Plastic Surgery Service Research Articles

Changing Faces: Factors Associated with the Intention to Pursue Plastic Surgery and Practice in Underserved Areas.

De-identified data for US medical school graduates were obtained from the Association of American Medical Colleges for students who matriculated in academic years 2007-2008 and 2011-2012. Data collected included self-reported demographic and future practice intentions. Multivariate analysis was conducted to determine indicators of students' interest in plastic surgery, and their intention to practice in underserved areas. Of the 57,307 graduating US medical students in our cohort who completed the Graduation Questionnaire, 532 (0.9%) reported an intention to pursue plastic surgery. Hispanic [adjusted odds ratio (aOR): 1.45; 95% confidence interval (95% CI), 1.07-1.98] and multiracial (aOR: 1.59; 95% CI, 1.03-2.45) students were more likely to pursue plastic surgery compared with other surgical specialties. Among students interested in plastic surgery, compared with non-Hispanic White students, Black (aOR: 6.15; 95% CI, 1.96-19.26) students were more likely to report intention to practice in underserved areas. Students with community-engagement experiences were more likely to report intention to practice in underserved areas. Diversity among medical trainees pursuing plastic and reconstructive surgery is critical for maintaining and expanding plastic surgery services rendered in underserved areas. These findings suggest that student demographics and experiences with community-engagement experiences are positive indicators of practicing in underserved communities.

THE EPIDEMIOLOGY OF PLASTIC SURGERY CASES IN A TERTIARY GENERAL HOSPITAL IN SURABAYA, INDONESIA

Highlights: Medical data registries play a crucial role in improving medical knowledge and enhancing patient care. Burn injuries, microtia, and orofacial clefts were identified as the most common occurrences among the patients The demographic patterns observed provide valuable insights into the patient population seeking plastic surgery services. Abstract: Introduction: Medical data registries are useful databases with well-defined data collection mechanisms. A well-designed and implemented registry can give surgeons a wealth of data for research and quality improvement efforts. The aim is describe the epidemiology of plastic surgery cases in a tertiary general hospital in Surabaya, Indonesia. Methods: A retrospective assessment of patients' medical records from 2016 to 2019 at Plastic Reconstructive and Aesthetic Surgery Unit, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia was conducted. A variety of factors were recorded and evaluated, including the patients' age, gender, diagnosis, and year. Results: We found that among 736 individuals' medical records during a four-year period, burn injuries (17.4%), microtia (11.7%), and orofacial clefts (11.5%) were the most prevalent occurrences. The majority of patients with burn injuries (31.3%), those with microtia (39.5%), those with cleft lip and palate (33%), and those with microtia (between the ages of 15 and 24) were all between the ages of 45 and 64. Patients who were men (52.6%) outnumbered those who were women (47.4%). This data indicates that there were more patients in 2019 than in previous years (397.%). Conclusion: The analysis of plastic surgery cases revealed a steady increase in the number of cases each year. Burns accounted for the biggest percentage of patient requests for care (17.4%). The majority of patients were male, and 21.9% of them were between the ages of 15 and 24 who were seeking care most frequently.

Beauty Borne out of Chaos: Molding a Surgical Subspecialty Through the World Wars.

The chaos during the Great Wars provided the impetus for the genesis of modern plastic surgery. Collectively, the World Wars caused disfiguring injuries to thousands of American soldiers, which challenged their acceptance into society. The Wars, however, propelled 2 leaders in the field of plastic surgery-Vilray P. Blair and James Barrett Brown. These two American pioneers used their surgical acumen and artistic skills to heal the wounds of the soldiers. During World War I, the wounds of injured soldiers were often poorly managed by inadequately trained surgeons and dentists. Upon return to the United States, these soldiers underwent specialized treatment under Blair's supervision. During World War II, James Barrett Brown, a disciple of Blair, was appointed as a consultant in the war. He spearheaded the establishment of several plastic surgery centers in Europe. Upon his return from the War, he led the plastic surgery service at Valley Forge General Hospital in Phoenixville, PA, where thousands of soldiers were sent after their initial operations in the war zones. Care of war wounds served as an impetus for the development of new techniques in reconstructive and plastic surgery. These techniques included a delayed transfer of long pedicled flaps and split-thickness skin grafts. Through our archival research at the Bernard Becker Medical Library at Washington University in St. Louis, we provide evidence for how reconstructive surgical approaches were advanced during the Great Wars and helped restore some form of normalcy to the lives of the injured soldiers.

