Novel Treatment of Pyoderma Gangrenosum With Porcine-Derived Extracellular Matrix Following Bilateral Latissimus Dorsi Breast Reconstruction: A Case Report.

Pyoderma gangrenosum (PG) is a rare disease characterized by ulcerative cutaneous lesions that can occur postoperatively and is often associated with autoimmune disorders. PG is diagnosed by excluding other conditions that can cause ulcerations, such as infections, which may also result in immunosuppressive treatment delays and suboptimal wound care. Operative debridement of wounds has traditionally been avoided in the acute setting secondary to pathergy. This article presents a case of extensive breast PG that was successfully treated with surgical debridement, porcine-derived extracellular matrix, and negative pressure wound therapy while on systemic immunosuppressive therapy.

Breastfeeding Ability After Breast Reductions: What does the Literature Tell us in 2023?

INTRODUCTION: Reduction mammaplasties are routinely performed on women of child-bearing age, yet there still exists some uncertainty regarding a patient's ability to breastfeed following the procedure. This is due to inconsistent definitions of "successful" breastfeeding, a variety of pedicles implemented, and inadequate follow-up in the published literature. Our aim was to summarize the current data and provide clear recommendations for counseling patients on expected breastfeeding outcomes following reduction mammaplasty. METHODS: A systematic review and meta-analysis in accordance with the PRISMA guidelines was conducted. We included papers that reported proportion of breastfeeding ability following reduction mammaplasty. RESULTS: We identified 33 papers that met our inclusion criteria. We found that women who undergo reduction mammaplasty are at a 3.5 times increased odds of not being able to breastfeed compared to controls. Overall, reduction mammaplasty patients have a breastfeeding success rate of 62%. The breastfeeding success rate for patients with inferior pedicles was 64%, superior pedicles was 59%, and lateral pedicles was 55%. No conclusions could be drawn regarding medial, central, vertical, and horizontal pedicles on breastfeeding ability. CONCLUSION: Current data suggest that women undergoing reduction mammaplasty have an increased odds of unsuccessful breastfeeding when compared to similar women who have not undergone the procedure. Based on the current literature, pedicle type does play a role in rate of breastfeeding success, although there is a need for further research on the aforementioned pedicles. Physicians should be aware of the likelihood of successful breastfeeding following reduction mammaplasty so that patients can be more thoroughly counseled prior to a decision for surgery. LEVEL OF EVIDENCE I: 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 .

Reducing drain use with paraspinal muscle flaps for spinal closures: A retrospective cohort study.

BACKGROUND: Paraspinal muscle (PSM) flaps can be mobilized with superficial undermining and lateral release from the thoracolumbar fascia and/or deep undermining and medial release from the transverse processes and ribs. The objective of the study was to compare the effect of the PSM flap technique on drain use, retention, and complication rates. METHODS: A retrospective chart review was performed for patients who underwent spinal coverage with PSM flaps at a single institution from April 2020 to June 2021. Patient demographics, preoperative comorbidities, surgical technique, drain usage, and postoperative complications were analyzed to compare the effects of different PSM flap surgical techniques on postoperative drain use and complications. RESULTS: Sixty patients were included. Both superficial and deep releases were performed in half (47%) of the cases, while the remainder was split between superficial (25%) and deep (28%) releases. Drains were used less frequently for the deep release (35%) than the superficial (93%) or both releases (96%, p < 0.01). The deep release had shorter mean drain retention time (5.8 days) than the superficial (30.3 days) or both releases (24.8 days, p < 0.01). There were no significant differences between the techniques in terms of complications. For the deep release, the use of drains was not associated with a reduction in complications (odds ratio 0.91 [0.84 - 0.98], p = 0.97). CONCLUSIONS: In a selected patient population, a "deep release only" PSM flap technique may allow for drainless spinal closure without an increased risk of seroma or other complications.

Syringe Suction Yields Greater Adipocyte Viability for Fat Grafting: Fact or Fiction?

ABSTRACT: Autologous fat grafting is a technique that can be used for cosmetic and reconstructive indications such as oncologic defects, aging, trauma, and congenital malformations. However, there is no standardized technique, and one of the main challenges is the unpredictable rate of fat resorption. When using fat grafting, it is crucial to understand the different factors that contribute to adipocyte viability. A literature search, using PubMed, was conducted in 2022 with variations of the terms "autologous fat grafting," "fat harvesting," "fat processing," and "fat injection." Articles in the English language that presented original data about different factors that may affect adipocyte viability for fat grafting were included in this review. Syringe suction harvests (lower pressures), compared with other methods with higher pressures, were found to have increased adipocyte counts and viability, but this did not translate clinically during in vivo studies. The studies have shown that, despite our efforts in optimizing fat harvest, processing, and injection, no statistical or clinical differences have been found. Additional studies are still needed to determine a universal protocol for optimal fat graft survival.

