Faculty Bibliography

OBJECTIVE:To describes our institutional experience of a case series using a novel multi-segment, chimeric free ileal flap for posterior urethral reconstruction, focusing on surgical technique, perioperative management, and functional outcomes. Complex posterior urethral defects, particularly those resulting from radiation pose a significant reconstructive challenge that is not easily approachable with standard reconstructive techniques. In this case series, we present a novel approach for this complex problem. METHODS:We retrospectively reviewed consecutive patients who underwent posterior urethral reconstruction with a chimeric free ileal flap at our institution. Data were collected via chart review. RESULTS:Six male patients (median age: 61 years range: 59-77) with radiation-associated posterior urethral stenosis and bladder neck pathology underwent reconstruction. One was an active smoker; three had prior failed reconstructions. A 20-cm ileal segment was harvested and designed into a chimeric construct in all cases. The left deep inferior epigastric vessels were used for flap anastomosis. Median operative time was 717 minutes, and median hospital stay was 9 days. Two patients experienced early postoperative complications; none had flap loss. At median follow-up of 204 days, four patients had successful functional outcomes. One had persistent leak, and one required cystectomy for newly diagnosed squamous cell carcinoma found at the bladder neck on final pathology. CONCLUSIONS:Chimeric free ileal flap reconstruction is a novel management option for radiation-associated posterior urethral defects, offering well-vascularized, versatile tissue in patients unsuitable for traditional approaches. However, this approach is complex that requires multidisciplinary collaboration and extensive surgical planning.

Two-photon polymerization (2PP) has enabled three-dimensional printing at micro- and nanometer level resolution, allowing for the fabrication of patient-specific implants and finely structured cell scaffolds. This comprehensive review highlights recent advancements in integrating 2PP across various medical specialties, emphasizing its potential role in clinical and translational settings including ophthalmology, orthopedics, neurology, dermatology, and otolaryngology. Despite technological achievements, significant challenges hinder its widespread use, which are also discussed. This includes scaling of manufacturing processes, ensuring long-term biocompatibility of fabricated structures, and a lack of 2PP research in other medical fields. Advancements in biomaterials, photoinitiators, and integrated fabrication approaches within 2PP could significantly impact clinical practice and further improve patient outcomes.

BACKGROUND:Reduction mammoplasty is an established treatment for symptomatic macromastia. Understanding risk factors associated with complications is essential for counseling and patient selection. The modified frailty index (mFI-5) has been proposed as a simple tool to assess risk in surgical candidates. OBJECTIVES/OBJECTIVE:We sought to determine if the mFI-5 can accurately predict wound healing complications following reduction mammoplasty. METHODS:A retrospective review was performed of primary bilateral reduction mammoplasty cases between 2017 and 2019 at one institution. MFI-5 scores were calculated for each patient. 30-day wound healing complications were defined as incisional dehiscence, T-point breakdown, nipple-areolar complex necrosis, and fat necrosis. Univariate and multivariate logistic regression were used to evaluate predictive value. RESULTS:474 patients were stratified into three age groups: 15-30, 31-50, and over 51. Twenty-six percent of patients developed 1 wound healing problem. On univariate analysis, ages 31-50 and 51+ (OR 2.75 and 3.16) and mFI score of 1 (OR 2.07) were associated with an increased risk of wound healing complications. Adjusted multivariate analysis indicated that age greater than 51 years significantly predicted wound healing issues (OR 2.89; p=0.001) when controlled for American Society of Anesthesiologists (ASA) score, smoking, and body mass index (BMI). The mFI-5 did not significantly predict wound healing issues when controlled for age, ASA, BMI, or smoking. CONCLUSIONS:In our population, the mFI-5 was not a statistically significant predictor of wound healing complications following reduction mammoplasty. When controlling for confounders, advanced age alone seems to place patients at higher risk for wound healing complications.

BACKGROUND:Concerns regarding information inaccuracy when using general-purpose large language models have prompted the quest for alternative tools. OpenEvidence has emerged as a healthcare-focused large language model trained exclusively on data from peer-reviewed medical literature. OBJECTIVES/OBJECTIVE:This study compared the quality, accuracy, and readability of aesthetic surgery patient education materials generated by OpenEvidence and ChatGPT. METHODS:A standardized prompt requesting comprehensive postoperative discharge instructions for twenty of the most common aesthetic surgery procedures was entered into OpenEvidence and ChatGPT-5. Outputs were evaluated using four validated assessment tools: the DISCERN instrument for information quality (1-5), the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) for information understandability and actionability (0-100), the Flesch-Kincaid scale for estimated grade level (fifth grade to professional level) and reading ease (0-100), and a Likert scale for citation accuracy (1-4). RESULTS:OpenEvidence scored significantly higher than ChatGPT-5 in DISCERN (3.3 ± 0.4 vs. 1.7 ± 0.4, p<0.001) and the citation accuracy scale (2.4 ±1.3 vs. 1.5 ± 0.7, p=0.007). Scores were comparable among both tools in PEMAT-P understandability (71 ± 5 vs. 69 ± 0, p=0.3) and actionability (52 ± 12 vs. 54 ± 5, p=0.6), as well as on the Flesch Kincaid Grade Level (9.3 ± 1.0 vs. 9.2 ± 0.6, p=0.8) and the Flesch Reading Ease Score (40.0 ± 6.6 vs. 41.0 ± 5.5, p=0.6). CONCLUSIONS:OpenEvidence generated materials of significantly higher quality and reliability than ChatGPT, suggesting it may serve as a more reliable alternative for patient education in aesthetic surgery practice.

