Use In Reconstructive Surgery Research Articles

Treatment of an Exposed Achilles Tendon within a Refractory Mixed Arterial Venous Leg Ulcer with the Novel Use of Pericardium Allograft in Combination with Amniotic Allografting, Synthetic Extracellular Matrix, and Acellular Dermis Allografting: A Case Report.

Xenografts, commonly from porcine or bovine sources, have decades-long documented use in reconstructive surgery, including the repair of Achilles tendons. Despite decellularization processes, the risk of antigenicity with xenografts still poses a threat for graft failure. Allograft tissues reduce the risk of immune response and provide greater likelihood of successful grafting. SteriGraft® Pericardium (BSP) (Bone Bank Allografts, San Antonio, Texas) is a lyophilized allograft obtained from the pericardial sac that has undergone sterilization and processing for use in the surgical repair. The aim of this case study was to highlight the novel use of human pericardium allograft in the repair of an exposed Achilles tendon within a vascular ulceration with the concomitant use of synthetic extracellular matrix, amniotic allografting, dermal allografting, and negative pressure wound therapy to achieve healing of the wound and restoration of limb function.

From Plastic Surgery to National Identity.

British surgical photographer Percy Hennell (1911-1987) worked alongside the ‘world famous … father of modern plastic surgery’[1] Harold Delf Gilles (1882-1960) to capture pioneering reconstruction facial surgery in 1941-42. The two toured America and Canada during this time helping to bolster ‘the status of Britain at war at a time when, initially, America was still teetering between neutrality and entering the conflict.’[2]
 The works shown here further dissect Hennell’s photographs by juxtaposing a number of his subjects into new painted images. This piecing together of images in paint hints at the now common use of plastic surgery in modern society. It marks the shift away from reconstruction and reassimilation towards vanity and the meddling in our ‘own physical attributes in a desire to sculpt a vision of perfect beauty.’[3]
 Manipulation through image connects painting to surgical operations, these works also draw on ideas of image, beauty, state propaganda and war. A direct reference to Eisenstein’s film “Battleship Potemkin” can be found in the glasses of one particular subject.
 
 [1] Christine Slobogin, “Full Article: ‘Something Useful in a National Sense’: Percy Hennell’s Surgical and Nationalist Colour Photography, 1940-1948,” Taylor and Francis online, November 8, 2022, https://www.tandfonline.com/doi/full/10.1080/14714787.2022.2094458.
 [2]Slobogin, 2022.
 [3] Madder139 Gallery. “Philip Gurrey.” Madder139 press release, May 15, 2008. www.madder139.com.

ChatGPT in Plastic and Reconstructive Surgery.

Background Chat Generative Pre-Trained Transformer (ChatGPT) is a versatile large language model-based generative artificial intelligence. It is proficient in a variety of tasks from drafting emails to coding to composing music to passing medical licensing exams. While the potential role of ChatGPT in plastic surgery is promising, evidence-based research is needed to guide its implementation in practice. Methods This review aims to summarize the literature surrounding ChatGPT's use in plastic surgery. Results A literature search revealed several applications for ChatGPT in the field of plastic surgery, including the ability to create academic literature and to aid the production of research. However, the ethical implications of using such chatbots in scientific writing requires careful consideration. ChatGPT can also generate high-quality patient discharge summaries and operation notes within seconds, freeing up busy junior doctors to complete other tasks. However, currently clinical information must still be manually inputted, and clinicians must consider data privacy implications. Its use in aiding patient communication and education and training is also widely documented in the literature. However, questions have been raised over the accuracy of answers generated given that current versions of ChatGPT cannot access the most up-to-date sources. Conclusions While one must be aware of its shortcomings, ChatGPT is a useful tool for plastic surgeons to improve productivity for a range of tasks from manuscript preparation to healthcare communication generation to drafting teaching sessions to studying and learning. As access improves and technology becomes more refined, surely more uses for ChatGPT in plastic surgery will become apparent.

Zn-Doped Calcium Magnesium Phosphate Bone Cement Based on Struvite and Its Antibacterial Properties.

