Reconstructive Surgery Research Articles

SurLym trial: study protocol for a multicentre pragmatic randomised controlled trial on the added value of reconstructive lymphatic surgery to decongestive lymphatic therapy for the treatment of lymphoedema

IntroductionLymphoedema is a chronic condition caused by lymphatic insufficiency. It leads to swelling of the limb/midline region and an increased risk of infection. Lymphoedema is often associated with mental and...

Publications in Plastic Surgery and Reconstruction: A Review from a Developing Country, Sudan.

Plastic and reconstructive surgery services need to be improved in developing African countries. Research and article publications from those countries are limited. This review was conducted to identify published articles from Sudan in the area of plastic and reconstructive surgery. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used for the preparation of this systematic review. A comprehensive systematic search was performed using PubMed, ScienceDirect, and Web of Science databases. Articles published in Sudan, specifically in the area of plastic and reconstructive surgery, and written in English were included in this review. The total number of articles that fulfilled the inclusion criteria was 23. The articles were written from 1969 to 2023. Only two articles were published in the 20th century. The most common study type was a retrospective study of eight articles, and the most common study area was Khartoum Teaching Hospital. Regarding the publishing journals, the number of subscription journals was six (30%), whereas open access was 17 (70%). This review demonstrates the lack of articles published on plastic surgery in Sudan. Further investigation is needed to determine the challenges and problems associated with possible clarifications.

Single Nuclear Analyses Reveal Compromised Integrity of Neuromuscular Junction Myonuclei Following Joint Injury

The neuromuscular junction is an essential structure that links electrical signals from the nervous system to contraction of skeletal muscle. The post synaptic region of a muscle cell is maintained by a subset of specialized myonuclei responsible for clustering of post synaptic structural proteins and acetylcholine receptors. Disruptions in the transcriptional program of these myonuclei may result in ineffective myofiber recruitment, slowed force generation, and muscle weakness. We have shown that traumatic joint injury results in protracted deficits in muscle strength and power, but the peripheral mechanistic underpinnings remain unclear. Phenotypically, muscle pathology occurring after traumatic joint injury resembles that of neuromuscular destabilization, yet molecularly, this remains uninvestigated. Therefore, we hypothesize that disruption of neuromuscular regulatory gene programs and destabilization of the neuromuscular junction following joint injury will result in rapid muscle functional deficits. Human muscle biopsies were obtained from the vastus lateralis of anterior cruciate ligament (ACL) injured and healthy limbs of 26 participants. Injured biopsies were taken before and 7 days following reconstruction surgery. Bulk tissue RNA-seq analysis was performed on all participants and single-nucleus RNAseq (snRNAseq) was performed on a subset of participants. Briefly, for snRNAseq, muscle was dounce homogenized, filtered, and nuclei isolated via fluorescent activated cell sorting. Following sequencing, CellRanger output files containing count matrices were filtered, and analyzed using Partek Flow and Seurat. Biopsy sections were processed for histochemistry to analyze fiber size and motor end plate innervation. All participants underwent strength testing on a biodex to assess isometric quadriceps torque and rate of torque development. RNA sequencing displayed >3 fold upregulation of CHRNA1 (P< 0.001) after injury alone and >18 fold upregulation 7 days following reconstruction surgery (P< 0.001). This was accompanied by a host of other neuromuscular regulatory genes including HDAC4 (P< 0.001), GDNF (P< 0.001), and RUNX1 (P< 0.001). Single nucleus sequencing revealed a complete disappearance of neuromuscular junction regulatory myonuclei following reconstruction surgery coupled with delocalization of acetylcholine receptor expression. These findings were confirmed with fluorescent in situ hybridization of CHRNA1 RNA on biopsy sections. Functionally, CHRNA1 RNA expression strongly correlates with deficits in rate of torque development following injury (R^2 = 0.85, P< 0.001). Our results display rapid remodeling of the postsynaptic neuromuscular junction following joint injury that underscores sustained deficits in strength and power. Interventions targeting the preservation of peripheral innervation may be warranted to enhance outcomes following joint injury. R01AR072061. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

