Faculty Bibliography

GENERAL PURPOSE/OBJECTIVE:To discuss a standardized methodology for wound photography with a focus on aiding clinicians in capturing high-fidelity images. TARGET AUDIENCE/BACKGROUND:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES/OBJECTIVE:After participating in this educational activity, the participant will be able to:1. Discriminate the components of high-quality wound photography.2. Identify the technological innovations that can augment clinical decision-making capacity.3. Choose strategies that can help clinicians avoid adverse medicolegal outcomes.

Although the ethical and technical feasibility of face transplant (FT) has been established, current literature lacks consensus on functional outcomes monitoring for recipients. This systematic review aims to appraise and summarize the current literature on tools used to assess motor functional outcomes in FT. This study complied with the guidelines outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). On September 15, 2020, two reviewers conducted independent electronic searches using medical literature databases, without language or time frame limitations. Eligibility criteria included studies reporting on the evaluation of motor functional outcomes in face transplant recipients. Of 451 papers found in the literature, 12 fulfilled the study inclusion criteria. The reported tools included clinical scales/examinations, electromyography, optical movement tracking devices, muscle volumetric measurement using magnetic resonance imaging, and software-based video and photo analyses. The frequency of data collection varied from every three months to every year. Publications reporting on motor functional outcomes tracking tools vary broadly and demonstrate a lack of consensus. Although quantitative measurements are desirable, adapted clinical scales are still the current standard of care.

BACKGROUND:Hematomas are reported to be the most common immediate complication in patients undergoing gender-affirming mastectomy, with rates substantially higher than those associated with other types of breast surgery. This study sought to examine the breadth of current literature and provide evidence-based explanations regarding the development of hematomas in chest masculinizing surgery and technical considerations for reducing their incidence. METHODS:A systematic review was conducted to identify all articles related to gender-affirming mastectomy published through September 2021. Literature search yielded 2,661 articles for screening, of which 20 met inclusion criteria. Themes from the selected articles were compiled to generate consensus statements qualified by associated level of evidence (LOE). RESULTS:The rate of hematoma following gender-affirming mastectomy is reported in the literature ranging from 0% to 31.2%. The use of more limited, nipple-sparing incisions is associated with a higher hematoma rate than mastectomy with free nipple grafting (Level III). There is no conclusive evidence indicating any relationship between the use of masculinizing hormones and the incidence of hematoma (Level IV). Factors such as body mass index (Level III) and breast size (Level III) were not found to influence hematoma risk, though nicotine use (Level IV) was significantly associated with the incidence of hematoma. CONCLUSIONS:Hematoma is a known complication following gender-affirming mastectomy. The use of limited incision approaches has the strongest association with an increased risk of hematoma. There is no evidence indicating an association between hormone use (i.e., testosterone) and hematoma incidence. Future studies are needed to better define factors, interventions, and protocols to reduce the rate of hematoma. LEVEL OF EVIDENCE/METHODS:III.

Background/Purpose: APS ACTION is an international Clinical Database and Repository of persistently antiphospholipid antibody (aPL)-positive subjects, collecting demographic, medical history, and aPL data.This study focused on the prevalence of antinuclear antibodies (ANA) in aPL positive patients without a defined concomitant autoimmune disease. The objective of this study was to evaluate potential differences when stratifying patients by ANA, and to better phenotype aPL positive patients.
Method(s): Data from aPL positive patients with or without APS classification criteria were retrieved from the APS ACTION Database. Patients with a diagnosis of systemic lupus erythematosus (SLE) or other connective tissue disease were excluded. Patients were divided in two groups (ANA+ and ANA-), based on ANA status at registry entry. Subsequently, Table 1. Demographic, clinical and serological characteristics of the patients. demographic, clinical (including 1997 ACR SLE classification criteria), and serological data were compared between the two subgroups.
Result(s): 521 aPL-positive patients were included in the study (meanage 52.1+/-13 years, 70% female). Among them, 224 patients were ANA+ and 297 ANA-. Patients characteristics are displayed in Table 1. ANA positivity was significantly associated with previous history of hematologicalmanifestations as a whole, including hemolytic anemia, thrombocytopenia, and leukopenia, (19.3% ANA+ vs. 8.4% ANA-, p < 0.01) and livedo reticularis (15.1% ANA+ vs. 10% ANA-, p < 0.05). A positive association with the number of unexplained fetal deaths beyond 10 weeks of gestation was also noted (p < 0.05), and a trend was observed for lower platelet count, aPL-related nephropathy and arthritis, though these associations were not statistically significant. No significant association was found for extra-criteria manifestations such as haemolytic anemia and history of thrombocytopenia, when considered individually. When sub-analysing the ANA-group, a significant association with any history of arterial thromboses (29.4% ANA+ vs. 38.8% ANA-, p < 0.02) and the number of arterial events was observed (p < 0.01). When evaluating ANA positivity in aPL carriers and primary APS (PAPS) individually, the association between ANA+ and previous hematologic disorder remained significant for both groups, with stronger significance for PAPS patients. In addition, ANA positivity in PAPS patients was significantly associated with livedo reticularis and previous history of small vessel disease (p < 0.05).
Conclusion(s): In this large international cohort, ANA positivity was associated with a higher rate of hematologic manifestations in aPL-positive patients without connective tissue disease. ANA+ patients, especially those with PAPS, showed a tendency toward a higher rate of microvascular manifestations and arthritis. ANA-subjects showed a significantly higher rate of arterial thrombosis, without any other significant association with clinical, serological or demographic data