The development of magnesium calcium phosphate bone cements (MCPCs) has garnered substantial attention. MCPCs are bioactive and biodegradable and have appropriate mechanical and antimicrobial properties for use in reconstructive surgery. In this study, the cement powders based on a (Ca + Mg)/P = 2 system doped with Zn2+ at 0.5 and 1.0 wt.% were obtained and investigated. After mixing with a cement liquid, the structural and phase composition, morphology, chemical structure, setting time, compressive strength, degradation behavior, solubility, antibacterial activities, and in vitro behavior of the cement materials were examined. A high compressive strength of 48 ± 5 MPa (mean ± SD) was achieved for the cement made from Zn2+ 1.0 wt.%-substituted powders. Zn2+ introduction led to antibacterial activity against Staphylococcus aureus and Escherichia coli strains, with an inhibition zone diameter of up to 8 mm. Biological assays confirmed that the developed cement is cytocompatible and promising as a potential bone substitute in reconstructive surgery.

Literature Review of Flaps in Reconstructive Surgery: Definition, Indications, Complications and Management

this literature review article, the topic of flaps in reconstructive surgery will be addressed in detail, focusing on their definition, indications, complications and management. The epidemiology of flaps and their significance in clinical practice will be explored. The methods used for the implementation of flaps will be discussed, highlighting the importance of preoperative planning and surgical techniques. In addition, the complications associated with flaps will be discussed and a comprehensive discussion on the advantages and challenges of their use in reconstructive surgery will be presented. A conclusion summarising the key aspects of this review will be provided

Topical Tranexamic Acid: Risks, Benefits and Novel Complications in Aesthetic Plastic Surgery.

Antifibrinolytics, particularly tranexamic acid (TXA), are agents used to reduce bleeding. TXA is a synthetic reversible competitive inhibitor to the lysine receptor found on plasminogen. By reversibly binding to this site, it leads to plasminogen being unable to bind to fibrin and so prevents fibrinolysis, this stabilizes the clot and thus prevents hemorrhage. (Pekrul in Der Anaesth 70:515-521, 2021) It can be used either intravenously or topically but has never entered mainstream use in plastic surgery. (Pekrul in Der Anaesth 70:515-521, 2021) This is most likely due to understandable fears of thromboembolic events. On the other hand, the tempting benefits are reduced bleeding (perioperatively) decreased bruising and swelling, and thus increased aesthetic, important for obvious reasons. A review of the literature was done to go deeper on this issue, examining topical use in aesthetic surgery. Clear benefit was shown in the literature, it could be postulated that it would not be unwise to consider more research on topical use of TXA in certain cases, the benefits could greatly outweigh the risks. Old fears and conceptions, unsupported by the literature at the time of writing, should not hold back further research, and the benefits shown could even potentially justify the topical use of these agents in the near future. Further studies evaluating the utility of TXA in Panniculectomy and Abdominoplasty surgery should be performed especially, since only one was found which reported no significant benefit. Minor complications were present, such as minor delayed post-auricular skin healing, temporary unilateral marginal mandibular neuropraxia and increased cumulative seroma volume. These were novel findings and could warrant further investigation as well. After performing a review of the literature, it was seen that topical TXA generally adds benefit in aesthetic plastic surgery, with no particularly significant complications. We would like to bring more attention to the issue and support more studies on TXA use. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Scoping Review of Mobile Apps in Plastic Surgery: Patient Care, Trainee Education, and Professional Development.

A scoping review of electronically available literature within PubMed, Embase, and Scopus databases was conducted in two waves in November and May 2022. Publications discussing mobile application use in plastic surgery were screened for inclusion. Of the 80 nonduplicate publications retrieved, 20 satisfied the inclusion criteria. Articles acquired from the references of these publications were reviewed and summarized when relevant. The average American Society of Plastic Surgeons evidence rating of the publications was 4.2. Applications could be categorized broadly into three categories: patient care and surgical applications, professional development and education, and marketing and practice development. Mobile apps related to plastic surgery have become an abundant resource for patients, attending surgeons, and trainees. Many help bridge gaps in patient care and surgeon-patient communication, and facilitate marketing and practice development. Others make educational content more accessible to trainees and performance assessment more efficient and equitable. The extent of their impact on patient decision-making and expectations has not been completely elucidated.