HDAC4 Genomic Methylation and Subsequent DNA Binding Following Joint Injury Confers a Sustained Epigenetic Memory of Disrupted Muscle Plasticity

Joint injury is associated with protracted atrophy and weakness that poorly recovers; our objective was to define molecular effectors of lost muscle size, strength, and plasticity following joint injury. We hypothesized that epigenetic imprinting of joint injury in muscle impairs muscle plasticity and contributes to poor functional recovery following surgical repair. We recruited a total of sixteen ACL-injured participants from whom we obtained vastus lateralis muscle biopsies Pre-, 7-days post-, and 4-months post- reconstruction surgery (Sx) and strength measures up to 6-months post-Sx. We performed immunohistochemistry, RNA-seq, reduced representation bisulfite sequencing (RRBS), and HDAC4 chromatin immunoprecipitation sequencing (HDAC4 ChIP-seq) to determine the impact of epigenetics and gene expression on histological profiles, muscle size and muscle strength following injury. Binding and Expression Target Analysis (BETA) of DNA methylation revealed a conserved 985bp regulatory genomic region that was differentially methylated upstream of the HDAC4 promoter. We observed 108 (Pre-Sx), 111 (7d post-Sx), and 110 (4-months post-Sx) differentially methylated promoter sites of which 95 sites were common across all timepoints in the injured limb. Additionally, we observed 1293 differentially methylated intragenic sites within the HDAC4 locus that were also common across all timepoints following injury. Altered HDAC4 methylation was associated with a 2.2 and 4.3 fold change in HDAC4 transcript abundance Pre-Sx and 7d post-Sx, respectively (FDR < 0.05). Notably, HDAC4 binding to critical contractile genes coincided with their downregulation 7d post-Sx (Log2 fold change: ACTA1: -2.02; CKM: -0.97; ATP2A1: -2.34; HOMER2: -1.09; all FDR<0.05). Altered transcript abundance of these genes coincided with lower mean muscle fiber cross-sectional area in the injured limb compared to Healthy (Healthy: 4845 ± 213.4μm2; pre-Sx: 4313 ± 190.6μm2, p<0.05; 7d post-Sx: 3685 ± 228.1μm2, p<0.05; 4-months post-Sx: 3422 ± 142.8μm2, p<0.05) and lower peak torque compared to Healthy (Healthy: 174.8 ± 10.72nm; pre-Sx: 135.2 ± 10.19nm, p<0.05; 4-months post-Sx: 82.64 ± 6.80nm, p<0.05; 6-months post-Sx: 105.9 ± 8.26nm, p<0.05) that was sustained throughout follow-up. Our results suggest that joint injury confers HDAC4 promoter-proximal and intragenic epigenetic imprinting by DNA methylation that increases HDAC4 transcript abundance and HDAC4-DNA binding to represses expression of genes regulating muscle contractile function. This HDAC4 gene regulatory program likely contributes to prolonged deficits in muscle size and strength following joint injury. This work was supported by NIH-NIAMS R01 AR072061. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Interdisciplinary plastic and reconstructive surgery of head and neck squamous cell carcinomas.

