Faculty Bibliography

BACKGROUND:The perception that complications are more frequent earlier in the medical academic year, known as the "July phenomenon," has been studied in several specialties, with conflicting results. This phenomenon has yet to be studied in plastic surgery; therefore, this study sought to evaluate the presence of the July phenomenon within plastic surgery. METHODS:The American College of Surgeons National Surgical Quality Improvement Program database was accessed, and cases from 2005 to 2014 where "plastic surgery" was listed as the surgical specialty were identified. Only cases with trainee involvement were included for analysis. Included cases were stratified into two groups based on calendar-year quarter of admission. The quarter-3 group included 2451 cases performed during July to September of each calendar year, and the remaining-quarters group included 7131 cases performed in the remaining quarters of each calendar year. Complication rates for 24 complications of interest for quarter-3 and remaining-quarters cases with trainee involvement were calculated, chi-square analysis was used to compare complication rates between groups. Multivariate regression analysis was performed to control for potential confounders. RESULTS:Comparison of complication rates within operations with trainee involvement showed a statistically significant increase in quarter-3 versus remaining-quarters groups for superficial wound infection (0.032 versus 0.023; p = 0.046) and wound dehiscence (0.010 versus 0.006; p = 0.034). No significant difference was found for the remaining 22 complications evaluated. CONCLUSION/CONCLUSIONS:This study of a nationwide surgical database found that for the vast majority of complications coded in the database, the rates do not increase in the beginning of the academic year. CLINICAL QUESTION/LEVEL OF EVIDENCE/METHODS:Therapeutic, III.

BACKGROUND:Despite the growing popularity of platelet-rich plasma, existing evidence supporting its efficacy remains controversial due to the lack of large-scale studies and standardized protocols for preparation and application. This article reviews its use in facial rejuvenation, fat grafting, acne scarring, and androgenic alopecia. Emphasis is placed on comparing methods of platelet-rich plasma preparation and application across studies. METHODS:A systematic review was performed for articles published between 2006 and 2015. All clinical studies and case reports that addressed platelet-rich plasma alone and/or in combination with fat grafting for facial rejuvenation, acne scarring, or androgenic alopecia were included. RESULTS:Of the 22 articles included in the analysis, seven studies used platelet-rich plasma alone for facial rejuvenation, seven in combination with fat grafting, two for treatment of acne scarring, and six for treatment of androgenic alopecia. Individual study procedures, means of evaluation, and significant results are summarized. Although the majority of studies in this review report positive results, significant variation exists in preparation protocols and in the number and frequency of clinical treatments. CONCLUSIONS:The majority of studies report positive results for all indications evaluated in this review, but the procedure is limited by the lack of a standardized method for preparation and application of platelet-rich plasma. The extent to which significant variability in platelet-rich plasma preparation and/or application methods may affect clinical outcomes is not completely clear. In the interim, we present a consolidation of platelet-rich plasma treatment techniques and outcomes currently in use to help guide physicians in their clinical practice.

Adenosine receptor activation has been explored as a modulator of the inflammatory process that propagates osteoarthritis. It has been reported that cartilage has enhanced regenerative potential when influenced by adenosine receptor activation. As adenosine's role in maintaining chondrocyte homeostasis at the cellular and molecular levels is explored, successful in vivo applications of adenosine delivery for cartilage repair continue to be reported. This review summarizes the role adenosine receptor ligation plays in chondrocyte homeostasis and regeneration of articular cartilage damaged in osteoarthritis. It also reports on all the modalities reported for delivery of adenosine through in vivo applications.

BACKGROUND:Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy (NSM) remains controversial. We therefore examined outcomes in NSM with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. METHODS:Autologous free flap reconstructions with NSM performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. RESULTS:221 free flaps for NSM reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. Most common flaps used were deep inferior epigastric perforator (DIEP) (64%), profunda artery perforator (PAP) (12.1%), and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps (10.4%). Autologous reconstructions with a skin paddle had significantly greater BMI (p=0.006). Mastectomy weight (p = 0.017) and flap weight (p<0.0001) were significantly greater in flaps incorporating a skin paddle. Comparing outcomes, there were no significant differences in flap failure (2.0% vs. 2.3%, p=1.000) or percentage of flaps requiring return to the operating room (6.0% vs. 4.7%, p=0.715) between groups. Buried flaps had an absolute greater mean number of revisional procedures per NSM (0.82) compared to the skin paddle group (0.44), however rates of revision procedures per NSM were statistically equivalent between the groups (p=0.296). CONCLUSIONS:While buried free flap reconstruction in NSM has been shown to be safe and effective, our technique has evolved to favor incorporating a skin paddle, which allows for clinical monitoring and can be removed at the time of secondary revision.

