Faculty Bibliography

This paper is aimed to present a biomaterials perspective in implant therapy that fosters improved bone response and long-term biomechanical competence from surgical instrumentation to final prosthetic rehabilitation. Strategies to develop implant surface texturing will be presented and their role as an ad hoc treatment discussed in light of the interplay between surgical instrumentation and implant macrogeometric configuration. Evidence from human retrieved implants in service for several years and from in vivo studies will be used to show how the interplay between surgical instrumentation and implant macrogeometry design affect osseointegration healing pathways, and bone morphologic and long-term mechanical properties. Also, the planning of implant-supported prosthetic rehabilitations targeted at long-term performance will be appraised from a standpoint where personal preferences (eg, cementing or screwing a prosthesis) can very often fail to deliver the best patient care. Lastly, the acknowledgement that every rehabilitation will have its strength degraded over time once in function will be highlighted, since the potential occurrence of even minor failures is rarely presented to patients prior to treatment.

Background  Length of immobilization after operative fixation of unstable distal radius fractures and management in elderly patients is an area of debate. Purpose  The purpose of this study is to delineate common practices of fellowship-trained hand surgeons and how they compare with current evidence-based protocols. Methods  Surveys were distributed to American Society for Surgery of the Hand members on preferred methods of fixation, postoperative immobilization, and variations in treatment of elderly patients with unstable distal radius fractures. Responses were analyzed in comparison to a literature review. Subgroups were compared with regard to training, practice type, and years in practice. Results  Four-hundred eighty-five surveys were analyzed. Volar fixed-angle plating was the most common choice of fixation (84.7%). Patients are most often immobilized for 1 to 2 weeks (40.0%) with range of motion (ROM) therapy begun most commonly between 1 and 4 weeks (47.2%). The majority of surgeons do not treat fractures differently in patients more than 65 years old. Physicians with more than 20 years of experience were significantly more likely to begin wrist ROM sooner with volar plating versus other fixation techniques compared with physicians with less than 20 years of experience (40.7% vs. 34.2%, respectively). Also, physicians in academic-only practices were more likely to immobilize patients for a shorter time after volar plating compared with those in privademics. Conclusion  Volar fixed-angle plating is the dominant fixation method for unstable distal radius fractures among fellowship-trained hand surgeons. Elderly patients are not treated more conservatively and rigid immobilization after operative fixation remains the treatment of choice despite current evidence-based protocols.

BACKGROUND:Cleft lip is the most common craniofacial malformation with an incidence of 1 in 700 live births. Our study sought to evaluate incidences and risk factors readmission following CLP repair using a well-validated national surgical database. METHODS:All cleft lip repairs performed between 2012 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Database. Patient demographics, surgical variables, and reasons for readmission were analyzed and identified. A binary logistic regression was performed to identify factors independently associated with readmission following cleft lip repair. RESULTS:The 4550 cleft lip repairs were identified with a thirty-day readmission rate of 3.8% (173 patients). A higher incidence of readmission was identified among patients with developmental delay (P ≤0.001), seizure disorder (P <0.001), structural central nervous system abnormality (P ≤0.001), steroid use within 30 days (P ≤0.001), a requirement for nutritional support (P <0.001), and ASA of 3 or higher (17.3% vs 9.9%, P <0.001). Readmitted patients were more likely to have deep incisional surgical site infections (P <0.001), deep wound dehiscence (P = 0.002), reoperation (P <0.001), pneumonia (P <0.001), and unplanned intubation (P <0.001).Multivariate regression identified seizure disorder (OR = 3.3; 95% CI = 1.3-8.3; P = 0.012) and steroid use within 30 days (OR = 3.8; 95% CI = 1.1-12.2; P = 0.030) as independently associated with readmission. The mean time of readmission was 9 days after operation. CONCLUSION/CONCLUSIONS:Patients with seizure disorder and steroid use were significantly more likely to be readmitted. Physicians should be cautious with management of patients with these risk factors.

BACKGROUND:The Physician Payment Sunshine Act requires biomedical companies to disclose financial relationships between themselves and physicians. The authors compared the amount of money received by speakers at the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery annual conferences with that received by the average plastic surgeon. METHODS:General payments data were gathered from the Open Payments database for physicians listed as a presenter, moderator, panelist, lecturer, or instructor at the 2017 annual American Society of Plastic Surgeons and American Society for Aesthetic Plastic Surgery conferences. Means and medians of payments to speakers were calculated for each conference. One-tail t tests were used to evaluate differences. RESULTS:The mean and median for general payments made to conference speakers at American Society for Aesthetic Plastic Surgery (n = 75) and American Society of Plastic Surgeons (n = 249) meeting were $75,577 and $861 and $27,562 and $1021, respectively. In comparison with the average general payment received by plastic surgeons (mean, $4788; median, $3209), these differences were significant (American Society for Aesthetic Plastic Surgery, p = 0.015; American Society of Plastic Surgeons, p = 0.0004). CONCLUSIONS:The significant difference in payments to speakers at conferences compared with the average plastic surgeon suggests that biomedical companies may have influence over some of the conference content. Speakers must make clear the full extent of industry relationships that could potentially bias their presentations.