Understanding employees' unused vacation days: A social cognitive approach.

Despite the benefits of vacations for health and well-being, many employees do not use all of their paid vacation days. In this article, we seek to understand why this occurs. Using a social cognitive perspective, we propose that employees use fewer vacation days when they do not believe they can successfully detach from work while on vacation (i.e., have low detachment self-efficacy), do not expect positive outcomes (e.g., feeling relaxed, connecting with loved ones) from their vacations, and expect negative outcomes (e.g., feeling stressed, facing negative financial consequences) from their vacations. We test this explanation across four studies in which we develop and validate measures for our social cognitive constructs (Studies 1-3) and test whether these constructs predict employees' unused vacation days (Study 4). Results revealed that employees had more unused vacation days if they lacked detachment self-efficacy, did not expect to feel relaxed on vacation, and expected negative financial consequences of vacations. Overall, our results highlight the usefulness of social cognitive theory for understanding employees' unused vacation days. We discuss implications for theory, future research, and practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Development and Validation of a Multidimensional Forced-Choice Format Character Measure: Testing the Thurstonian IRT Approach.

There has been reemerging interest within psychology in the construct of character, yet assessing it can be difficult due to social desirability of character traits. Forced-choice formats offer one way to address response bias, but traditional scoring methods (i.e., ipsative) associated with this format makes comparing scores between people problematic. Nevertheless, recent advances in modeling item responding (Thurstonian IRT) enable scoring that recovers absolute standing on latent traits and allows for score comparisons between people. Based on recent work in character measurement (CIVIC), we developed a multidimensional forced-choice measure of character (CIVIC-MFC) and scored it using Thurstonian IRT. Initial validation using a sample of 798 participants demonstrated good support for factorial, convergent, and concurrent validity for scores on the CIVIC-MFC, although they did not demonstrate more faking resistance than scores on a Likert-type format version. Potential explanations are discussed.

Leisure Choices and Employee Well-Being: Comparing Need Fulfillment and Well-Being during TV and Other Leisure Activities.

BACKGROUND: Working adults spend most of their leisure time watching TV. In this paper, we seek to clarify how experiences of psychological need fulfillment and well-being differ when watching TV and engaging in other leisure activities. We suggest that, compared to other leisure activities, watching TV is equally conducive to fulfilling needs for: (a) relaxation and detachment from stress and (b) autonomy, but is less conducive to fulfilling needs for (c) meaning, (d) mastery, and (e) affiliation and thus also less conducive to promoting subjective wellbeing. METHODS: We tested our predictions in two day reconstruction studies and a daily diary study. RESULTS: People experienced similar levels of detachment and relaxation when watching TV and engaging in other types of leisure. However, they experienced less fulfillment of other needs, and lower levels of satisfaction and some aspects of affective well-being, when watching TV compared to other activities. Further, unlike time spent watching TV, daily time spent in physical activities was positively associated with positive activated affect. CONCLUSIONS: Given that watching TV tends to be associated with lower levels of need fulfillment and well-being than other leisure activities, leisure choices may be an important target for improving employee well-being.

Adding Depth to Cephalometric Analysis: Comparing Two- and Three-Dimensional Angular Cephalometric Measurements.

INTRODUCTION: Lateral cephalometric radiographs (LCR) have been the standard tool used for cephalometric analysis in craniofacial surgery. Over the past decade, a three-dimensional (3D) revolution in cephalometric analysis and surgical planning has been underway. To date, research has not validated whether cephalometric measurements taken from two-dimensional (2D) and 3D data sources are equivalent and interchangeable. The authors sought to compare angular cephalometric measurements taken with 2D and 3D modalities. METHODS: Sixty-two head CT scans (36 females, 26 males) with an average age of 63 ±â€Š20 years were studied. Twelve cephalometric angular measurements were taken from 3D reconstructed skulls using the software package Mimics 19.0 (Materialize; Leuven, Belgium). These same facial angles were measured from 2D lateral cephalograms reconstructed from the original CT scans using Dolphin 11.9. Measurements taken with both techniques were compared for agreement using a paired t test. Intra-class correlation coefficient assessment was used to determine inter-rater reliability. Statistical significance was set at P < 0.05. RESULTS: Five of the 12 angular measurements (SNA, SNB, MP-FH, U1-SN, and U1-L1) demonstrated statistically significant differences (P < 0.05) between the 2D and 3D analyses. All of these differences were less than the standard deviations for the respective measure. CONCLUSION: The differences between angular cephalometric values obtained from 2D LCRs and 3D CT reconstructions are small. This supports the practices of using 2D and 3D cephalometric data interchangeably in most applications. Clinicians must be selective in which measures they employ to maximize accuracy and care must be taken when measuring dental inclination with lateral cephalograms.