Squamous cell carcinomas are the most common malignancies in the oral cavity, pharynx, and larynx. Even in the age of the most modern drug treatment methods, radical resection of these tumors is and currently remains the therapeutic gold standard. The loss of anatomical structures associated with surgery inevitably increases the functional deficits caused by the tumor itself. In this context, the extent of functional deficits is largely determined by the extent of resection. Complete organ resections, such as glossectomy, complete palate resection, laryngectomy, or transverse pharyngo-laryngectomy, lead to severe functional deficits, such as swallowing disturbances with life-threatening aspiration and articulation disorders up to the inability to speak. With the help of plastic reconstructive surgery, the lost tissue can be replaced and the specific functions of the upper aerodigestive tract can be preserved or restored.In recent decades, reconstructive surgical procedures have developed enormously in the treatment of malignant tumors of the head and neck. In order to make optimal use of them, a comprehensive, interdisciplinary therapy concept is a prerequisite for positive oncological and functional outcome. In addition to general medical and social parameters, surgical parameters play a crucial role in the choice of the reconstruction method. The extent to which the surgical measures must be interdisciplinary depends on the localization of the defects in the head and neck region and on the type of replacement tissue required. Here, the expertise of plastic surgery, oral and maxillofacial surgery, and abdominal surgery comes into play in particular. The use of different tissues, the combination of different grafts and flaps, or the preforming of donor regions allow reconstructions far beyond the level of simply restoring surface integrity. The functional results and thus the quality of life of patients after surgical therapy of extensive tumors of the mentioned localizations depend decisively on the type of reconstruction. Therefore, in the following review, special emphasis 1 be placed on the choice of reconstruction method and reconstruction technique for tissue loss after resections of HNSCC.

Gender Affirmation Surgery-related Hashtag Utilization on Instagram: Implications for Education and Patient Care.

Gender-affirmation surgery (GAS) allows for transgender and nonconforming patients to achieve a more congruent physical appearance and alleviate dysphoria. Social media, such as Instagram, has adopted an increasingly important role in plastic and reconstructive surgery, and understanding trends and usage related to GAS can have significant implications for patient education and outreach. As such, this cross-sectional study aims to address the following questions related to GAS-related content available on Instagram: (1) Who is posting this content? (2) What specific hashtags are they using? and (3) What are the implications behind these posts? This study analyzed 22 GAS-related hashtags on Instagram. Content analysis was then used to evaluate the "top" 15 posts (n = 330) associated with each hashtag. A total of 425,607 posts were associated with the 22 hashtags queried. #topsurgery had the highest number of associated posts (n = 279,480), followed by #ftmtopsurgery (n = 41,769) and #vaginoplasty (n = 39,737). Of the "top" 330 posts, 299 were not duplicates. Plastic surgeons eligible for membership in the American Society of Plastic Surgeons accounted for only 1.7% of "top" posts (n = 5); noneligible physicians accounted for 6.0% of posts (n = 18). Patients accounted for the majority of the "top" posts sampled (n = 236; 79.9%). When used appropriately, social media can be a powerful tool for spreading awareness on procedures and educating patients. Although there is a paucity of plastic surgeons posting GAS-related content on Instagram, patients are playing an important role in disseminating information.

3D Lipogluing: Preliminary Results of a Novel Technique for Direct Three-dimensional Fat Grafting in Breast Reconstruction Surgery.

Lipofilling has emerged as an effective technique in breast reconstruction for enhancing aesthetic outcomes and addressing residual deformities. Traditionally, fat grafting has been performed as a secondary step in implant-based breast reconstruction during the replacement of the expander with a breast implant or as a revisional procedure. Our study investigates the technical feasibility and presents preliminary results of a new promising technique for delivering fat grafting in a three-dimensional (3D) shape, directly during mastectomy with immediate breast reconstruction or in delayed breast reconstructive procedures. Our new 3D lipogluing technique involves securing the fat tissue in a 3D manner using fibrin glue. This method enhances the coverage of soft tissues and provides improved volume and shape supplementation. In selected cases between December 2015 and September 2023, we treated 24 patients using the 3D lipogluing technique and five patients using 3D lipocubing (without use of fibrin glue).The patient cohort consisted of different indications for breast reconstructions: direct-to-implant, expander-based breast reconstruction, and "conservative" surgery. Preliminary findings suggest the technique is a safe and effective approach that can enhance the soft-tissue envelope of reconstructed breasts by acting as an autologous scaffold, owing to its regenerative properties. This technique not only improves the overall aesthetic outcome but also has the potential to reduce implant-related complications. Furthermore, ongoing studies are investigating methods to optimize the results and explore the potential application of 3D lipogluing and 3D lipocubing in breast-conserving oncoplastic surgery, cosmetic breast surgery, and other areas of plastic reconstructive and aesthetic surgery.

