Impact of Resident and Attending Surgeon Training Level on Free Tissue Transfer Ischemia Time and Complications.

BACKGROUND: Microsurgical free tissue transfer has become an essential method for reconstruction of complex surgical defects, making the level of training an important factor to consider. There is little published regarding the impact of training level on microsurgical outcomes. This study investigates microsurgical free tissue transfer ischemia time and postoperative complications based on resident and attending surgeon experience level. METHODS: A retrospective review of all free flaps at a single institution from January 1, 2013, to December 31, 2021 was performed. Linear regression was performed analyzing ischemia time of 497 free flaps and attending surgeon experience defined by years in practice and resident level defined as postgraduate year (PGY). Logistic regression model was used to analyze complications based on attending experience and resident level. RESULTS: The average resident PGY was 3.5 ± 0.8; the average attending has been practicing for 6.4 ± 5.1 years. There was no statistically significant difference in ischemia time or complication rates based on resident PGY or attending surgeon experience level. CONCLUSION: Lower PGY residents were not found to increase ischemia time or increase complication rates. Lower attending surgeon year was not found to increase ischemia time or increase complication rates compared with surgeons who had been practicing for longer. Microsurgical free tissue transfer is considered a safe procedure in residency training and trainee involvement should be encouraged to improve resident education and enhance technical skills.

Craniosynostosis Associated With Novel TUBG1 Mutation (NM_001070.4:c.821C>T) (p.Thr274Ile).

TUBG1, a tubulin gene, plays an important role in neurodevelopment. Here we describe a case of a novel TUGB1 mutation (NM_001070.4:c.821C>T) (p.Thr274Ile). This patient presented similarly to previous cases with features including microcephaly, epilepsy, and speech and motor delay. Unique characteristics were also present such as trigonocephaly, tethered frenulum, scoliosis, nystagmus, and a concurrent FBXW7 mutation. This case expands our breadth of knowledge on TUBG1 genotypic and phenotypic variation. However, further work is needed to fully understand this rare mutation and the associations between TUBG1 and FBXW7 mutations.

Tumescent technique for split-thickness skin graft donor sites: A systematic review of randomized controlled trials.

BACKGROUND: Split-thickness skin grafting (STSG) is widely used for reconstructive wound management. This review aimed to use level I evidence to determine if tumescent techniques were safe and effective compared to other interventions for STSG donor sites. It was hypothesized that tumescent techniques were safe and effective for STSG donor sites. METHODS: Five databases (MEDLINE via PubMed, Embase, Cochrane Library, Web of Science, and Scopus) were searched to identify studies concerning the use of tumescent solutions for STSG. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Cochrane's guidelines were strictly followed. RESULTS: Nine randomized controlled trials met the criteria. Included studies were published from 2001 to 2021, with results from 40 of 121 possible queried outcomes and complications. Outcomes included patient demographics, formulations of tumescent solutions, tumescent technique, hemodynamics, pain, perfusion, graft take, healing time, and postoperative complications. The tumescent technique reduced estimated blood loss (standard mean differences [SMD]: -2.68, 95%CI: -3.41 to -1.94; participants = 72; studies = 2; I2 = 96%; p < 0.001), and postoperative analgesic use within 24 hours (SMD: -1.75, 95%CI: -2.09 to -1.41; participants = 202; studies = 2; I2 = 96%; p < 0.001), without increasing graft loss/take (SMD: 0.29, 95%CI: -0.02 to 0.61; participants = 158; studies = 3; I2 = 41%; p = 0.07) and infection (risk ratios [RR]: 0.52, 95%CI: 0.08 to 3.54; participants = 87; studies = 3; I2 = 0%; p = 0.58) complications compared to other interventions. CONCLUSIONS: Level I evidence demonstrated tumescent techniques were safe and effective for STSG donor sites. Tumescent techniques reduced blood loss and postoperative analgesic use within 24 hours without increasing graft loss/take and infection complications compared to other interventions. Inconsistencies between studies limit conclusions and emphasize the need for standardized protocols regarding tumescent solution formulations, techniques, and reported outcomes.