Craniofacial Trauma from Electronic Scooter Use.

BACKGROUND: In 2018, the City of Providence introduced a program in which electronic scooters were deployed for public use. We aim to characterize the burden of craniofacial injuries associated with these scooters. METHODS: A retrospective review was conducted of all patients consulted to the plastic surgery service for evaluation of craniofacial injury between September 2018 and October 2022. Data pertaining to patient sociodemographics, site and time of injury, and craniofacial trauma were recorded. RESULTS: Twenty-five patients sustaining craniofacial trauma were identified over a four-year period. Most patients required soft tissue repair (64%) and bony fractures were sustained by approximately half of all patients (52%). Admission to ICU was uncommon (16%), and there were no fatalities. CONCLUSIONS: The incidence of craniofacial injury from electronic scooter use is low. However, these injuries may involve extensive surgical reconstruction and ICU admission. We advise the City of Providence to optimize best safety practices and monitoring to minimize risk.

Geographic Trends of International Medical Graduate Residents and Faculty in US Plastic Surgery Training Programs.

BACKGROUND: Of the academic plastic surgeons in the United States, 13.6% are international medical graduates (IMGs). The objective of this study was to identify the countries from which IMGs obtained their medical degrees and the states they matched in. We sought to establish a correlation between IMG faculty and residents in plastic surgery programs. METHODS: Plastic surgery program Web sites were reviewed. The primary outcome of interest was the country IMG residents had obtained their medical degrees from. Secondary outcomes of interest were program state location, IMG resident postgraduate year, and programs' number of IMG faculty. RESULTS: One hundred one programs were screened. A total of 39 states were represented; there were 1262 current residents, of which 92 (7.3%) were IMGs. International medical graduate residents received their medical degrees from 46 different countries. The most common countries were England (n = 6 [6.5%]) for IMG residents and Canada (24.5%) for IMG faculty. The most common region represented for residents was South America (n = 44 [47.8%]). The highest proportions of IMGs per total state plastic surgery residents were found in West Virginia (33.3%) and Minnesota (25%); 13.5% and 15.6% of program directors and program chairs were IMGs, respectively. There was a statistically significant difference between the proportion of IMG residents in programs that had an IMG program director versus programs with no IMG program director (P = 0.016). No such statistically significant difference was found between the proportion of IMG residents in given programs with IMG chairs (P = 0.55). There were significantly more IMG faculty in programs with IMG chairs (P = 0.001). The number of IMG faculty was positively correlated to the number of IMG residents in a given program (P = 0.0001, r = 0.39). CONCLUSION: International medical graduate residents constitute a small but appreciable portion of current plastic surgery residents; the majority have earned their degrees from the South America region. International medical graduate plastic surgery residents are more likely to be recruited to programs that have an IMG program director and a higher number of IMG faculty. International medical graduate faculty have a strong representation in academic plastic surgery, as evidenced by the percentage of IMG program directors and chairs. Programs with IMG chairs had a greater number of IMG faculty.

Rethinking the Need for Nail Plate Removal: A Comparison of the Risks Between Standard Nail Bed Repair and Nonoperative Management.

PURPOSE: Nail bed injuries are commonly treated with nail plate removal and repair due to concern for future nail deformity. There is controversy whether this is necessary. We compared the outcomes for adult patients with simple nail bed lacerations who underwent either formal nail bed repair or nonoperative management. METHODS: A retrospective cohort study was performed of adult patients with nail bed lacerations from 2012 to 2019. Nail bed lacerations were diagnosed in patients with fingertip injuries resulting in subungual hematoma greater than 50% or in any subungual hematoma in the setting of a distal phalanx fracture. All patients included had an intact nail plate. Patients were treated with nail bed laceration repair or nonoperatively without nail plate removal. The primary outcome was the development of a nail deformity. Secondary outcomes included infection, fracture nonunion, and patient-reported functional outcomes using the quick Disabilities of the Arm, Shoulder and Hand score. RESULTS: Thirty-eight patients with nail bed lacerations were treated nonoperatively, and 40 patients were treated with nail bed repair. The average follow-up time was 4.5 weeks in the office. In addition, 1-year evaluation of patients was performed through telephone interview. The patients in the nonoperative group exhibited no statistically significant difference in the calculated risk for nail deformities compared with the nail bed repair group (13% vs 23%, relative risk = 0.58, P = 0.40, 95% confidence interval = 0.42-1.25). There were no significant differences in secondary outcomes or quick Disabilities of the Arm, Shoulder and Hand scores between groups. CONCLUSIONS: The authors observed no meaningful difference in the rate of nail deformities in adult patients who underwent nail bed repair compared with those managed nonoperatively.

Predicting open wound mortality in the ICU using machine learning.

