Faculty Bibliography

BACKGROUND:Umbilicoplasty is a critical step in donor-site closure following abdominally based autologous breast reconstruction (ABR). While various incision designs and transposition techniques have been described, their impact on patient- and surgeon-assessed aesthetic outcomes remains poorly defined. METHODS:A systematic review was conducted following PRISMA guidelines. PubMed, Ovid EMBASE, and Cochrane Library were searched through August 1, 2025, for studies evaluating umbilicoplasty after ABR. Eligible studies included randomized controlled trials, cohort studies, and case series reporting surgical technique, aesthetic, and/or patient satisfaction outcomes. Data extraction included study characteristics, surgical techniques, patient- and surgeon-assessed aesthetic outcomes, and complications. Risk of bias was assessed using standardized tools. RESULTS:Eight studies comprising 362 patients met inclusion criteria. Umbilicoplasty techniques varied, including oval, U/inverted-U, and Mercedes/inverted Mercedes as well as a neo-umbilicoplasty approaches. Complication rates were low with hypertrophic scarring and umbilical stenosis being most common. Aesthetic outcomes were variably reported, with limited use of validated scales, but generally favored designs that avoid an uninterrupted oval. CONCLUSION/CONCLUSIONS:While reported complication rates are low, methodological limitations and underreporting preclude definitive conclusions about technique safety or superiority. Umbilicoplasty should be individualized, with careful attention to perfusion. Future studies should prioritize standardized reporting, validated outcome measures, and multicenter collaboration to strengthen the evidence base and guide best practices in abdominally based breast reconstruction. LEVEL OF EVIDENCE III/METHODS: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:The "July Effect" refers to the potential increase in adverse outcomes associated with the annual turnover of medical trainees, though its impact on surgical fields remains uncertain. Additionally, few studies have examined whether the operative day of the week and subsequent flap monitoring during the weekend affect time to reoperation or flap salvage. This study investigated whether academic quarter and operative day influence reoperation rates, flap salvage, or flap failure in microvascular free flap procedures. METHODS:A retrospective review was conducted on 769 free flaps performed between June 2011 and November 2023. Multivariate analyses adjusted for patient demographics, comorbidities, flap type, and recipient region. Flaps were categorized by academic quarter and operative day, excluding weekends due to limited sample size. Primary outcomes included reoperation rates for vascular compromise, time to reoperation, and flap salvage. RESULTS:No significant differences in reoperation rates for vascular compromise were observed across academic quarters. While procedure duration trended longer in the first three quarters compared to the fourth, these differences were not statistically significant. Additionally, operative day did not impact reoperation rates, flap salvage, or time to reoperation. Flaps were predominantly indicated for head and neck reconstruction (74.4%) and had an overall flap loss rate of 3.0%. CONCLUSION/CONCLUSIONS:We found no evidence of a "July Effect" in microvascular surgery or that operative day affects free flap outcomes. Institutional factors, such as structured flap monitoring, attending oversight, and advanced practice provider support, likely mitigate risks associated with trainee turnover and shift-based staffing fluctuations.

Cleft lip and/or palate (CL/P) is a life-long condition that requires multidisciplinary care throughout childhood and beyond. Studies have examined the impact of CL/P on psychosocial outcomes including lower self-esteem, higher incidence of bullying, social isolation, and rejection. As a result, patients may be predisposed to experiencing mood disorders or trauma related to their facial difference. Moreover, access to dedicated cleft centers is limited in many areas in the United States. For children with a CL/P who present to the healthcare system, evaluating for trauma symptoms and incorporating trauma-informed care can support these patients' psychosocial wellbeing during an impressionable developmental period.

BACKGROUND:While radiographic outcomes after distal radius fractures (DRFs) are emphasized in clinical guidelines, several studies demonstrated that radiographic measures do not correlate with patient-reported outcomes (PROs), especially in patients aged ≥65 years. This study aims to determine whether fracture severity and radiographic parameters following fracture healing are prognostic of PROs, hypothesizing no strong association exists between these factors. METHODS:This study retrospectively reviewed prospectively collected Patient-Reported Outcomes Measurement Information System Upper Extremity Function (PROMIS UE) scores in patients sustaining acute DRF between January 2016 and January 2023 with a 6-month minimum follow-up. Independent variables were patient demographics, comorbidities, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture classification, and radiographic parameters following treatment. Multivariate linear regression analyzed associations between nonradiographic and radiographic parameters and PROMIS UE score. We performed subanalyses of patients treated operatively and nonoperatively and patients above and below the cohort's median age. RESULTS:In total, 385 patients were included, of which 193 were treated conservatively and 192 operatively. Multivariate analysis demonstrated no association of PROMIS UE score with AO/OTA fracture classification, ulnar variance, volar tilt, or radial inclination at 6 months. A subanalysis of patients aged ≤62 years showed that every degree increase in radial inclination was associated with 0.3-point decrease in PROMIS UE. CONCLUSIONS:This study found no robust relationship between patient-reported function and radiographic outcomes following DRF. Initial fracture severity, similarly, did not predict mid-term patient-reported function. Our findings support prior evidence that achieving reduction within the established range of radiographic parameters is sufficient for patient function. LEVEL OF EVIDENCE/METHODS:3, prognostic retrospective cohort study.

