Publications

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.

BACKGROUND: Globally, vegan and vegetarian diets have grown in popularity. At the same time, it is well-known that nutrition plays a critical role in postoperative outcomes, including wound healing. The present investigation undertakes a systematic scoping review of the current literature that explores the impact of vegan or vegetarian diets on wound healing.

METHODS: The protocol followed PRISMA-ScR guidelines. PubMed, Web of Science, and Cochrane Library were used to identify articles published until 2024. Studies comparing any wound healing outcome between vegan or vegetarian patients and omnivorous patients were considered eligible. A two-stage screening process was conducted for study selection. Data extraction focused on the primary outcome-any wound healing outcome-and secondary outcomes, which included study general information, laboratory values, limitations, and future perspectives.

RESULTS: Eight studies were included in this review. The majority of publications (87.5%) were prospective studies. Papers reported diverse wound healing outcomes after the following interventions: fractional microneedle radiofrequency, laser surgery, microfocused ultrasound, narrow-band ultraviolet B phototherapy, ultrapulsed CO2 resurfacing, excisional biopsy, skin graft, and photodynamic therapy. In almost all studies (87.5%) wound healing outcomes were statistically inferior in vegan or vegetarian patients compared to omnivorous patients.

CONCLUSION: Our results suggest that wound healing outcomes may be suboptimal in patients adhering to vegan or vegetarian diets, indicating that these dietary patterns might contribute adversely to the wound healing process. Future research is needed to understand better the underlying mechanisms and the potential implications in the preoperative assessment and postoperative course of these patients.

NO LEVEL ASSIGNED: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.

BACKGROUND: Artificial intelligence (AI) technologies use a three-part strategy for facial visual enhancement: (1) Facial Detection, (2) Facial Landmark Detection, and (3) Filter Application (Chen in Arch Fac Plast Surg 21:361-367, 2019). In the context of the surgical patient population, open-source AI algorithms are capable of modifying or simulating images to present potential results of plastic surgery procedures. Our primary aim was to understand whether AI filter use may influence individuals' perceptions and expectations of post-surgical outcomes.

METHODS: We utilized Amazon's Mechanical Turk platform and collected information on prior experience using AI-driven visual enhancement. The cohort was divided into two groups: AI-exposed and non-AI-exposed. Questions gauged confidence in plastic surgery's ability to meet participant expectations. A second survey exposed users to either AI-enhanced or to unenhanced pre-operative photographs. Then, unedited post-operative photographs were shown and surgery's ability to enhance appearance was assessed. A multivariable linear analysis was constructed to measure associations between exposure to AI enhancement and survey outcomes.

RESULTS: A total of 426 responses were analysed: 66.9% with AI exposure and 33.1% with no prior exposure. Participants with previous experience using AI-driven enhancers had a significantly higher average score for expectations after plastic surgery (P < 0.001). This finding was true across all outcomes, including surgery's ability to relieve discomfort with appearance/self-esteem (P < 0.001), to avoid post-operative complications (P < 0.001), to decrease post-operative scarring (P < 0.001), and to improve overall appearance (P < 0.001). The image comparison survey revealed that post-operative images were viewed as more successful at improving appearance when no pre-operative filter was applied (P = 0.151).

CONCLUSION: Exposure to AI photograph enhancement may significantly raise expectations for plastic surgery outcomes and may predispose to having lower satisfaction after surgery. The significance of this study lies in its potential to reveal the extent to which AI technologies can shape patient understanding of their plastic surgery outcomes. Plastic surgeons aware of the effect of AI enhancement may consider using these results to guide counselling.

LEVEL OF EVIDENCE III: his 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: Industry financial relationships for physicians in the United States are reported publicly in the Sunshine Act Open Payments Database. This study aims to highlight trends and compare plastic surgery with subspecialty data, such as hand and craniofacial surgery. Methods: The Open Payments Database was utilized to retrieve all industry relationship payments made to plastic surgeons in the United States from January 1, 2017 to December 31, 2023. The individual payment dollar values per plastic surgeon were evaluated along with their subspecialty, payment year, type of financial relationship, partnering company, and region. Results: On average, there were 35,333 individual payments made to 4050 plastic surgeons, 1336 payments made to 208 hand surgeons, and 1091 payments made to 214 craniofacial surgeons each year. The top five percent of plastic surgeons received 85.0% of the total payment value, while the top five percent of hand and craniofacial surgeons received 99.8% and 87.8%, respectively. Royalties and licensing were the largest type of payment by dollar value for general plastic (43.0%) and craniofacial surgeons (98.4%), but ownership or investment interest was the most valued type of payment for hand surgeons (48.0%). Conclusion: Within the Open Payments Database, there were a variety of industry payments made to plastic, hand, and craniofacial surgeons over the last 7 years. Current trends suggest that the majority of payment dollar value will continue to go to a specific minority of those in plastic surgery and its subspecialties in the form of royalties, licensing, or ownership and investment interests.

