Plastic Surgery Research Articles

Utilizing Relative Citation Ratio to Compare Academic Productivity by Gender in Plastic Surgery

IntroductionThe relative citation ratio (RCR) is a bibliometric index utilized to assess research productivity. Mean relative citation ratio (m-RCR) and weighted relative citation ratio (w-RCR) can be utilized to assess individual research quality as well as career-long productivity, respectively. We sought to determine differences in academic productivity between genders and identify demographic variables associated with increased academic productivity. MethodsA list of Plastic and Reconstructive Surgery residency programs was compiled utilizing the American Council of Academic Plastic Surgeons website. Each program department's website was utilized to generate a list of practicing surgeons and respective demographic information. Both mean and weighted RCR were obtained using the iCite, a National Institutes of Health bibliometric tool. Surgeons were excluded if any demographic or RCR data was not accessible. Chi-squared test, Mann–Whitney U test, Kruskal–Wallis test, and multivariable linear regressions were performed. ResultsA total of 785 academic plastic surgeons met the criteria and were included in the analysis, 186 of whom were women and 599 men. Both academic rank and model of residency training were significantly associated with gender in chi-squared analysis (P < 0.05). Mean relative citation ratio was higher among men in departments. Mean w-RCR was higher among men of assistant professor status, chief/chairperson status, integrated model of residency training, faculty size ≥six and in departments and divisions. Academic rank and faculty size were associated with higher w-RCR upon multivariable linear regression. ConclusionsAlthough differences exist in mean w-RCR between men and women in plastic surgery, gender is not a predictor of increased academic productivity. RCR is an accurate means of assessing gender differences in academic productivity as it comprehensively considers both quality and quantity of research and may be superior to other, older bibliometric indices.

Does the geographic region of plastic surgery away rotations influence residency match success by region?

Integrated plastic surgery is consistently one of the most competitive residency specialties to successfully match. Students, advisors, and mentors are constantly looking for strategies to increase the odds of successfully matching. Away rotations (AR) give students and residency programs a chance to experience each other and get a gage of program fit and gives the student ability to show interest in a geographic region. The purpose of this study is to determine if completing an away rotation in a specific geographic region increases the chances of matching there. U.S. medical student seniors from 2018-2023 applying into integrated plastic surgery were analyzed. The Texas STAR survey was used as a data source. Data was collected on the number of applications, interviews, AR, applicant home region, and match outcome and stratified into 4 regions, central, northeast, south, and west based on AAMC program listings. Applicant statistics such as standardized exam scores were also collected. Linear and logistic regression were conducted assess associations with increased interviews and successfully matching in specific geographic regions. χ² and independent T-tests were used to assess associations between match outcome and applicant statistics. 401 applicants with 28561 applications were included for analysis. Match success was 78.3%. Most applicants completed at least 1 AR (85.9%) with a mean of 2.04 per applicant. Completing more AR in a region resulted in significantly more interview offers in that area, with an average increase of 1.3 interviews for each AR completed (p<.001). Completing more AR and having more interviews in a particular region increased the odds of matching in that region (p<.05). Number of interviews, completing an AR, USMLE Step 2 score, alpha omega alpha membership, and cumulative quartile rank were associated with increased match success. Completing AR in specific geographic regions increased the number of interviews and chances of matching in the same region.

Bilateral absence of the common femoral artery with high-origin and superficial course of the deep femoral artery: a rare case report.

The common femoral artery is a chief source of blood supply to the lower limb. Variations in its anatomy, like its absence, high level commencement of the deep femoral artery (DFA) with a superficial course, are unusual. The knowledge of such variations may have substantial clinical applications, specifically in vascular surgical procedures, catheterizations, and diagnostic or interventional radiology. During femoral triangle dissection of a 78-years female cadaver, absence of common femoral artery, commencement of DFA at the inguinal ligament level, following a superficial path contrary to its name was observed bilaterally. The exterior diameter of superficial and DFA were 5mm, 4mm and 6mm, 4mm respectively on the right and left side. Awareness of such variations is essential for interventional radiologists, vascular, orthopaedic, plastic & reconstructive surgeons to plan and execute interventional and surgical procedures effectively and for Anatomist for successful embalming.