Electrical Burns in Albania and their Treatment: A Review of Cases Treated in 2019–2020

BACKGROUND: Electrical burns, although constituting a small part of the burns treated in a tertiary hospital, remain a constant burden to the medical staff, due to the nature of the causative agent. PATIENTS AND METHODS: After the Institutional Review Board approval, a retrospective study was performed including all the patients admitted to the Service of Burns and Plastic Surgery, University Hospital Center “Mother Theresa” of Tirana, Albania, from January 2018 to December 2019. Descriptive statistics was used to review the cases for age distribution, body surface area burned, points of entry and exit of the current, acute and late complications, surgical approach, and timing of the latter. RESULTS: Twenty-six patients were admitted during this period, of which 22 suffered a real electrical burn, four of them having only superficial damage from the flash of the electric arc without direct contact with the electrical source. Mean hospital stay was 58.1 days for true electrical burns and 7.5 days for burns from electrical arc. Each patient underwent three surgical interventions in average, of which 20% were fasciotomies, 30% were eschar excision, 35% were reconstructive procedures, and 15% were amputations. Only one fatal outcome was registered. About 36% of the patients were children and the only death was registered among them. Most of cases were due to neglect of safety measures while working with the electrical power, although being professional qualified workers. Acute complications were myoglobinuria, cardiac rhythm disorders, respiratory acidosis, psychomotor agitation, brain concussion and contusion, and acute bleeding. Anemia is the most common late complication. CONCLUSIONS: The prevention is still the best treatment, especially for true electrical burns. Working with the corporate that controls the production and transmission of the electrical power could further reduce the incidence of true electrical burns, while moving to more aggressive surgical approach to such burns might avoid long-term complications and degree of invalidity caused by them.

Demand for Plastic Surgery Services via Inpatient Referrals in a Nigerian Teaching Hospital

Background: Plastic surgery is one of the most collaborative surgical specialties and is also considered the most consulted service in a hospital. Plastic surgeons respond to many medical consults or inpatient referrals, and the comprehensive impact of these services, when they are nonoperative, often goes unnoticed. Objectives: The objectives of the study were to assess the nature of demands of plastic surgery services for admitted patients in a teaching hospital and the specialties and types of patients that benefit from them. Materials and Methods: Clinical records of inpatients evaluated by plastic surgeons were retrieved using a compendium of consults received from other specialties within the hospital over a period of 1 year period. Results: The plastic surgeons received a total of 151 hand-written consults from surgeons, physicians, gynecologists, and pediatricians. The vast majority came from physicians (45.7%) and surgeons (40.4%). Among the physicians, endocrinologists sent the highest number of consults (42.5%). Ulcers constituted the commonest reason for inpatient referrals (66.2%). Over 29% of consults were for patients with primary diagnosis of diabetes mellitus, whereas 13.9% were for head injuries. Conclusions: The demands for the services of plastic surgeons come from virtually all the clinical specialties in a tertiary hospital. The commonest reason for such referral is for their review and management of ulcers. There is a need to utilize telemedicine in reducing the burden of reviewing these patients, especially in large tertiary hospitals.

Review of Plastic and Reconstructive Surgery in a General Hospital Setting: Experience from a Developing Country

Background: Plastic and reconstructive surgery in developing countries and underserved areas are significantly limited and face changes to start a proper service. This study presents a review of plastic surgery services and experiences in a district hospital located in an underserved area.Methods: This descriptive, retrospective, hospital-based study was conducted to review patients who presented to the plastic and reconstruction departments from January 2014 to January 2015. All patients seen in the outpatient clinic or emergency departments for plastic surgical consultation or management were included in the study.Results: The total of 403 cases fulfilled the inclusion criteria. The emergency surgical operation performed in our unit were distributed in the following descending order; fingertip injury (32%), cut wrist (12.7%), cut extensor tendon (9.9%), gunshot injuries (9.4%), fracture of a small bone of the hand (8.3%), and lower limb trauma. Surgery for congenital deformities constituted the most elective operation done in our unit (31.6 %), followed by tumor surgery (18.7%), burn surgery (17.3%), aesthetic surgery procedure (12.2%), and other miscellaneous cases (12.2%).Conclusion: This report demonstrates the efficacy of secondary hospital setting to accommodate a large volume of patients during the first year of establishment, and further predicting development needs, staff training, and governmental support.