A Meta-Analysis of Gender Differences in Subjective Well-Being: Estimating Effect Sizes and Associations With Gender Inequality.

Despite global gender inequalities, findings on gender differences in subjective well-being have been inconsistent. We conducted a meta-analysis on gender differences in subjective well-being to account for the type of subjective-well-being measure, sampling variability, and levels of national gender inequality from which samples are gathered. Based on 281 effect sizes for life satisfaction ( N = 1,001,802) and 264 for job satisfaction ( N = 341,949), results showed no significant gender differences in both types of subjective well-being. Supplementary meta-analyses found significantly lower job satisfaction, but not life satisfaction, in women for studies that used both life-satisfaction and job-satisfaction measures, and studies that relied on measures that previously demonstrated measurement equivalence. Using the Gender Inequality Index, we found that greater national gender inequality significantly predicts greater gender differences in job satisfaction, but not life satisfaction. We discuss the implications of these findings and the use of subjective well-being as a measure of societal progress.

Flap-Mastopexy in Autologous Breast Reconstruction: Timing and Technique.

BACKGROUND: Techniques in breast reconstruction have significantly advanced the possibility to create more natural and aesthetically appealing breasts. Despite thorough preoperative planning and vigilant operative technique, symmetry remains a concern for select patients who have undergone autologous breast reconstruction. Although symmetry procedures of the contralateral breast have been well described in the literature, little has been published regarding secondary revision in the autologous reconstructed breast, leaving uncertainty as to the appropriate timing and technique for revision procedures that will not hinder the viability of the flap. In this article, we provide an effective, reproducible and safe method of mastopexy after autologous breast reconstruction. METHODS: A retrospective review of all patients undergoing autologous breast reconstruction by a single surgeon between 2007 and 2014 was performed. Patients who underwent mastopexy after autologous breast reconstruction were included. Patient characteristics, type of reconstruction, staging of procedures, secondary operations, and complications were recorded. RESULTS: Ten patients with asymmetric autologous breast reconstruction underwent flap mastopexy in 1 or both breasts. Indications for mastopexy included asymmetry resulting from immediate loss of autologous flaps, unilateral fat necrosis, scarring after mastectomy flap necrosis, excess ptosis, and volume asymmetries. No flap loss, fat necrosis, or nipple loss occurred after flap mastopexy. CONCLUSIONS: The autologous mastopexy technique is a useful option in secondary refinement procedures for breast reconstruction. It provides a reliable and predictable method to adjust the inframammary fold, increase projection, and address excess ptosis. It has a low complication rate and can be safely and reliably performed as early as 3 months after initial reconstruction.

Outcomes in Deep Inferior Epigastric Perforator Flap and Implant-Based Reconstruction: Does Age Really Matter?

Despite the growing elderly population, there is limited research specific to this demographic concerning breast reconstruction (BR). Lack of evidence-based BR recommendations in older populations may contribute to misconceptions and subsequent underutilization of BR, especially autologous BR. Patients who received either deep inferior epigastric perforator (DIEP) flap BR or tissue expander/implant (TE/I) BR by a single surgeon between July 2011 and July 2015 were surveyed postoperatively by using the psychometrically validated BREAST-Q questionnaire to determine patient satisfaction. Patients were categorized into younger and older cohorts based on median age (55 years) and further stratified based on the type of reconstruction. Of the 311 patients surveyed, 95 patients responded (31% response rate). Overall, younger patients (<55 years old, n = 42) compared with older patients (≥55 years old, n = 53) had significantly higher satisfaction with their outcome (mean difference [MD] 12.06; 95% confidence interval [CI]: 0.96-23.15; P = 0.034). In the TE/I group (n = 58), younger patients had significantly higher satisfaction with breasts (MD: 14.17; 95% CI: 2.58-25.75; P = .017) and outcome (MD: 18.25; 95% CI: 3.95-32.5; P = .010) with fewer complications (odds ratio [OR]: 3.29; 95% CI: 1.37-7.86; P = .010). In the DIEP flap group (n = 55), there was no significant difference inr any of the satisfaction outcomes between younger and older patients. Younger patients tend to be more satisfied and demonstrate fewer complications with implant-based BR. In contrast, both younger and older patients undergoing abdominally based autologous BR were equally satisfied with comparable outcomes.