Clinical application of beta-tricalcium phosphate (β-TCP) has been limited by a lack of bone infiltration within its bulk form. Lithography-based ceramic manufacturing (LCM), a novel additive manufacturing (AM) technique, leverages photopolymerization to create β-TCP structures with higher feature resolution and surface quality than traditional techniques. This modality allows for a more efficient and precise means to control implant microarchitecture and macroarchitecture, enabling the production of novel implant configurations. This pilot study explores the bone regenerative capacity of lithography-based ceramic-manufactured 100% β-TCP scaffolds for the repair of critically sized mandibular defects in a skeletally mature rabbit model. Quantitative and qualitative analyses of regenerated bone were performed using micro-computer tomography (micro-CT) and two-dimensional histologic analysis, respectively. Three-dimensional volumetric reconstruction revealed bridging bone in sites treated with β-TCP implants, yielding ~8.6±3.5% of regenerated bone within the construct and ~33±3.2% remaining scaffold volume. Bone regeneration and remaining scaffold quantification were corroborated using traditional two-dimensional histologic micrographs and three-dimensional volumetric analysis (P<0.05). Qualitative histologic analysis revealed vascularized woven and lamellar bone, with no evidence of ectopic bone, excess inflammation, or fracture. Bone regeneration in this short-term rabbit model following a critical-sized mandibular defect repaired with LCM β-TCP scaffolds demonstrated analogous radiographic and histologic properties to native bone.

BACKGROUND:Complex scalp defects represent a significant reconstructive challenge and frequently require free tissue transfer. Although the latissimus dorsi (LD) and anterolateral thigh (ALT) flaps are widely regarded as preferred options, existing studies are limited by small sample sizes or short follow-up. This study reviews an 8-year institutional experience with scalp free flap reconstruction to inform best practices in managing complex scalp defects. METHODS:A retrospective review was conducted of a consecutive set of scalp reconstruction cases that required free tissue transfer between 2015 and 2023. Comorbidities, surgical details, and postoperative complications up to 90 days after surgery were noted. Standard descriptive analysis was performed. RESULTS:The LD flap was the most frequently used flap, accounting for 45.2% (n = 14) of reconstructions, followed by the ALT flap in 35.5% (n = 11) of cases. Among LD flaps, hematoma was the most frequent 30-day complication, occurring in 35.7% (n = 5) of patients, and 1 patient (7.1%) experienced complete flap necrosis within 90 days. In the ALT group, wound dehiscence occurred in 27.3% (n = 3) of patients and hematoma in 18.2% (n = 2), representing the most common 30-day complications. No patients in the ALT group developed complete flap necrosis within 90 days. Across the entire cohort, the overall rate of complete flap necrosis at 90 days was 3.2% (n = 1). CONCLUSION/CONCLUSIONS:Free flap reconstruction is an effective method for complex soft tissue scalp defects, although it carries associated morbidities. Understanding the risks and benefits of such procedures is crucial in patient education and shared decision-making.

Despite the growing demand for hyaluronic acid (HA) lip fillers, there is a paucity of robust, quantitative data across high-powered studies. This systematic review and meta-analysis aims to assess the efficacy and safety of HA lip fillers as reported by randomized controlled trials (RCTs). A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, utilizing PubMed, Embase, and Cochrane, and eligible studies included RCTs with human subjects utilizing HA filler for lip augmentation. Meta-analysis evaluated rates of improvement in lip fullness, aesthetic appearance, patient satisfaction, and adverse events. A comprehensive review initially identified 2,038 articles. Following screening by title and abstract, full-text review, and risk of bias assessment with the Cochrane risk-of-bias tool for randomized trials (RoB 2), sixteen articles were included in the study. Meta-analysis demonstrated that 60% (95% CI: 44-76%) had improvement in lip fullness, 82% (95% CI: 67-92%) had improvement in aesthetic appearance, 68% (95% CI: 58-78%) reported satisfaction, 50% (95% CI: 27-73%) had adverse events, and 1.5% (95% CI: 1.9-4.0%) had serious adverse events requiring treatment, needing follow-up, or lasting beyond 30 days. The most common adverse events were swelling (78%), firmness (48%), bruising (34%), and tenderness (33%). Across studies with the highest level of evidence, HA filler efficacy and patient satisfaction is moderate to high. Severe adverse reactions are rare, but adverse events are common.