Facial disfigurement can significantly affect personal identity and access to social roles. Although conventional reconstruction can have positive effects with respect to identity, these procedures are often inadequate for more severe facial defects. In these cases, facial transplantation (FT) offers patients a viable reconstructive option. However, FT's effect on personal identity has been less well examined, and ethical questions remain regarding the psychosocial ramifications of the procedure. This article reviews the literature on the different roles of the face as well as psychological and social effects of facial disfigurement. The effects of facial reconstruction on personal identity are also reviewed with an emphasis on orthognathic, cleft, and head and neck surgery. Finally, FT is considered in this context, and future directions for research are explored.

OBJECTIVE:To evaluate the education process for the effective use of the Munro Pressure Ulcer Risk Assessment Scale by practicing perioperative staff at an urban tertiary medical center. Given that pressure injury formation is tied to the surgical process, there is a need for a pressure injury risk assessment scale that addresses the uniqueness of the perioperative process. METHODS:Participants were staff who worked in the surgical admissions area, the main operating room, and the main postanesthesia care unit. The authors' facility was 1 of 8 participants in a multisite study. Each site was required to educate staff using standard written instructions and an instructional webinar. However, sites were also encouraged to consider any other methods that would successfully engage the staff in the learning process. After the education process, staff were surveyed and asked to evaluate the educational interventions. MAIN RESULTS/RESULTS:Findings indicated that the staff did not prefer written instructions alone but rather preferred a combination of different learning modalities and media to assist them in using the Munro Scale effectively. CONCLUSIONS:This article discusses the strategies required to engage staff in the implementation process of this scale, the barriers encountered during this implementation, and the implications for perioperative nursing using this scale. The lessons learned from conducting this research provided insight into engaging and educating the adult learner in a new process.

STATEMENT OF PROBLEM/BACKGROUND:Multiple definitions of centric relation (CR) have evolved over time that may have created confusion or impeded understanding. A recent attempt to achieve a singular definition by surveying the members of the Academy of Prosthodontics (AP) did not achieve majority consensus. PURPOSE/OBJECTIVE:The purpose of this study was to identify those aspects or attributes within the existing definitions of CR in which there was agreement or disagreement among the members of the AP. MATERIAL AND METHODS/METHODS:After pretesting and institutional review board approval, a second survey of the AP membership was performed using both email and postal mail survey methods of contact. The CR Attributes Survey separated and stratified the previous definitions of CR into 5 domains: spatial relationship, condylar position, articular disks, mandibular movement, and recording. Each domain attribute was evaluated by agree-uncertain-disagree assessments. Also recorded were demographics, perception of scientific evidence, and open comments. RESULTS:Of the total 146 fellows, 100 completed the survey for an overall response rate of 68.5%. The query completion rate ranged from 96% to 98%. The CR Attributes Survey revealed those components within each domain in which there was strong agreement, disagreement, or uncertainty. The survey assessment of those queries with a moderate to strong agreement were that CR is a "spatial relationship" that is (1) a clinically determined relationship of the mandible to the maxilla, (2) a repeatable position, (3) is independent of tooth contact, and (4) is a physiologic position. Relative to "disks," the condyles articulate with the thinnest avascular intermediate zone of their respective disks; however, there is a lack of sufficient evidence to determine the position of the disks and the condyles. Relative to "mandibular movement," CR is (1) a starting point for vertical, lateral, or protrusive movements, (2) is where the individual can make to and from lateral movements, and (3) is restricted to pure rotary movement about a transverse horizontal axis. Relative to "recording CR" (1) it can be determined in patients without pain or derangement of the temporomandibular joints (TMJs), (2) but may not be recordable in the presence of dysfunction of the masticatory system, or (3) due to the neuromuscular influence or proprioception from the dentition, (4) is a clinical useful repeatable reference position for mounting casts, or (5) for developing a functional treatment occlusion, (6) at an established vertical dimension, and (7) may vary slightly by recording method. CONCLUSIONS:The CR Attributes Survey revealed a majority agreement or consensus for various CR attributes that should be considered for defining the term 'centric relation.' In contrast, those CR attributes with a plurality agreement, disagreement, or uncertainty outcomes should be considered for exclusion. The evaluated weakness of these latter attributes indicates the need for further research and reassessment.

