Faculty Bibliography

BACKGROUND:Body contouring surgery (BCS) is a common postoperative trajectory for adults following bariatric surgery, yet research on its application to adolescents is lacking. This scoping review aimed to map the available literature on quality of life (QoL) and potential for BCS in adolescents after bariatric surgery. METHODS:This review followed the Joanna Briggs Institute (JBI) guidance for scoping reviews and is reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). Three electronic databases were queried for studies regarding QoL and BCS in adolescents following bariatric surgery within the last 20 years. A descriptive and thematic analysis was conducted. RESULTS:Twenty-three studies met inclusion criteria. A total of 19 (82.6%) evaluated QoL and 4 (17.4%) explored the role of BCS in adolescents following bariatric surgery. The most common method of data collection was prospective study (65.2%). Two themes were described: QoL after bariatric surgery, which expressed improvement in several domains within 6 months, and role for BCS, which showed high interest in addressing residual excess skin and appearance. Gaps in the literature were identified, including a need for studies exploring mediators of QoL, predictors of compliance, and outcomes of BCS. CONCLUSIONS:Studies describing residual symptoms and BCS in adolescents following bariatric surgery are lacking. BCS may complement bariatric surgery, but further research must be conducted to assess its safety in adolescents. By addressing the research gaps described in this review, physicians may have a better understanding of the needs of this population and how to counsel them. LEVEL OF EVIDENCE AND TYPE OF STUDY/UNASSIGNED:Level IV; Systematic Scoping Review.

The scapholunate ligament (SLL) is a critical stabilizer of the wrist joint. Disruption of the SLL leads to altered wrist kinematics, including scaphoid flexion, lunate extension, and increased stress on surrounding cartilage and ligaments, which can progress to dorsal intercalated segment instability and scapholunate advanced collapse. Despite predictable biomechanical changes, clinical outcomes vary widely because some patients develop significant functional limitations, whereas others remain asymptomatic. Nonoperative management, including immobilization, therapy, and bracing, remains the first-line treatment for partial tears or stable injuries. Surgical intervention, such as SLL repair with capsulodesis or reconstruction, is indicated for cases with persistent pain, instability, or functional deficits. Capsulodesis is a commonly used adjunct to SLL repair. Multiple surgical techniques exist for SLL repair in the acute setting and for reconstruction in the chronic setting when SLL is deemed irreparable. Although several surgical techniques are available for chronic injuries, a gold standard has not yet been established.

BACKGROUND:Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition often requiring surgical intervention for definitive treatment. Previous studies evaluated post-surgical outcomes, but no standardization exists for collection and nomenclature for HS surgical outcomes. OBJECTIVE:To characterize and define surgical outcome terminology. METHODS:A modified Delphi protocol was used to reach consensus on data to collect and terms to describe outcomes following HS surgical procedures. A five-member steering committee created preliminary definitions and surveys which were distributed via Qualtrics to a group of international HS experts. A nine-point Likert scale was used and a score of at least 7 was needed for an item to reach agreement. RESULTS:Twenty-five dermatologists and general and plastic surgeons participated in the Delphi study. Following two rounds of surveys and feedback, the consensus terminology to describe outcomes included surgical site and regional persistence and progression. Consensus was also reached on key features to report as part of each outcome. LIMITATIONS/CONCLUSIONS:Limitations include narrow scope and small number of participants from limited geographical areas. CONCLUSION/CONCLUSIONS:Surgery persistence and progression definitions were agreed upon by a group of international HS experts. This consensus is a first step towards standardizing terminology and reporting for HS surgical outcomes.

Patients requiring breast reconstruction following radiation therapy or prior failed autologous breast reconstruction (ABR) or implant-based breast reconstruction (IBBR) represent a challenging cohort and often present with compromised vascularity, scarred anatomy, and subsequent increased rates of complications. In this review, we discuss microsurgical strategies designed to optimize donor tissue in these challenging clinical scenarios, including the use of stacked or bipedicled flaps, and the utility of intraoperative indocyanine green angiography. We also review approaches to alternate recipient vessel selection in the suboptimal chest, and we address specific strategies for the revision setting, like soft tissue support and hybrid reconstruction with ABR and IBBR. By synthesizing the current literature and expert experience, this narrative review provides a practical framework for microsurgeons managing complex breast reconstruction in higher-risk patients.

Prepectoral breast reconstruction offers esthetic and recovery advantages but may be more vulnerable to complications due to the absence of muscular coverage. This study examined the clinical course of patients with failed prepectoral implant reconstruction. All consecutive prepectoral reconstructions performed between March 2017 and July 2022 at a single tertiary center were reviewed. Of 239 reconstructions, 42 (17.5%) ultimately failed, most commonly due to infection (50%). Sixteen patients (38%) underwent definitive reconstruction with a median interval of 379 days (IQR 249) from initial surgery to final reconstruction. The most common secondary reconstruction modalities were implant-based reconstruction (31%) and free-tissue transfer (31%). On multivariate analysis, increasing age, higher body mass index (BMI), and prior radiation were independently associated with implant loss. Failure of salvage after prepectoral reconstruction remains a major challenge and often results in delayed or abandoned reconstruction, highlighting the need for careful patient selection.

Trabecular Metal^TM (TM) dental implants comprise a tantalum (Ta)-based biomimetic open-cell structure designed to replicate the structural, functional, and physiological properties of cancellous bone. Yet, the current literature primarily focuses on the evaluation of osseointegration outcomes surrounding TM implants in uncompromised bone environments and/or brief periods of observation in pre-clinical models. In addition, the performance of TM implants in bony defect environments reconstructed with allogenic grafts and bioactive molecules, such as platelet-rich fibrin (PRF), has not been thoroughly investigated. This longitudinal, randomized clinical trial comprised patients presenting with completely edentulous maxillaries. Guided Bone Regeneration (GBR) was performed using a cortico-cancellous allograft/PRF agglomerate. After 26 weeks, bone biopsies were obtained, followed by the insertion of a TM implant, after which patients were allowed to heal for 52 weeks for assessment of osseointegration. Qualitatively, histomicrographs at 26 weeks confirmed the presence of newly formed bone extending from the periphery of defects and along the direct surface of the allograft. TM implant biopsies at 52 weeks demonstrated osseointegration with bone ongrowth and ingrowth at the interconnected, porous trabecular region. These histological characteristics were consistent across all patients. No metal debris was detected, and the TM implants maintained their porous structure throughout the study period. TM implants placed in PRF-augmented allograft-reconstructed maxillae fostered a conducive environment for osseointegration. By leveraging the open-cell Ta structure, robust new bone formation was achieved without signs of adverse tissue reactions.

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.