Faculty Bibliography

Effective surface treatment of implants is essential for enhancing osseointegration outcomes. This study assessed the influence of alcohol decontamination both with and without secondary argon-based non-thermal plasma (NTP) treatment on osseointegration of endosteal implants in a large translational (sheep) model. Ti6Al4V dental implants were utilized either as received (CTRL), or subjected to ethanol cleaning (for 60 s) followed by NTP (for 60 s) (Clean+Plasma); or treated with NTP alone (Plasma) for 60 s. X-ray photoelectron spectroscopy was used for surface elemental analysis, followed by interferometry and sessile drop tests to measure changes in surface roughness and surface energy, respectively. Twelve sheep received implants (one implant per group per sheep) in the iliac crest, and bone healing was evaluated after 3 and 12 weeks using histomorphometric analysis (six sheep/time point). No significant differences in surface roughness (arithmetic mean (Sa) and root mean square (Sq) height: p > 0.161 and p > 0.173, respectively) or topographies were detected between implant surfaces. However, both NTP treated groups presented higher surface energies and lower water contact angle values relative to CTRL surface (p < 0.001). Compared to the CTRL, both NTP-treated groups exhibited reduced levels of Carbon and elevated levels of Oxygen. No significant differences in Bone-to-Implant Contact (BIC) or Bone Area Fractional Occupancy (BAFO) were observed among groups at 3 weeks. At the 12-week time point, Plasma implants demonstrated significantly higher BAFO (p = 0.014) compared to the CTRL group, as well as an increase in both BIC and BAFO over time (3 vs. 12 weeks in vivo) (p = 0.041 and p = 0.043, respectively). Building on the existing literature, the current study suggests that NTP treatment alone may be adequate to successfully enhance osseointegration while minimizing contamination risks, thereby eliminating the need for additional cleaning protocols.

PURPOSE/OBJECTIVE:Offering the benefits of rigid fixation while minimizing soft tissue dissection, intramedullary implants have become a popular choice among hand surgeons. Their placement often requires traversing or passing in proximity to joint surfaces. This study aimed to assess the damage to the articular cartilage of the base of the proximal phalanx resulting from antegrade placement of threaded headless intramedullary nails. METHODS:A cadaveric study comparing two techniques for antegrade placement of threaded headless intramedullary nails was conducted in 56 digits. The first entailed a single 2.1 mm intramedullary nail placed via the dorsal base of the proximal phalanx, whereas the second used two 1.8 mm intramedullary nails inserted via the collateral recesses of the phalangeal base. All specimens were analyzed for articular surface damage with the cartilage defect measured as a percentage of total joint surface area. Damage to the extensor tendons was also assessed in a subset of specimens. RESULTS:No significant difference in the percentage of articular surface damage was observed, with an average 3.21% ± 2.34% defect in the single 2.1 mm nail group and a 2.71% ± 3.42% mean defect in the two 1.8 mm nails group. There was no articular surface injury in 18% of digits in each group. Damage to extensor tendons was seen in three (9.4%) specimens and in all cases involved either the extensor indicis proprius or extensor digiti minimi. CONCLUSIONS:Hardware insertion using either the dorsal base of the proximal phalanx or the collateral recesses of the phalangeal base both demonstrated minimal articular cartilage damage and infrequent injury to the extensor tendons. CLINICAL RELEVANCE/CONCLUSIONS:With proper technique for antegrade insertion into the proximal phalanx, the cartilage defect observed often encompasses only a small percentage of the overall joint surface area.

BACKGROUND/UNASSIGNED:Virtual reality (VR) has not been tested for cleft surgery training in low-resource settings where the surgical instructor provides the lesson from another continent. METHODS/UNASSIGNED:Fifty-one plastic and maxillofacial surgery trainees in India participated in a VR simulation of the Furlow palatoplasty given by a New York-based cleft surgeon. Participants completed pre- and postsurveys, which included a knowledge assessment regarding the Furlow technique, confidence in VR as an educational tool, and opinions on the use of VR in surgical education. Satisfaction and acceptance of the technology were assessed with learning measures postsimulation. RESULTS/UNASSIGNED:< 0.001). The opinion that VR should be included in surgical education began high and remained high. Learners reported that the simulation was stimulating (4.63 ± 0.49), increased interest (4.51 ± 0.67), was clear (4.45 ± 0.67), and was effective for teaching (4.78 ± 0.47), and they would recommend the lecture to others (4.78 ± 0.46). VR simulation increased control and active learning (4.73 ± 0.49), facilitated comprehension (4.76 ± 0.51), allowed for reflective thinking (4.59 ± 0.57), had high fidelity (3.98 ± 0.93), was easy to use (4.29 ± 0.73), and was enjoyable (4.78 ± 0.42). CONCLUSIONS/UNASSIGNED:VR cleft simulation can be effectively used in low- to emerging-resource settings. Surgical instructors can provide real-time, immersive surgical experiences to trainees across the world.

