The Aesthetic Surgery Education and Research Foundation (ASERF): A 30-Year Retrospective Analysis.

Federal government research grants provide limited funding to plastic surgeon-scientists, with reconstructive research taking precedence over aesthetic research. The Aesthetic Surgery Education and Research Foundation (ASERF) is a nonprofit, 501(c)(3) organization that seeks to support innovative, diverse research endeavors within aesthetic surgery. A total of 130 ASERF-funded studies and 32 non-funded applications from 1992 to 2022 were reviewed. Kruskal Wallis, Fisher's exact, and chi-squared tests were utilized to assess the potential relationship between self-identified gender, practice setting, geographical location, and study type with individual grant amounts and grant funding decision. Although significant differences were observed between male and female grant recipient h-indices (P < .05), there were no differences in the amount of funding they received (P > .05). Grant amounts were also consistent between study types as well as principal investigator practice settings and geographical locations (P > .05). The subanalysis revealed that the practice setting of the primary investigator (PI) was the only variable to exhibit a significant association with the decision to award funding (P < .05). Further, of the 61 applicants between 2017 and 2022, only 2 PIs self-identified as female. ASERF serves as an excellent funding source for global aesthetic surgery. To promote further research diversification, increased emphasis should be placed on recruiting applicants from outside academia and those who identify as female or gender nonbinary.

Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: a longitudinal study.

To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5-18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring.

Heads Up Play: Acute Assessment and Management of Basketball-Related Craniofacial Injuries by On-Court Personnel.

INTRODUCTION: With a following of over 825 million people, basketball currently ranks amongst the world's most popular sports. Despite a number of concussion awareness and player safety protocols that have been implemented at the professional level of organized play, a standardized, layperson-friendly algorithm for the acute management of basketball-related craniofacial injuries does not appear to presently exist. METHODS: This 10-year retrospective cohort study was conducted using the National Electronic Injury Surveillance System database to examine basketball-related craniofacial injuries from 2010 to 2019. Within the National Electronic Injury Surveillance System dataset, factors including patient age, gender, diagnosis, injury type, and injury location were included in our analysis. RESULTS: Overall, 22,529 basketball-related craniofacial injuries occurred between 2010 and 2019 in players ages 5 to 49 years old. Adolescent (12-18-year-old) and young adult (19-34-year-old) age groups had the highest incidence of craniofacial injuries. The adolescent cohort experienced a significantly greater proportion of concussions and lower proportion of both facial lacerations and fractures compared with the within group null hypothesis of equal proportions (P < 0.05). The young adult cohort experienced a significantly greater proportion of facial lacerations and fractures and lower proportion of concussions, contusions/abrasions, hematomas, and internal injuries compared to this cohort's null hypothesis (P < 0.05). Males experienced a significantly greater proportion of fractures, lacerations, and dental injuries and lower proportion of concussions, contusions/abrasions, and internal injuries compared to the hypothesized equality of proportions (P < 0.05). Females experienced a significantly greater proportion of concussions, contusions/abrasions, and internal injuries and lower proportion of fractures, lacerations, and dental injuries compared to the hypothesized equality of proportions (P < 0.05). CONCLUSIONS: Although several steps have already been taken at the professional level to try to promote player safety, particularly with concussion protocols and prevention of lower extremity injuries, there remains a paucity of resources to guide management of other types of acute craniofacial injury. The role of layperson-friendly educational interventions remains intriguing as a potential means of improving outcomes regardless of socioeconomic status or health literacy. Additional studies still need to be completed to determine efficacy and best future direction.

Atypical Mycobacterial Infections After Plastic Surgery Procedures Abroad: A Multidisciplinary Algorithm for Diagnosis and Treatment.