The effect of tranexamic acid on blood loss in liposuction: a randomized controlled study.

BackgroundLiposuction is one of the most common procedures in the practice of plastic surgery. Since it evolved, continuous modifications have been to decrease blood loss so that patients are hemodynamically stable intra- and postoperatively. Tranexamic acid (TXA) has long been used for its antifibrinolytic properties that were beneficial in reducing blood loss, rate of transfusion, and hemoglobin drop in major trauma and surgeries. Its use in plastic surgery, however, is still limited. In this study, we aim to illustrate the effect of intravenous (IV) and local infiltration of TXA on blood loss in liposuction surgery.MethodsBetween April 2019 and April 2021, 90 patients who requested liposuction for various body parts were randomly allocated into 3 equal groups: control group, IV TXA, and local infiltration of TXA. A sample was taken from infranatant and sent for hematocrit calculation. Volume of blood in lipoaspirate was then calculated. Patients were assessed for blood loss and postoperative bruising.ResultsVolume of blood loss in lipoaspirate was considerably lower in the TXA groups, with 60% decrease in blood loss for the local TXA group in comparison with the control group. TXA has also been shown to markedly decrease bruising tendency in postoperative liposuction patients.ConclusionsTXA can be used to decrease blood loss in large-volume liposuction, modify the need for blood transfusion intra- and postoperative, and improve the results of liposuction procedure without the need for multiple sessions.Level of evidence:Level II, Risk/Prognostic Study.

Hologram accuracy evaluation of HoloLens 2 for thermal imaging in medical applications

Abstract Surgical navigation-assisted interventions, providing augmented previously acquired image data to support the physician, are routinely used. Visualization techniques like extended reality (XR) promise improvements because the desired information can be shown where most suitable. The accuracy of such systems is essential for usability in clinical interventions but lacks research. This work shows a system to project thermal data for use in reconstructive surgery and investigates the accuracy of the XR technology. The system consists of a thermal camera (PI450, Optris GmbH, Germany), a depth camera system (D415, Intel Inc., USA), and a HoloLens2 (Microsoft Corp., USA). 5 probands annotated the locations of 9 marker points on a calibration pattern of the real object and the projection in the XR headset. The mean and max residual projection errors were 2.8 and 6.2 mm, respectively. An XR system to superimpose thermal images was shown. The mean projection error of 2.8 mm is sufficient for further exploration of medical applications.

The Future of Visual Documentation? Assessing the Use of Videography in Facial Plastic Surgery.

Recent technological advancements in the field of portable electronics have facilitated the use of videography as a form of visual documentation in facial plastic surgery. Currently, the degree of video adoption and perceptions relating to its use in plastic surgery are not known. This study aimed to evaluate the current use, perceptions, and barriers regarding the adoption of video in the clinical practice of facial plastic surgery. A cross-sectional study of all American Academy of Facial Plastic and Reconstructive Surgery members was conducted through an e-mail-disseminated 24-item online survey. A total of 164 surgeons responded to the survey. Nearly all surgeons reported routinely employing photography for the documentation and marketing of surgical results. Fewer than 25% of respondents acknowledged using video to document surgical outcomes. Younger surgeons (<10 years in practice) and those in academic practices were significantly more likely to adopt videography (32 vs. 17%, p = 0.042 and 38 vs. 18%, p = 0.027, respectively). Most surgeons regarded video as the superior visual documentation format for dynamic facial expression and as being more difficult to deceptively manipulate. Most frequently cited barriers to adoption included time-consuming capture, file editing/storage requirements, and lack of clear standards. Videography holds favorable potential as the future format of visual documentation in facial plastic surgery due to its ability to capture the full range of dynamic facial expression. Establishing standards and setup guidelines for video capture will be essential in increasing its adoption.