PURPOSE/OBJECTIVE:To evaluate the effect of composition, fabrication mode, and thermal cycling on the mechanical properties of different polymeric systems used for temporary dental prostheses. MATERIALS AND METHODS/METHODS:Standard bar-shaped specimens (25 × 2 × 2 mm) were fabricated of six polymeric systems of varying compositions and fabrication modes (n = 10/group): conventional PMMA (Alike, GC) - group CGC; conventional PMMA (Dêncor, Clássico) - group CD; bis-acryl (Tempsmart, GC) - group BGC; bis-acryl (Yprov, Yller) - group BY; milled PMMA (TelioCAD, Ivoclar) - group MI; 3D printed bis-acryl - (Cosmos Temp, Yller) group PY. Half of the specimens were subjected to 5000 thermal cycles (5 °C to 55 °C). Three-point bending tests were performed using a universal testing machine with a crosshead speed set to 0.5 mm/min. Flexural strength and elastic modulus were calculated from the collected data. FTIR spectra were recorded pre and post curing and after thermal cycling to evaluate material composition and degree of conversion. Energy-dispersive spectroscopy (EDS) and scanning electron microscope (SEM) were utilized to examine the composition and micromorphology of the systems, respectively. Data were analyzed using two-analysis of variance and Tukey tests (α = 0.05). RESULTS:FTIR spectra indicated that BGC, BY and PY groups corresponded to urethane dimethacrylate systems (bis-acryl), while CGC, CD, and MI groups corresponded to monomethacrylate systems, polymethyl methacrylate (PMMA). Bis-acryl BGC system yeilded the highest flexural strength (80 MPa), followed by the milled PMMA MI system (71 MPa), both statistically significant different relative to other groups. Bis-acryl BY exhibited the lowest flexural strength (27 MPa). Thermocycling significantly increased the flexural strength of all polymeric systems (∼10-15 MPa), except for the 3D-printed PY group. Bis-acryl BGC (1.89 GPa) and conventional PMMA CGC (1.66 GPa) groups exhibited the highest elastic modulus, followed by milled PMMA MI group (1.51 GPa) and conventional PMMA CD (1.45 GPa) systems, with significant difference detected between BGC group and MI and CD groups. The 3D printed PY (0.78 GPa) and bis-acryl BY (0.47 GPa) systems presented the lowest elastic modulus. Thermocycling did not have a significant influence on the elastic modulus. FTIR spectra indicate water sorption and release of unreacted monomers as well as increased degree of conversion (∼5-12%) after thermal cycling. CONCLUSION/CONCLUSIONS:Composition and fabrication mode and thermal cycling significantly affected the mechanical properties of polymeric systems used for temporary dental prostheses.

OBJECTIVES/OBJECTIVE:To outline an expert-based consensus of recommendations for the diagnosis and management of pediatric patients with congenital tracheal stenosis. METHODS:Expert opinions were sought from members of the International Pediatric Otolaryngology Group (IPOG) via completion of an 18-item survey utilizing an iterative Delphi method and review of the literature. RESULTS:Forty-three members completed the survey providing recommendations regarding the initial history, clinical evaluation, diagnostic evaluation, temporizing measures, definitive repair, and post-repair care of children with congenital tracheal stenosis. CONCLUSION/CONCLUSIONS:These recommendations are intended to be used to support clinical decision-making regarding the evaluation and management of children with congenital tracheal stenosis. Responses highlight the diverse management strategies and the importance of a multidisciplinary approach to care of these patients.

BACKGROUND:This study characterizes the potential loss of velar length in patients with a wide cleft and rescue of this loss of domain by local flap reconstruction, providing anatomic evidence in support of primary lengthening of the soft palate during palatoplasty. METHODS:A retrospective review was conducted of all patients with a cleft palate at least 10mm in width, who underwent primary palatoplasty with a buccal flap prior to 18 months of age over a 2-year period. All patients underwent primary palatoplasty with horizontal transection of the nasal mucosa, which was performed after nasal mucosa repair, but prior to muscular reconstruction. The resulting palatal lengthening was measured and the mucosal defect was reconstructed with a buccal flap. RESULTS:Of the 22 patients included, 3 (13.6%) had a history of Pierre Robin sequence, and 5 (22.7%) had an associated syndrome. No patients had a Veau I cleft, 7 (31.8%) had a Veau II, 12 (54.5%) had a Veau III, and 3 had (13.6%) a Veau IV cleft. All patients had a right buccal flap during primary palatoplasty. The mean cleft width at the posterior nasal spine was 10.6  ±  2.82mm, and mean lengthening of the velum after horizontal transection of the nasal mucosa closure was 10.5  ±  2.23mm. There were 2 (9.1%) fistulas, 1 (4.5%) wound dehiscence, 1 (4.5%) 30-day readmission, and no bleeding complications. CONCLUSIONS:Patients with a wide cleft palate have a potential loss of 1cm velar length. The buccal flap can rescue the loss of domain in palatal length, and potentially improve palatal excursion.