BACKGROUND: The recent rise in medical tourism, especially for cosmetic procedures, has been mirrored by an increase in the incidence of infections with Mycobacterium abscessus, which is an atypical mycobacterium that is ubiquitous in aquatic environments. M. abscessus soft tissue infections arise from the use of improperly sterilized water and surgical equipment during surgical procedures, and these infections have devastating consequences if not promptly treated. M. abscessus infections are notoriously difficult to diagnose and properly treat, and therefore, we illustrate a typical case presentation and provide a comprehensive diagnostic and treatment algorithm. METHODS: Of the patients who have presented to our hospital for treatment of cutaneous M. abscessus infections, a representative patient's story was included to illustrate the typical presentation and treatment timeline. The current literature on M. abscessus infections was reviewed, and this literature and the clinical experience of our plastic surgery and infectious disease teams were used in the creation of a diagnostic and treatment algorithm for M. abscessus infections. RESULTS: M. abscessus infections can have an incubation period of months, and the classic presenting signs include purulent drainage, violaceous nodules, and subcutaneous abscesses at the site of a recent surgery. A key finding is persistence of the infection despite debridement and empiric antibiotic treatment. Cultures grown on mycobacterial-specific growth media are considered the diagnostic criterion standard, but high clinical suspicion is enough to warrant the initiation of treatment. Treatment itself consists of surgical drainage and debridement in combination with multidrug antibiotic regimens that typically include amikacin, a macrolide, and a carbapenem or cephalosporin antibiotic, with the option for macrolide and fluoroquinolone maintenance therapy. CONCLUSIONS: M. abscessus cutaneous infections present with unique history and physical examination findings and often require complex diagnostic workups and treatment plans. Increased provider awareness of the management and potential complications of M. abscessus is crucial to the improvement patient outcomes, as is a multidisciplinary approach that incorporates primary care providers, pathologists, plastic surgeons, and infectious disease specialists.

A Multidisciplinary Technique for Concurrent Panniculectomy-Living Donor Renal Transplantation.

BACKGROUND: Recently, it has been shown that panniculectomy concurrent to living donor renal transplantation is a safe option for management of renal transplant recipients with a large focal pannus. This combined management requires precise coordination of teams. We describe the technique, timing, and sequence for combined renal transplantation and panniculectomy. METHODS: We conducted a retrospective chart review of adult patients (≥18 years old) who underwent simultaneous living donor renal transplantation-panniculectomy from 2015 to 2019. A multi-team approach that included urology, transplant, and plastic surgery was used to perform the combined operations. Typically, the plastic surgery team initiates the operation by performing the panniculectomy. This is followed by kidney transplantation and graft anastomosis. The plastic surgery team then completes the operation with closure of the wound. RESULTS: Twenty patients were identified. Most were male (12:8) with a mean age of 55 years and an average body mass index of 35 kg/m. The mean total operative duration was 394 minutes. On average, 17% of operating time was devoted to panniculectomy. At 90 days follow-up, there was 100% graft survival and all patients had primary graft function. There was a 25% wound complications rate and a 15% reoperation rate. CONCLUSION: By performing panniculectomy first in the sequence, concurrent panniculectomy provides wide exposure and a large operative field for transplantation. Wound closure by plastic surgeons may mitigate the high complication rate commonly seen in obese patients with end-stage renal disease. Future studies are needed to evaluate the cost-benefit of the combined living donor renal transplantation-panniculectomy.

What Does it Mean to Be a #PlasticSurgeon? Analyzing Plastic Surgery Hashtag Utilization in Social Media.

BACKGROUND: The utilization of social media is growing among academic and private practice plastic surgeons. OBJECTIVES: The aim of this study was to determine training backgrounds and board certification of medical professionals through the use of plastic surgery-related hashtags on a single social media platform, Instagram. METHODS: Instagram was queried with 15 plastic surgery-related hashtags. Only the top 50 posts of each hashtag were analyzed at a single time point and international accounts were excluded. Data collected included account owner, degree, medical specialty, board certification, and type of post. RESULTS: The study sample consisted of 750 posts from an Instagram query in January 2019. Medical professionals accounted for 75% (n = 561) of posts. Board-certified physicians accounted for 56% (n = 420) of posts. Of the physician posters, 51% (n = 230) were trained in plastic surgery, 30% (n = 133) in otolaryngology, and 19% (n = 87) in other specialties. Facial rejuvenation content was more likely to be posted by otolaryngologists rather than plastic surgeons (P ≤ 0.001), whereas body-contouring procedures were more likely to be posted by plastic surgeons. Nonsurgical procedures and injectables were more likely to be posted by nonphysicians (P ≤ 0.001). Physicians without training in plastic surgery or otolaryngology were also more likely to post nonsurgical procedure-related hashtags (P ≤ 0.001). CONCLUSIONS: Medical professionals publish the majority of plastic surgery-related posts on Instagram; however, the utilization of plastic surgery hashtags by other specialties may be confusing or misleading to social media users who are unaware of interdisciplinary training differences.

Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury.