Too much of a good thing? Exploring the inverted-U relationship between self-control and happiness.

OBJECTIVE: Can having too much self-control make people unhappy? Researchers have increasingly questioned the unilateral goodness of self-control and proposed that it is beneficial only up to a certain point, after which it becomes detrimental. The little empirical research on the issue shows mixed results. Hence, we tested whether a curvilinear relationship between self-control and subjective well-being exists. METHOD: We used multiple metrics (questionnaires, behavioral ratings), sources (self-report, other-report), and methods (cross-sectional measurement, dayreconstruction method, experience sampling method) across six studies (Ntotal = 5,318). RESULTS: We found that self-control positively predicted subjective well-being (cognitive and affective), but there was little evidence for an inverted U-shaped curve. The results held after statistically controlling for demographics and other psychological confounds. CONCLUSION: Our main finding is that self-control enhances subjective well-being with little to no apparent downside of too much self-control.

Measuring the Dispositional Tendency to Spread Oneself Too Thin.

This paper describes the development and validation of a scale to measure the dispositional tendency to spread oneself too thin (SOTT) - a tendency that is likely an important antecedent of work-nonwork conflicts. In two studies, we develop and validate a scale for measuring this tendency and examine how it relates to other dispositional causes of role conflicts. In Study 1 we tested our initial item pool using a heterogeneous sample of full-time workers (N = 193) and used exploratory factor analysis to reduce our item pool to a set of five items. In Study 2, using another heterogeneous sample of full-time workers (N = 212), we conducted confirmatory factor analyses to demonstrate that the items fit a unidimensional construct. We also demonstrated that the scale has moderately high test-retest reliability, is distinct from other potentially related constructs, and predicts work-nonwork conflicts above and beyond previously studied dispositional antecedents. We discuss the importance of studying the dispositional tendency to SOTT as a potentially malleable antecedent of work-nonwork conflict and note other employee outcomes that it may also impact.

Unilateral Versus Bilateral Breast Reconstruction: Is Less Really More?

OBJECTIVE: Over the recent years, there has been an increase in prophylactic mastectomies with an associated increase in bilateral breast reconstruction. We aimed to compare outcomes in terms of patient satisfaction with unilateral versus bilateral breast reconstruction after deep inferior epigastric perforator (DIEP) flap and implant-based reconstruction. METHODS: Patients who underwent breast reconstruction by a single surgeon between July 2011 and July 2015 were surveyed using the independently validated BREAST-Q questionnaire. Mean satisfaction scores between patients undergoing unilateral versus bilateral breast reconstruction were compared and stratified based on the type of reconstruction [eg, DIEP flap, tissue expander to implant (TE/I)]. Groups were further categorized by age (patients <55 years and ≥55 years of age) and body mass index (<24.9 and >24.9). Complications were recorded. RESULTS: Of the 308 patients included, 118 (38%) had unilateral reconstruction (42 TE/I and 76 DIEP) and 190 (62%) had bilateral reconstruction (124 TE/I and 66 DIEP). A total of 95 patient surveys were included (31% response rate). Overall, patients receiving unilateral reconstruction demonstrated increased satisfaction with outcome (P = 0.028), psychosocial well-being (P = 0.043), and sexual well-being (P = 0.002). Complication rates were similar between unilateral and bilateral reconstruction. No significant differences for satisfaction were found in the TE/I group (N = 58; unilateral, 10; bilateral, 48).In the DIEP group (N = 37; unilateral, 20; bilateral, 17), those receiving unilateral reconstruction had higher satisfaction with outcome (P = 0.013) and sexual well-being (P = 0.014).Additionally, younger patients (<55 years) were more likely to undergo bilateral reconstruction (P = 0.018). Body mass index did not have a significant association with unilateral or bilateral reconstruction. CONCLUSIONS: Patients undergoing DIEP flap reconstruction showed higher satisfaction with unilateral reconstruction, whereas patients receiving TE/I reconstruction, either unilateral or bilateral, were equally satisified. Additionally, younger women were more likely to undergo bilateral reconstruction, which is consistent with current data trends. When considering surgical options, unilateral DIEP flap reconstruction may provide improved outcomes in terms of patient satisfaction when compared with bilateral reconstruction in select patients.

