Diversity of Leadership and Its Influence on Diversity of Integrated Plastic Surgery Residency Cohorts: A Study in the Virtual Era.

Background: In the aftermath of COVID-19, the residency application process has largely remained in the virtual space, introducing a new challenge to prospective integrated plastic surgery residents. Many programs enhanced their online presence to address this challenge, but both programs and applicants are still limited to a virtual snapshot when determining "fit." An important influence of fit is the ability to racially, ethnically, and/or culturally identify with the program. The aims of this study are to: (1) better understand the online information that residency programs are making available to prospective applicants, (2) characterize the racial diversity of programs, and (3) investigate the effect of program leadership on racial diversity. Methods: A cross-sectional study of US integrated plastic surgery residency programs was performed in August 2022. Data on race were collected for residency program directors and resident cohorts and compared with self-reported data from the Association of American Medical Colleges (AAMC). Relationships between these groups were analyzed. Results: Racial data were collected on 82 program directors and their corresponding residency cohorts, representing a total of 1174 individuals. These data closely matched the AAMC data on race/ethnicity in plastic surgery programs. By race, the smallest percentage of resident groups are Black/African American (3.4%) and Hispanic (4.2%). Though not statistically significant, more residents of a given race are in programs with a director of the same race. Conclusions: Online information about residency programs and their cohorts is robust. The racial diversity of a residency cohort is positively associated with racial diversity of program directors.

The Expanding Utility of Robotic-Assisted Flap Harvest in Autologous Breast Reconstruction: A Systematic Review.

The expansion of robotic surgery has led to developments in robotic-assisted breast reconstruction techniques. Specifically, robotic flap harvest is being evaluated to help maximize operative reliability and reduce donor site morbidity without compromising flap success. Many publications are feasibility studies or technical descriptions; few cohort analyses exist. This systematic review aims to characterize trends in robotic autologous breast reconstruction and provide a summative analysis of their results. A systematic review was conducted using PubMed, Medline, Scopus, and Web of Science to evaluate robot use in breast reconstruction. Studies dated from 2006 to 2022 were identified and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Full-text, peer-reviewed, English-language, and human subject studies were included. Non-breast reconstruction articles, commentary, expert opinion, editor's letter, and duplicate studies were excluded. A total of 17 full-text articles were analyzed. The two robotic breast procedures identified were the deep inferior epigastric perforator (DIEP) and the latissimus dorsi (LD) flap. Results showed comparable complication rates and increased operative times compared to NSQIP data on their corresponding open techniques. Additional findings reported in studies included patient reported outcomes, incision lengths, and downward trends in operative time with consecutive procedures. The available data in the literature confirms that robotic surgery is a promising alternative to traditional open methods of breast reconstruction following mastectomy.

Breast Implant-Associated Anaplastic Large Cell Lymphoma Following Gender Reassignment Surgery: A Review of Presentation, Management, and Outcomes in the Transgender Patient Population.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma with approximately 650-700 reported cases worldwide. The incidence, however, is increasing as more practitioners become aware of the diagnosis, and recent studies show that early diagnosis and treatment is critical to improve prognosis. There have been four cases of BIA-ALCL in total reported in the transgender population in the literature. These reported cases were reviewed in detail to determine presentation and management of BIA-ALCL in transgender patients compared to the larger population of BIA-ALCL patients. This review highlights BIA-ALCL in transgender women, a population that is often excluded from breast screening and follow-up. Transgender women may not routinely go through the same post-operative follow-up protocols as patients with breast implants for breast cancer reconstruction and can thus be at risk for delayed recognition and diagnosis. BIA-ALCL is a rare complication of breast implantation, and it is important to counsel all patients undergoing implant placement, including transgender women, on its risk.

Laser-assisted indocyanine green imaging to assess perfusion of scalp closure in an infant.

The current treatment of craniosynostosis is open surgical excision of the prematurely fused suture and cranial vault remodeling. Due to the change in skull morphology and the increase in volume, some tension on the skin flaps is noted with closure. Although complete wound breakdown is rare, it can be a devastating complication. We present our experience with the use of the SPY imaging system (Lifecell Corporation, Branchburg, NJ, USA) to visualize and record blood flow within the flaps of a 1-year-old patient with anterior plagiocephaly. Intraoperative indocyanine green angiography has the potential to be a significant advantage in such cases, providing a safe and objective method to assess intraoperative scalp perfusion, allowing the surgeon to take additional measures to ameliorate any ischemic problems.

Abdominal wall reconstruction following severe loss of domain: the R Adams Cowley Shock Trauma Center algorithm.

BACKGROUND: Large, complex, posttraumatic and recurrent abdominal hernias present a reconstructive challenge. Multiple techniques have been described to restore the integrity of the abdominal wall, although the indications and applications can be difficult to navigate. The authors propose an algorithm that facilitates the assessment and treatment of secondary large ventral defects. METHODS: The algorithm described involves a systematic approach to abdominal wall reconstruction and was applied to 23 consecutive patients at the R Adams Cowley Shock Trauma Center. Data collected from the chart review included age, body mass index, mechanism of injury, placement of skin graft and use of resorbable mesh before definitive reconstruction, size of defect, number of tissue expanders placed, length of follow-up, and complications. RESULTS: There were six female patients and 17 male patients, with an average age of 36 years. The average follow-up was 7 months. Seventeen patients had posttraumatic laparotomies, five patients had aggressive abdominal wall debridement following necrotizing fasciitis, and one patient developed a large abdominal wall hernia following complications from gastric bypass surgery. All patients underwent delayed abdominal wall reconstruction, with an average time to initial reconstruction of 19.5 months. Sixteen patients had no postoperative complications. Seven patients had complications, including one with an enterocutaneous fistula, one with a partial small bowel obstruction, two with seromas, one with a superficial wound infection, and two with recurrent abdominal wall laxity. CONCLUSIONS: The reconstructive ladder for large, complex abdominal hernias is poorly defined. The proposed algorithm provides a systematic staged approach that incorporates available techniques used for delayed reconstruction of the abdominal wall.

Stabilization of p53 is a novel mechanism for proapoptotic function of NF-kappaB.

Both pro- and antiapoptotic activities of NF-kappaB transcription factor have been observed; however, less is known about the mechanism by which NF-kappaB induces apoptosis. To elucidate how NF-kappaB regulates proapoptotic signaling, we performed functional analyses using wild-type, ikk1(-/-), ikk2(-/-), rela(-/-) murine fibroblasts, MDAPanc-28/Puro, MDAPanc-28/IkappaBalphaM, and HCT116/p53(+/+) and HCT116/p53(-/-) cells with investigational anticancer agent doxycycline as a superoxide inducer for generating apoptotic stimulus. In this report, we show that doxycycline increased superoxide generation and subsequently activated NF-kappaB, which in turn up-regulated p53 expression and increased the stability and DNA binding activity of p53. Consequently, NF-kappaB-dependent p53 activity induced the expression of p53-regulated genes PUMA and p21(waf1) as well as apoptosis. Importantly, lack of RelA, IKK, and p53 as well as expression of a dominant negative IkappaBalpha (IkappaBalphaM) inhibited NF-kappaB-dependent p53 activation and apoptosis. The doxycycline-induced NF-kappaB activation was not inhibited in HCT116/p53(-/-) cells. Our results demonstrate that NF-kappaB plays an essential role in activation of wild-type p53 tumor suppressor to initiate proapoptotic signaling in response to overgeneration of superoxide. Thus, these findings reveal a mechanism of NF-kappaB-regulated proapoptotic signaling.