BACKGROUND: Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature. OBJECTIVES: The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery. METHODS: A literature review was performed utilizing the PubMed database to identify painful complications of brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery. RESULTS: Title and abstract review followed by application of inclusion and exclusion criteria resulted in 20 clinical studies for this review, including lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear, and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; and intercostobrachial nerve after breast surgery. CONCLUSIONS: Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be employed in patients with persistent pain after aesthetic surgery.

Adipofascial Flaps With Acellular Dermal Matrix Compared With Myocutaneous Flap Reconstruction in Lumbar Myelomeningocele Defects.

BACKGROUND: Adipofascial flaps (AFF) with acellular dermal matrix (ADM) have the potential to reconstruct neural tube defects without sacrificing muscle that may be critical for long-term function. Comparative studies between myocutaneous flap (MF) reconstruction, the accepted standard reconstructive technique, and AFF/ADM remain under-reported. The aim of this study was to evaluate the safety and efficacy of myelomeningocele reconstruction using muscle sparing AFF/ADM versus MF. METHODS: A retrospective comparison was conducted on consecutive myelomeningocele patients reconstructed with MF or AFF/ADM over an 84-month period. Data analyzed included: basic demographics, defect size, reconstructive technique, complications, and length of follow-up. A supplemental meta-analysis based on systematic review of literature was performed to compare alternative reconstructive options. RESULTS: Twelve patients were identified who met inclusion criteria. Median age, weight, and defect size at reconstruction in the AFF/ADM group (n = 6) was 37.5 weeks, 3.25 kg, and 20.0 cm, respectively, and in the MF group (n = 6) was 37 weeks, 3.6 kg, and 22.5 cm (P > 0.5). For the AFF/ADM versus MF groups, median follow-up was 33.8 versus 22.6 months, reoperation rate was 0% versus 17% (P = 1.0), and complex skin flap closure rate was 17% versus 100% (P = 0.015). No cerebrospinal fluid leaks or surgical site infections occurred in either group. Meta-analysis of the literature revealed no statistically significant difference in complications rates between muscle and nonmuscle flap reconstruction (P > 0.5); potential long-term sequelae of muscle flap harvest were not included. CONCLUSIONS: Muscle sparing AFF with ADM is a safe and effective surgical alternative to muscle flaps for lumbar myelomeningocele reconstruction.

Transverse Infraclavicular Approach to the Thoracoacromial Pedicle for Microsurgical Breast Reconstruction.

BACKGROUND: In microvascular breast reconstruction, the internal mammary and thoracodorsal vessels are commonly used recipients. However, these vessels are sometimes compromised or unavailable. We hypothesize that a transverse infraclavicular (TIC) incision may provide efficient and reliable exposure to perform free flap anastomosis to the thoracoacromial (TAC) vessels for breast reconstruction. METHODS: The authors present their results from a cadaveric feasibility study and a retrospective case series of 4 consecutive breast reconstruction patients in which the TIC-TAC approach was used. RESULTS: The cadaveric dissection demonstrated a 5.5-cm pedicle length and a 3.75-mm diameter on the left side. On the right, the pedicle measured 5 cm in length and 4 mm in diameter. The dissection time was 10 minutes on the left side and 13 minutes on the right side. Five free flap breast reconstructions were performed in 4 patients using the TIC approach to the TAC artery which served as the primary recipient. The average pedicle length was 6.25 cm with a diameter of 3.55 mm. The pedicle was isolated and delivered through the infraclavicular incision in an average of 16.3 minutes on the left (n = 2) and 12.6 minutes on the right (n = 3). There were no complications, such as flap compromise or reoperation. CONCLUSIONS: The TIC-TAC approach is feasible for microvascular breast reconstruction and can be considered for use by microvascular breast surgeons.

Preventing Breast Implant Contamination in Breast Reconstruction: A National Survey of Current Practice.

