Pediatric Plastic Surgeons Research Articles

A Sustainable Solution for Reducing Draping Waste in Cleft Surgeries.

This study aims to reduce the waste generated from primary cleft lip and/or palate (CL/P) repair. A retrospective chart review examined a single surgeon's experience with CL/P repair using standard draping technique and reduced draping technique. Fisher's exact tests were performed comparing complication rates between techniques. All procedures were conducted at a single academic medical center under the care of a board-certified pediatric plastic surgeon and fellowship-trained pediatric anesthesiologists. The study included all patients ≤ 24 months of age who underwent primary CL/P repair using a reduced draping technique at the senior author's institution. An equivalent number of patients who underwent CL/P repair by the senior author immediately prior to implementation of the reduced draping technique were included for comparison. Patients undergoing CL/P repair before the change in technique were draped using the standard CL/P draping. The senior author then switched to using a reduced draping on all CL/P repairs afterwards. Weights and costs of both draping sets were obtained and differences calculated. A manual chart review was performed to assess rates of accidental intraoperative extubation, postoperative infection, fistula formation, and wound dehiscence. The implementation of a reduced draping technique resulted in a 530 gram weight savings and $7.49 cost savings per procedure. Fisher's exact tests revealed no statistically significant differences in complication rates except for oral mucosal dehiscence, which was lower in the reduced draping group. Reduced draping in CL/P repairs significantly reduces operative waste without compromising surgical outcomes.

Sociodemographic Factors Associated with Delayed Presentation in Craniosynostosis Surgery at a Tertiary Children's Hospital.

Craniosynostosis is a common diagnosis requiring early referral to a pediatric plastic surgeon; however, disparities in healthcare may influence presentation timing and affect treatment options and outcomes. This study aimed to explore sociodemographic factors contributing to delay in craniosynostosis surgical consultation. A retrospective cohort study of 694 California-based craniosynostosis patients at a tertiary children's hospital was performed from 2006 to 2023. State-specific Area Deprivation Index (ADI) and distance to the hospital were calculated using ZIP codes. Multivariate linear and logistic regressions considered race, insurance type, syndromic status, suture type, and ZIP code-based socioeconomic factors. Median age of presentation was 4.5 [interquartile range: 2.6-7.6] months with racial/ethnic breakdown of Hispanic/Latinx (41.2%), White (23.6%), Asian (3.7%), Black/African American (2.0%), or other/unreported (29.5%) with 58.4% having public insurance and an average distance to the hospital of 48.3 km. Median ADI was 5.4 [interquartile range: 4.0-7.1]. By linear regression, public insurance (P < 0.001) and higher ADI decile (P < 0.001) independently contributed to an older age of presentation. Patients with public insurance (odds ratio 1.90; P = 0.002) were more likely to present after 4 months of age. Patients who had public insurance or resided in more disadvantaged areas presented later for craniosynostosis surgical consultation. Eliminating disparities in these populations ensures more equitable access to surgical options and can improve patient outcomes.

Inter-Rater and Intrarater Reliability of Radiographs in the Diagnosis of Pediatric Scaphoid Fractures.

Pediatric scaphoid fractures can be challenging to diagnose on plain radiograph. Rates of missed scaphoid fractures can be as high as 30% to 37% on initial imaging and overall sensitivity ranging from 21% to 97%. Few studies, however, have examined the reliability of radiographs in the diagnosis of scaphoid fractures, and none are specific to the pediatric population. Reliability, both between different specialists and for individual raters, may elucidate some of the diagnostic challenges. We conducted a 2-iteration survey of pediatric orthopedic surgeons, plastic surgeons, radiologists, and emergency physicians at a tertiary children's hospital. Participants were asked to assess 10 series of pediatric wrist radiographs for evidence of scaphoid fracture. Inter-rater and intrarater reliability was calculated using the intraclass correlation coefficient of 2.1. Forty-two respondents were included in the first iteration analysis. Inter-rater reliability between surgeons (0.66; 95% confidence interval, 0.43-0.87), radiologists (0.76; 0.55-0.92), and emergency physicians (0.65; 0.46-0.86) was "good" to "excellent." Twenty-six respondents participated in the second iteration for intrarater reliability (0.73; 0.67-0.78). Sensitivity (0.75; 0.69-0.81) and specificity (0.78; 0.71-0.83) of wrist radiographs for diagnosing scaphoid fractures were consistent with results in other studies. Both inter-rater and intrarater reliability for diagnosing pediatric scaphoid fractures on radiographs was good to excellent. No significant difference was found between specialists. Plain radiographs, while useful for obvious scaphoid fractures, are unable to reliably rule out subtle fractures routinely. Our study demonstrates that poor sensitivity stems from the test itself, and not rater variability.

