Faculty Bibliography

OBJECTIVE:To evaluate the residual stress (nanoindentation based on hardness) of fatigued porcelain-fused to zirconia 3-unit fixed dental prostheses (FDP) with different framework designs. METHODS:Twenty maxillary 3-unit FDP replacing second-premolar (pontic) were fabricated with conventional framework-design (even-thickness of 0.5mm and 9mm2 connector area) and modified framework-design (thickness of 0.5mm presenting lingual collar connected to proximal struts and 12mm2 connector area). Connector marginal ridges were loaded and the fractured and suspended FDPs were divided (n=3/each) into: (1) Fractured zirconia even-thickness (ZrEvenF); (2) Suspended zirconia even-thickness (ZrEvenS); (3) Fractured zirconia with modified framework (ZrModF); (4) Suspended zirconia with modified framework (ZrModS); (5) Non-fatigued FDP with conventional framework design (Control). The FDPs were nanoindented at 0.03mm (Region of Interest (ROI) 1), 0.35mm (ROI 2) and 1.05mm (ROI 3) distances from porcelain veneer outer surface with peak load 4000μN. The Linear Mixed Analysis of Variance (ANOVA) Model on ranks and Least Significant Difference Test on ranks (95%) were used. RESULTS:Highest rank hardness values were found for Control group and ZrModS, whereas the lowest values were found in ZrModF. Statistical differences (p=0.000) were found among all groups except for comparison between ZrModS and Control group (p=0.371). Hardness between ROIs were statistically significant different (p<0.001) where ROI 1 presented the lowest values. SIGNIFICANCE/CONCLUSIONS:Framework-design modification did not influence the residual stress of porcelain-fused to zirconia fatigued 3-unit FDP. Whereas fractured FDPs showed the highest residual stress compared to suspended and control FDPs. Residual stress increased as nanoindented away from framework.

BACKGROUND:Despite the growing success of facial transplantation, organ donor shortages remain challenging. Educational health campaigns can effectively inform the general public and institute behavioral modifications. A brief educational introduction to facial transplantation may positively influence the public's position on facial donation. METHODS:The authors anonymously surveyed 300 participants, gathering basic demographic information, donor registration status, awareness of facial transplantation, and willingness to donate solid organs and facial allografts. Two-hundred of these participants were presented an educational video and subsequently resurveyed on facial donation. Factorial parametric analyses were performed to compare exposure responses before and after watching video exposure. RESULTS:Among participants completing the survey alone (control group), 49 percent were registered donors, 78 percent reported willingness to donate solid organs, and 52 percent reported willingness to donate facial allograft. Of participants who watched the video (video group) 52 percent were registered; 69 and 51 percent were willing to donate solid organs and face, respectively. Following educational intervention, 69 percent of participants in the video group reported willingness to donate facial tissue, an 18 percent increase (p < 0.05), that equated to those willing to donate solid organs. The greatest increase was observed among younger participants (23 percent); women (22 percent); Jewish (22 percent), Catholic (22 percent), and black/African American (25 percent) participants; and respondents holding a higher degree. No significant differences according to gender or ethnicity were observed. CONCLUSION/CONCLUSIONS:Educational interventions hold much promise for increasing the general public's awareness of facial transplantation and willingness to participate in donation of facial allografts.

INTRODUCTION/BACKGROUND:Breast augmentation is the most common aesthetic surgery performed in the United States (US) annually. Analysis of Google Trends (GT) data may give plastic surgeons useful information regarding worldwide, national, and regional interest for breast augmentation and other commonly performed aesthetic surgeries. METHODS:Data were collected using GT for breast augmentation and associated search terms from January 2004 to May 2017. Case volume was obtained from the American Society of Plastic Surgeons (ASPS) annual reports for the calendar year 2005-2016. RESULTS:Trend analysis showed that total search term volume for breast augmentation and breast implants gradually decreased worldwide and in the US over the study period while the search term boob job slowly increased. Univariate linear regression demonstrated a statistically significant positive correlation between average annual Google search volume of "breast augmentation" and the annual volume of breast augmentations performed in the US according to ASPS data (R 2 = 0.44, p = 0.018). There was no significant correlation between national volume of breast augmentations performed and search volume using the terms "breast implants" or "boob job" over time (p = 0.84 and p = 0.07, respectively). In addition, there appears to be country specific variation in interest based on time of year and peaks in interest following specific policies. CONCLUSIONS:To our knowledge, this is the first and only analysis of GT data in the plastic surgery literature to date. To that end, this study highlights this large and potentially powerful data set for plastic surgeons both in the US and around the world. LEVEL OF EVIDENCE V/UNASSIGNED: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 .

OBJECTIVE:The Council on Medical Student Education in Pediatrics and Association of Pediatric Program Directors developed a Pediatric Subinternship (CAPS) Curriculum for use with an individualized learning plan (ILP). The authors determined which learning objectives (LOs) pediatric subinterns selected when provided the CAPS Curriculum, summarized students' self-reported progress, and determined feasibility of ILPs in subinternship. METHODS:Students from 10 medical schools completed a standardized ILP during pediatric subinternship. Students listed > 3 LOs using CAPS Curriculum as a guide and self-assessed progress. Students reviewed ILPs with faculty preceptors; preceptors completed questionnaires on time/effort spent. Authors mapped student LOs to CAPS curriculum objectives and grouped in ACGME competency domains. RESULTS:204 students documented 850 LOs. Authors mapped student LOs to 60 of the 68 (88%) CAPS objectives. Students most commonly chose Patient Care LOs with top three related to 1)oral presentations, 2)time management, and 3)management plans. Student LOs not in CAPS addressed nutrition, child development, test interpretation, and cost. No students chose LOs related to health disparities, shared-decision making, informed consent, or patient safety. Students self-reported significant progress on most (73%) LOs. Faculty met with students >1 time and 93% met for total <1 hour. According to faculty, students required little or no help completing ILPs. CONCLUSIONS:Students chose a wide range of LOs when provided the CAPS Curriculum. Revision to include additional student-identified LOs would enhance CAPS Curriculum's comprehensiveness. Using this curriculum with an ILP during subinternship is feasible but gaps between educator-identified and student-identified objectives require further exploration.