BACKGROUND:Severe proximal interphalangeal (PIP) contractures in Dupuytren disease significantly impair hand function and quality of life. Surgical correction is common, but the relationship between improved joint mobility and patient-reported outcomes remains unclear. This study evaluated surgical outcomes for severe PIP contractures and assessed patient-reported function using Patient-Reported Outcomes Measurement Information System (PROMIS). METHODS:< .05). RESULTS:The study included 60 digits from 48 patients. Significant contracture reductions were observed across all groups, averaging more than 60%. However, PROMIS scores did not consistently reflect improvements in pain, activity interference, or upper extremity function. A significant decrease in upper extremity function was noted in group 3 (60°-89°). No operative complications or reoperations occurred. CONCLUSIONS:Surgical correction markedly improves joint contracture but does not consistently enhance PROMIS-reported outcomes. These results question PROMIS applicability in this context and highlight the need for alternative assessment tools to better address functional recovery in patients with severe PIP contractures.

ObjectiveTo describe and demonstrate the effectiveness and reproducibility of a modified enhanced recovery after surgery (ERAS) protocol for patients with cleft palate (CP).DesignProspective cohort study.SettingOutreach Medical Programs, resource-limited settings.PatientsPediatric patients with CP who underwent CP repair.InterventionsModified ERAS protocol.Main Outcome Measure(s)Complication rate, post-operative pain management, time to discharge.Results52 CP repairs done during three outreach medical programs were included in the study. 22 (42.3%) procedures were performed in GYE SEP 2022, 6 (11.5%) procedures in SAL JAN 2023, and 24 (46.2%) in GYE MAR 2023. The mean age was 4.9 years across all programs. 22 (42.4%) patients were between 1 and 3 years of age, 26 (50%) were between 3 and 12 years of age, and 4 (7.6%) were older than 12 years of age. Patients were equally distributed among gender with 26 (50%) being males and 26 (50%) females. A total complication rate of 5.8% was reported. 51 patients were discharged on post-op day one and only one patient was kept for an additional day for monitoring. Four patients required Fentanyl in PACU for post-operative pain, ketamine was used in 1 patient, 7 patients received Dexmedetomidine (Precedex), and ketorolac was used in 16 patientsConclusionsA modified ERAS protocol for CP surgery has been developed and implemented for outreach settings. This approach showed decreased post-operative complications, decreased length of hospital stay, and decreased opioid use while maintaining adequate pain control, establishing early enteral feeding and thus enhancing patient recovery.

CONTEXT.—/UNASSIGNED:The use of hormonal therapy and gender-affirming surgery in the transgender community has been rising during the last several years. Although it is generally safe, hormonal therapy's link to testicular cancer remains uncertain. OBJECTIVE.—/UNASSIGNED:To review the incidence of testicular cancer in specimens from gender-affirming orchiectomies at our institution and evaluate the tumors for histologic and genetic alterations. DESIGN.—/UNASSIGNED:Pathology reports for gender-affirming orchiectomies (January 1, 2018, to August 1, 2023) were reviewed for testicular neoplasms, with additional analysis for chromosome 12 abnormalities. Incidence and chromosome variations were compared with those in the general population. RESULTS.—/UNASSIGNED:Among 458 cases during 5.5 years, 5 germ cell neoplasms in 4 patients emerged. Our institution's annual incidence rate (159 per 100 000) is 26.5 times higher than the National Cancer Institute's previous report (6.0 per 100 000). Although they were morphologically no different from germ cell neoplasms in the general population, fluorescence in situ hybridization tests showed no i(12p) in 4 of 5 neoplasms (80%) in our cohort. CONCLUSIONS.—/UNASSIGNED:The cause behind this rise in incidence remains uncertain but may be due to long term pretreatment with hormones or blockers. The lower isochromosome 12p frequency suggests an alternative mechanism driving tumor development, which requires more detailed molecular studies.

BACKGROUND/PURPOSE/UNASSIGNED:The ability to save a digital copy of a fabricated denture is poignant for large dental institutions. The purpose of this study was to evaluate the trueness and precision of an intraoral scanner (IOS) in its ability to digitally duplicate a complete denture (CD) and evaluate the possible effects of file resolution reduction on different exported media types. MATERIALS AND METHODS/UNASSIGNED:A desktop scanner was used to scan a complete mandibular denture and utilized as the control file. An IOS was used to scan the same denture and exported into both standard triangular language (STL) and polygon (PLY) file types and stored for additional analysis. The different file types at original resolution were compared to the desktop scan (DS100) to evaluate the accuracy of the IOS. Then the STL (Groups S100, S75, S50, S25) and PLY (Groups P100, P75, P50, P25) files were reduced in their resolutions to evaluate any statistical discrepancies in the volumetric analysis of the scan using the Hausdorff distance (HD) and dice similarity coefficient (DSC). RESULTS/UNASSIGNED:) files from the IOS produced a similarity of 98.34% and 98.39% respectively. The similarity of the IOS files at different resolutions ranged from 99.99% to 99.96%. CONCLUSION/UNASSIGNED:We conclude that the IOS used in this study demonstrates very high trueness and precision when digitally duplicating complete dentures.

BACKGROUND: While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction. METHODS: A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 801 identified articles, 648 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups. RESULTS: A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received preflap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared with the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69 vs. 9.80%) and partial flap failure (2.24 vs. 6.54%). CONCLUSION/CONCLUSIONS: Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.