Parenting in Plastic Surgery Residency.

BACKGROUND: In 1994, Mackinnon advocated that plastic surgery residents should have accessible child care to promote a productive return to work. Decades later, lack of adequate child care remains a dilemma for trainees. The authors' survey aims to evaluate childrearing during plastic surgery training. METHODS: An anonymous, voluntary survey was sent to plastic surgery residents. It evaluated demographics, childcare accommodations, and attitudes/issues surrounding childrearing during residency. RESULTS: There were 32 respondents: 66 percent women and 34 percent men. Seventy-five percent were married, and 38 percent were parents. Seventy-five percent of male parents compared to 12 percent of female parents reported that their spouse was the primary childcare source. One hundred percent of respondents with children reported that child care creates a financial burden. Three percent of respondents felt their institution provided services to arrange adequate child care. Sixty-three percent of residents felt their program did not allow flexibility to accommodate childcare needs. Female residents missed work twice as often and were twice as likely to require a co-resident to cover clinical duties because of childcare difficulties when compared to male residents (p = 0.296 and p = 0.145). Sixty-seven percent of women agreed with the statement, "If you had to pick a residency program today, the availability of on-site child care would influence your decision," compared to only 9 percent of men (p = 0.002). CONCLUSIONS: Training institutions are not meeting the childcare needs of plastic surgery trainees. If the specialty wishes to recruit and retain the top applicants, it must improve the childcare accommodations for residents. All institutions with plastic surgery residency programs should provide affordable, accessible child care that accommodates the 24-hour natures of both patient care and parenthood.

Totally extraperitoneal approach for open complex abdominal wall reconstruction.

BACKGROUND: Ventral hernia repair is typically performed via a transabdominal approach and the peritoneal cavity is opened and explored. Totally extraperitoneal ventral hernia repair (TEVHR) facilitates dissection of the hernia sac without entering the peritoneal cavity. This study evaluates our experience of TEVHR, addressing technique, decision-making, and outcomes. METHODS: This is an IRB-approved retrospective review of open TEVHR performed between January 2012 and December 2016. Medical records were reviewed for patient demographics, operative details, postoperative outcomes, hospital readmissions, and reoperations. RESULTS: One hundred sixty-six patients underwent TEVHR (84 males, 82 females) with a mean BMI range of 30-39. Eighty-six percent of patients underwent repair for primary or first-time recurrent hernia, and 89% CDC wound class I. Median hernia defect size was 135 cm2. Hernia repair techniques included Rives-Stoppa (34%) or transversus abdominis release (57%). Median operative time was 175 min, median blood loss 100 mL, and median length of stay 4 days. There were no unplanned bowel resections or enterotomies. Four cases required intraperitoneal entry to explant prior mesh. Wound complication rate was 27%: 9% seroma drainage, 18% superficial surgical site infection (SSI), and 2% deep space SSI. Five patients (3%) required reoperation for wound or mesh complications. Over the study, four patients were hospitalized for postoperative small bowel obstruction and managed non-operatively. Of the 166 patients, 96%, 54%, and 44% were seen at 3-month, 6-month, and 12-month follow-ups, respectively. Recurrences were observed in 2% of patients at 12-month follow-up. One patient developed an enterocutaneous fistula 28 months postoperatively. CONCLUSIONS: TEVHR is a safe alternative to traditional transabdominal approaches to ventral hernia repair. The extraperitoneal dissection facilitates hernia repair, avoiding peritoneal entry and adhesiolysis, resulting in decreased operative times. In our study, there was low risk for postoperative bowel obstruction and enterotomy. Future prospective studies with long-term follow-up are required to draw definitive conclusions.

Cardioplastic Approach to Omental Flap Coverage for Severe Aortic Root Infections in the Opioid Era.

Aortic root abscesses are severe sequelae of endocarditis that clinically manifest as life-threatening infection. As the opioid epidemic continues to yield a national crisis, the incidence and severity of this disease process have increased. Reconstruction of the aortic root is a challenging undertaking and carries the risk of recurrent infection. The omentum has an established reputation as a reliable flap in thoracic reconstruction, given its amorphous form and immunogenic properties, but it has not been utilized for aortic root infections. We present a novel indication for the omental flap using a cardioplastic approach in coverage of aortic root reconstruction. Four patients were treated with pedicled omental flap coverage after aortic root reconstruction. All patients had successful flap healing with no evidence of recurrent infection. This series demonstrates the technical feasibility and clinical utility for providing soft tissue coverage and antimicrobial protection when used in aortic root reconstruction.

Rural-Urban Differences in Breast Reconstruction Utilization Following Oncologic Resection.

BACKGROUND: Breast reconstruction (BR) is the reconstructive surgical technique that focuses on restoring normal form and function to the breast following oncologic resection. The goal of this study was to determine if BR disparities exist among rural female patients in Kentucky. METHODS: A retrospective (2006-2015), population-based cohort study was conducted on breast cancer patients (stages I-III) treated with mastectomy with or without BR. We used 2013 Beale codes to stratify patients according to geographic status. Chi-square tests were used to examine the association of BR along the rural-urban continuum. A multivariate logistic regression model controlling for patient, disease, and treatment factors was used to predict BR. The likelihood of BR was reported in odds ratios (OR) using a 95% confidence interval (CI). RESULTS: Overall, 10,032 patients met study criteria. Of those, 2,159 (21.5%) underwent BR. The rate of BR among urban, near-metro, and rural patients was 31.1%, 20.4%, and 13.4%, respectively (P < .001). Multivariate analysis revealed that women from near metro (OR 0.54, CI: 0.47-0.61; P < .001) and rural areas (OR 0.36, CI: 0.31-0.41; P < .001) were less likely to undergo BR than women from urban areas. CONCLUSION: Although BR benefits are well documented, women from rural Kentucky undergo BR at lower rates and are less likely to receive BR than their urban counterparts. Efforts should seek to promote equitable access to BR for all patients, including those from rural areas.