OBJECTIVE/OBJECTIVE:To determine the opinions of healthcare clinicians in the Philippines regarding the 2016 National Pressure Ulcer Advisory Panel (NPUAP) terminology changes and revised staging definitions. DESIGN AND SETTING/METHODS:A survey methodology was used in Manila, Philippines. Convenience samples of healthcare clinicians of varying disciplines and employment settings were invited to participate in this research. INTERVENTIONS/METHODS:A survey was administered at key intervals regarding the revised NPUAP terminology changes and revised staging definitions. The survey was administered before and after an interactive, basic 2-day wound course was conducted. MAIN RESULTS/RESULTS:Results revealed strong support for the 2016 NPUAP terminology change from pressure ulcer to pressure injury and the revised staging definitions. CONCLUSIONS/CONCLUSIONS:Since the NPUAP changed its terminology and revised the staging definitions, the wound care community has been responding to those changes. Because pressure injuries are a global health concern, the opinions of clinicians outside the United States are equally valuable. The healthcare clinicians in the Philippines surveyed appear to embrace the new terminology changes and revised staging definitions put forth by the NPUAP.

PURPOSE/OBJECTIVE:Mandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint (TMJ) because it requires precise bone graft alignment for full restoration of joint function. The use of computer-aided design and manufacturing (CAD/CAM) technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study was to analyze clinical and functional outcomes after reconstruction of mandibular condyle defects using only a free fibula graft with the help of virtual surgery techniques. MATERIALS AND METHODS/METHODS:A retrospective review was performed to identify all patients who underwent mandibular reconstruction with only a free fibula flap without any TMJ adjuncts after a total condylectomy. Three-dimensional modeling software was used to plan and execute reconstruction for all patients. RESULTS/RESULTS:From 2009 through 2014, 14 patients underwent reconstruction of mandibular defects involving the condyle with the aid of virtual surgery technology. The average age was 38.7 years (range, 11 to 77 yr). The average follow-up period was 2.6 years (range, 0.8 to 4.2 yr). Flap survival was 100% (N = 14). All patients reported improved facial symmetry, adequate jaw opening, and normal dental occlusion. In addition, they achieved good functional outcomes, including normal intelligible speech and the tolerance of a regular diet with solid foods. Maximal interincisal opening range for all patients was 25 to 38 mm with no lateral deviation or subjective joint pain. No patient had progressive joint hypomobility or condylar migration. One patient had ankylosis, which required release. CONCLUSION/CONCLUSIONS:TMJ reconstruction poses considerable challenges in bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise planning and intraoperative manipulation with optimal functional outcomes.

PURPOSE: The dependent nature of the lower extremity predisposes to venous congestion, especially following significant trauma. The benefit of a second venous anastomosis, however, remains unclear in lower extremity trauma free flap reconstruction. This study investigated the effect of an additional venous anastomosis on flap outcomes in lower extremity trauma reconstruction. METHODS: Retrospective review between 1979 and 2016 identified 361 soft tissue flaps performed for Gustilo IIIB/C coverage meeting inclusion criteria. Muscle flaps were performed in 287 cases (79.9%) and fasciocutaneous flaps in 72 cases (20.1%). Single-vein anastomosis was performed in 76% of cases and dual-vein anastmoses in 24% of cases. Patient demographics, flap characteristics, and outcomes were examined. RESULTS: Fasciocutaneous flaps were more likely to have two veins performed (P < .001). Complications occurred in 143 flaps (39.8%): 45 take-backs (12.4%), 37 partial losses (10.3%), 31 complete losses (8.6%). Compared to single-vein flaps, two veins reduced major complications (P = .005), partial flap failures (P = .008), and any flap failure (P = .018). Multivariable regression analysis demonstrated two veins to be protective against complications (RR = 2.58, P = .009). Subset regression analysis by flap type demonstrated an even more significant reduction in complications among muscle flaps (RR = 3.92, P = .005). Additionally, a >1 mm vein size mismatch was predictive of total flap failure (RR = 3.02, P = .038). CONCLUSION: Lower extremity trauma free flaps with two venous anastomoses demonstrated a fourfold reduction in complication rates compared to single-vein flaps. Additionally, venous size mismatch >1 mm was an independent predictor of total flap failure, suggesting beneficial effects of both two-vein outflow and matched vessel diameter.

The influence of heat treatment on the microstructure, tensile and compressive properties and failure mechanisms of WE43 alloy is studied. The eutectic phase is dissolved into the α-Mg phase and the grain size is refined in the heat treated alloy. Heat treatment improves the tensile yield and ultimate strengths by 40% and 53%, respectively. The compressive yield and ultimate strengths of heat treated alloy are also 55% and 23%, respectively, higher compared to the as-cast alloy. Compressive characterization is also conducted at high strain rates. The energy absorption capability of WE43-T5 specimens is higher than the as-cast WE43 specimens at all strain rates investigated in this work. Failure initiates with cracks in the eutectic phase in the as-cast alloy. These cracks grow through the grain to result in transgranular fracture. The absence of eutectic mixture in heat treated alloy results in grain boundary sliding and crack initiation at triple junctions. The crack propagation is delayed in the absence of eutectic precipitates, which improves the mechanical properties of the heat treated alloy.