Palmaris Longus Inversus Muscle Present Bilaterally in an 82‐Year‐old Cadaver and Unilaterally in a 68‐Year‐old Cadaver

The palmaris longus muscle is one of the most variable muscles in the human body. Palmaris longus muscle anatomical variations include reversed (palmaris longus inversus muscle), duplicated, triplicated, bifid, hypertrophied, accessory (additional) slips, and/or complete absence. During anatomical dissection of fifty cadavers in the 2019 undergraduate first‐year anatomy course at the Uniformed Services University of the Health Sciences, we found a palmaris longus inversus muscle bilaterally on an 82‐year‐old white female cadaver and a unilateral palmaris longus inversus muscle on the right forearm of a 68‐year‐old white female cadaver. Due to the prevalence of anatomical variations in the palmaris longus muscle, adequate knowledge of such prevalence and clinical significance is necessary in various medical specialties for its use in reconstructive surgery, and the possibility and treatment of clinical syndromes. An accessory (additional) palmaris longus muscle, hypertrophied palmaris longus muscle, hypertrophied palmaris longus inversus muscle, or just the presence of a palmaris longus inversus muscle, can all cause compression to adjacent neurovascular structures, such as the median nerve, ulnar nerve, ulnar artery, and/or the anterior interosseous artery, in the distal forearm and wrist. Palmaris longus tendons are used as grafts in a variety of surgeries, such as extensor tendon repair in rheumatoid arthritis patients, injuries of flexor tendons and repair, lip augmentation, reconstructive hand surgery, frontalis suspension sling in ptosis correction, plastic surgery, and pulley reconstructions. Surgeons, physicians, radiologists, and physiotherapists must be knowledgeable of the many palmaris longus muscle anatomical variations and their possible contributions to pathological processes.

RECONSTRUCTIVE SURGERY IN PATIENTS WITH MALIGNANT DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

The causes of mechanical jaundice (MJ) are benign and malignant diseases of the hepaticopancreaticoduodenal area. Literature sources indicate the development of MJ in 15-40 % of patients with gallstone disease and in the vast majority of patients with malignant neoplasms of the biliary tract. MJ of malignant etiology occurs in 40-67 % of patients.&#x0D; Aim. To study the results of the use of reconstructive surgery in patients with malignant diseases of the biliary tract complicated by mechanical jaundice.&#x0D; Materials and methods. An analysis of surgical treatment of 22 patients with malignant diseases of the biliary tract complicated by MJ in the SI “ V.T. Zatsev IGUS NAMSU ». Patients are divided into subgroups. Subgroup 1 - 11 (50 %) included patients treated with antegrade endobiliary interventions as biliary decompression. Subsequently, the reconstructive and restorative stage of surgical treatment was performed. Subgroup 2 - 11 (50 %) included patients who underwent reconstructive surgery without prior biliary decompression.&#x0D; Results of the research. After successful biliary decompression, 11 (50 %) patients underwent reconstructive surgery, which was included in 1 subgroup. The remaining 11 (50 %) patients in subgroup 2 underwent similar surgery without prior biliary decompression. In patients of subgroup 1 (n = 11 (50 %)) we performed percutaneous transhepatic cholangiodrainage for biliary decompression and MJ resolution. After its successful implementation, the reconstructive and restorative stage of surgical treatment was performed. This reduced the number of postoperative complications from 18.2 % to 9.1 % compared with subgroup 2 of patients who underwent surgery without prior biliary decompression.&#x0D; Conclusions. Performing reconstructive and reconstructive operations in conditions of high levels of serum bilirubin, cholangitis, hepatic failure is dangerous and is accompanied by a large number of complications in the postoperative period. In patients who underwent antegrade endobiliary interventions as a previous biliary decompression, complications were noted in 2 (18.2 %) cases and mortality was 9.1 % (1 patient), which reduced the number of postoperative complications by 9.1 % and mortality by 9.1 %. This is confirmed by studies that prove the benefits of antegrade endobiliary interventions in the preparation of patients for reconstructive surgery in comparison with their performance without the use of the latter.

Social Media Use among Plastic and Reconstructive Surgery Residency Programs in the United States.

