An Evidence-Based Approach to Management of Pectus Excavatum and Carinatum.

Pectus excavatum (PE) and pectus carinatum (PC) are the most common congenital chest wall anomalies. Current research suggests that PE and PC may result from overgrowth of the sternocostal cartilages. This can produce a deformation that displaces the sternum inward as in PE or outward as in PC. The etiology, clinical presentation, evaluation, and management of PE and PC are reviewed. Varied clinical presentations, cardiopulmonary effects, and psychosocial aspects are described.

Predicting postoperative complications of inguinal lymph node dissection for penile cancer in an international multicentre cohort.

OBJECTIVES: To assess the potential complications associated with inguinal lymph node dissection (ILND) across international tertiary care referral centres, and to determine the prognostic factors that best predict the development of these complications. MATERIALS AND METHODS: A retrospective chart review was conducted across four international cancer centres. The study population of 327 patients underwent diagnostic/therapeutic ILND. The endpoint was the overall incidence of complications and their respective severity (major/minor). The Clavien-Dindo classification system was used to standardize the reporting of complications. RESULTS: A total of 181 patients (55.4%) had a postoperative complication, with minor complications in 119 cases (65.7%) and major in 62 (34.3%). The total number of lymph nodes removed was an independent predictor of experiencing any complication, while the median number of lymph nodes removed was an independent predictor of major complications. The American Joint Committee on Cancer stage was an independent predictor of all wound infections, while the patient's age, ILND with Sartorius flap transposition, and surgery performed before the year 2008 were independent predictors of major wound infections. CONCLUSIONS: This is the largest report of complication rates after ILND for squamous cell carcinoma of the penis and it shows that the majority of complications associated with ILND are minor and resolve without prolonged morbidity. Variables pertaining to the extent of disease burden have been found to be prognostic of increased postoperative morbidity.

Amniotic Band Syndrome: Head-to-Toe Manifestations and Clinical Management Guidelines.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand and describe the basic principles underlying the intrinsic versus extrinsic proposed mechanisms for the development of amniotic band syndrome (ABS). 2. Discuss risk factors and conditions that are associated with the development of ABS. 3. Understand the various presentations and associated clinical implications of ABS by anatomic location. 4. Describe the basic tenets underlying various repair technique options for ABS of the extremities. 5. Discuss the common manifestations of ABS in the face and trunk. 6. Understand clinical implications of fetoscopic surgery as it relates to ABS treatment as a novel method for limb salvage in utero. SUMMARY: Amniotic band syndrome (ABS) refers to the development of constrictive bands of fibrotic tissue in utero. It can lead to a variety of clinical manifestations after delivery. There is much debate in the plastic surgery community regarding the exact pathophysiologic mechanism for the development of ABS, and the most appropriate management. This CME article aims to provide an overview of ABS manifestations throughout the body, and to expound on the most recent advances in anticipatory and definitive management of the condition.

Auricular reconstruction after Mohs excision utilizing combination of pre-auricular transposition and chondrocutaneous advancement flaps.

Auricular reconstruction can pose a challenge for any well-trained plastic surgeon, especially with the COVID-19 pandemic and pressure to decrease stages and office visits. The case report involves a single-stage reconstruction of the auricular upper-third in an elderly male using a unique combination of pre-auricular fasciocutaneous transposition and chondrocutaneous advancement flaps.

Nipple-areolar tattoo: Comprehensive review of history, theory, technique, and outcomes.

Breast reconstruction aims to achieve a natural look and can involve manipulation or removal of the nipple-areola complex (NAC) as well. One of the final steps of the breast reconstruction process involves creation of the appearance of a new NAC, either via surgical intervention or medical tattooing. Medical tattooing involves little to no surgical intervention while still resulting in aesthetically pleasing results. This specific type of tattooing can be performed by a member of the plastic surgeon team, or a medical tattoo specialist. Integration of this method into plastic surgery practice can prove beneficial to the patient as a viable solution for aesthetically pleasing NAC recreation.

For What It's Worth: Medical School Reputation in The Integrated Plastic Surgery Match.

Integrated Plastic and Reconstructive Surgery residency programs may use medical school reputation to help fill the gap of a pass/fail USMLE Step 1 in the match. The main objective of this manuscript was to consider if this shifting emphasis is warranted. Herein, a cross-sectional analysis of academic plastic surgeons found that medical school reputation did not predict career achievement. In the absence of evidence demonstrating its worth, residency programs should exercise caution in using medical school reputation in the match.

Hand and Upper Extremity Trauma in the Undocumented Immigrant Population in the United States.

Undocumented immigrants in the United States are at risk for upper extremity trauma due to occupational exposure, and decreased access to healthcare can worsen outcomes. The purpose of this study was to compare documented versus undocumented patients in a large cohort of patients in New York City's most diverse neighborhood in order to characterize upper extremity trauma in this population. METHODS: The Elmhurst Hospital trauma database was examined for patients admitted with upper extremity trauma from April 2016 to December 2019. Charts were examined for demographic information, documentation status, injury mechanism, and outcomes. RESULTS: Of the 1041 patients included, 865 (83.1%) were documented and 176 (16.9%) were undocumented. Undocumented immigrants were younger (40.5 versus 62.4 years, P < 0.0001) and predominantly men (83.5% versus 57.1%, P < 0.0001) with fewer comorbidities (42.6% versus 64.6%, P < 0.0001). Occupational injury was three times as likely in undocumented immigrants (13.6% versus 4.6%, P < 0.0001) and these patients were nearly twice as likely to be harmed from violence (19.9% versus 10.2%, P = 0.0003). Increased rates of injury during bicycle/motorcycle accidents (8.0% versus 3.0%, P = 0.0017) or being struck as a pedestrian (21.6% versus 14.3%, P = 0.0149) were found in the undocumented cohort, with falls (39.8% versus 59.3%, P < 0.0001) or vehicle collisions (0.6% versus 3.5%, P = 0.0402). CONCLUSIONS: Undocumented patients with upper extremity trauma represent a younger/healthier cohort, but are more likely to be injured at work or by violence. Documentation status plays a role in injury characteristics.

The Cutting Edge: Surface Texture Analysis following Resection of Nerve Stumps Using Various Instruments.

BACKGROUND: Preparation of nerve ends is an essential part of nerve repair surgery. Multiple instruments have been described for this purpose; however, no consensus exists regarding which is the least traumatic for tissue handling. We believe that various instruments used for nerve-end excision will lead to different surface roughness. METHODS: Median and ulnar nerves from fresh frozen cadavers were dissected, and 1-2 cm lengths were excised using a No. 11 blade, a razor blade, or a pair of scissors. Using electron microscopy, 3-dimensional surface analysis of roughness (Sa) for each specimen was performed using ZeeScan optical hardware and GetPhase software (PhaseView, Buisson, France). An ANOVA or Kruskal-Wallis test compared roughness measures among cutting techniques. RESULTS: Forty nerves were included. Of these, 13 (32.5%) were cut using scissors, 15 (37.5%) using a razor blade, and 12 (30%) using a No. 11 blade. An ANOVA test showed statistical differences in Sa among the cutting techniques (P = 0.002), with the lowest mean Sa noted in the scissors group (7.2 µM, 95% CI: 5.34-9.06), followed by No. 11 blade (7.29 µM, 95% CI: 5.22-9.35), and razor blade (11.03 µM, 95% CI: 9.43-12.62). Median Ra (surface profile roughness) was 4.58 (IQR: 2.62-5.46). A Kruskal-Wallis test demonstrated statistical difference in Ra among techniques (P = 0.003), with the lowest by No. 11 blade (3 µM, IQR: 1.87-4.38), followed by scissors (3.29 µM, IQR: 1.56-4.96), and razor (5.41 µM, IQR: 4.95-6.21). CONCLUSION: This novel technique of 3-dimensional surface analysis found razor blade use demonstrated poor roughness, whereas a No. 11 blade or nerve-specific scissors led to equivocally smooth nerve ends.

Narrative Review of Ligamentous Wrist Injuries.

Ligamentous wrist injuries are common occurrences that require complex anatomical mastery and extensive understanding of diagnostic and treatment modalities. The purpose of this educational review article is to delve into the most clinically relevant wrist ligaments in an organized manner to provide the reader with an overview of relevant anatomy, function, clinical examination findings, imaging modalities, and options for management. Emphasis is placed on elucidating reported diagnostic accuracies and treatment outcomes to encourage evidence-based practice.

The evolution of mastectomy surgical technique: from mutilation to medicine.

Breast surgeries for cancer and tumors were first described approximately 3,000 years ago, and since that time the standard of management has changed dramatically. From Egyptian papyri to Hippocratic theory, from Galen's dissections to Halsted's radical mastectomy, and from sentinel lymph node mapping to the development of nipple-sparing mastectomies, this review starts at the beginning and highlights breakthroughs and innovation in technique and medicine that have fundamentally changed the way breast cancer is managed. The progression depicted in this review acts as a proxy to the management of other complex diseases. Breast cancer was initially managed with operative extirpation alone, but now requires a multidisciplinary team across various surgical, medical, psychological, and social specialties in order to produce the best outcomes for our patients.