Artificial Intelligence Analysis of Periorbital Rejuvenation.

BACKGROUND: Periorbital rejuvenation surgery aims to restore a youthful appearance to the face. Despite the popularity of these procedures, few objective measurements exist to evaluate their impact on perceived facial aging. OBJECTIVES: This study aims to quantify the impact of brow lift and blepharoplasty on age as perceived by convolutional neural network (CNN) algorithms. METHODS: A retrospective review was performed on patients who underwent upper blepharoplasty, lower blepharoplasty, and/or brow lift at a single cosmetic practice between 2018 and 2023. Collected data included patient demographics, procedure performed, fat pad resection, and pre- and postoperative frontal images. Each photo was analyzed by four artificial intelligence (AI) platforms to estimate the change in perceived age following surgery. The estimated age reduction was compared between procedures. RESULTS: Of the 153 included patients, 118 underwent blepharoplasty, 12 underwent brow lift, and 23 had both blepharoplasty and brow lift. Across all AI platforms, the mean age estimation percent error was 10.6%, with a tendency for AI to underestimate compared to true age. Univariate analysis revealed an age reduction following any surgery of 1.03 years (p<0.001). When controlling for other variables, brow lift patients saw a mean age reduction of 1.432 years (p=0.031). Upper and lower blepharoplasty, patient characteristics, and ancillary procedures were not found to be independently associated with significant age reduction. CONCLUSIONS: Brow lifts provide significant reduction in perceived age. When planning for periorbital rejuvenation, a thorough preoperative evaluation should be performed, and additional consideration should be given to brow lifting procedures.

Performance of ChatGPT on the Plastic Surgery Inservice Training Examination.

BACKGROUND: Developed originally as a tool for resident self-evaluation, the Plastic Surgery Inservice Training Examination (PSITE) has become a standardized tool adopted by Plastic Surgery residency programs. The introduction of large language models (LLMs), such as ChatGPT (OpenAI, San Francisco, CA), has demonstrated the potential to help propel the field of Plastic Surgery. OBJECTIVES: The authors of this study wanted to assess whether or not ChatGPT could be utilized as a tool in resident education by assessing its accuracy on the PSITE. METHODS: Questions were obtained from the 2022 PSITE, which was present on the American Council of Academic Plastic Surgeons (ACAPS) website. Questions containing images or tables were carefully inspected and flagged before being inputted into ChatGPT. All responses by ChatGPT were qualified utilizing the properties of natural coherence. Responses that were found to be incorrect were divided into the following categories: logical, informational, or explicit fallacy. RESULTS: ChatGPT answered a total of 242 questions with an accuracy of 54.96%. The software incorporated logical reasoning in 88.8% of questions, internal information in 95.5% of questions, and external information in 92.1% of questions. When stratified by correct and incorrect responses, we determined that there was a statistically significant difference in ChatGPT's use of external information (P < .05). CONCLUSIONS: ChatGPT is a versatile tool that has the potential to impact resident education by providing general knowledge, clarifying information, providing case-based learning, and promoting evidence-based medicine. With advancements in LLM and artificial intelligence (AI), it is possible that ChatGPT may be an impactful tool for resident education within Plastic Surgery.

Analysis of Frontal Sinus Fracture Management and Resource Utilization.

Frontal sinus fractures require a large amount of force and often occur in the context of a major trauma. Many patients with these fractures are assessed in an emergent setting where stabilization takes precedence. Delayed diagnosis and treatment of a sinus fracture can result in life-threatening conditions, such as a cerebrospinal fluid (CSF) leak. A number of different treatment algorithms have been proposed, highlighting the complexity of frontal sinus fracture management. The goal of this study is to determine how patients with frontal sinus fractures were treated at Texas Tech University Health Sciences Center and what complications arose as a result of the fracture and subsequent management strategy. Over 9 years, there were 69 reported cases. A total of 63 of these occurred in males (91.3%) versus 6 (8.7%) in females. The majority occurred after a motor vehicle collision (MVC) or a motorcycle collision (MCC). A total of 51 cases were unilateral fractures and 18 were bilateral fractures. Five patients (7.2%) had CSF leakage and 64 (92.8%) did not have CSF leakage. One patient with CSF leakage (20.0%) was managed operatively. Of the 64 patients without CSF leakage, 4 (6.3%) were managed operatively. All operative patients were managed by cranialization. Complications included vision changes, facial pressure, anosmia, facial paresthesia, pneumocephalus, and mucus retention cysts. Vision changes were the most common complication. There did not appear to be any significant difference in complications between the CSF leakage groups, indicating that non-operative management remains a viable option in the management of frontal sinus fractures.