BACKGROUND: Implant-based breast reconstruction is commonly performed by plastic surgeons worldwide. Bacterial contamination is of paramount concern because of its role in biofilm formation and capsular contracture. Plastic surgeons have adopted a variety of perioperative interventions in efforts to reduce implant contamination; however, definitive evidence supporting these practices is lacking. OBJECTIVE: The goal of this study was to assess current practice patterns aimed at reducing implant-related infections. METHODS: A 20-question survey assessing practices aimed at preventing breast implant-associated infections was generated and distributed via SurveyMonkey to members of the American Society of Plastic Surgery whose e-mail addresses were listed on the American Society of Plastic Surgery member Web site in April 2015. RESULTS: A total of 1979 invitations to participate in the survey were sent, and 253 responses were received during the 4-month study period. Of respondents, 81% were in private practice. Respondents averaged 21 ± 9 years in practice, and 34 ± 50 implant-based breast reconstructions were performed per year. A majority of surgeons used chlorhexidine to prepare the surgical site (52%), a triple antibiotic soak for the implant prior to placement (50%) and povidone-iodine for implant pocket irrigation (44%). A no-touch technique utilizing the Keller funnel was adopted by 69% of surgeons. Regarding antibiotic use in the postoperative period, first-generation cephalosporins (eg, cephalexin, cefadroxil) were used by a majority of surgeons (84%), and the most common duration was until drain removal (45%). CONCLUSIONS: There is considerable heterogeneity in surgical practices aimed at preventing bacterial contamination in implant-based breast reconstruction. Surgeons may benefit from high-level studies designed to create standardized evidence-based practice guidelines.

Antimicrobial Prophylaxis Practice Patterns in Breast Augmentation: A National Survey of Current Practice.

BACKGROUND: Breast augmentation is one of the most commonly performed aesthetic surgery procedures worldwide. Bacterial contamination is of paramount concern due to its role in biofilm formation and capsular contracture. Plastic surgeons have adopted a variety of perioperative interventions in efforts to reduce implant contamination, however definitive evidence supporting these practices is lacking. OBJECTIVE: The goal of this study was to assess current practice patterns aimed at reducing implant-related infections in breast augmentation and comparing them to current evidence-based medicine recommendations. METHODS: A 20-question survey assessing practices aimed at preventing breast implant associated infections was generated and distributed via SurveyMonkey to members of the American Society of Plastic Surgery whose electronic mail addresses were listed on the American Society of Plastic Surgery member website in April 2015. RESULTS: A total of 253 responses were received from the survey. Of the respondents, 81% were in private practice. Respondents averaged 21 ± 9 years in practice, and 69 ± 111 breast augmentations performed per year. A majority of surgeons used Chlorhexidine to prepare the surgical site (45%) and triple antibiotic solution both as a soak for the implant before placement (40%) as well as for implant pocket irrigation (47%). A no-touch technique using the Keller Funnel was adopted by 42% of surgeons. Regarding antibiotic use in the postoperative period, first-generation cephalosporins were used by the majority of respondents (79%), and the most common duration was for 4 to 6 days (45%). CONCLUSIONS: Although there is heterogeneity in specific aspects of antimicrobial prophylaxis during breast augmentation, there is a clear trend toward practice modification geared towards preventing bacterial contamination in breast augmentation. Surgeons may benefit from high-level studies designed to create standardized evidence-based practice guidelines.

The Dawn of Transparency: Insights from the Physician Payment Sunshine Act in Plastic Surgery.

BACKGROUND: The Physician Payments Sunshine Act (PSSA) is a government initiative that requires all biomedical companies to publicly disclose payments to physicians through the Open Payments Program (OPP). The goal of this study was to use the OPP database and evaluate all nonresearch-related financial transactions between plastic surgeons and biomedical companies. METHODS: Using the first wave of OPP data published on September 30, 2014, we studied the national distribution of industry payments made to plastic surgeons during a 5-month period. We explored whether a plastic surgeon's scientific productivity (as determined by their h-index), practice setting (private versus academic), geographic location, and subspecialty were associated with payment amount. RESULTS: Plastic surgeons (N = 4195) received a total of US $5,278,613. The median (IQR) payment to a plastic surgeon was US $115 (US $35-298); mean, US $158. The largest payment to an individual was US $341,384. The largest payment category was non-CEP speaker fees (US $1,709,930) followed by consulting fees (US $1,403,770). Plastic surgeons in private practice received higher payments per surgeon compared with surgeons in academic practice (median [IQR], US $165 [US $81-$441] vs median [IQR], US $112 [US $33-$291], rank-sum P < 0.001). Among academic plastic surgeons, a higher h-index was associated with 77% greater chance of receiving at least US $1000 in total payments (RR/10 unit h-index increase = 1.47 1.772.11, P < 0.001). This association was not seen among plastic surgeons in private practice (RR = 0.89 1.091.32, P < 0.4). CONCLUSIONS: Plastic surgeons in private practice receive higher payments from industry. Among academic plastic surgeons, higher payments were associated with higher h-indices.