Discussion: Immediate Breast Cancer Reconstruction with or without Dermal Matrix or Synthetic Mesh Support: A Review and Network Meta-Analysis.

New York, NY From the Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center. Received for publication October 14, 2021; accepted November 15, 2022. Disclosure:The authors have no financial interest to declare in relation to the content of this Discussion or of the associated article. Jonas A. Nelson, MD, MPH, 321 E 61st St, 6th Floor, New York, NY 10065, [email protected], Joseph J. Disa, MD, 321 E 61st St, 6th Floor, New York, NY 10065, [email protected]

Psychosocial Burden of Pediatric and Adult Patients With Congenital Versus Traumatic Facial Differences: Assessment of Psychiatric Distress and Healthcare Utilization in the United States From 2004 to 2012.

Psychiatric distress and its effects on healthcare utilization in pediatric patients with congenital and traumatic facial differences remain poorly understood. This study analyzes the psychosocial burden along with mental health and reconstructive surgery services utilization of this patient population in comparison with adult patients with such facial differences. The 2004-2012 Medical Expenditures Panel Survey was queried for all patients with facial differences. Socioeconomic variables, Patient Health Questionnaire 2 and Kessler 6 scores, responses from validated screening surveys, and utilization of mental health and reconstructive surgery (ie, plastic surgery and otolaryngology) services were compared between pediatric and adult patients with congenital and traumatic facial differences. Children ages 5 to 12 years were more likely to be affected by facial trauma, whereas adolescents aged 13 to 17 years were more affected by congenital facial conditions. Pediatric patients with congenital facial conditions had higher rates of medical care, education, and special therapy utilization ( P < 0.0001), although their facial trauma counterparts used mental health services more often ( P < 0.0001). In adults, more facial trauma patients reported poorer perceived mental health status ( P = 0.01). Among patients with any facial difference, distressed adult patients were less likely to see a reconstructive surgeon even when controlling for socioeconomic variables (0.55 [0.31-0.97], P = 0.04). In the pediatric population, psychosocial considerations should include both age and etiology of facial differences to best optimize care. Among adults with facial trauma, poor mental health may contribute to lower rates of surgical follow-up, highlighting a potential benefit for provision of mental health services earlier for these patient populations.

Access to female pelvic medicine and reconstructive surgery services in federally qualified health centers: findings from a national mystery caller study in the united states

Access to female pelvic medicine and reconstructive surgery services in federally qualified health centers: findings from a national mystery caller study in the united states

Abstract Number ‐ 91: A Case of Complex Giant Neck Arteriovenous Malformation Treated with Endovascular Embolization