Discussion: Parents' Perceptions of Social Media Use by Pediatric Plastic Surgeons.

Discussion: Parents' Perceptions of Social Media Use by Pediatric Plastic Surgeons.

Pediatric Plastic Surgery in the COVID-19 Era.

The COVID-19 pandemic has forced the healthcare system to adopt novel strategies to treat patients. Pediatric plastic surgeons are uniquely exposed to high rates of infections during examinations and surgeries via aerosol-generating procedures, in part because of the predilection of viral particles for the nasal cavities and pharynx. Telemedicine has emerged as a useful virtual medium for encouraging prolonged patient follow-up while maintaining physical distance. It has proven beneficial in mitigating infection risks while decreasing the financial burden on patients, their families, and healthcare teams. New trends driven by the pandemic added multiple elements to the patient-physician relationship and have left a lasting impact on the field of pediatric plastic surgery in clinical guidelines, surgical care, and patient outcomes. Lessons learned help inform pediatric plastic surgeons on how to reduce future viral infection risk and lead a more appropriately efficient surgical team depending on early triage.

Easing the Burden on Caregivers- Applications of Artificial Intelligence for Physicians and Caregivers of Children with Cleft Lip and Palate.

Many caregivers of children with cleft lip and palate experience a high level of anxiety throughout their child's medical and surgical care. We aim to evaluate artificial intelligence (AI) as a tool to mitigate these feelings and can aid clinicians in the development of robust pediatric educational materials for caregivers and families. Thirteen of the most common postoperative questions following cleft lip and/or palate repair were developed by an expert panel of senior Pediatric Plastic Surgeons and were posed to ChatGPT. Professional answers from the expert panel were provided and compared to responses from ChatGPT. A literature review was also conducted to generate a new support model for caregivers with children undergoing a surgical procedure. Department of Pediatric Plastic Surgery at a metropolitan Children's Hospital. Senior Pediatric Plastic Surgeons at a metropolitan Children's Hospital. None. The primary outcome was to determine the ability of ChatGPT to respond to common postoperative questions and to develop a model for AI assistance in family-centered perioperative care. ChatGPT had a postoperative question response accuracy rate of 69% when compared with subject matter expert responses, with its greatest errors being information errors. An extensive literature search revealed that AI can assist in multiple traditional perioperative strategies to reduce caregivers and patient anxiety. Artificial Intelligence can help to reduce the burden of generating patient education materials as well as support caregivers in multiple aspects and perioperative care.

Reduction Mammaplasty in Younger Patients: An Evidence-Based Approach to Treatment.

Macromastia is a common condition that can lead to physical pain, emotional burden, and behavioral impairment, with significant decrements in quality of life. Reduction mammaplasty offers the only effective treatment of symptomatic macromastia, and patients experience significant improvements in their physical and psychosocial health through surgical correction. Although symptoms typically arise during adolescence, most women seeking surgical intervention do not undergo reduction mammaplasty until their fifth decade of life. Providers often delay surgery due to speculative concerns about emotional immaturity, postoperative breast regrowth, and future lactation performance. The strict guidelines related to age and body mass index imposed by insurance companies further restrict the options available to younger patients with macromastia. This review offers an evidence-based approach to treating macromastia in younger patients. After more than 15 years of treatment and research centered on adolescents and young adults with macromastia led by the senior author (B.I.L.), a pediatric plastic surgeon, we have found that reduction mammaplasty is a safe and effective treatment option for this patient population. It is our hope that our work will enable care providers to make data-supported decisions when treating younger patients with symptomatic macromastia.