ХИРУРГИЧЕСКАЯ ТАКТИКА ПРИ ИНФЕКЦИИ В РЕКОНСТРУКТИВНОЙ ХИРУРГИИ НА АОРТЕ И АРТЕРИЯХ НИЖНИХ КОНЕЧНОСТЕЙ

Background. The relevance of the literature review is explained by the frequent development of purulent-septic complications after reconstructive operations on the abdominal aorta and arteries of the lower extremities. Objective. To analyze the literature covering the problem of purulent-septic complications after reconstructive surgery on the aorto-femoral-popliteal arterial segment. Material and methods. A total of 50 literature sources were analyzed. Results. Purulent-septic complications after reconstructive operations on the abdominal aorta and arteries of the lower extremities are caused by many factors. There are various types of purulent and septic complications arising after arterial surgery, and several algorithms of their treatment have been proposed. However, the results of their practical use do not allow us to claim a positive solution to this problem in angiosurgery. Conclusions. With the development of purulent-septic complications after reconstructive operations on the abdominal aorta and arteries of the lower extremities, individual surgical solutions are required.

Flow-Through Procedure in Sequela After Complex Injuries of the Hand With Fingers’ Amputation

PurposeComplex injuries of the hand with finger amputation can result in important functional impairment. If the amputated fingers cannot be replanted, the developed sequelae should be further evaluated. Sometimes, in the presence of a few remaining local vascular resources, the use of the flow-through technique can help in solving the problem. MethodsThis study retrospectively reviews 4 cases who underwent single or multiple fingers reconstruction with toe transfers by using true flow-through or flow-through conduit flaps. A thorough description of the two methods is done, and the quality of the regained functionality of the hand is presented. ResultsAll the patients were males, aged between 21 and 45 (median age 31.75). One of them injured the left dominant hand, and the other three their right dominant hand. The median time between the accident and reconstructive surgery was 14.5 months (range, 3 months-36 months). All the initial lesions were work-related trauma. One patient had severe sequela after forearm compartment syndrome and amputation of the thumb and fifth finger; one patient had a metacarpal hand, one patient had amputation of two fingers (2nd and 4th); and one patient had three fingers amputated (2nd, 3rd, and 4th). In the first patient, a true flow-through flap and a second toe transfer was done, and in the other three patients multiple toe transfers by using the flow-through conduit technique were used. A good functionality of the reconstructed hand was obtained in all the patients. ConclusionsToe transfer remains one of the best methods in the reconstruction of hands with missing fingers. The use of both true flow-through flap and flow-through conduit methods are very useful, especially in cases with few vascular resources.

A bundle of opioid-sparing strategies to eliminate routine opioid prescribing in a urogynecology practice