The effect of exogenous mitochondria in enhancing the survival and volume retention of transplanted fat tissue in a nude mice model

BackgroundDespite the pivotal role of fat grafting in plastic, reconstructive, and aesthetic surgery, inconsistent survival rates of transplanted adipose tissue, primarily due to early ischemic and hypoxic insults, remain a significant challenge. The infusion of healthy mitochondria has emerged as a promising intervention to support tissue recovery from ischemic, hypoxic, and other types of damages across various organ systems.ObjectivesThis study aims to evaluate the impact of supplementing human adipose tissue grafts with healthy exogenous mitochondria on their volume and mass retention rates when transplanted into the subcutaneous layers of nude mice. This approach seeks to improve and optimize fat grafting techniques.MethodsHuman adipose tissues were preconditioned with exogenous mitochondria (10 µg/mL), a combination of exogenous mitochondria and the inhibitor Dyngo-4a, Dyngo-4a alone, or PBS, and then transplanted into the subcutaneous tissue of 24 nude mice. Samples were harvested at 1 and 3 months post-transplantation for analysis of mass and volume retention. The structural morphology and integrity of the adipose tissues were assessed using Hematoxylin and Eosin (H&E) staining.ResultsMitochondrial preconditioning significantly enhanced the retention of mass and volume in fat grafts, demonstrating superior structural morphology and integrity compared to the control group.ConclusionsThis study highlights the potential of exogenous mitochondrial augmentation in fat transplantation to significantly improve fat graft survival, thereby optimizing the success of fat grafting procedures.

A Comparison of Postoperative Outcomes Based on Muscle versus Fasciocutaneous Flaps in Scalp Reconstruction: A Systematic Review and Meta-analysis.

Scalp reconstruction in plastic and reconstructive surgery often necessitates the transfer of soft-tissue flaps to restore form and function. The critical decision lies in choosing between muscle-containing (MC) and fasciocutaneous (FC) flaps for scalp reconstruction, and while both variants have their merits, flap composition remains a subject of ongoing debate. This scientific discussion aims to explore this contentious issue through a comprehensive meta-analysis, shedding light on the rationale behind the choice of these flaps and the potential impact on clinical outcomes. A comprehensive systematic review was conducted following PRISMA-P guidelines, encompassing six prominent databases up to the year 2023. Data were collected from studies assessing outcomes of MC and FC flaps for scalp reconstruction. Quality evaluation was performed using ASPS criteria and the ROBINS-I tool. Statistical analysis included descriptive statistics, meta-analysis, sensitivity analysis, and assessment of bias using STATA software. The meta-analysis included 28 nonrandomized studies, totaling 594 flaps (MC: 380, FC: 214). MC flaps were significantly larger than FC flaps. There were no significant differences in flap loss, flap necrosis, or wound dehiscence between the two flap types. However, the incidence of venous congestion was significantly higher in FC flaps. Sensitivity analysis confirmed the robustness of results, and publication bias assessment showed no significant evidence of bias. While both MC and FC flaps offer viable options for scalp reconstruction, the choice should be tailored to individual patient characteristics and defect size. FC flaps may provide advantages such as shorter operative times and reduced morbidity, whereas MC flaps could be preferred for addressing larger defects. Future research should focus on prospective studies and strategies to mitigate venous congestion in FC flaps, enhancing their safety and efficacy in scalp reconstruction.

Computer-Aided Design and Manufacturing to Facilitate Microvascular Free Tissue Transfer in Extremity, Pelvic, and Spinal Reconstructions.

Numerous surgical fields have embraced computer-aided design and computer-aided manufacturing (CAD/CAM), including plastic and reconstructive surgery. However, most of the literature and clinical use pertains to reconstruction of the head and neck. Herein, we provide a case series and systematic review of the literature, documenting the use of CAD/CAM in facilitating complex microvascular free tissue transfer for reconstructions involving the extremities, pelvis, and spine (EPS). This study consisted of two components: a case series and a systematic review of the literature. For the case series, the senior author's cases that included CAD/CAM to assist microvascular free tissue transfer reconstructions of the EPS were included. For the systematic review, all PubMed-, Scopus-, and Google Scholar-indexed studies describing the use of CAD/CAM to facilitate free tissue transfer in the EPS were identified and included using PRSMA guidelines. The case series identified 10 patients who received CAD/CAM-assisted microvascular reconstruction. Our systematic review identified 15 articles, representing 124 patients and 133 CAD/CAM-assisted free tissue transfers. Most authors believed that CAD/CAM facilitated a more efficient operation by shifting much of the intraoperative planning to the preoperative phase, ultimately translating to a shorter and more accurate surgery with improved function and cosmesis. CAD/CAM can be used to facilitate microvascular reconstruction of the EPS. Our cases series and systematic review suggest that CAD/CAM for EPS surgery may improve outcomes.

