

CLINICAL RELEVANCE STATEMENT: Computational simulations can evaluate the strength of 3D-printed implants and their potential to replace septal cartilage in septorhinoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.