Introduction Arteriovenous malformations (AVM) of the head and neck are vascular malformations composed of a cluster of connecting arteries and veins that form a central nidus without an intervening capillary network1. They make up 1.5% of vascular malformations and more than 90% of AVMs are located intracranially1. Extracranial AVMs are predominantly located in the head and neck and can manifest with pain, ulcerations, fatal hemorrhage, airway compromise, and cosmetic aberrations1,2. Methods We present a case of a 21 year old female with a medical history of multiple suspected neck hemangiomas status post microsurgical and laser resections, with a surrounding port wine stain, who presented to the hospital with growth of one of her posterior neck hemangiomas during and after pregnancy. In the postpartum period she reported increasing neck pain and persistent bleeding from the site. Initially, she was hemodynamically stable and her neurologic exam did not show any focal deficits. She underwent computed tomography angiogram of her neck which showed an extensive dorsal neck AVM with multiple arterial supplies frombranches of the bilateral subclavian, vertebral, and external carotid arteries.Her lesion continued to bleed with a precipitous drop in hemoglobin requiring blood transfusions. Subsequently, she underwent urgentpercutaneousN‐butyl‐2‐cyanoacrylate (n‐BCA) embolizationand endovascular onyx embolization of a left thyrocervical trunk branch.The procedure was completed without complications. Months later, she developed skin exfoliation and underwent successful elective embolization involving vertebral artery branches. This, to reduce profuse venous shunting in the paravertebral venous plexus, avoiding long term spinal cord injury. Results The management of complex head and neck AVMs is both challenging and complex. They may pose significant bleeding risk and can become infiltrative within surrounding tissue3. AVMs may be classified as either focal or diffuse. Focal lesions may be curable with resection, whereas diffuse lesions pose a significant challenge, with relapse in 90% of cases3. Head and neck AVMs require expert management and a multidisciplinary approach. The team may consist of neurosurgery, neuro‐endovascular,plastic surgery, and dermatology services. Treatment options include medical management, surgical resection, endovascular and percutaneous embolization. Percutaenous n‐BCA embolization is employed to prevent hemorrhage during surgical resection, or stabilization in acute hemorrhage4,5. This holds especially true when an endovascular approach is difficult; typically due to tortuous vasculature5. Treatment may require a staged target approach, with endovascular or percutaneous embolization prior to surgical excision. Conclusions This case highlights the complexities of AVM management and the multidisciplinary approach necessary, to provide optimal care. In this case, we believe that pregnancy could have contributed to the overall change in aggressive nature of the AVM. The patient underwent emergent percutaneous and endovascular embolization to prevent life threatening hemorrhage followed by palliative embolization to avoid long term cervical spinal cord injury due to venous hypertension.

Botulunim Toxin Type A Followed by TAR (Transversus Abdominal Release) with Abdominoplasty as the Best Combination for Big Hernia Repair

Introduction: The current incidence of incisional hernia is up to 11%. Botulinum toxin type A shows atrophy in the extrafusal and intrafusal muscle fibers. With the addition of Muscle Paralysis and improving strength, it is possible to perform an effective posterior component separation. Objective: Describe an easy algorithm to treat complex abdominal wall reconstruction and improve the quality of adjacent tissues. Material and Methods: Fifty-nine patients were analyzed over 1 year in the General Surgery and Plastic and Reconstructive Surgery Service, patients with midline abdominal wall hernias, using the effective reconstruction algorithm, placing by ultrasound-guided botulinum toxin in the muscle transverse, 1 month later performing TAR, with Abdominoplasty for skin flap management, and comparing with the control group that did not apply botulinum toxin. Discussion: Botox is a neurotoxin derived from the bacterium Clostridium botulinum (botulinum toxin type A) that has been observed at the sensory level causing atrophy in the extrafusal and intrafusal muscle fibers. Repair of the abdominal wall after incisional hernias has been a great challenge with recurrence rates of 11%. Performing the release of the transverse muscle has a recurrence of 6%, as well as the compensation of skin flaps are ideal for proper management. Results: Within the observed analyzes, the results were divided into trans-surgical (99% of the patients closed the midline), immediate post-surgical (Pain, Seroma and Infection &lt;1%) and late (with &lt;3% recurrence) in the experimental group. Conclusions: Within the study, we will be able to analyze that lowering the recurrence rate &lt;3% in patients properly protocolized, is translated as an adequate and totally reproducible method in our environment.

HIV-associated lipodystrophy: epidemiological analysis of a Plastic Surgery Service in Brazil

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Pretibial lacerations

Patients with pretibial lacerations are commonly referred to plastic surgery services for operative intervention. However, the vast majority of cases can be managed conservatively. Through understanding the epidemiology and pathophysiology underlying these injuries to appropriately assessing and managing these patients, this review demonstrates how best to facilitate wound healing and undertake conservative management. A multidisciplinary approach to managing patients with pretibial lacerations is discussed so that clinicians can provide a better quality of life for patients through optimisation and preventing further decline.