Adipose stem cells regulate lipid metabolism by upregulating mitochondrial fatty acid β-oxidation in macrophages to improve the retention rate of transplanted fat

BackgroundAt present, fat transplantation is widely used in the plastic surgery industry, but the long-term preservation rate of transplanted fat decreases because of complications such as oil cysts due to the inability in macrophages to metabolize absorption. In cell-assisted lipotransfer technology, adipose-derived stem cells (ASCs) can influence the inflammatory response of grafts through the immunoregulation in macrophages, and the lipid metabolism in macrophages plays an important role in this process. Therefore, we hypothesized ASCs could improve the retention rate of fat grafts by regulating the progress of lipid metabolism in macrophages.MethodsWe established fat transplantation and ASC-assisted fat transplantation model in C57BL/6 mice in vivo, and bone marrow-derived macrophages cocultured with apoptotic adipocytes were treated with or without ASCs in vitro. Graft retention, tissue structure, fibrosis, macrophage phenotype transformation, lipid deposition, mitochondrial morphology, oxygen consumption rate (OCR), fatty acid β-oxidation (FAO) level, and ATP production were assessed. Additionally, fat transplantation and ASC-assisted fat transplantation model was treated with etomoxir which inhibits mitochondrial FAO. Macrophages pretreated with etomoxir were co-cultured with apoptotic adipocytes and treated with or without ASCs. The method aboved was used for detection and verification.ResultsIn vivo, ASC-assisted fat transplantation improved macrophage mitochondrial expression and FAO level, promoted the early transformation of M2 macrophages, reduced the long-term lipid deposition of macrophages, and improved the retention rate of fat grafts. In vitro, ASCs up-regulated the level of mitochondrial FAO, OCR and ATP production in macrophages, reduced lipid deposition of macrophages and promoted M2 macrophages polarization by paracine function. The ability of ASCs in group pretreated with etomoxir to reduce the foaming of macrophages, promote the transformation to M2 macrophages, and improve the retention rate of fat transplantation was weakened.ConclusionsASCs increased the retention rate of transplanted fat by upregulating mitochondrial FAO to promote M2 polaration in macrophages. In addition, ASCs up-regulate mitochondrial FAO by paracrine effect to reduce foam cells formation and promote M2 transformation in macrophages in vitro.

Insights into upper blepharoplasty: Conservative volume-preserving techniques.

This editorial commentary critically examines the systematic review by Miotti et al, which discusses the evolving trends in upper lid blepharoplasty towards a conservative, volume-preserving approach. The review emphasizes the shift from traditional tissue resection to techniques that maintain anatomical integrity, paralleling broader trends in panfacial rejuvenation. Miotti et al delve into the nuances of fat pad management, advocating for conservation over reduction to sustain natural contours and improve long-term aesthetic outcomes. This perspective is supported by comparative studies and empirical data, such as those from Massry and Alghoul et al, highlighting the benefits of conservative approaches in terms of patient satisfaction and aesthetic longevity. The review also stresses the importance of surgeon discretion in adapting procedures to diverse patient demographics, particularly in addressing distinct features such as the Asian upper eyelid. However, it identifies a significant gap in long-term comparative research, underscoring the need for future studies to substantiate the safety and efficacy of these minimalist techniques. Overall, Miotti et al.'s work contributes profoundly to the discourse on personalized, conservative cosmetic surgery, urging ongoing research to refine and validate surgical best practices in upper eyelid blepharoplasty.