Quite a Pickle: A 10-Year Increase in Pickleball-Related Hand Injuries.

BACKGROUND: Pickleball popularity has significantly increased in the United States. Wrist, hand, and finger injuries are commonly seen among pickleball players and are on the rise. METHODS: The National Electronic Injury Surveillance System database was queried from 2013 to 2022 tennis- and pickleball-related injuries in the United States. Data were filtered to include wrist, hand, and finger injuries only. RESULTS: There were a total of 12 021 estimated pickleball injuries between 2013 and 2022, most commonly in white women greater than 55 years old. The most common mechanism of injury (90.5%) was a fall. The number of injuries increased by 765.6% between 2013 and 2022. The growth in the number of pickleball-related injuries was found to be statistically significant (P < .05), whereas the growth for tennis-related injuries was found to be not statistically different from 0. There was a statistical difference between the growth of the number of pickleball injuries per year and the number of tennis injuries. The wrist was the most common location of injury (70.0%) compared with the hand (10.5%) and fingers (19.5%). The most common injury diagnosis was fracture (60.3%). Overall, the most common injury was wrist fracture (50.0%). CONCLUSIONS: Hand surgeons should be aware of the increasing prevalence of pickleball-related injuries as an alternative mechanism of injury, particularly among the elderly.

Public Perception of Scrub Color and Style in Plastic Surgery.

Background: Scrubs have become widespread office attire for plastic surgeons. The purpose of this study is to evaluate the public perception of scrub color and style for plastic surgeons. Methods: A crowdsourced survey was performed via MTurk. Respondents were asked to rate images of a surgeon dressed in black, navy, blue, and green scrubs as well as traditional or fitted scrubs. Qualities including representativeness, skill, trustworthiness, knowledge, and compassion were rated on a Likert scale across all images. Analysis of variance and one-sided t test were used to analyze differences in means. Results: In total, 562 responses were collected. For female plastic surgeons, navy and blue scrubs were perceived to be superior to those wearing black for skill, representativeness, trustworthiness, and compassion (P < 0.05). For male plastic surgeons, navy and blue scrubs were superior to black for knowledge, skill, representativeness, trustworthiness, and compassion (P < 0.05). For skill and representativeness, navy was superior to green (P < 0.05). For representativeness, blue was superior to green (P < 0.05). For trustworthiness and compassion, green was superior to black (P < 0.05). Fitted scrubs were significantly preferred (P < 0.05) across all characteristics with the exception of representativeness in the subgroup of male plastic surgeons. Conclusions: Black scrubs are associated with more negative characteristics than navy or blue scrubs, which were found to be the most positively perceived. Fitted scrubs were associated with positive characteristics for both male and female surgeons. The purchase of fitted scrubs may be a worthwhile purchase to maximize the patient-physician relationship.

The Experience of the Virtual Interview Process for Hand Fellowship Program Directors.

Purpose: Due to the Coronavirus Disease-19 pandemic, the fellowship application process has transitioned from in-person interviews to virtual interviews. Although several studies have assessed the impact of Coronavirus Disease-19 on residency and fellowship interviews, fewer studies have investigated the program director's perspective. Therefore, the aim of this study was to assess the experience of virtual interviews on hand fellowship program directors and understand some of the important factors that may make an applicant more competitive. Methods: A 21-question survey was conducted through Google Forms and distributed through a standardized email to hand fellowship program directors and coordinators. Questions used a 5-point Likert scale with the opportunity for respondents to answer some questions in a free-response format. Statistical analysis was conducted with significance assigned to P values < .05. Results: Ninety-three surveys were distributed, of which 35 responses were obtained, corresponding to a 37.6% survey response rate. Program directors reported that they tended to place more emphasis on applicant's curriculum vitae, calls from colleagues, and applicants that they had previously met. In addition, program directors felt that applicants were able to accurately represent themselves through the virtual format. Finally, most program directors stated that they were highly likely to continue to offer virtual interviews. Conclusions: With several parenting organizations and program directors affirming that they are comfortable with proceeding with virtual interviews, it is essential for hand fellowship applicants to understand what factors program directors may perceive as more important. It is possible that the virtual interview process may effectively achieve suitable matches between applicants and institutions. Type of study/level of evidence: Decision analysis IIIb.

Applying GPT-4 to the Plastic Surgery Inservice Training Examination.