Unused opioid prescription prevalence after pediatric ambulatory surgery: a survey study

BackgroundSurgery is a risk factor for opioid initiation, persistent use, and subsequent misuse in pediatric patients. The objective of this study was to assess the rate of postoperative opioid prescribing and extent of unused opioid prescriptions on the first postoperative day after pediatric ambulatory surgery.MethodsA telephone survey was administered on postoperative day 1 (POD1) to guardians of all pediatric patients who underwent ambulatory surgery at a single medical center. Participants were asked whether postoperative opioids were prescribed, and, if yes, whether they were currently taking them. Multivariable logistic regression was used to assess factors associated with postoperative opioid prescribing and unused opioids on POD1.ResultsOf 1344 pediatric patients who underwent ambulatory surgical procedures, 849 (63.1%) guardians responded to the survey. 275 (32.4%) were prescribed postoperative opioids, and 164 (59.6%) reported not taking opioids on POD1. The highest rates of unused opioid prescriptions were from orthopedic and plastic surgery services (28% and 29%, respectively). Governmental insurance status predicted having unused opioids (OR 0.59, CI 0.35–0.97).ConclusionsUnused opioid prescriptions were prevalent in this pediatric ambulatory surgical population. Opportunities remain to streamline opioid prescribing in pediatric patients undergoing ambulatory surgical procedures.

Evaluation of a Structured Female Pelvic Medicine and Reconstructive Surgery Resident Rotation Curriculum.

Residency education is moving toward competency-based learning, which requires novel educational methods. One solution is structured learning through a formalized curriculum. The purpose of this study is to evaluate the educational aspects of a novel structured curriculum in female pelvic medicine and reconstructive surgery. This was a prospective cohort study of third-year obstetrics and gynecology residents who rotated on the female pelvic medicine and reconstructive surgery service. The curriculum was organized into 7 specific topics with weekly required reading, key specialty articles, and reviewed quizzes on subspecialty topics adapted from the American Board of Obstetrics and Gynecology Guide to Learning. A prerotation and postrotation self-assessment of pelvic anatomy and pelvic floor dysfunction content comprehension was assessed using a Likert scale (0-10) for each domain. Obstetrics and gynecology residents from 4 academic years resulted in a total of 17 paired assessments for analysis. Each of the 7 domains showed significant improvement among all academic years, with a mean increase of 4.9 ± 0.8 points ( P < 0.001). The 2 domains that showed the greatest improvement were stress urinary incontinence (5.5 ± 1.3, P < 0.001) and pelvic organ prolapse (5.5 ± 1.9, P < 0.001). There was no significant association between score improvement and the number of previous surgical rotations or having the rotation in the first or second half of the academic year. This study demonstrated that a structured curriculum in female pelvic medicine and reconstructive surgery was associated with significant improvement in self-assessed perceived resident knowledge during the subspecialty rotation. This approach could be applied to other rotations and direct education curriculum development.

High Satisfaction With a Virtual Assistant for Plastic Surgery Frequently Asked Questions.

Most of a surgeon's office time is dedicated to patient education, preventing an appropriate patient-physician relationship. Telephone-accessed artificial intelligent virtual assistants (AIVAs) that simulate a human conversation and answer preoperative frequently asked questions (FAQs) can be effective solutions to this matter. An AIVA capable of answering preoperative plastic surgery-related FAQs has previously been described by the authors. The aim of this paper was to determine patients' perception and satisfaction with an AIVA. Twenty-six adult patients from a plastic surgery service answered a 3-part survey consisting of: (1) an evaluation of the answers' correctness, (2) their agreement with the feasibility, usefulness, and future uses of the AIVA, and (3) a section on comments. The first part made it possible to measure the system's accuracy, and the second to evaluate perception and satisfaction. The data were analyzed with Microsoft Excel 2010 (Microsoft Corporation, Redmond, WA). The AIVA correctly answered the patients' questions 98.5% of the time, and the topic with the lowest accuracy was "nausea." Additionally, 88% of patients agreed with the statements of the second part of the survey. Thus, the patients' perception was positive and overall satisfaction with the AIVA was high. Patients agreed the least with using the AIVA to select their surgical procedure. The comments provided improvement areas for subsequent stages of the project. The results show that patients were satisfied and expressed a positive experience with using the AIVA to answer plastic surgery FAQs before surgery. The system is also highly accurate.