BACKGROUND: Open wounds have a significant impact on the health of patients causing pain, loss of function, and death. Labeled as a comorbid condition, open wounds represent a "silent epidemic" that affect a large portion of the US population. Due to their burden of care, open wound patients face an increased risk of ICU stay and mortality. There is a dearth of studies that investigate mortality among wound patients in the ICU. We sought to develop a model that predicts the risk of mortality among wound patients in the ICU. METHODS: Random forest and binomial logistic regression models were developed to predict the risk of mortality among open wound patients in the Medical Information Mart for Intensive Care III (MIMIC-III) database. MIMIC-III includes de-identified data for patients who stayed in critical care units of the Beth Israel Deaconess Medical Center between 2001 and 2012. Six variables were used to develop the model (wound location, gender, age, admission type, minimum platelet count and hyperphosphatemia). The Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index were used to assess model strength. RESULTS: A total of 3,937 patients were included with a mean age of 76.57. Of those, 3,372 (85%) survived and 565 (15%) died during their ICU stay. The random forest model achieved an area under the curve (AUC) of 0.924. The CCI and Elixhauser models resulted in AUC of 0.528 and 0.565, respectively. CONCLUSIONS: Machine learning models may allow clinicians to provide better care and management to open wound patients in the ICU.

Using 3D Printing and Mirror Image Modeling in Orbital Floor Reconstruction.

ABSTRACT: Three-dimensional (3D) modeling and printing technologies are increasingly utilized as tools to assist in complex craniofacial reconstructions. Herein, the authors report the intraoperative use of sterilized 3D models printed in-house to mold a custom resorbable implant in the case of a pediatric patient with a unilateral complex orbital fracture. The imaging was processed with open-source software. Two patient-specific orbital models were 3D-printed (Fig. 2): a life-size print of the patient's preoperative CT scan and a left orbit reconstructed to resemble its uninjured state using mirrored-imaging of the uninjured side. This construct ultimately served as a sterilized template to mold a resorbable implant intraoperatively. Post-operatively, the patient experienced no complications. At the 18-month follow-up, the patient had done well without diplopia, headaches or visual problems. The authors report a case of a successful orbit reconstruction assisted by mirrored-image computer modeling and patient-specific 3D printing.

Cleft Lip and Palate Surgery Crowdfunding and Access to Care.

ABSTRACT: A total of 169 ACPA approved teams treat cleft deformities in the United States. These centers are unevenly distributed, and families may disproportionally pay extra travel costs to consult a multidisciplinary cleft team. Families experiencing hardships are able to create campaigns on GoFundMe to advertise their fundraiser publicly. The authors sought to establish whether a correlation exists between patients asking for support for cleft treatment and their geographic location in the US.A total of 635 crowdfunding campaigns for cleft lip and/or palate were reviewed from GoFundMe. Google searches for cleft lip and palate were evaluated utilizing Google Trends, with values reported as Relative Search Volumes (RSV). Driving distances and travel time to the nearest approved ACPA center were calculated using Google Maps data.There was a statistically significant difference in average driving distance and travel duration between the different subregions of the US (P  =  0.0059 and 0.026, respectively). The South subregion had the highest proportion of campaigns (n = 259, 40.9%), mean driving distance (105.75 km) and mean driving duration (1 hour 8 minutes). The number of approved teams per state was negatively correlated to both RSV scores (r = -0.38, P  =  0.048) and the number of campaigns (r = -0.34, P  =  0.014).There is an uneven distribution of ACPA centers among the US subregions. The South seems to have the highest need for care, as identified by proportionate number of campaigns, adjusted driving distances and travel time. This data suggests that underserved areas for cleft care are correlated with greater numbers of hardship campaigns and more internet searches regarding cleft lip and palate.

Online Crowdfunding Enables Patients' Access to Gender-Affirming Surgery.

Online crowdfunding allows transgender patients to fundraise for their surgeries or hormonal therapy. In this study, we updated the geographic trends in fundraising for gender-affirming surgery and sought to establish the factors influencing the amount raised per campaign. Campaigns were identified from GoFundMe. In total, 1010 crowdfunding campaigns were identified. The West had the highest proportion of campaigns (n=242, 34.6%). Controlling for each variable, we found that campaigns that raised the greatest amount of funds were associated with longer descriptions (p<0.0001, r=0.34), higher number of social media shares (p<0.0001, r=0.39), higher goal amount (p=0.041, r=0.19), and number of donors (p<0.0001, r=0.44).

Utilization of Three-Dimensional Printing in Burn Mask Production.

ABSTRACT: Hypertrophic scarring is a significant complication of severe face and neck burns. Burn masks offer an effective treatment. However, the conventional method of making these masks has notable shortcomings. Most notably, the use of alginate to form an impression is a laborious and uncomfortable process, especially for younger patients. To optimize this practice, the authors present a novel method of burn mask production that utilizes a 3-dimensional-printed positive mold to avoid the direct placement of alginate onto burned patient skin.

Persistent Trigger Finger Due to Tendon Subluxation.

We report the case of an adult patient with persistence of triggering after A1 pulley division in the ring finger, which was caused by flexor digitorum superficialis tendon subluxation. This resolved after longitudinal flexor digitorum superficialis tendon separation.

Practical Management of Common Skin Injuries, Lacerations, Wounds, Trigger Fingers, and Burns.

Primary care clinicians encounter many conditions during their day-to-day visits with patients. A few of these common presentations include burns, lacerations, trauma to the hand, and wounds, some of which do not require an evaluation by a specialist and can be managed outpatient by primary care clinicians. In this article, we share evidence-based tips to avoid common pitfalls in primary care recognition and management of such presentations as well as guide them to manage many of these conditions themselves. We also provide guidance in the decision to refer the patient to a plastic surgeon or other specialists.

Unilateral Birdshot Chorioretinopathy in an Elderly Patient.

[Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].