Social media have grown exponentially in the United States over the past 15 years. Despite its widespread use in plastic surgery, the role of social media within plastic surgery training programs has yet to be well defined.1,2 Therefore, the purpose of our study was to determine the prevalence, purpose, and ethical principles guiding social media use in plastic surgery training programs within the United States. A survey questionnaire was designed using Research Electronic Data Capture software (REDCap; developer, Vanderbilt University). The survey included questions about participant and program demographics and detailed questions regarding social media use. The survey was emailed to 135 program directors and division chiefs, as well as 88 program coordinators. The program coordinators were asked to distribute the survey to residents at their respective programs. Completed responses were recorded and analyzed. Forty-five faculty responded, resulting in a 33 percent response rate for the faculty group. An additional 30 responses were received from the trainee group. Sixty-seven percent of the faculty responses were from program directors and 33 percent were from division chiefs. Eighty percent of the trainee responses were from integrated residents and the remaining 20 percent were from independent residents. Seventy-six percent of programs reported having an official social media account, similar to results obtained by Azoury et al.3 Instagram appeared to be the most popular platform in our study, with 85 percent of programs using it (Fig. 1). The most common reasons for social media use were branding (77 percent), education (74 percent), and residency recruitment (66 percent). Our study found that the majority of social media accounts were managed by residents (65 percent) (Fig. 2).Fig. 1.: Social media platforms used by plastic surgery training programs compared to those used by plastic surgery trainees for personal use.Fig. 2.: The composition of personnel directly managing professional plastic surgery program social media accounts.Sixty-nine percent of faculty reported social media increased the reach of the program to potential applicants. This is likely due to increasing number of applicants using online resources to find information about training programs before submitting applications.4,5 Only 22 percent of programs reported using social media as a screening tool during the residency interview process. Of those programs that did, 70 percent reported it affected whether an applicant received an interview. Almost all plastic surgery trainees had at least one personal social media account (97 percent). Preferred platforms are shown in Figure 1. Only 19 percent of trainees currently had a separate professional account. However, 52 percent of trainees planned to have a professional social media account after completing training. Sixty-nine percent of faculty reported having guidelines for social media use at their university. Fifty-one percent reported not having formal training for residents and faculty. Breach of patient privacy was reported by 11 percent of programs and 31 percent had professionalism concerns. Only 58 percent of programs had reprimands in place for inappropriate use. Overall, our data suggest that social media use is common among plastic surgery training programs. The most popular social media platform appears to be Instagram. While many universities have guidelines to govern institutional social media use, the majority do not provide residents with formal training in this arena. Further studies should focus on the development of proper training modules for social media use by residency training programs and possibly governing societies. DISCLOSURE None of the authors has a financial interest in any of the products or devices mentioned in this article. Abhishek Jain, B.A.College of Medicine Daniel Crane, M.D.Sami Tarabishy, M.D.Division of Plastic Surgery Isis Scomacao, M.D.Fernando A. Herrera, M.D.College of Medicine and Division of Plastic SurgeryMedical University of South CarolinaCharleston, S.C.

Thirty-eight-year follow-up of the first patient of mandibular reconstruction with free vascularized fibula flap

BackgroundThe mandible is responsible for vital functions of the stomatognathic system, and its loss results in functional and aesthetic impairment. Mandibular reconstruction with free fibula flap is considered the gold standard for mandibular reconstruction.Case presentationWe describe here the 38-year follow-up of the patient who was the first case of mandibular reconstruction with free fibula flap reported in the literature. The original report describes a 27-year-old woman who had undergone extensive mandibulectomy due to an osteosarcoma. A microvascularized fibula flap was used for mandibular reconstruction in 1983. Two years later, a vestibulo-lingual sulcoplasty with skin graft was performed to allow the construction of a total dental prosthesis. Fifteen years after the initial treatment, an autologous iliac crest graft was placed in the fibula flap, aimed at increasing bone thickness and height for rehabilitation with implant supported prosthesis. In 2015, a rib graft was positioned in the mental region, enhancing the support to the soft tissues of the face and improving the oral function. A recent review of the patient shows well-balanced facial morphology and optimal functional results of the procedure.ConclusionsThe fibula flap method, described in 1975 and first reported for mandibular reconstruction in 1985, continues to be applied as originally described, especially where soft tissue damage is not extensive. Its use in reconstructive surgery was expanded by advancements in surgery and techniques such as virtual surgical planning. However, there is still a lack of evidence related to the long-term evaluation of outcomes. The present work represents the longest-term follow-up of a patient undergoing mandibular reconstruction with free vascularized fibula flap, presenting results showing that, even after 38 years, the procedure continues to provide excellent results.