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 .

BACKGROUND: Alcohol-based surgical hand scrubs are a safe, environmentally friendly, and cost-effective alternative to traditional water-based hand antisepsis, supported by the World Health Organization (WHO). These advantages make alcohol-based hand scrubs ideal for various plastic and reconstructive surgery settings. This study evaluates the potential financial savings of transitioning to alcohol-based surgical scrubs within a division of plastic and reconstructive surgery.

METHODS: Data was collected from a division of plastic and reconstructive surgery at a single institution. Water consumption for traditional surgical hand scrub was measured according to WHO guidelines. Water costs were calculated based on the Boston Water and Sewer Commission rates. The costs of alcohol solution and impregnated brushes were obtained from the hospital's perioperative services. Annual surgical volume data were used to estimate water consumption and consumable costs. Time savings were calculated based on WHO protocols and converted into cost savings.

RESULTS: The average water consumption per scrub was 7.62 L, with an average of 36.17 L used per surgery. If every plastic surgery procedure used traditional wet scrubs, the annual water consumption would be 87,233.76 L. The cost of water per scrub was $0.05. The consumable cost per scrub was $0.20 for alcohol-based scrubs and $0.52 for wet scrubs. Annually, transitioning to alcohol-based scrubs would save $3090.96 in consumable costs. Adopting waterless scrubs and decreasing scrub time could result in savings of $1316,445.48 annually in our division.

CONCLUSION: Transitioning to alcohol-based surgical hand scrub in plastic and reconstructive surgery may provide significant environmental and economic benefits.

BACKGROUND: Rising abdominoplasty costs in the United States have driven patients to seek affordable options abroad despite risks, fueling the medical tourism industry. This study compared the cost-effectiveness of abdominoplasty performed in the United States versus abroad.

METHODS: Patients presenting to an academic hospital's emergency department with complications from out-of-state/country abdominoplasties (2018-2022) were surveyed. Utility scores were obtained from the survey and used to calculate quality-adjusted life years (QALYs) for each health state. Probabilities and outcomes were obtained by literature review, and a decision-analysis tree was constructed with rollback analysis to determine the more cost-effective strategy. An incremental cost-utility ratio was calculated with a willingness-to-pay threshold of $100,000 per QALY. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: Cosmetic tourism abdominoplasty was associated with a lower clinical effectiveness (QALY 39.08) compared with abdominoplasty in the United States (39.09), and a relative cost decrease of $2066.26. The incremental cost-utility ratio of $811,471.83 per QALY did not result in cosmetic tourism abdominoplasty being cost-effective. Although the lower costs of cosmetic tourism are appealing, the marginal difference in clinical effectiveness raises concerns about the overall value. In the case that the cost of the cosmetic tourism abdominoplasty was less than $7061.63, 1-way sensitivity analyses showed that this option was more cost-effective than abdominoplasty in the United States, with 68.03% Monte Carlo confidence.

CONCLUSIONS: Cosmetic tourism abdominoplasty may be cost-effective only when priced less than $7061.63. This analysis may inform patients' reservation prices, considering postoperative complications, follow-up, and long-term relationships with healthcare providers.

BACKGROUND: Many patients seek body contouring surgery (BCS) to address excess skin following significant weight loss (WL), including from GLP-1 receptor agonists such as semaglutide. Optimal BCS timing is crucial, as postoperative weight fluctuations can distort outcomes. While weight stabilizes 12-18 months after bariatric surgery, the timeline for semaglutide-associated WL is less clear, particularly with weight recurrence (WR) after drug discontinuation METHODS: A systematic review of MEDLINE, Embase, Web of Science, and PubMed was performed. Randomized controlled trials (RCTs) and prospective observational studies measuring weight change over time with semaglutide use were included. Time to weight loss plateau (WLP), defined as ≥1 month with WL <3%, was calculated. WR, defined as ≥25% WL regained, was calculated for studies including drug discontinuation, and meta-analysis was performed RESULTS: Of 555 studies, 12 met inclusion criteria (n=13,947 patients). WLP occurred at 53.0±8.2 weeks at 16% (±3.1%) WL, deviating from greatest on-treatment WL by 2% (±0.7%) and end-of-treatment WL by 1% (±1.2%). Two studies assessed WR following drug discontinuation. WR occurred at 12 weeks and 24 weeks post-discontinuation. By the end of the observation period, participants regained 62.7 and 74.3% of greatest on-treatment WL, respectively CONCLUSION: This systematic review and meta-analysis suggests weight stabilizes after 8-12 months of semaglutide use, at which time BCS may be appropriate. This timeline is slightly earlier than post-bariatric surgery. However, given initial data indicating weight recurrence exceeding 50% after drug discontinuation, surgeons should approach BCS cautiously until further research clarifies the impact of WR on surgical outcomes.

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 .