BACKGROUND:Fostering a culture of inquiry within an academic health system can be both challenging and rewarding. Having a strategic approach can help navigate these complexities. PURPOSE/OBJECTIVE:The aim of this program evaluation is to describe the steps taken to develop, implement, and sustain a nursing science fellowship (NSF) in an academic health system. METHODS:Grounded by a nursing strategic map, the NSF was established under the leadership of a steering committee. Key components of the NSF, including eligibility guidelines, curriculum development, outcome measurements, and faculty and mentor selection, were created over a three-month period. The first cohort of fellows began the 13-month program in January 2023. Fellows attended monthly lectures and were provided with individualized mentorship to advance either an evidence-based practice (EBP) or research project. Prior to beginning the curriculum, fellows were given a research/EBP textbook. A survey to determine their confidence in nursing science skills both before and after the program was administered to all fellows. RESULTS:Of the 11 inaugural fellows, eight completed the program. Four fellows conducted research studies, and four completed EBP projects. The results were disseminated through national presentations, posters, and peer-reviewed publications. Evaluations demonstrated significant improvements in the fellows' confidence in all measured nursing science skills and topics, with notable increases in navigating institutional review board submissions (148.54%), utilizing theoretical frameworks (86.92%), and critically appraising evidence (68.07%). A second cohort began the NSF program in September 2024, and a third will begin in 2026. CONCLUSION/CONCLUSIONS:The NSF helped to sustain a culture of inquiry within the academic health system. This program highlights the critical role of strategic planning and stakeholder engagement in advancing a culture of inquiry. The NSF fosters professional curiosity and aligns with the tenets of the American Nurses Credentialing Center Magnet model by advancing nursing science. As health care evolves, programs like the NSF are essential for cultivating sustainable nursing research and EBP practices that drive professional growth and innovation and can lead to enhanced patient care.

OBJECTIVES/OBJECTIVE:To determine the relationships between the number and class of xerogenic medications on whole stimulated salivary flow rates and oral health-related quality of life (OH-QOL) measures in patients who received high-dose external beam radiation therapy (RT) for head and neck cancer (HNC). STUDY DESIGN/METHODS:Complete medication lists were generated using patient electronic health records from every attended study visit for 146 HNC patients. Whole stimulated salivary flow was measured before RT, and 6 and 18-months after RT. Ten single-item questions and two composite scales of swallowing problems and senses problems (taste and smell) were assessed at baseline and at 6-month intervals up to 24 months after RT. Linear mixed-effects models examined associations between the total number and class of medications and stimulated salivary flow and OH-QOL. RESULTS:There was no detected association between the total number of medications and stimulated salivary flow (p-value = .18). Only antidepressant usage was significantly associated with stimulated salivary flow (P = .006). Number of medications, narcotic analgesic, and antidepressant usage were significantly associated with a clinically meaningful decrease in OH-QOL. CONCLUSION/CONCLUSIONS:Antidepressants were associated with reduced stimulated salivary flow, but no cumulative negative effect on whole stimulated salivary flow was identified. Polypharmacy was associated with worse OH-QOL.

OBJECTIVE:To review currently available devices on pressure injury (PI) early detection, summarize challenges and opportunities to clinical implementation, and propose evaluation standards for device categories. DATA SOURCES/METHODS:PubMed and US Food and Drug Administration (FDA) databases. STUDY SELECTION/METHODS:Published in English from peer-reviewed journals with full text available. Excluded if opinion statements, lack of empirical data, or unrelated to project's objective. DATA EXTRACTION/METHODS:For both clinical device and research equipment: measurement mechanisms, measurement types, outcome/output, FDA classification, and indications for use. Addition data were extracted for clinical devices: instruction for use, end user, order requirement, and billable code. DATA SYNTHESIS/RESULTS:The 4 clinical devices are ultrasound, long-wave infrared thermography, subepidermal moisture assessment, and nearinfrared spectroscopy. The 3 research devices are laser Doppler flowmetry, laser speckle contrast imaging, and colorimetry. CONCLUSIONS:The measurement mechanisms of all devices are unique and different from each other. One commonality is that they could measure the nonvisual signs of PI (eg, inflammation, edema, ischemia, and hypoxia) except colorimeter. Some clinical devices are promising to assist with early identification of PIs, especially in individuals with dark skin tones. Currently, there is no reimbursement available for early detection of PI. Current evidence did not support replacing the standard skin assessment of visual inspection and palpation with the devices reviewed, rather using validated devices to augment the current practice standard. This is especially recommended for individuals identified as high risk for a PI on admission to a facility.