What is a Pediatric Plastic Surgeon?

What is a Pediatric Plastic Surgeon?

Pediatric Cutaneous Mastocytosis: A Case Report and Literature Review

An important component of innate immunity, mast cells contain intensely basophilic granules of anticoagulants (such as heparin) and vasoactive amines (histamine and others), playing key roles in the initiation of inflammation. They have a vast array of cell surface receptors for IgE and complements. FcεRI, with high affinity for IgE Fc terminals, respond to a wide variety of stimuli including damage-associated molecular pattern (DAMP) and pathogen-associated molecular pattern (PAMP). CD 88 and C3aR bind anaphylatoxins from the complement system. We report a case of infantile cutaneous mastocytosis with an extensive review of literature on both mastocytosis and mast cell function and dysfunction for pediatric plastic surgeons.

Short-term Satisfaction, Psychosocial Impact, and Complication Profile of Reduction Mammaplasty during Adolescence.

Reduction mammaplasty is an effective and safe treatment option for adults with symptomatic macromastia, but there is less data regarding outcomes in adolescents. The purpose of this study is to determine the short-term psychosocial impact, satisfaction, and safety of reduction mammaplasty when performed during adolescence. A retrospective review was performed of a single pediatric plastic surgeon's experience with reduction mammaplasty from 2018 to 2021 in patients ≤ 18. Patients completed the preoperative and postoperative "Satisfaction with Breasts" and "Psychosocial Well-Being" sections of the BREAST-Q Survey. Clinical variables gathered included age, weight, BMI, complication profile, specimen resection weight, and follow-up duration. 41 patients met inclusion criteria. The mean converted Rasch scores for BREAST-Q "Satisfaction with Breasts" and "Psychosocial Well-Being" increased significantly following reduction mammaplasty (Satisfaction with Breasts, Preop: 24.1 vs. Postop: 92.6; Psychosocial Well-Being, Preop: 37.7 vs. Postop: 90.4, p < 0.001). Obesity (BMI ≥ 30 kg/m2) was associated with lower preoperative "Psychosocial Well-Being" scores (Obese: 29.7 vs. Non-obese: 43.3, p < 0.001) but a greater improvement in score following surgery (Obese: + 63.9 vs. Non-obese: + 44.9, p < 0.001). Specimen weight ≥ 1,000 grams was also associated with greater improvement in score on the "Psychosocial Well-Being" section (≥ 1,000 grams: + 58 vs. < 1,000 grams: + 49.7, p = 0.046). Overall complication rate was 31.7% while the major complication rate was 2.4%. Mean specimen resection weight was higher in patients who experienced complications (1141.3 grams vs. 836.8 grams, p = .008). Reduction mammaplasty during adolescence predictably improves both short-term satisfaction with breasts and psychosocial well-being while demonstrating a favorable short-term complication profile.

Our Experience with Tension-Free Urethral Reconstruction with Urethral Plate Dorsal Slit Technique