Parasite detection in the ornamental fish trade using environmental DNA.

Effective border control relies on stringent biosecurity protocols to detect and prevent introductions of exotic pests and diseases. Detection of pathogens and parasites in the live ornamental fish trade using environmental DNA (eDNA) techniques has the potential to improve current biosecurity practices. We examined water samples from 11 target consignments (cyprinids susceptible to Dactylogyrus spp. infections) and seven non-target fish consignments (non-cyprinids, not susceptible to Dactylogyrus spp. infections) imported from Southeast Asia to Australia for the presence of eDNA from five Dactylogyrus species (Monogenea: Dactylogyridae). A four-step predictive framework was used to predict putative positive and putative negative detections from quantitative PCR assays. Both target and non-target consignments were positive for Dactylogyrus spp. eDNA as confirmed by Sanger sequencing. Positive detections for Dactylogyrus spp. eDNA in non-target fish consignments demonstrates the possibility of source water contamination, limiting the applicability of eDNA screening methods at border control. This study suggests that screening for parasite eDNA within ornamental fish consignments should be tested during pre-export quarantine periods to avoid false positive detections at border control. Lastly, the proposed predictive framework has a broad utility for minimizing false positive and false negative eDNA detections of aquatic organisms.

Anterior versus Posterior Component Separation: Which Is Better?

In the field of hernia surgery, there have been many advances in techniques that have provided the surgeon with a variety of options to repair the difficult abdominal wall hernia. Regardless of the technique, the ultimate goal was to provide a tension-free repair, which attempts to approximate the midline while returning abdominal wall musculature to its normal anatomic position, thus providing the patient with both a cosmetic and durable result with or without the use of a prosthetic reinforcement. Component separation techniques have been widely popularized as techniques to repair complex hernias and are frequently categorized based upon the anatomic location of the myofascial release. CSTs are generally categorized as either an anterior component separation or posterior component separation based upon the surgical approach to the abdominal wall musculature. This report objectively outlines the various techniques of component separation and specifically compares the outcomes among techniques to facilitate decision making in abdominal wall reconstruction.

Colour and polarity contributions to global motion perception.

The influence of the image segmentation cues based on colour and polarity on a motion coherence task were examined. In line with previous reports, when the signal and noise were given unique identities thresholds were much lower than when they were the same, suggesting a strong influence of segmentation. In another paradigm extra noise elements that differed in colour or polarity interfered despite this perceptual segmentation. We suggest that the results when signal and noise have unique identities are attributable to the subjects' ability to attend to a particular location(s) in space. When this strategy was eliminated by presenting the stimuli in the near-periphery or very briefly the effect of the colour or polarity information disappears.

Undercover 'shopping' to evaluate lab services.

Wonder what goes on at your outpatient labs when you're not there? This clever adaptation from the retail world can help you ferret out foul play and affirm first-rate employees.

Alveolar bone graft resorption associated with abnormal dental follicle.

An unusual case of an alveolar bone graft that underwent almost complete resorption in association with a large radiolucent lesion around the erupting canine is reported. Clinical and radiographic follow-up after grafting is important to detect and manage any pathologic changes which might occur. Early detection of any abnormal radiologic changes and surgical intervention to excise the lesion could prevent further destruction of the grafted bone.

Light and ultrastructural relationship between oxytalan fibers in the periodontal ligament of the guinea pig.

The interfaces and the relationships between collagen and oxytalan fibers were observed under light and electron microscopy. Guinea pig periodontal ligament was prepared for light and electron microscopy with perfusion using Peter's buffered formalin for light microscopy and GTA-S-collidine and OSO4 for electron microscopic studies. The tissue for light microscopy was stained with a modified Gomori's aldehyde fuchsin technique, in which pre-oxidization with potassium monopersulfate was carried out before staining so as to demonstrate the oxytalan fibers. EM tissues were routinely stained with lead citrate and uranyl acetate. Two different structural relationships were observed. First, the subcomponents of the collagen and oxytalan fiber types interweave with each other; and, second, some of these two-fiber subcomponents appear attached to each other. These relationships and the known orientation of oxytalan fibers as seen in the periodontal ligament provide insight as to the function of oxytalan fibers. The oxytalan fibers may provide increased structural integrity and increased distribution of forces over a wider area of the periodontal ligament. Because of their close relationship to blood and lymph vessels in the periodontal ligament, they may also help to stabilize these elements by the same structural relationships to collagen fibers.

Newer fashions in illegitimacy.

In 1968 Illsley and Gill examined the rise in illegitimacy in the decade 1955-65 and showed that this rise, unlike rises in the first and second world wars, had not been accompanied by a fall in prenuptial conceptions but by a rise. Statistics from 1970 to 1975 have been examined and a third parameter, legal abortion, added. After a period characterised by an apparent rise in the total of extramarital conceptions there has since 1972 been a decline; and in the age group 20-24 this fall dates from 1971. Improved contraceptive practice is probably the reason.