BackgroundCurrent evidence supports that many patients do not use prescribed opioids following reconstructive pelvic surgery, yet it remains unclear if it is feasible to eliminate routine opioid prescriptions without a negative impact on patients or providers. ObjectiveTo determine if there is a difference in the proportion of patients discharged without opioids after implementing a bundle of opioid-sparing strategies and tiered prescribing protocol (BOSS) compared to usual care after minimally invasive pelvic reconstructive surgery (transvaginal, laparoscopic or robotic). Secondary objectives include measures of patient-perceived pain control and provider workload. Study DesignThe BOSS intervention was implemented as a division-wide evidence-based practice change on August 1, 2022. This retrospective cohort compares a 6-month post-intervention (BOSS) cohort to 6- month pre-intervention (usual care) of patients undergoing minimally invasive pelvic reconstructive surgery. A 3-month wash out period was observed after BOSS initiation. We excluded patients <18 years, failure to consent to research, combined surgery with other specialties, urge urinary incontinence or urinary retention procedures alone, and minor procedures not typically requiring opioids. Primary outcome was measured by proportion discharged without opioids and total oral morphine equivalents (OME) prescribed. Pain control was measured by pain scores, post-discharge prescriptions and refills, phone calls and visits related to pain, and satisfaction with pain control. Provider workload was demonstrated by phone calls and post-discharge prescription refills. Data were obtained through chart review on all patients who met inclusion criteria. Primary analysis only included patients prescribed opioids according to the BOSS protocol. Two sample t tests compared continuous variables and chi-square tests compared categorical variables. Results416 patients were included in the primary analysis (207 BOSS, 209 Usual Care). Baseline demographics were similar between groups, except a lower proportion of IBS (13% vs 23%; p<0.01) and pelvic pain (15% vs 24.9%; p=0.01), and higher history of prior gynecologic surgery (69.1% vs 58.4%; p=0.02) in the BOSS cohort. The BOSS cohort was more likely to be discharged without opioids (68.1% vs 10.0%; p<.01). In those prescribed opioids, total OME on discharge was significantly lower in the BOSS cohort (48.1 vs 81.8; p<.01). The BOSS cohort had a 20.6 greater odds (CI 11.4, 37.1) of being discharged without opioids after adjusting for surgery type, arthritis/joint pain, IBS, pelvic pain, and contraindication to NSAIDs. The BOSS cohort was also less likely to receive a rescue opioid prescription after discharge (1.4% vs 9.5%; p=0.03). There were no differences in opioid prescription refills (19.7% vs 18.1%; p=0.77), emergency room visits for pain (3.4% vs 2.9%; p=0.76), postoperative pain scores (mean 4.7 vs 4.0; p=0.07), or patient satisfaction with pain control (81.5% vs 85.6%; p=0.21). After BOSS implementation, the proportion of postoperative phone calls for pain also decreased (12.6% vs 21.5%; p=0.02). Similar results were identified when non-adherent prescribing was included in the analysis. ConclusionsA bundle of evidence-based opioid sparing strategies and tiered prescribing based on inpatient use increases the proportion of patients discharged without opioids after minimally invasive pelvic reconstructive surgery without evidence of uncontrolled pain or increased provider workload.

AB142. SOH24AB_154. Clinical efficacy and cost-effectiveness of intraoperative flap perfusion assessment with indocyanine green angiography in plastic and reconstructive surgery: a systematic review and meta-analysis

AB142. SOH24AB_154. Clinical efficacy and cost-effectiveness of intraoperative flap perfusion assessment with indocyanine green angiography in plastic and reconstructive surgery: a systematic review and meta-analysis

D161. Effectiveness of Topical Negative Pressure Dressing on Patient Outcomes in Plastic and Reconstructive Surgery

D161. Effectiveness of Topical Negative Pressure Dressing on Patient Outcomes in Plastic and Reconstructive Surgery

High Rates of Discordant Ureteral Perfusion During Open Ureteral Reconstruction With Indocyanine Green: Does Near-Infrared Fluorescence Imaging Change Management or Stricture Outcomes?