Acellular dermal matrix reduces capsule formation in two-stage breast reconstruction.

Acellular dermal matrix (ADM) is commonly employed to create an inferior pocket for the tissue expander in two-stage breast reconstruction. The authors sought to determine whether placement of ADM during the first stage of reconstruction decreases the amount of capsule formation at implant exchange. Patients who underwent mastectomy and tissue expander reconstruction were included in this study. Two biopsies were obtained at the time of implant exchange, one from the pocket adjacent to the ADM and the other from the area adjacent to the pectoralis muscle. Pathology analysis was performed on each sample. Ten patients underwent immediate breast reconstruction with Alloderm during the 3-month study period. Capsule thickness was significantly greater in the areas where the expander was in direct contact with the pectoralis muscle (782 ± 194 µm) compared to those in contact with human acellular dermal matrix (hADM) (47·91 ± 110·82 µm; P < 0·05). Analysis of the sub-pectoral capsule demonstrated diffuse deposition of collagen, neutrophils, contractile myofibroblasts and synovia-like metaplasia, characteristic of a foreign body response. Conversely, within the inferior pocket where the hADM was in direct contact with the expander, we noted migration of host epithelial cells, fibroblasts, mesenchymal cells and angiogenesis, indicating host tissue regeneration. Acellular dermal matrix, when placed at the first stage of breast reconstruction, significantly reduces thickness and inflammatory character of the capsule in comparison to the patient's native tissue.

Management of Mycobacterium abscessus Infection After Medical Tourism in Cosmetic Surgery and a Review of Literature.

INTRODUCTION: Despite news reports, Food and Drug Administration disclaimers, and warnings from US plastic surgeons against the perils of cosmetic tourism, patients continue to seek care abroad and often present with infectious complications. Recent reports of Mycobacterium abscessus surgical site infection (SSI) is of particularly concern and its management, particularly surgical intervention, has been poorly documented. METHODS: A retrospective review of 2 sisters who presented with M. abscessus SSI after cosmetic surgery in the Dominican Republic was performed. A comprehensive review of the literature was conducted to unveil similar cases after cosmetic tourism. RESULTS: Both patients presented four months after index operation after definitive diagnoses have been reached. They were counselled to undergo immediate, aggressive debridement and antibiotic therapy. Although 1 patient agreed, the other patient opted for local wound care and oral antibiotics in hopes to avoid reoperation. When unsuccessful, she agreed to the initial plan which led to rapid convalescence of her infection. However, aesthetic result was far inferior to the first patient. Review of literature revealed 14 women with an average age of 40 years (range, 19-60 years). Most frequent cosmetic operations that resulted in M. abscessus SSI were abdominoplasty (41%), liposuction (27%), breast augmentation (14%), breast reduction (9%), and rejuvenation surgery (9%). Surgical interventions were performed in all cases except one. Antibiotic therapies focused on macrolides, particularly clarithromycin or azithromycin, with average time to complete recovery of 8 months (range, 2-22 months). CONCLUSIONS: The 2 cases highlighted the importance of multidisciplinary approach of early aggressive surgical intervention and long-term intravenous antibiotics in treating M. abscessus SSI that is highly prevalent among those returning from medical tourism in cosmetic surgery.

Techniques to Repair Implant Malposition after Breast Augmentation: A Review.

BACKGROUND: Implant malposition is a complication of breast augmentation that adversely affects aesthetic outcomes. It is one of the most common reasons for revisionary aesthetic breast surgery yet there is a lack of peer reviewed literature dedicated to the management of this complication. OBJECTIVES: The purpose of this article was to summarize the malposition literature, review the types and causes of this complication, and evaluate the strengths and weakness of procedures aimed at addressing it. METHODS: A review of the literature was performed using the PubMed database. Articles describing surgical techniques for correction of implant malposition, as well as outcome data for patients undergoing revision with described techniques, were included. Articles describing revisionary surgery following breast reconstruction were excluded. A series of cases are presented to illustrate techniques discussed. RESULTS: Search criteria resulted in 763 articles. Title and abstract review followed by application of inclusion and exclusion criteria resulted in a total of 21 clinical studies from 1988 to 2014 that were included in this review. All studies included in this study were of level IV or V evidence. CONCLUSIONS: Despite the overall low level of evidence in the literature regarding secondary breast augmentation, a thorough understanding of the corrective techniques presented will allow surgeons to make the most informed judgments. Weighing the strengths and weakness of these surgical techniques in the context of each patient will allow surgeons to develop the most appropriate treatment strategy. LEVEL OF EVIDENCE 4: Therapeutic.