Leisure engagement and subjective well-being: A meta-analysis.

Numerous studies show a link between leisure engagement and subjective well-being (SWB). Drawing on common experiential features of leisure, psychological need theories, and bottom-up models of SWB, we suggest that leisure engagement influences SWB via leisure satisfaction. We examine the proposed cross-sectional relations and mediation model using random-effects meta-analyses that include all available populations. To provide a stronger test of causal influence, we also examine longitudinal relations between leisure satisfaction and SWB and effects of experimental leisure interventions on SWB using random effects meta-analyses of all available populations. Findings based on 37 effect sizes and 11,834 individuals reveal that leisure engagement and SWB are moderately associated (inverse-variance weighted r = .26) and mediated by leisure satisfaction. Cross-lagged regression analyses of longitudinal studies, controlling for prior SWB, reveal bottom-up effects of leisure satisfaction on SWB (ß = .15) and top-down effects of SWB on leisure satisfaction (ß = .16). Experimental studies reveal that leisure interventions enhance SWB (d = 1.02). Compared with working samples, retired samples exhibit a stronger relation between leisure engagement and SWB, and between leisure satisfaction and SWB. Measures of the frequency and diversity of leisure engagement are more strongly associated with SWB than measures of time spent in leisure. Overall, although not minimizing top-down influences, results are consistent with bottom-up models of SWB and suggest that the leisure domain is a potentially important target for enhancing SWB.

Employee subjective well-being and physiological functioning: An integrative model.

Research shows that worker subjective well-being influences physiological functioning-an early signal of poor health outcomes. While several theoretical perspectives provide insights on this relationship, the literature lacks an integrative framework explaining the relationship. We develop a conceptual model explaining the link between subjective well-being and physiological functioning in the context of work. Integrating positive psychology and occupational stress perspectives, our model explains the relationship between subjective well-being and physiological functioning as a result of the direct influence of subjective well-being on physiological functioning and of their common relationships with work stress and personal resources, both of which are influenced by job conditions.

Estrogen treatment of acetic acid burns to the vagina, cervix, and perineum: a case report and review of the literature.

In colposcopic evaluation of the cervix, acetic acid of 3 to 5% is commonly used for identification of preneoplastic and neoplastic cells. Acetic acid is a known caustic substance and has the potential to cause irritation and chemical burns when there is sufficient concentration or duration of contact. The authors present a unique case of a woman who inadvertently received undiluted acetic acid during a routine colposcopy, resulting in significant chemical burns of the vagina, cervix, and perineum. Her burns were treated with topical estrogen cream of 1 g twice daily applied directly to the wounds. The burn wounds were fully healed within 8 weeks without complication or additional treatment. At 6 months after the injury, the patient was allowed to engage in sexual activity, and vaginal dilation and pelvic floor therapy were initiated. At 12 months postinjury, her only symptomatic scarring at the left vaginal wall continues to improve. Thus, topical estrogen treatment of 1 g applied twice daily should be continued until burn scar maturation is complete and treatment improvement plateaus in cases of burns to the vagina, cervix, and perineum. This case is further clinical evidence of estrogen's positive effect on wound healing and its potential role in burn treatment.

Free nipple grafting: an alternative for patients ineligible for nipple-sparing mastectomy?

Nipple-sparing mastectomy is an option for patients fitting oncologic criteria and may improve cosmetic outcomes of breast reconstruction. When anatomical limitations exist, we propose the use of free nipple grafting, akin to reduction mammaplasty. This study is a retrospective review of patients having a nipple-sparing mastectomy and immediate reconstruction using free nipple grafting (N = 36 breasts). Average graft take was 93.6% with no nipples having complete graft loss. Four nipples (11%) lost all projection and 4 nipples experienced significant hypopigmentation requiring tattooing (11%). For those ineligible for nipple-sparing mastectomy due to anatomical limitations, free nipple grafting is an option with acceptable complication rates similar to free nipple grafting in reduction mammaplasties and, more importantly, saves women a subsequent operation for nipple reconstruction.