BACKGROUND: The recent introduction of Generative Pre-trained Transformer (GPT)-4 has demonstrated the potential to be a superior version of ChatGPT-3.5. According to many, GPT-4 is seen as a more reliable and creative version of GPT-3.5. OBJECTIVE: In conjugation with our prior manuscript, we wanted to determine if GPT-4 could be exploited as an instrument for plastic surgery graduate medical education by evaluating its performance on the Plastic Surgery Inservice Training Examination (PSITE). METHODS: Sample assessment questions from the 2022 PSITE were obtained from the American Council of Academic Plastic Surgeons website and manually inputted into GPT-4. Responses by GPT-4 were qualified using the properties of natural coherence. Incorrect answers were stratified into the consequent categories: informational, logical, or explicit fallacy. RESULTS: From a total of 242 questions, GPT-4 provided correct answers for 187, resulting in a 77.3% accuracy rate. Logical reasoning was utilized in 95.0% of questions, internal information in 98.3%, and external information in 97.5%. Upon separating the questions based on incorrect and correct responses, a statistically significant difference was identified in GPT-4's application of logical reasoning. CONCLUSION: GPT-4 has shown to be more accurate and reliable for plastic surgery resident education when compared to GPT-3.5. Users should look to utilize the tool to enhance their educational curriculum. Those who adopt the use of such models may be better equipped to deliver high-quality care to their patients.

Detailed Anatomy and Reconstructive Approach of a Wassel VI Thumb Duplication.

Thumb duplication is a congenital hand difference that occurs in 0.08 of every 1000 live births and is categorized by level of duplication by the Wassel classification system. The anatomy and reconstruction of type VI thumb duplication is not well described, likely due to its rarity. In this report, we detail the anatomy and reconstruction of an ulnar-dominant Wassel VI thumb duplication, with particular attention paid to management of the first CMC joint and intrinsic muscle rebalancing of the preserved digit.

Medicaid for the Plastic and Reconstructive Surgeon.

Medicaid is a complex federally and state funded health insurance program in the United States that insures an estimated 76 million individuals, approximately 20 percent of the U.S. population. Many physicians may not receive formal training or education to help understand the complexities of Medicaid. Plastic surgeons, residents, and advanced practice practitioners benefit from a basic understanding of Medicaid, eligibility requirements, reimbursement methods, and upcoming healthcare trends. Medicaid is implemented by states with certain federal guidelines. Eligibility varies from state to state (in many states it's linked to the federal poverty level), and is based on financial and nonfinancial criteria. The passage of the Affordable Care Act in 2010 permitted states to increase the federal poverty level eligibility cutoff to expand coverage for low-income adults. The aim of this review is to provide a brief history of Medicaid, explain the basics of eligibility and changes invoked by the Affordable Care Act, and describe how federal insurance programs relate to plastic surgery, both at academic institutions and in community practice environments.

A Case of Overlooked Popliteal Artery Entrapment Syndrome.

Popliteal artery entrapment syndrome (PAES) is an uncommon cause of lower extremity claudication that is often overlooked. It most commonly occurs in young athletes without risk factors for peripheral vascular disease. We present a case of a 47-year-old man who went undiagnosed for over 10 years despite multiple orthopedic, chiropractic, and neurosurgery consults. A definitive diagnosis of PAES was confirmed in the catheterization lab by angiography. The patient underwent popliteal artery bypass surgery and his symptoms completely resolved. PAES must be considered in the differential diagnosis of lower extremity pain, especially in younger patients.

Medicare for the Plastic and Reconstructive Surgeon.

Medicare, a federally funded insurance program in the United States, is a complex program about which many physicians may not receive formal training or education. Plastic surgeons, residents, and advanced practitioners may benefit from at least a basic understanding of Medicare, its components, reimbursement methods, and upcoming health care trends. Medicare consists of Parts A through D, each responsible for a different form of insurance coverage. Medicare pays hospitals, physicians, and graduate medical education. Since the introduction of Medicare, several reforms and programs have been introduced, particularly in recent years with the implementation of the Affordable Care Act. Many of these changes are moving reimbursement systems away from the traditional fee-for-service model toward quality-of-care programs. The aim of this review is to provide a brief history of Medicare, explain the basics of coverage and relevant reforms, and describe how federal insurance programs relate to plastic surgery both at academic institutions and in a community practice environment.

Rare Hypothenar Myxoma Causing Ulnar Neuropathy: Histopathology and Treatment Pearls.

A myxoma is a neoplasm comprised of mesenchymal connective tissue. Myxomas of the upper extremity, and particularly of the hand, are rare. We present a case of a hypothenar myxoma causing ulnar neuropathy in a patient with a history of acute inflammatory demyelinating process. Treatment and management of myxoma may vary depending on whether the process is malignant or benign; thus, histologic diagnosis is critical to determining treatment. The purpose of this article is to review the pathophysiology and clinical features of myxomas, and to provide recommendations for evaluating and treating individuals with extremity masses of unclear clinical diagnosis.