A Comparison of Research Productivity Across Plastic Surgery Fellowship Directors.

BACKGROUND: Objective measures of research productivity depend on how frequently a publication is cited. Metrics such as the Hirsch index (h-index; total number of publications h that have at least h citations) allow for an objective measurement of the scientific impact of an author's publications. OBJECTIVES: The purpose of this study was to assess and compare the h-index among aesthetic plastic surgery fellowship directors to that of fellowship directors in craniofacial surgery and microsurgery. METHODS: We conducted a cross-sectional study of all fellowship directors in aesthetic surgery, craniofacial surgery, and microsurgery in the United States and Canada. The gathered data were categorized as bibliometric (h-index, i10-index, total number of publications, total number of citations, maximum citations for a single work, and number of self-citations) and demographic (gender, training background). Descriptive statistics were computed. RESULTS: The sample was composed of 30 aesthetic surgeons (93% male), 33 craniofacial surgeons (97% male), and 32 microsurgeons (94% male). The mean h-index was 13.7 for aesthetics, 16.9 for craniofacial, and 12.4 for microsurgery. There were no significant differences for any of the bibliometric measures between the three subspecialties, despite the fact that academic rank and years in practice were significantly different. CONCLUSIONS: As measured by the h-index, there is a high level of academic productivity among fellowship directors, regardless of subspecialty area. Unlike other plastic surgery subspecialties however, the h-index of aesthetic plastic surgeons is not correlated to academic rank, revealing a discrepancy between perceptions of aesthetic plastic surgery and its actual academic impact.

The 'French Fry' VAC technique: hybridisation of traditional open wound NPWT with closed incision NPWT.

Surgical site occurrences (SSO), specifically surgical site infections represent a significant burden in the US health care system. It has been hypothesised that postoperative dressing can help drive down SSO. We describe the successful use of a novel technique combining both closed incision and open negative pressure wound therapy in the management of a high-risk wound associated with lymphoedema of obesity.

Porcine acellular dermal matrix (PADM) vascularises after exposure in open necrotic wounds seen after complex hernia repair.

Biological alternatives to synthetic meshes are increasingly utilised in complex abdominal wall reconstruction. There is a lack of evidence demonstrating that non-cross-linked porcine acellular dermal matrix vascularizes and integrates with human tissue in suboptimal wound conditions. We aimed to evaluate these properties in Strattice™ (Life Cell Inc., Branchburg, NJ) following ventral hernia repair. A retrospective review of patients with high-risk ventral hernia repair utilising Strattice™ as an onlay after open component separation was conducted. Patients with postoperative wound exploration and exposure of the onlay were included in this review. One patient underwent punch biopsy for histological analysis. Eleven patients with wound complications necessitating postoperative debridement and exposure of Strattice™ onlay were identified. The onlay was partially debrided in two cases, and one case required complete excision. Vascularisation was clinically evident in 10 of 11 cases (91%) as demonstrated by the presence of granulation tissue and/or the ability to support a skin graft. Histological analysis of one onlay 3 months postoperatively showed neovascularisation and collagen remodelling with minimal inflammatory response. Strattice™ demonstrated resistance to rejection, ability to undergo vascularisation and incorporation into host tissues in sub-optimal wound conditions following ventral hernia repair.

Massive localized lymphedema revisited: a quickly rising complication of the obesity epidemic.

Massive localized lymphedema (MLL) is a rising and potentially fatal complication of the obesity epidemic. Described as a benign lymphoproliferative overgrowth of obese patients, MLL is a form of secondary lymphedema, caused by the obstruction of lymphatic flow, with characteristic clinical and histological presentation. Patients have a large mass with classic skin changes often accompanied by lymphatic weeping that require complex reconstruction. Although oftentimes benign, if left untreated, MLL can progress to angiosarcoma, further supporting the need for more research into MLL and its sequelae. We present a unique case of MLL of the mons pubis in a 52-year-old man with a body mass index of 75.7 kg/m. The literature was comprehensively reviewed with a total of 65 cases of MLL being described, 9 of which resulted in angiosarcoma (10.3% of all cases), 6 of which resulted in death (9.2% of all cases). We found a female predominance of 1.24 to 1, an average weight of 183 kg, and a 48.5% majority of cases in the thigh.