Orthoplastic Reconstruction of Distal Tibia High-Energy Fractures Using a Circular External Fixator—A Systematic Review

Background: Compound fractures of the distal tibia (with or without the middle third) represent a challenge for orthopedic and plastic surgeons because of the scarcity of available soft tissue reconstruction and the important comminution of the fractures that usually appear. Methods: The design of this study is based on the PRISMA guidelines. Databases were searched for articles published and available until the first half of 2023. Articles that presented the evolution of patients treated by combining circular external fixators with reconstructive methods were selected. Results: After searching the literature using keywords, we obtained 3355 articles, out of which 14 articles met all the inclusion criteria, with a total number of participants of 283. The bone loss varied between 0.7 and 18.2 cm, while the soft tissue defect was between 3/3 cm and 16/21 cm. The average period of fixation ranged from 4 to 22.74 months. The most used reconstruction methods were 80 free flaps and 73 pedicled flaps out of 249 interventions. Complete flap loss appeared only in 3/283 patients. Regarding the bone union, the percentage of non-union was low, and in all cases, it was achieved after reintervention. A low rate of major complications was observed. Conclusions: The orthoplastic team is the key to successfully treating the high-energy traumatism of the distal tibia (with or without a middle third). The Ilizarov external fixator can be used as a definitive limb-salvage treatment (secondary to the standard primary methods of fixation) in combination with a flap to cover the defects because it does not damage the pedicle, and it helps stabilize the soft tissues and bones around the flap to lower the complications.

Effect of cephalosporin injection postoperative after cell assisted lipografting in fat survival and improving post burn scar quality

Scars have always been an issue, and the majority of treatments have failed to address them adequately. The biggest obstacle that plastic surgeons still face is finding an effective procedure that works for all skin types in the long run. In a non-invasive way, external volume expansion (EVE) devices use suction to mechanically stretch and stimulate tissues. Different studies have proposed various mechanisms for how stretch releases the skin, including mechanical action on individual cells, inflammation, ischemia, and soluble mediators that promote cell proliferation, adipogenesis, and most crucially, vascular remodeling. Platelet-rich plasma (PRP) is a product made from autologous blood that is concentrated in plasma volume and contains an abundance of platelets, growth factors, and chemo/cytokines. The contents of the alpha and dense granules in PRP have the ability to provide a high concentration of growth factors to the tissues that need them. Autologous fat grafting, initially described by Neuber in 1893 and subsequently improved by Coleman, is a relatively new alternative to scar tissue removal. It is believed that autologous fat grafting improves skin quality by increasing dermal thickness and volume via stimulating the neosynthesis of collagen fibers. It is still unclear what impact autologous fat grafting has on scar tissue, despite its growing popularity in the medical field, and the use of postoperative cephalosporin is very essential for guarding against infection and losing of fat. Critics have cast doubt on its usefulness due to the fact that survival rates can range from 30% to 80% , the infection rate and loss of fat

Fat embolism syndrome: a review in cosmetic surgery

The growing popularity of cosmetic procedures such as liposuction and fat grafting has been accompanied by a rise in associated side effects. Among these, fat embolism syndrome stands out as a potential complication that sometimes has critical consequences. It is important to recognize that fat embolism affects organs through distinct mechanisms from those involved with other types of embolisms. Early diagnosis is crucial. Unfortunately, no effective treatments have been established for this condition. Therefore, starting with a more detailed categorization of diagnoses, developing new treatment methods for each subtype is essential.

Long-term functional results of reconstructive plastic surgery on the pelvic floor

Background. With all the variety of treatment methods for pelvic organ prolapse (POP), the criteria for cure are reduced to the absence of anatomical defects of the pelvic floor. At the same time, the complete restoration of the physical, psycho-emotional and social components of a woman’s life is practically not taken into account. Studying the quality of life, as well as the sexual function of patients with POP will help to clarify the effectiveness of the synergy of surgical treatment and hardware rehabilitation methods.The purpose of the study is to assess the quality of life and sexual function of women of reproductive age after reconstructive plastic surgery on the pelvic floor in combination with radiofrequency exposure.Material and methods. An open prospective longitudinal study was conducted on 60 patients of reproductive age with stage II-III genital prolapse according to the POP-Q classification. The women were divided into two groups: group 1 — patients who underwent vaginal plastic surgery with their own tissues (n=30); group 2 — patients who, after reconstructive plastic interventions, underwent postoperative rehabilitation using dynamic quadripolar radiofrequency (n=30). Before surgery, 1 month and 1 year after treatment, a survey was conducted to determine the quality of life using the Short Form-36 questionnaire and sexual function using the Female Sexual Function Index and Female Sexual Distress Scale.Research results. The combination of surgical correction of pelvic organ prolapse with subsequent radio wave therapy makes it possible to correct anatomical defects, and at the same time statistically significantly increases the index of quality of life and female sexual function, reducing a woman’s experiences associated with problems in her sexual life.Conclusion. The synergy of surgical methods of correction and postoperative rehabilitation with the use of DCRF contributes to the long-term preservation of the functional results of treatment of pelvic floor incompetence during reproductive age.