OBJECTIVES/OBJECTIVE:The aim of this study was to quantify the internal void volume formation in commercially available, resin composites inserted using conventional or sonic insertion methods, and analyzed using three-dimensional (3D) micro-computed tomography (μCT). METHODS AND MATERIALS/METHODS:Four resin composites were evaluated: one conventional (Herculite, Ultra, Kerr Corporation, Orange, CA, USA), one flowable bulk fill (SureFil SDR Flow, Dentsply International, York, PA, USA), and two packable bulk fill (SonicFill, Kerr Corporation, and Tetric EvoCeram Bulk Fill, Ivoclar Vivadent Inc, Schaan, Liechtenstein). Eight groups were evaluated according to each resin composite type and insertion method (conventional or sonic; n=5). Forty ABS 3D-printed cylindrical molds, 5.0 mm in diameter and 4.0 mm in depth, were fabricated. For the conventional resin composite, the mold was filled incrementally (two layers), while for bulk-fill resin composites, insertion was performed in a single increment. The sonic insertion method was performed using a specific handpiece (SonicFill Handpiece, Kerr Corporation). Resin composites were light cured using a multipeak light-emitting diode light-curing unit (VALO, Ultradent Products Inc, South Jordan, UT, USA) in its regular mode. Samples were evaluated by μCT, and data were imported into software (Amira, version 5.5.2, VSG, Burlington, MA, USA) for 3D reconstruction, from which the percentage of void volume was calculated. Data were analyzed using two-way analysis of variance and Tukey post hoc test at a preset alpha of 0.05. RESULTS:The conventional insertion method resulted in reduced porosity, compared with sonic insertion, for SureFil SDR Flow and Tetric EvoCeram bulk fill. The sonic insertion method did not demonstrate any influence on void formation for Herculite Ultra or SonicFill. CONCLUSION/CONCLUSIONS:Results suggest that the sonic insertion method might increase void formation during resin composite delivery, depending on restorative material brand.

BACKGROUND:Lack of access to oral health care is a significant burden for disadvantaged populations, yet rarely draws the attention of policymakers or community leaders. OBJECTIVES/OBJECTIVE:To understand how UNITED SIKHS identified oral health care as a priority need through its involvement in community-based participatory research (CBPR) initiatives and local data collection, thereby building its capacity to lead participatory oral health projects. METHODS:The foundation for the partnership between UNITED SIKHS and the New York University (NYU) Prevention Research Center (PRC) was the joint implementation of a CBPR project to prevent diabetes in the Sikh Asian Indian community. Project partners also included a community coalition composed of religious leaders, health providers, members of the media, and dental students and faculty at the NYU College of Dentistry (NYU Dentistry). A community needs and resources assessment survey was jointly developed and conducted in 2010 to better understand health needs in the Sikh community. RESULTS:Fewer than one-half of the Sikh participants (43.0%) reported ever receiving a check-up or screening by a dentist, and of those who did, only one-half (50.0%) reported that it occurred in the past 12 months. Upon clinical assessment, more than one-half of Sikh adults (58.2%) had untreated dental decay. The collection and analysis of local data motivated UNITED SIKHS to develop new priorities based upon the findings. CONCLUSIONS:UNITED SIKHS applied for and received external funding to lead a CBPR project that developed, implemented, evaluated, and disseminated a culturally tailored oral health and healthy living curriculum for the Sikh Asian Indian community.

OBJECTIVE:To characterize the mechanical properties of different coating methods of DLC (diamond-like carbon) onto dental implant abutment screws, and their effect on the probability of survival (reliability). METHODS:Seventy-five abutment screws were allocated into three groups according to the coating method: control (no coating); UMS - DLC applied through unbalanced magnetron sputtering; RFPA-DLC applied through radio frequency plasma-activated (n=25/group). Twelve screws (n=4) were used to determine the hardness and Young's modulus (YM). A 3D finite element model composed of titanium substrate, DLC-layer and a counterpart were constructed. The deformation (μm) and shear stress (MPa) were calculated. The remaining screws of each group were torqued into external hexagon abutments and subjected to step-stress accelerated life-testing (SSALT) (n=21/group). The probability Weibull curves and reliability (probability survival) were calculated considering the mission of 100, 150 and 200N at 50,000 and 100,000 cycles. RESULTS:DLC-coated experimental groups evidenced higher hardness than control (p<0.05). In silico analysis depicted that the higher the surface Young's modulus, the higher the shear stress. Control and RFPA showed β<1, indicating that failures were attributed to materials strength; UMS showed β>1 indicating that fatigue contributed to failure. High reliability was depicted at a mission of 100N. At 200N a significant decrease in reliability was detected for all groups (ranging from 39% to 66%). No significant difference was observed among groups regardless of mission. Screw fracture was the chief failure mode. SIGNIFICANCE/CONCLUSIONS:DLC-coating have been used to improve titanium's mechanical properties and increase the reliability of dental implant-supported restorations.