The Challenge of 3D Bioprinting of Composite Natural Polymers PLA/Bioglass: Trends and Benefits in Cleft Palate Surgery.

Cleft lip and palate is the fourth most common congenital malformation. Its prevalence is about 1 in 750 to 1 in 2000 live births. The consequences of this malformation are major: maxillary growth deficit, unaesthetic appearance, phonation disorders, difficulty in eating, and psycho-social disorders. Cleft palate repair establishes the division between the oral and nasal cavities. The alveolar bone graft is a key step. Different sites of autogenous bone harvesting are used, the most common being the iliac crest. Nevertheless, the large number of complications associated with harvesting has led to the use of substitute biomaterials. Bioactive glasses, discovered in 1969, are a group of synthetic silica-based materials with bone-bonding properties. Although 45S5 granular composition is commonly used in bone surgery to repair critical defects, it is only rarely used in the repair of cleft palates because this galenic form is only moderately adapted. However, advances in bone tissue engineering allow the shaping of three-dimensional scaffolds, which support colonization by host cells. Recent advances in computer-aided design/computer-aided manufacturing (CAD/CAM) have even led to the 3D printing of scaffolds combining 45S5 bioglass with a natural and biocompatible poly-lactic acid matrix. The shape of the parts is customized and adapted to the particular shape of the critical bone defects. The objective of this literature review is to highlight the particularities of alveolar defects subsequent to facial clefts, then to detail the characteristics of the materials and technologies used to elaborate 3D matrices by bioprinting. Finally, we will explore research directions regarding their use in reconstructive surgery of cleft palates.

Current use of botulinum neurotoxin in esthetic practice-Clinical guide and review.

Botulinum neurotoxin is one of the most versatile and widely used medical products in the world. The review's focus is the plastic and dermatologic uses of botulinum neurotoxin currently supported by published data. Relevant clinical articles regarding botulinum neurotoxin use in plastic surgery, dermatology, and general esthetic literature were searched and reviewed. The search yielded 258 studies. Two hundred articles were excluded following title and abstract review. Twenty-one studies were excluded following full-text screening. A total of 37 studies remained and were discussed in this review. Botulinum neurotoxin is widely used for numerous off-label indications from head to toe. Some uses are well documented, and their safety has been demonstrated in controlled trials, yet most remain poorly researched.

Level of Evidence on Platelet-rich Plasma in Plastic Surgery

Background:Despite the increased popularity of platelet-rich plasma (PRP) in plastic surgery, there is no detailed analysis on the level of evidence on PRP use in plastic surgery. As the number of applications of PRP in plastic surgery increases, it is important for plastic surgeons to understand the scientific and validated evidence behind its use. Therefore, we performed a literature review to identify current level of evidence on platelet-rich plasma in plastic surgery.Methods:We performed a computerized search of platelet-rich plasma in plastic surgery using the MEDLINE, Cochran Library, and EMBASE databases. Data regarding the type of study, PRP application, and outcomes were collected. Then, the level of evidence was assigned using the American Society of Plastic Surgeons Level of Evidence Rating.Results:Our search identified 105 articles, and about 78.1% of studies were lower-quality studies: 37 level-III articles (35.2%), 32 level-IV articles (30.5%), and 13 level-V articles (12.4%). There were only 6 level-I articles and 17 level-II studies. Level-I studies were on facial rejuvenation using a laser, carpal tunnel release, cleft lip repair, trauma wounds, breast reconstruction using latissimus dorsi, and hair regrowth.Conclusions:Our review of the literature shows that the level of evidence on PRP use in plastic surgery is low (21.9%). Nevertheless, we believe level-III to level-V studies are still valuable, as performing high-level quality studies in plastic surgery is difficult due to variability in surgical techniques, experiences, and materials.