Biliverdin improved angiogenesis and suppressed apoptosis via PI3K/Akt-mediated Nrf2 antioxidant system to promote ischemic flap survival

Plastic and reconstructive surgeons frequently utilize random skin flap transplantation to repair skin defects. However, the procedure carries a substantial risk of necrosis. Previous research has suggested that Biliverdin (Bv), the main component of Calculus Bovis, possessed potent anti-ischemic properties, making it a potential therapeutic agent for skin flap survival. Hence, in this study, the potential of Bv in promoting flap survival has been comprehensively investigated. Network pharmacology analysis revealed that the pharmacological effects of Bv on ischemic diseases may be attributed to its modulation of various signaling molecules, including the PI3K-Akt pathway. In vitro results demonstrated that Bv treatment significantly promoted angiogenesis in human umbilical vein endothelial cells (HUVEC), even in the presence of H2O2. This was evident by the increased cell proliferation, enhanced migration, and improved tube formation. Bv also effectively attenuated the intracellular generation of reactive oxygen species (ROS) induced by H2O2, which was achieved by suppressing mitochondrial ROS production through the PI3K/Akt-mediated activation of Nrf2/HO-1 signaling pathway. Consequently, Bv treatment led to a significant reduction in apoptosis and an increase in cell viability of HUVEC. Furthermore, in vivo experiment demonstrated that Bv treatment vastly elevated flap survival through enhancing angiogenesis while decreasing oxidative stress and apoptosis, which was comparable to the results of positive control of N-acetylcysteine (Nac). In conclusion, this study not only established a solid foundation for future study on therapeutic potential of Bv, but also proposed a promising treatment approach for enhancing the success rate of flap transplants and other ischemic-related tissue repair.

Algorithm postmastectomy breast reconstruction secondary to breast cancer in a reference center in Mexico City

Background: Postmastectomy breast reconstruction represents a challenge for the plastic surgeon. Contemporary techniques offer numerous options, the reconstructive procedure performed depends on the individual profile of each patient, but will also be influenced by the surgeon's preoperative analysis of their individualized risk profile. Methods: Descriptive, longitudinal, and retrospective study. The reconstructed patients with breast cancer sequelae in the period from May 2023 to May 2024 were included. Based on the review of the literature and the experience of our center, a proposal for a breast reconstruction algorithm was formulated to standardize the ideal surgical treatment according to the case. Results: 119 patients were reconstructed using the algorithm to decide the ideal surgical management. Breast reconstruction was performed in 3 stages: the first stage [1st BRS] (119 patients) consisted of a tissue expander, breast implant ± acellular dermal matrix or autologous pedicled flaps after the mastectomy; in the 2nd BRS (68 patients) the expander was replaced with an implant with or without contralateral symmetrization; and finally in the 3rd BRS (18 patients), the reconstruction of the nipple-areola complex ± neurotization, autologous fat transfer and scar remodeling was performed. Conclusions: The algorithm proposed in this paper provides a guide for making decisions about ideal surgical management according to the clinical characteristics of each subgroup of patients to be reconstructed, improving results by making them reliable and predictable, which positively impacts patient's quality of life.

Morphological verification of the effects of dynamic quadripolar radio frequency in patients of reproductive age with pelvic organ prolapse

Background. Pelvic organ prolapse is a common pathology that has a significant impact on women’s quality of life. According to literature data, 30% of women of reproductive age have symptomatic forms of pelvic organ prolapse (POP). 13% of patients undergo surgical treatment of POP. However, some patients again complain about the symptoms of genital prolapse, despite the surgical correction.Objective. To evaluate the effect of dynamic quadripolar radio frequency on the histological picture of the vaginal mucosa in patients of reproductive age with pelvic organ prolapse.Materials and methods. A prospective comparative study was conducted, which included 38 patients of reproductive age. The patients were randomized and divided into 2 groups 2 months before the surgical treatment of POP. The first group (n=17) of patients underwent preoperative preparation using dynamic quadripolar radio frequency (DQRF) before surgical treatment. The second group (n=21) did not undergo preoperative preparation. Both groups of women received surgical treatment in volume — plastic surgery of genital prolapse with their own tissues. A biopsy of the vaginal mucosa was obtained intraoperatively, and its histological assessment was performed. The material was stained with hematoxylin-eosin, light microscopy was performed using an Axioplan 2 microscope (CarlZeissJena, Germany).Results. Increased vascularization of the vaginal mucosa, absence of signs of inflammation and fibrosis, and ordering of collagen bundles were noted in patients who underwent preoperative preparation using DQRF.Conclusion. Changes in the histological picture of the vaginal mucosa after the use of DQRF indicate an increased regenerative ability of tissues, which may be a predictor of better healing after surgical treatment and may affect the long-term results of surgical treatment.