Dear Program Directors: There Are Numerous Entrustable Professional Activities on a Burns Rotation!

Background: Burn care has long been an integral part of the scope of plastic surgery, but the time allocated to exposure for plastic surgery residents is under threat due to the range of sub-specialities competing for their time. As part of the Competence by Design approach to plastic surgical training, residents are provided with a list of 52 "Entrustable professional activities' (EPA's) to ensure that core skills and knowledge are acquired. Methods: This survey, distributed via email using a link to Survey MonkeyTM, sought to determine which EPA's were available for completion by plastic surgeons in training during the burn rotation at a major academic burn centre in Canada. Via investigator consensus, 26 of the 52 EPA's were included for assessment; the remaining 26 were not regarded as relevant to the burn centre rotation and therefore better acquired elsewhere. Results: Thirty two residents who underwent a burn rotation between 1 January 2015 and 31 December 2021 completed the anonymous survey. Seventeen of the 26 EPA's evaluated were judged by more than 75% of respondents as being readily amenable to completion during the burn rotation. Most of these EPA's relate to the comprehensive care of patients with acute burn injuries, the management of an in-patient plastic surgery service, and associated quality improvement processes. Residents who completed rotations less than three months in duration had less opportunity to complete a further 8 EPA's in comparison to those who had longer rotations, especially with respect to the care of patients undergoing complex wound care and burn reconstruction. Conclusions: In addition to threatening seamless service delivery at burn centres, reduced resident exposure to the burn rotation may compromise the delivery of burn care in the community. The results of this survey refute any argument that the burn service is a "low yield" rotation from an EPA acquisition perspective.

Reconstruction of Facial Skin Defects with Flap and Graft Techniques: A Comparative Study

Background: Reconstruction of facial skin defects is challenging. Skin flaps and grafts are well-known techniques for reconstructing these defects. The outcomes of the surgeries can vary depending on the surgical procedures and the patient's characteristics. Objectives: This study aimed to compare the results of reconstructing facial skin defects using skin grafts and flaps in patients referred to Imam Reza Hospital, Birjand, Iran. Methods: This quasi-experimental study was performed on 100 patients with tumors and traumatic lesions in the facial area referred to the plastic surgery service of Imam Reza Hospital, Birjand, Iran. For comparison, the data of 50 patients with skin grafts and 50 patients with flaps who underwent facial skin defect repair surgery were collected. Patients' demographic characteristics were extracted from their hospital records. The final reconstruction results were evaluated based on the presence or absence of aesthetic or functional complications three months after surgery. Results: The mean ages of participants were 64.6±14.0 and 58.3±19.1 in the flap and graft groups, respectively. Women comprised 26 (52%) of the flap and 22 (44%) of the graft groups. The mean size of lesions in the graft group was 21.3±17.3 cm and 4.7±3.9 cm in the flap group (P=0.001). The frequency of aesthetic and functional complications in the flap group was 13 (26%) and 9 (18%), and in the graft group was 24 (48%) and 15 (30%), respectively. The frequency of aesthetic complications in the flap group was significantly lower than that in the graft group (P=0.023). There was no significant difference between the two groups in terms of the frequency of functional complications (P=0.160). The frequency of disease recurrence was not significantly related to surgical technique (P=0.749). Furthermore, the lesion location had a significant association with the surgical technique (P=0.009); however, the number of surgeries had no significant association with the surgical technique (P=0.389). Conclusion: In general, except for when there is an indication for using a method, the reconstruction of facial skin defects using a skin flap will have better results than a skin graft.

The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany-Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa).