Background Hypospadias is among the most common urogenital anomaly which is usually corrected by various surgical techniques. The global burden of hypospadias is shared among adult and pediatric urologists and plastic surgeons as well. Potential complications of the repair include meatal stenosis, urethrocutaneous fistula, urethral stricture, and urethral diverticulum. Fistula rates in large hypospadias series have been reported to range from 2% to 14% in Snodgrass repairs. Objective Our aim of this study is to identify the effectiveness of the dorsal urethral plate slit technique for tension-free hypospadias repair. Material and Methods A retrospective review was performed. A total of 53 patients presented to the plastic surgery outpatient department of Liaquat National Hospital within 2 years from January 2019 – December 2020 with congenital hypospadias, out of these 14 patients were included in the study who met the inclusion criteria. None of the patients had any prior hypospadias correction. The surgical technique involved the dorsal slit technique for tension-free repair. The patients were followed post-operatively for a total duration of 2 years to assess for any post-operative complications. Result The mean age of patients was 11 years, with the most common preoperative complaints of abnormal urinary stream. In all operated cases we observed a 7.1% rate of fistula formation. None of the subject patients developed meatal stenosis and only 1 patient developed a fistula during the study period. All other patients reported a good urinary stream and had an acceptable cosmesis postoperatively. Conclusions The urethral plate dorsal slit technique for tension-free hypospadias repair has a good outcome with relatively fewer complications and a high success rate. This modification along with careful preoperative planning during patient selection plays a key role in the outcome of the repairs.

Cosmetic Outcomes of Simple Pediatric Facial Lacerations Repaired With Skin Adhesive Compared With Skin Adhesive With Underlying Adhesive Strips: A Randomized Controlled Trial.

A randomized controlled trial was designed to compare 2 methods of repairing simple pediatric facial lacerations. We hypothesized that wounds repaired with skin adhesive and underlying adhesive strips compared with skin adhesive alone would be superior in regard to cosmetic outcome. Patients aged younger than 18 years presenting to the emergency department with simple facial lacerations requiring repair were eligible for enrollment. Patients were randomly assigned to repair with either skin adhesive alone or skin adhesive with underlying adhesive strips. Families were contacted by phone 1 week after enrollment to discuss short-term complications. The cosmetic appearance of photographs of the scars at 2 months was analyzed using a visual analog scale by a blinded pediatric emergency physician and pediatric plastic surgeon. One hundred twenty patients were enrolled, with 92 returning for the 2-month follow-up. The visual analog scale scores for the skin adhesive with adhesive strips group were similar to the skin adhesive alone group (60 mm vs 58 mm, P = 0.540). Spearman ρ correlation coefficient between the raters was 0.669, indicating strong agreement. There was no significant difference in rates of return visits, wound dehiscence, or infection. The skin adhesive with adhesive strips group had a longer time to perform the repair (195 seconds vs 107 seconds, P < 0.001). Using adhesive strips to first approximate a wound before applying skin adhesive leads to a similar cosmetic outcome compared with simple facial lacerations repaired with skin adhesive alone. Although the study showed longer time to complete the repair, this approach may still be useful in settings where approximation is difficult to obtain manually.

498 Assessing Knowledge Silos in the Craniosynostosis Literature

INTRODUCTION: The surgical treatment of craniosynostosis has traditionally been a multidisciplinary effort, involving pediatric neurosurgeons and plastic surgeons. Advances in treating this condition may result from collaboration between these two specialties, yet there exists a certain risk of sequestering clinical knowledge between the two which may limit continued progress in this regard. METHODS: During September 2020, the Scopus database was queried to identify journal articles related to craniosynostosis. Bibliometric measures were collected for each article, and a database was constructed to assess knowledge sharing between neurosurgeons and plastic surgeons. RESULTS: 5335 articles were identified. 720 (13.5%) were published in a neurosurgery journal with 499 (9.4%) published by neurosurgeons and 665 (12.5%) by neurosurgeons and plastic surgeons collaborating together. As expected, neurosurgeons published primarily (319, 63.9%) in neurosurgical journals, whereas plastic surgeons published most in plastic surgery journals (990, 65.7%). Collaborations were mostly published in plastic surgery journals (326, 49%). After normalizing for years in press, neurosurgeons were observed to be cited significantly less than plastic surgeons (p &lt;0.0001), and articles published in neurosurgery journals were cited at a lower rate than those published in plastic surgery journals. The differential association of terms used in plastic surgery versus neurosurgery article abstracts illustrates the potential sites of knowledge silo formation in the craniosynostosis literature. CONCLUSION: This study demonstrates that a distinct sequestering of knowledge exists between neurosurgeons and plastic surgeons publishing on the topic. Publications by plastic surgeons are more highly cited than by neurosurgeons. While there are certainly specialty-based topics within craniosynostosis, we recommend continued collaboration on all research fronts to avoid sequestration of knowledge and progress.