Modern Views on the Clinical Anatomy of the Medial Cutaneous Nerve of Arm and the Prospects for its Use in Reconstructive Surgery

In the modern aspect, the relevance of damage to the medial cutaneous nerve of the arm during surgical interventions in the axilla and brachial region is displayed. Due to the superficial location in the subcutaneous layer, the nerve is most often subject to accidental damage, including in brachioplasty, axillary lymphodissection, breast cancer surgeries and breast augmentation. The material on variant anatomy, macroscopic structure and topography of the nerve is presented. The medial cutaneous nerve of the arm is formed from the medial cord of the brachial plexus, in some cases - from the posterior cord; isolated cases of the absence of the nerve are described. When exiting the axilla at arm level, the nerve penetrates into the deep brachial fascia, passes in the subcutaneous layer medially from the basilic vein of the arm and provides sensitive innervation to the skin of the medial surface of the arm, the skin of the medial epicondyle and the olecranon of the ulna. The medial cutaneous nerve of the arm has an average of 7-8 cutaneous branches, which are characterized by significant variability in the location under the skin. The significance of the medial cutaneous nerve of the arm in clinical practice, namely, in surgical interventions in the arm region, the development of neuropathic pain syndrome, brachial plexus blockages and the diagnosis of nerve damage, medial cord and inferior trunk of the brachial plexus. This review summarizes recent data, which allow to form a more complete picture of the clinical anatomy of the medial cutaneous nerve of arm and the possibilities of its use in reconstructive surgery. An especially relevant area is the possibility of using a medial skin flap of the arm with directed innervation by the medial cutaneous nerve of the arm for reconstruction and restoration of the sensitivity of the nipple-areola complex.

Expanding the Utilization of Low-Dose Computed Tomography in Plastic and Reconstructive Surgery Based on Validated Practices Among Surgical Specialties.

As computed tomography (CT) usage increases, so have concerns over radiation-induced malignancy. To mitigate these risks, low-dose CT (LDCT) has emerged as a versatile alternative by other specialties, although its use in plastic surgery remains sparse. This study aimed to investigate validated uses of LDCT across surgical specialties and extrapolate these insights to expand its application for plastic surgeons. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using search terms "low dose CT" OR "low dose computed tomography" AND "surgery," where the name of each surgical specialty was substituted for word "surgery" and each specialty term was searched separately in combination with the 2 CT terms. Data on radiation dose, outcomes, and level of evidence were collected. Validated surgical applications were correlated with similar procedures and diagnostic tests performed routinely by plastic surgeons to extrapolate potential applications for plastic surgeons. A total of 3505 articles were identified across surgical specialties, with 27 ultimately included. Depending on the application, use of LDCT led to a 25% to 97% reduction in radiation dose and all studies reported noninferior image quality and diagnostic capability compared with standard-dose CT. Potential identified uses included the following: evaluation of soft tissue infections, preoperative and postoperative management of facial and hand fractures, flap design, 3D modeling, and surgical planning. Low-dose CT is a valid imaging alternative to standard-dose CT. Expanded utilization in plastic surgery should be considered to minimize the iatrogenic effects of radiation and to promote patient safety without compromising outcomes.

The Doctor Will "See" You Now - Unmet Expectations of Telemedicine in Plastic Surgery.

Social distancing protocols during the COVID-19 pandemic have resulted in a rapid expansion of telemedicine. It has allowed patients to save time and money on clinic visits, and physicians to communicate with patients who live remotely. Telemedicine has also been valuable in plastic surgery during initial consultations, transfers, and follow up visits. However, given the often-sensitive nature of plastic surgery, the professionalism and expectations of telemedicine have to be reviewed. A comprehensive literature search of the MEDLINE, PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for studies published through October 2020 with multiple search terms related to telemedicine and its use in plastic surgery. Data on the effectiveness, challenges, and professionalism of telemedicine were collected. Our review suggests that telemedicine can be an effective mode of communication in many realms of plastic surgery, including cleft care and craniofacial deformities. However, many plastic surgeons are unfamiliar with the existing platforms, and there are no clear guidelines on the most optimal platforms. Physicians have to recognize that patients might have low digital health literacy or may not even possess digital device for telemedicine. There also needs to be an overall improvement in patient education. Given that telemedicine use will continue to increase after the COVID-19 pandemic, regulations on Health Insurance Portability and Accountability Act-compliant platforms and specific guidelines on telemedicine visits, such as undressing, chaperones, privacy matters, need to be established while maintaining a professional relationship between the patient and the physician.