Simple SummaryThe mainstay of soft-tissue-sarcoma treatment remains ablative surgery with complete tumor resection. In this context, reconstructive plastic surgery has become an important aspect of multidisciplinary sarcoma therapy aiming at limb preservation as an alternative to amputations. In this present study, cross-sectional data collected prospectively at 39 study centers across Germany were analyzed, focusing on both the inhouse availability of plastic surgery and external accessibility to plastic surgery in 621 cases. In summary, unplanned and incomplete primary tumor resections carried out at centers with lower degrees of specialization were associated with a significantly increased need for subsequent flap-based defect coverage. In line with this, a readily available team of plastic surgeons was independently associated with successful defect reconstruction, which in turn was associated with significantly higher chances of limb preservation. We conclude that easily accessible plastic surgery and a high degree of expertise in the field of sarcoma treatment are indispensable for limb preservation following sarcoma resection. Plastic and reconstructive surgery therefore plays a vital role in achieving the best possible outcomes in the interdisciplinary treatment of soft-tissue sarcomas.Although the involvement of plastic surgery has been deemed important in the treatment of sarcoma patients to avoid oncological compromises and ameliorate patient outcomes, it is not ubiquitously available. The accessibility of defect reconstruction and its therapeutic impact on sarcoma care is the subject of this analysis. Cross-sectional data from 1309 sarcoma patients were collected electronically at 39 German study centers from 2017 to 2019. A total of 621 patients with surgical treatment for non-visceral soft-tissue sarcomas were included. The associated factors were analyzed exploratively using multifactorial logistic regression to identify independent predictors of successful defect reconstruction, as well Chi-squared and Cochran–Mantel–Haenszel tests to evaluate subgroups, including limb-salvage rates in extremity cases. A total of 76 patients received reconstructive surgery, including 52 local/pedicled versus 24 free flaps. Sarcomas with positive margins upon first resection (OR = 2.3, 95%CI = 1.2–4.4) that were excised at centers with lower degrees of specialization (OR = 2.2, 95%CI = 1.2–4.2) were independently associated with the need for post-oncological defect coverage. In this context, the inhouse availability of plastic surgery (OR = 3.0, 95%CI = 1.6–5.5) was the strongest independent predictor for successful flap-based reconstruction, which in turn was associated with significantly higher limb-salvage rates (OR = 1.4, 95%CI = 1.0–2.1) in cases of extremity sarcomas (n = 366, 59%). In conclusion, consistent referral to specialized interdisciplinary sarcoma centers significantly ameliorates patient outcomes by achieving higher rates of complete resections and offering unrestricted access to plastic surgery. The latter in particular proved indispensable for limb salvage through flap-based defect reconstruction after sarcoma resection. In fact, although there remains a scarcity of readily available reconstructive surgery services within the current sarcoma treatment system in Germany, plastic and reconstructive flap transfer was associated with significantly increased limb-salvage rates in our cohort.

Surgical Treatment of Nonmelanoma Skin Cancer in Older Adult Veterans.

Older adult patients are frequently referred to surgical services for the treatment of nonmelanoma skin cancer (NMSC). The appropriateness of offering surgery to patients with serious comorbidities and a limited life expectancy has been questioned in the literature. The purpose of this study was to determine the morbidity and 5-year mortality for patients with NMSC referred to the plastic surgery service. A retrospective chart review was performed from July 1, 2011, to June 30, 2015, of all plastic surgery service consults for the treatment of NMSC. We collected the following data: age and life-limiting comorbidities at the time of referral, treatment, complications, and 5-year mortality. A χ2 analysis was used to determine the statistical significance (P < .05) between the individual risk factors and 5-year mortality. The relative risk of 5-year mortality was calculated combining advanced age with individual comorbidities. The plastic surgery service completed 800 consults for NMSC over a 4-year period. Five-year mortality was 28.6%. Median age of patients deceased at 5 years was 78 years at the time of the consult submission. The surgical complication rate was 5%. Aged ≥ 80 years, coronary artery disease, congestive heart failure, cerebral vascular disease, peripheral vascular disease, dementia, chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus were found individually to be statistically significant predictors of 5-year mortality. Combining aged ≥ 80 years, coronary artery disease, congestive heart failure, or dementia increased the 5-year mortality to a relative risk > 3. Surgical excision of NMSC in older adult patients is indicated in most situations. A frank discussion with the patient and caregiver is suggested. Surgical treatment of NMSC in older adult patients has a low morbidity but needs to be balanced against a patient's quality of life when they present with life-limiting comorbidities.