Management of Calcified Cephalohematoma of Infancy: The University of Michigan 25-Year Experience.

Cephalohematoma of infancy is the result of a subperiosteal blood collection that usually forms during birth-related trauma. A small proportion of cephalohematomas can calcify over time, causing a permanent calvarial deformity that is only correctable with surgery. The authors present a technique for the excision and reconstruction of calcified cephalohematoma and their management experience over the past 25 years. All patients with a diagnosis of calcified cephalohematoma between 1994 and 2019 were identified. Patients were included if the diagnosis was confirmed by a pediatric plastic surgeon or a neurosurgeon. All patients underwent surgical evaluation followed by surgical intervention or observation. Patient demographics and potential risk factors for both surgical and nonsurgical groups were compared using chi-square or Fisher's exact test. Additional data were collected for the surgical cohort. Of 160 infants diagnosed with cephalohematoma, 72 met inclusion criteria. Thirty patients underwent surgical treatment. There was no significant difference in demographics, baseline characteristics, or potential risk factors between the operative and nonoperative groups. Mean age at the time of surgery was 8.6 months. Twenty-one surgical patients (70 percent) required inlay bone grafting. All surgery patients had improvement in calvarial shape. The main risk of surgery was blood loss requiring transfusion [eight patients (26.7 percent)]. Thirteen percent of patients experienced minor complications. This series of 72 children with calcified cephalohematomas, 30 of whom required surgical intervention, is one of the largest to date. The technique presented herein demonstrated excellent surgical outcomes by restoring normal cranial contours and was associated with a low complication profile. Therapeutic, IV.

Update on infantile hemangioma.

The International Society for the Study of Vascular Anomalies classifies vascular anomalies into vascular tumors and vascular malformations. Vascular tumors are neoplasms of endothelial cells, among which infantile hemangiomas (IHs) are the most common, occurring in 5%–10% of infants. Glucose transporter-1 protein expression in IHs differs from that of other vascular tumors or vascular malformations. IHs are not present at birth but are usually diagnosed at 1 week to 1 month of age, rapidly proliferate between 1 and 3 months of age, mostly complete proliferation by 5 months of age, and then slowly involute to the adipose or fibrous tissue. Approximately 10% of IH cases require early treatment. The 2019 American Academy of Pediatrics clinical practice guideline for the management of IHs recommends that primary care clinicians frequently monitor infants with IHs, educate the parents about the clinical course, and refer infants with high-risk IH to IH specialists ideally at 1 month of age. High-risk IHs include those with life-threatening complications, functional impairment, ulceration, associated structural anomalies, or disfigurement. In Korea, IHs are usually treated by pediatric hematology-oncologists with the cooperation of pediatric cardiologists, radiologists, dermatologists, and plastic surgeons. Oral propranolol, a nonselective beta-adrenergic antagonist, is the first-line treatment for IHs at a dosage of 2–3 mg/kg/day divided into 2 daily doses maintained for at least 6 months and often continuing until 12 months of age. Topical timolol maleate solution, a topical nonselective beta-blocker, may be used for small superficial type IHs at a dosage of 1–2 drops of 0.5% gel-forming ophthalmic solution applied twice daily. Pulse-dye laser therapy or surgery is useful for the treatment of residual skin changes after IH involution.

Clinical and ultrasound characteristics of pediatric lateral neck masses.