OBJECTIVETo determine the role of near-infrared fluorescence imaging (NIFI) combined with indocyanine green (ICG) to assess ureteral tissue perfusion in a benign genitourinary reconstruction cohort with a high prevalence of prior abdominopelvic radiation and surgery. MATERIALS AND METHODSA prospective, single-surgeon series, between June 2018 and April 2022, of patients who underwent open genitourinary reconstructive surgeries in which NIFI/ICG was utilized to intraoperatively assess ureteral tissue perfusion prior to ureteral anastomosis. Primary outcome was ureteroanastomotic stricture (UAS). Secondary outcomes included impact of NIFI/ICG on surgical decision-making and ureter resection length. RESULTS39 patients, median age 66, underwent 40 multimodality reconstructive surgeries during which NIFI/ICG was utilized in the open setting. Radiation-induced etiology was present in 32 of 40 (80%) patients. UAS occurred in 1 of 57 (1.8%) anastomoses with median follow-up 23.4 months. Use of NIFI/ICG changed intraoperative decision-making in 63% of cases. Change in intraoperative decision-making was more common in patients with prior abdominopelvic radiation (66%) compared to non-radiated patients (13%), p=0.007. Discordance between subjective (white-light) and objective (NIFI/ICG) ureteral perfusion (white-light) occurred in 61% of ureters. Mean length of resected ureter was higher following objective assessment with NIFI/ICG (3.6 cm) versus subjective assessment (white light) conditions (1.8 cm), p=0.001. CONCLUSIONSUse of NIFI/ICG was associated with low rates of UAS at 2 years follow-up in a cohort with high prevalence of prior radiation. NIFI/ICG was associated with longer lengths of ureter resection and ureteral perfusion assessment discordance compared to subjective surgeon assessment under white-light conditions.

Anatomic study of flexor carpi ulnaris and brachioradialis muscles and their implication in reconstructive surgeries

Management of soft tissue loss around the posterior aspect of the elbow region is most challenging for clinicians, as it may require reconstructive methods for the better healing of wounds. One of the options for reconstructive surgery is local muscle rotational flaps by the flexor carpi ulnaris (FCU) and brachioradialis (BR). This study aimed to explore the morphometry and vascular anatomy of FCU and BR. Thirty formalin-embalmed cadaveric upper extremities (16 right and 14 left) were utilized for this study. The average length of the FCU muscle belly was 28.96 ±2.16 cm within a range of 24.3 to 32.5 cm, and the average length of the tendon was 10.05 ± 2.2 cm, with a range of 6.9 to 14.3 cm. The number of vascular pedicles for FCU was one in 5, two in 21, and three and four in 2 specimens respectively. All the pedicles arose from the ulnar artery. The average length of the BR muscle was 28.2 ±3.58 cm, with a range of 22.8 to 36.8 cm, and the average length of its tendon was 8.2 cm, with a range of 5.7 to 13.5 cm. In 90% of specimens, BR had only one vascular pedicle and in 10% there were two pedicles. These pedicles arose from the radial recurrent artery and the radial artery. Detailed morphometric and topographic anatomy of the vascular pedicles of FCU and BR are provided in this study, which can be considered the morphological database for the South Indian population.

P22. Cost and Utilization Analysis of Operating Room Instruments in Plastic and Reconstructive Surgery

P22. Cost and Utilization Analysis of Operating Room Instruments in Plastic and Reconstructive Surgery

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Pelvic Organ Prolapse and Reconstructive Surgery (Including Non-trauma Related Fistula and Urethral Diverticulum) (PD24)

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Pelvic Organ Prolapse and Reconstructive Surgery (Including Non-trauma Related Fistula and Urethral Diverticulum) (PD24)

Three-dimensional Simulation on Patient-reported Outcomes Following Oncoplastic and Reconstructive Surgery of the Breast: A Randomized Trial.

Three-dimensional (3D) imaging using computer simulations is an evolving technology. There is a lack of strong data on the use of this technology for oncoplastic (OP) and reconstructive surgery. A prospective, randomized, single-center trial including breast cancer patients undergoing OP or mastectomy with immediate breast reconstruction with implant (IBR) enrolled from November 2019 to October 2021 at the Hospital Nossa Senhora das Graças, Breast Unit in Curitiba, Brazil. Both patients undergoing OP and those in the IBR group were randomized to undergo 3D imaging and simulation of postoperative results (intervention group) or 3D imaging without simulation (control group). All patients were invited to complete a patient-reported outcome (BREAST-Q) expectations module and breast reconstruction or reduction/mastopexy module before and 6 months after surgery. A total of 96 patients were enrolled. Sixty-nine patients (45 OP and 24 IBR) completed the pre- and postoperative questionnaires and were randomized for the simulation. Women in the OP group had higher expectations for breast appearance when clothed than those in the IBR implant group (93.4 ± 16.3 versus 82.9 ± 26.5; P = 0.03). The intervention group was more satisfied with information than the control group (P = 0.021). Both patients who underwent OP and IBR believed that the 3D simulation helped them understand the surgical process (86.6% and 75%, respectively). Preoperative 3D simulation significantly improved patient's satisfaction with information and did not decrease postoperative satisfaction with the outcomes. The incorporation of preoperative 3D simulation may be a valuable tool in breast reconstruction.

