Cultural Influences on the Receipt of Breast Reconstruction: a Scoping Review.

INTRODUCTION: Post-mastectomy breast reconstruction can provide breast cancer patients with lasting psychosocial, functional, and body image benefits. While sociodemographic factors affecting the receipt of breast reconstruction have been well studied, the cultural factors influencing patients' decisions to undergo breast reconstruction remain unclear. There are currently no reviews on cultural factors influencing breast reconstruction decision-making. This scoping review aimed to broadly evaluate the current literature on cultural factors that influence the receipt of breast reconstruction in breast cancer patients who have undergone mastectomies. METHODS: A combination of keywords and subject headings was used to search for articles related to breast reconstruction and decision-making. Databases were searched from inception to November 20, 2023. Screening was performed according to PRISMA-ScR guidelines and quantitative studies examining the receipt of breast reconstruction in breast cancer patients following mastectomy were evaluated for inclusion. RESULTS: Of the 4,520 studies that underwent screening, 61 studies were included in the final review. The majority of studies included in the review were retrospective studies and studies in the United States. Included studies were evaluated for cultural influences on the receipt of breast reconstruction. Six themes emerged across the included studies: race and ethnicity, language and communication barriers, education and literacy, cultural competency, patient perceptions, and family and relationships. CONCLUSIONS: In addition to well-established influences on breast reconstruction like race and ethnicity, this review broadly identified additional cultural factors that influence patients' decisions to undergo breast reconstruction.

Contemporary Abdominal Wall Reconstruction: Emerging Techniques and Trends.

Abdominal wall reconstruction is a common and necessary surgery, two factors that drive innovation. This review article examines recent developments in ventral hernia repair including primary fascial closure, mesh selection between biologic, permanent synthetic, and biosynthetic meshes, component separation, and functional abdominal wall reconstruction from a plastic surgery perspective, exploring the full range of hernia repair's own reconstructive ladder. New materials and techniques are examined to explore the ever-increasing options available to surgeons who work within the sphere of ventral hernia repair and provide updates for evolving trends in the field.

Navigating the Ethical Landmines of ChatGPT: Implications of Intelligent Chatbots in Plastic Surgery Clinical Practice.

ChatGPT is a cutting-edge language model developed by OpenAI with the potential to impact all facets of plastic surgery from research to clinical practice. New applications for ChatGPT are emerging at a rapid pace in both the scientific literature and popular media. It is important for clinicians to understand the capabilities and limitations of these tools before patient-facing implementation. In this article, the authors explore some of the technical details behind ChatGPT: what it is, and what it is not. As with any emerging technology, attention should be given to the ethical and health equity implications of this technology on our plastic surgery patients. The authors explore these concerns within the framework of the foundational principles of biomedical ethics: patient autonomy, nonmaleficence, beneficence, and justice. ChatGPT and similar intelligent conversation agents have incredible promise in the field of plastic surgery but should be used cautiously and sparingly in their current form. To protect patients, it is imperative that societal guidelines for the safe use of this rapidly developing technology are developed.

Quality Improvement: A Primer for Plastic Surgeons.

SUMMARY: It is the duty of all health care workers to improve the quality of care and patient outcomes. Quality improvement is a component of health policy required by residency accrediting bodies and is a mandatory component of postgraduate medical education. It is imperative for plastic surgeons to develop skills in quality improvement to ensure that they can cope with increased patient volumes while ensuring that their patients have access to care that is safe, equitable, effective, efficient, timely, and patient-centered. This article discusses techniques and tools often used in quality improvement. Challenges encountered with quality improvement initiatives are discussed, and recommendations on how to handle them as they occur are offered. This primer provides a foundation for plastic surgeons and their staff to guide their quality improvement efforts. A hypothetical quality improvement project is used as an example to illustrate the concepts of quality improvement in this primer.

Human venous valve disease caused by mutations in FOXC2 and GJC2.

Venous valves (VVs) prevent venous hypertension and ulceration. We report that FOXC2 and GJC2 mutations are associated with reduced VV number and length. In mice, early VV formation is marked by elongation and reorientation ("organization") of Prox1hi endothelial cells by postnatal day 0. The expression of the transcription factors Foxc2 and Nfatc1 and the gap junction proteins Gjc2, Gja1, and Gja4 were temporospatially regulated during this process. Foxc2 and Nfatc1 were coexpressed at P0, and combined Foxc2 deletion with calcineurin-Nfat inhibition disrupted early Prox1hi endothelial organization, suggesting cooperative Foxc2-Nfatc1 patterning of these events. Genetic deletion of Gjc2, Gja4, or Gja1 also disrupted early VV Prox1hi endothelial organization at postnatal day 0, and this likely underlies the VV defects seen in patients with GJC2 mutations. Knockout of Gja4 or Gjc2 resulted in reduced proliferation of Prox1hi valve-forming cells. At later stages of blood flow, Foxc2 and calcineurin-Nfat signaling are each required for growth of the valve leaflets, whereas Foxc2 is not required for VV maintenance.

The management of pediatric type 1 nasoorbitoethmoidal fractures with resorbable fixation.

Nasoorbitoethmoid (NOE) fractures are rare in the pediatric population. A recent study reported that NOE fractures account for 1% to 8% of all pediatric craniofacial fractures based on the National Trauma Data Bank. Although infrequent, NOE fractures must be appropriately identified and treated because of potential severe esthetic and functional complications. In this report, we discuss our experience treating the uncommon case of a 9-year-old girl who was involved in a motor vehicle accident and had traumatic injuries to the midface, including a type 1 NOE fracture. We elected to use biodegradable plates to treat her left type 1 NOE fracture because of concerns of facial growth disturbances with the use of conventional rigid fixation techniques at her young age. At 1-year follow-up, the patient demonstrated an acceptable outcome with no functional problems reported. We have also incorporated in this article a thorough review of the literature relating the evolution of biodegradable plates for the treatment of pediatric facial fractures.