The impact of COVID-19 on Australian plastic and reconstructive surgery trainees: a survey study

Introduction: The COVID-19 pandemic had a significant impact on the training of plastic and reconstructive surgeons and the wellbeing of surgical trainees internationally. The aim of this study was to evaluate the impact of the COVID-19 pandemic on Australian plastic and reconstructive surgery trainees. Method: A web-based self-administered survey was distributed by the Australian Society of Plastic Surgeons to all Australian plastic and reconstructive surgery registrars in October 2021. A questionnaire developed to assess the impact of the COVID-19 pandemic on plastic and reconstructive surgery trainees in the United States of America was adapted for the Australian context. Subgroup analysis evaluated differences in responses between early and late Surgical Education and Training trainees and between Australian states. ​Results: Of 103 Australian plastic and reconstructive surgery trainees invited to participate, 24 responded (23%). Of these, 52 per cent were in their first two years of training. Total working hours were reduced for 61 per cent of respondents, 54 per cent reported less direct operative supervision, and 75 per cent reported missing out on critical operative learning experiences due to elective operating changes. Overall impact on trainee education was reported to be negative by 71 per cent of respondents. Self-assessed overall wellbeing was negatively impacted in 92 per cent of respondents: all reported feeling isolated from colleagues and 67 per cent reported burnout due to changes during the pandemic. Positive innovation in plastic and reconstructive surgery unit management was reported by 29 per cent of respondents. There were no statistically significant differences in responses between early and late Surgical Education and Training trainees. There were some differences identified in senior supervision and frequency of organised teaching between states. Conclusion: Australian plastic and reconstructive surgery trainees in our cohort reported that the COVID-19 pandemic had a negative impact on their clinical training opportunities, formal education and wellbeing. These findings should be considered in planning for future periods of significant disruption to try to mitigate the negative impacts on trainees.

Lessons from Covid-19 and the potential benefit of the implementation of Axon’s personal electronic health records (PEHR) into aesthetic care, plastic and reconstructive surgery

BackgroundCovid-19 pandemic highlighted the need for implementing Personal Electronic Health Records (PEHR) for patients’ data management. Furthermore, this pandemic underscored the relevance for integrated and interoperable Electronic Health Records (EHR) to support disease surveillance, hospital capacity planning and resource management (Peek N, Sujan M, Scott P (2020) Digital health and care in pandemic times: impact of COVID-19. BMJ Health Care Inf 27(1):e100166. https://doi.org/10.1136/bmjhci-2020-100166). Due to the lack of comprehensive patients’ record in plastic, reconstructive and aesthetic surgery, Axon’s myHealth app offers a break-through patient-centric design allowing patients to be in control of their records and updating them in real-time for their plastic and aesthetic care providers to have a clearer understanding of patients’ history and progress from pre-op to post-op.MethodsThe Axon Dublin survey took place during Covid-19 pandemic in two phases: Phase 1 aimed to assess the feasibility of patients integrating the Axon myHealth application into their clinical visits. Testing occurred in a clinical environment, where patients were encouraged to download and use the Axon system with a health practitioner (HP) present. Phase 2 focused on home testing, evaluating patients’ willingness to manage their health remotely with HP assistance. This phase included self-testing activities such as performing rapid Covid-19 antigen tests, recording medical history, and measuring blood pressure at home.ResultsThe Axon Dublin Study aimed to assess patient engagement, clinical impact, and cost-effectiveness of the Axon myHealth application. Over 85% of patients showed interest in owning a Personal Electronic Health Record. Notably, 36% continuously monitored chronic conditions. Clinical decisions, informed by patient data, saw 61.9% compliance. Noteworthy, 23% of hypertensive participants required immediate medication changes. Patient self-capture of data reduced consultation time. Public health implications were significant, with 39% vaccinated and 31% reporting complications. High user satisfaction (97%) demonstrated the app’s effectiveness in infection control and chronic care.ConclusionsOffering patients the ability to update and control their data is a growing interest, with a clear need in plastic and aesthetic surgery to have a better understanding of a patient’s medical past and progress throughout the surgical process and period. This platform, which is time and cost efficient, can only facilitate personalised care and improve outcomes while maintaining patient’s confidentiality.Level of evidenceNot gradable.