Nerve Bypass Surgery for Spinal Cord Reconstruction

ObjectiveSpinal cord injury (SCI) is a devastating condition that significantly decreases the patient's quality of life. Therefore, treatments that can facilitate nerve regeneration, reduce complications, and increase quality of life are valuable for these patients. In this study, we aimed to assess nerve bypass surgery's feasibility and clinical outcomes by transferring the intercostal nerves (ICNs) into the spinal cord. MethodsEight patients with complete thoracic SCI and delayed presentation more than a year after the injury were analyzed retrospectively. All patients underwent nerve bypass surgery with the transfer of two pairs of ICNs from proximal to the injury site to the anterolateral spinal cord, followed by duraplasty with fascia grafting to close the dura. ResultsSix of the eight (75%) patients demonstrated motor and sensory improvements, based on the American Spinal Cord Injury Association score. Three patients demonstrated a limited recovery of motor function that could be independently triggered without ICN initiation. Five patients demonstrated evidence of cerebrospinal fluid (CSF) leakage after surgery; however, only one patient complained of a headache. ConclusionSpinal cord bypass surgery is a potential reconstruction method to treat chronic complete thoracic SCI with functional improvements, and is worth further investigation.

Factors influencing early postsurgical mobilization following Vascularized Iliac Crest Flap for jaw defect reconstruction

Objectives/hypothesisEarly mobility following vascularized iliac flap (VIF) may be influenced by several factors. This study evaluated early mobility and factors influencing patient mobilization following VIF. Study designProspective observational study MethodsWe recruited 115 inpatients who underwent VIF surgery for jaw defect reconstruction at our hospital. Sociodemographic, clinical, and Tinetti test data were analyzed using univariate and multiple logistic regression. Receiver operating characteristics (ROC) curves were used to analyze factors hindering early mobilization. ResultsThe proportion of patients who could sit up on POD2 and walk on POD3 was 61.74% and 56.52%, respectively. The mean Tinetti score at discharge was 9.56 ± 4.27 (range, 3–22). Logistic regression analysis revealed five significant indicators associated with delayed mobilization: pain (odds ratio [OR] = 0.396, p = 0.010), soft tissue flap area (OR = 0.818, p = 0.012), length of bone harvested (OR = 0.443, p = 0.009), and fatigue (OR = 0.449, p = 0.030). The area under the ROC curve for the five indicators was 0.964, with a cutoff value of 22.108, sensitivity of 0.940, specificity of 0.846, and Youden's index of 0.786. The length of bone harvested (B = −0.696, p < 0.001), soft tissue flap area (B = −0.103, p = 0.039), and fatigue (B = −0.628, p = 0.009) influenced the Tinetti test at discharge. ConclusionsMore than half of the patients could be mobilized early. Pain significantly influenced mobilization progress, followed by soft tissue flap area, length of bone harvested, and fatigue.

P2. Is Reconstructive Plastic Surgery Appropriately Valued? Comparison of Reimbursement Per Unit Time for Reconstructive Vs Aesthetic Procedures

P2. Is Reconstructive Plastic Surgery Appropriately Valued? Comparison of Reimbursement Per Unit Time for Reconstructive Vs Aesthetic Procedures