BACKGROUND:Avascular necrosis (AVN) of the proximal pole is a well-known complication of scaphoid fractures. Avascular necrosis is poorly understood, including the transition from ischemia to necrosis, optimal treatment, and why some AVN heals but others do not. The primary purpose of this study is to evaluate patient-related factors that are associated with healing outcomes in individuals with proximal pole AVN following scaphoid fractures. METHODS:This is a retrospective review of all patients diagnosed with scaphoid proximal pole AVN secondary to a fracture from 2018 to 2024 in a single center. Patient baseline characteristics and comorbidities at time of diagnosis were collected. If the patient underwent surgical management, procedural factors were collected. The primary outcome was AVN healing after 4 months of follow-up. RESULTS:= .886, respectively). CONCLUSIONS:Hyperlipidemia, elevated BMI, and advanced age are patient factors negatively associated with scaphoid proximal pole AVN healing-key information for accurately assessing patient prognosis. For surgical management, the choice of a vascularized bone, nonvascularized bone graft, or no graft does not significantly impact AVN healing.

Therapeutic, IV.

There has been an increasing trend in using piezoelectric devices in craniofacial surgery to selectively cut bone and reduce collateral soft tissue trauma. Although the benefits of piezosurgery have been well demonstrated for osteotomies, its impact on bone healing during rasping remains understudied. This study evaluated bone regeneration following medial maxillary rasping performed with a manual rasp (MR) compared with piezotome-assisted rasping (PR) in a skeletally mature sheep model. Bilateral defects (rasps: ∼2 cm x ∼2 cm) were created along the coronal plane on the anterodorsal aspect of the nasal bone, with PR used on the anatomic right side and MR on the anatomic left side. Nondecalcified histologic processing and analysis was performed on the nasomaxillary bone at 3 and 12 weeks postoperatively (n=6 sheep/timepoint). At 3 weeks, MR-treated defects showed smoother, intact bone defect margins with minimal bone deposition. PR-treated defects displayed more irregular margins with scattered bone fragments, consistent with ultrasonic microfracturing. By 12 weeks, both techniques demonstrated comparable healing patterns with a regenerating nasal bone contour, maturation of bone architecture, visible osteocytes, and no evidence of bone fragments or inflammatory infiltrates. Semiquantitative scoring of osteogenesis revealed statistically homogenous findings between MR and PR usage (p=0.63 at 3 weeks; p=1.00 at 12 weeks). Within the limits of this model, piezotome-assisted rasping altered early bone surface topography but did not impair long-term bone regeneration compared with manual rasping. This provides preclinical support for piezotome use as an alternative bone-modifying technique in rhinoplasty.

To keep pace with the advancements of technology, training models must also adapt, prioritizing safety, efficiency, and accessibility. Simulation-based training has emerged as a powerful tool to address these demands, offering structured, safe environments where junior cleft providers can build procedural confidence and sharpen their technical skills. The Comprehensive Cleft Care Workshop was established to provide sustainable, targeted solutions to challenges faced by cleft providers in their local contexts, by focusing on capacity building. As evidenced by measurable improvements in procedural confidence, long-term satisfaction, and clinical impact, this model represents a scalable and sustainable solution to global cleft care challenges.

BACKGROUND:This study examined whether the timing of total hip or knee arthroplasty (TJA) relative to elective hand surgery (HS) is associated with perioperative TJA outcomes, as both are among the most common orthopaedic procedures in the United States. METHODS:A retrospective cohort study was conducted of patients who underwent elective HS and TJA between 2011 and 2024. Patients were grouped by surgical order: HS first (HSF, n = 645) and TJA first (TJAF, n = 785). Differences between HSF and TJAF were assessed. Multivariable logistic regressions, Cox proportional hazards regressions, and linear regressions were used to adjust for patient demographics and comorbidities. The HSF patients were older (67.1 versus 64.3 years, P < 0.001), more prone to be discharged home (90.7 versus 83.8%, P < 0.001), and had a shorter length of stay (45.6 versus 60.4 hours, P < 0.001) compared to TJAF patients. RESULTS:Surgical order showed no association with 90-day emergency department visits and readmissions. Multivariable Cox regressions revealed that HSF was associated with a significantly higher hazard of aseptic revision (hazard risk (HR) = 2.65, P = 0.012). Functional TJA outcomes did not differ (P > 0.05) between groups. Although both groups improved in Patient-Reported Outcomes Measurements Information System (PROMIS) Pain Intensity and Pain Interference scores after TJA, HSF patients showed significantly less improvement in Pain Intensity at all timepoints (P < 0.05). Surgical order was not associated with improvement in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Hip Injury and Osteoarthritis Outcome Score for Joint Replacement, or PROMIS Pain Interference scores. CONCLUSIONS:The timing of these elective surgeries is associated with TJA outcomes. While HSF is linked to a higher adjusted risk of aseptic revision, it is also independently associated with less adjusted improvement in PROMIS Pain Intensity. These findings suggest that although surgical order impacts specific recovery metrics, a patient's comorbidities may be the primary driver of complications.