Lateral neck masses (LNM) often present a diagnostic challenge in the practice of pediatric plastic surgeon. The aim of this study is to investigate the clinical and ultrasound (US) characteristics of pediatric LNM in order to make mutual comparison between their entities and enable the most accurate preoperative diagnosis. A cross-sectional study was conducted among 250 pediatric patients treated by surgical excision or sclerotherapy in our institution in the period from July 2009 to June 2019. Lymphatic malformation was the most frequent congenital LNM (60.9%), while reactive or granulomatous lymphadenitis was the most frequent acquired LNM (47%). Congenital anomalies were significantly more often localized in the upper half of the sternocleidomastoid (SCM) muscle region, and had more often soft consistency than acquired ones. Congenital LNM had a 32.37 (3.44–304.63) times higher likelihood of incorrect (p = 0.002) and 5.86 (1.35–25.48) times higher likelihood of undetermined (p = 0.018) than correct US findings, respectively. Acquired LNM were significantly more often localized in the region behind the SCM muscle and more often had solid US appearance in comparison to the congenital ones. Association of the clinical and US findings is very important in determining the most accurate preoperative diagnosis without exposing the children to unnecessary utilizing ionizing radiation or anesthesia. Although they are mostly benign, extreme caution is necessary due to malignancies which were found in 16.4% of all our patients.

What is a Pediatric Plastic Surgeon?

Patient Education| 2021 What is a Pediatric Plastic Surgeon? Connected Content Translation: ¿Qué es un Cirujano Plástico Pediátrico?: (What is a Pediatric Plastic Surgeon?) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation What is a Pediatric Plastic Surgeon?. Pediatric Patient Education 2021; 10.1542/peo_document168 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Pediatric Specialist Handouts Topics: plastic surgery specialty If your child needs surgery to fix a deformity caused by a birth defect, injury, illness, or tumor, a Pediatric Plastic Surgeon has the experience and qualifications to treat your child. All children become ill or injured at one time or another. Most problems are simple and can be solved by your pediatrician. At times, however, special care from a pediatric plastic surgeon may be needed and may make the difference in achieving the best possible cosmetic result. If you think your child needs this kind of special care, request a visit with a pediatric plastic surgeon. Pediatric plastic surgeons are medical doctors who have had At least 4 years of medical schoolThree years of residency training in general surgery, or completion of a residency training program in general surgery, otolaryngology, urology, orthopedic surgery, neurosurgery, or a combined general surgery/oral surgery... Copyright © 20002000American Academy of Pediatrics You do not currently have access to this content.

Characteristics and Academic Productivity Among Pediatric Plastic Surgeons in the United States.

The characteristics that predispose plastic surgeons to a career in pediatric plastic surgery remain unclear. Therefore, the aim of this study is to analyze the characteristics of current pediatric plastic surgeons and to determine their academic productivity. Pediatric plastic surgeons were identified through an internet search of all academic children's hospitals affiliated with an Accreditation Council for Graduate Medical Education-accredited integrated or independent plastic surgery program. Demographics, training background, institutional and leadership positions, and academic productivity were determined. A total of 304 pediatric plastic surgeons were identified. The majority of pediatric plastic surgeons were white (n = 217, 71.8%) males (n = 235, 77.6%). Clinical fellowships were completed by 86.8% (n = 263) of the cohort, with craniofacial (n = 181, 59.7%) being the most common followed by hand (n = 54, 17.8%); 41.1% had clinical fellowship training at 10 institutions, with the top 3 most represented programs being University of Pennsylvania (n = 19, 6.2%), University of California-Los Angeles (n = 16, 5.3%), and Harvard University (n = 15, 4.9%); 25.7% (n = 78) held leadership positions within their institutions. A significant higher academic productivity was found among research fellowship-trained surgeons, chiefs of pediatric plastic surgery, fellowship directors, and members of departments of plastic surgery. Those who completed an independent residency had a significant higher H-index and number of citations. Pediatric plastic surgery is represented by surgeons of diverse training background. An elite cohort of programs has trained the most pediatric plastic surgeons. Lastly, high academic productivity was found to be correlated with certain demographic and leadership variables highlighting its impact on career advancement.

Time for a Consensus? Considerations of Ethical Social Media Use by Pediatric Plastic Surgeons.

Time for a Consensus? Considerations of Ethical Social Media Use by Pediatric Plastic Surgeons.

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Authors' Comments—Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts