No Increase in Complications With Intravenous Tranexamic Acid Use in Vaginoplasty: A Retrospective Study.

Background: Across surgical specialties, tranexamic acid (TXA) is applied to reduce intraoperative and postoperative bleeding. Within plastic surgery, both topical and intravenous routes are used. The application of TXA has yet to be examined in vaginoplasties. Methods: The authors performed a retrospective chart review of Mayo Clinic patients receiving penile inversion vaginoplasty from January 2017 through July 2021. Incidence of hematoma formation was assessed as the primary outcome. Secondary outcomes included perioperative hemoglobin, vaginoplasty complications, and possible TXA complications. These outcomes were compared across topical only (t-TXA), any intravenous (IV- TXA), and no TXA groups. Results: Of the 124 vaginoplasties, 21 patients received t-TXA only and 43 received any IV-TXA. Only 4 patients developed a hematoma; 2 were from the no TXA group and 2 were from the any IV-TXA group. There was no significant change in perioperative hemoglobin across groups. Analysis showed lower incidence of divergent urine stream (odds ratio [OR], 0.499 [95% confidence interval (CI)], 0.316-0.789], P = .003) and neovaginal stenosis (OR, 0.435 [95% CI, 0.259-0.731], P = .002) within the any IV-TXA group and no increased incidence of other complications. Conclusions: The use of either t-TXA or IV-TXA in vaginoplasty cases did not result in an increased rate of complications. There was no significant reduction in hematoma formation or postoperative hemoglobin decrease across groups.

Diversity Matters: A 21-Year Review of Trends in Resident Recruitment into Surgical Specialties.

Background: Diversity within the healthcare workforce is essential to improve quality of care, although evaluation of diversity within surgical training remains limited. This study analyzed diversity in recruitment of residents into surgical subspecialties at a large academic medical institution and national trends. Methods: A 21-year cross-sectional study of medical school graduates accepted into all surgical subspecialty training programs was performed. The institutional cohort was divided into two groups (1997-2006, 2007-2017). Subspecialty acceptance rates were determined between 2011 and 2018. Data on candidate demographics including gender, race, ethnicity, citizenship, and origin of medical education at a single institution and nationally were extracted. Results: Two thousand found hundred seventy-two residents were included in this study. From 1997 to 2018, female acceptances increased from 21.1% to 29.7% (p < 0.01), non-White increased from 27.9% to 31.8% (p = 0.01), and international medical graduates decreased from 28.8% to 25.5% (p = 0.02). There was no significant change in accepted Hispanic and Non-US candidates. Female subspecialty rates for subspecialties increased nationally and was comparable to our cohort, except in general surgery. Hispanic subspecialty acceptance rates were less than 10% and Black/African American acceptance rates remained less than 5% across subspecialties nationally and at our institution. Conclusion: Diversity in surgical training has modestly progressed over the last two decades, but the degree of positive change has not been universal and highlights the critical need for improvement and action. Continued institution driven and collaborative strategies are essential to promote diversity in recruitment across all surgical specialties that has implications on our future workforce and surgical leadership.

Inferior pedicle breast reduction and long nipple-to-inframammary fold distance: How long is safe?

BACKGROUND: Free nipple grafting indications in breast reduction surgery are outdated. Safety of inferior pedicle technique for large resections and long pedicles has not been clearly defined. We evaluated patients who underwent inferior pedicle reduction mammoplasty to define the safety constraints of the inferior pedicle. METHODS: A retrospective review of patients who underwent inferior pedicle reduction mammoplasty due to symptomatic macromastia at Mayo Clinic over a six-year period was conducted. Patients with prior breast surgeries were excluded. Demographics, breast measurements, and surgical outcomes were collected. Univariate and multivariate analyses were performed to assess for predictors of necrosis. RESULTS: Overall, 288 patients (576 breasts) underwent inferior pedicle breast reduction from 2014 to 2019. The mean sternal notch-to-nipple (SNN) distance was 31.5 cm (standard deviation[SD]:4.2; range[r]:16-48), and the mean nipple-to-inframammary fold (N-IMF) distance was 14.8 cm (SD:4.0; r:7.5-27). The mean resection weight was 699.6 g (SD:310.4; r:125-2,385). The median follow-up was 3.9 months (interquartile range[IQR]:2.8-9.0). The overall skin or nipple areolar complex necrosis rate was 2.1%; the overall complication rate was 14.8%. On multivariate analysis, overall necrosis was not found to be associated with the N-IMF distance (adjusted odds ratio[aOR]:1.05, 95%-CI 0.88-1.16). Resection weight was statistically associated with an increased risk of overall necrosis (aOR:1.003, 95%-CI 1.001-1.005), adjusting for N-IMF and SNN distances. CONCLUSION: Inferior pedicle breast reduction offers low risk of necrosis and can be safely performed in patients regardless of the N-IMF distance. No association was found between N-IMF distance and overall necrosis in our cohort, including lengths >15 cm. However, large resections could increase the risk of necrosis.