INTRODUCTION/BACKGROUND:Cleft palate repair has rare, but potentially life-threatening risks. Understanding the risk factors for adverse events following cleft palate repair can guide surgeons in risk stratification and parental counseling. METHODS:Patients under 2 years of age in National Surgical Quality Improvement Project Pediatric Database (NSQIP-P) from 2012 to 2016 who underwent primary cleft palate repair were identified. Risk factors for adverse events after cleft palate repair were identified. RESULTS:Outcomes for 4989 patients were reviewed. Mean age was 1.0 ± 0.3 years and 53.5% were males. Adverse events occurred in 6.4% (320) of patients. The wound dehiscence rate was 3.1%, and the reoperation rate was 0.9%.On multivariate analysis, perioperative blood transfusion (adjusted odds ratio [aOR] 30.2), bronchopulmonary dysplasia/chronic lung disease (aOR 2.2), and prolonged length of stay (LOS) (aOR 1.1) were significantly associated with an adverse event.When subdivided by type of adverse event, reoperation was associated with perioperative blood transfusion (aOR 286.5), cerebral palsy (aOR 11.3), and prolonged LOS (aOR 1.1). Thirty-day readmission was associated with American Society of Anesthesiologists Physical Status Classification class III (aOR 2.0) and IV (aOR 4.8), bronchopulmonary dysplasia/chronic lung disease (aOR 2.5), cerebral palsy (aOR 5.7), and prolonged LOS (aOR 1.1). Finally, wound dehiscence was significantly associated with perioperative blood transfusion only (aOR 8.2). CONCLUSIONS:Although adverse events following cleft palate surgery are rare, systemic disease remains the greatest predictor for readmission and reoperation. Neurologic and pulmonary diseases are the greatest systemic risk factors. Intraoperative adverse events requiring blood transfusion are the greatest surgical risk factor for post-surgical complications.

OBJECTIVE:To ascertain caregiver satisfaction with silver diamine fluoride (SDF) application(s) as an intermediate care path for their children with caries. METHODS:Caregivers were recruited at two community health centers when they arrived for a previously scheduled operating room/sedation appointment for their children with caries who had previously been treated with SDF. They were asked to complete a survey regarding their satisfaction with SDF treatment while they waited during their children's dental treatment. RESULTS:Caregivers overwhelmingly reported that they were satisfied with SDF treatment (81.3%), and that the black mark was not an issue for their children (91.7%) or themselves (87.5%). Moreover, their perception of their children's oral health quality of life was high. CONCLUSIONS:By arresting caries, SDF offers an intermediate care path for pediatric patients for whom OR/sedation treatment was not immediately available. Moreover, most caregivers were satisfied with SDF treatment for their children.

BACKGROUND:Facial Feminization Surgery (FFS) entails a series of surgical procedures that help the trans-woman pass as their affirmed gender. While virtual surgical planning (VSP) with intra-operative cutting guides and custom plates have been shown helpful for craniomaxillofacial reconstruction, they have not yet been studied for FFS. We used cadaveric analysis for morphologic typing and to demonstrate the utility of VSP in FFS procedures. METHODS:Male cadaveric heads underwent morphological typing analysis of the frontal brow, lateral brow, mandibular angle, and chin regions (n=50). Subsequently, the cadavers were split into two groups; 1) VSP intra-operative cutting guides and 2) No preoperative planning. Both groups underwent a)anterior frontal sinus wall set-back, b)lateral supraorbital recontouring, c)mandibular angle reduction, and d)osseous genioplasty narrowing. Efficiency (measured as operative time), safety (determined by dural or nerve injury), and accuracy (scored with 3D CT preop plan vs postop result) were compared between groups with significance being p<0.05 (*). RESULTS:For Frontal Brow/Lateral Lower Face Morphologic Type 3 (severe) predominated; For Lateral Brow/Chin Type 2 (moderate) predominated. For Frontal Sinus wall setback, VSP improved efficiency (19 vs 44min*), safety (100% vs 88%*; less intracranial entry), and accuracy (97% vs 79%*) compared to 'No preoperative planning'. For mandibular angle reduction, VSP improved safety (100% vs 88%*; less inferior alveolar nerve injury) and accuracy (95% vs 58%*). CONCLUSIONS:Preoperative planning for FFS is helpful to determine morphologic typing; VSP with the use of cutting guides/custom plates improved efficiency, safety, and accuracy when performing 4 key craniofacial techniques for FFS.