Therapeutic Drug Monitoring for Sirolimus in Children with Vascular Anomalies: What Can We Learn from a Retrospective Study.

Objectives: Sirolimus (SRL), a mammalian target of rapamycin inhibitor, has been widely used to treat patients with vascular anomalies (VAs). The objectives of this study were to summarize the routine blood SRL monitoring data for VAs children, to investigate the factors contributing to the variable blood SRL concentrations and to evaluate the efficacy and safety of SRL therapy. Methods: VAs patients with routine blood SRL monitoring from July 2017 to April 2022 at the Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University were retrospectively collected. Clinical data were obtained from the hospital information system. Results: In total, 67 children (35 females) were enrolled. The therapeutic drug monitoring data showed that the range of measured blood trough concentrations (Ctrough) was 3.6-46.8 ng/mL. At the initial measurements, only 33% of patients were in the target concentration range (10-15 ng/mL). But this proportion became 54% at the last measurements. The whole blood-Ctrough-to-daily dose (Ctrough/Dose) ratio was significantly associated with age and body weight (BW). The patients' laboratory results did not change significantly after SRL treatment. Although the incidence of adverse events was relatively high (44.8%), most of them were mild and tolerable. 70.3% patients had total responses to SRL, whereas 29.7% children exhibited stable disease or progressive disease. No significant differences were found in Ctrough between the total response group and non-response group. Conclusions: This retrospective study revealed a high variability in SRL blood concentrations in Chinese children with VAs. Of note, pediatric patients with older age and a higher BW had a lower Ctrough/Dose ratio. It is a concern whether the range of 10-15 ng/mL is feasible for Chinese children based only on our study. Further studies recruiting more patients are required to redefine the target reference range for children with VAs.

Effects of Nanofat in Plastic and Reconstructive Surgery: A Systematic Review.

Effects of Nanofat in Plastic and Reconstructive Surgery: A Systematic Review.

Advances in Microsurgical Treatment Options to Optimize Autologous Free Flap Breast Reconstruction

Introduction: Reconstructive plastic surgeons have made great strides in the field of breast reconstruction to achieve the best results for patients undergoing treatment for breast cancer. As microsurgical techniques have evolved, these patients can benefit from additional treatment modalities to optimize the results of the reconstruction. Free tissue transfer from alternative donor sites for breast reconstruction is routinely performed, which was not possible in the past. Neurotization is now possible to address the numbness and lack of sensation to the reconstructed breast. For those patients who develop lymphedema of the upper extremity as a result of their breast cancer care, supermicrosurgical options are now available to treat and even to prevent the development of lymphedema. This study presents a narrative review regarding the latest microsurgical advancements in autologous free flap breast reconstruction. Methods: A literature review was performed on PubMed with the key words “autologous free flap breast reconstruction”, “deep inferior epigastric perforator flap”, “transverse upper gracilis flap”, “profunda artery perforator flap”, “superior gluteal artery perforator flap”, “inferior gluteal artery perforator flap”, “lumbar artery perforator flap”, “breast neurotization”, “lymphovenous bypass and anastomosis”, and “vascularized lymph node transfer”. Articles that specifically focused on free flap breast reconstruction, breast neurotization, and lymphedema surgery in the setting of breast cancer were evaluated and included in this literature review. Results: The literature search yielded a total of 4948 articles which were screened. After the initial screening, 413 articles were reviewed to assess the relevance and applicability to the current study. Conclusions: Breast reconstruction has evolved tremendously in recent years to provide the most natural and cosmetically pleasing results for those patients undergoing treatment for breast cancer. As technology and surgical techniques have progressed, breast cancer patients now have many more options, particularly if they are interested in autologous reconstruction. These advancements also provide the possibility of restoring sensibility to the reconstructed breast as well as treating the sequela of lymphedema due to their cancer treatment.