Cleft Summit 2022: The Impact of a Unified Voice.

OBJECTIVE: The inaugural Cleft Summit aimed to unite experts and foster interdisciplinary collaboration, seeking a collective understanding of velopharyngeal insufficiency (VPI) management. DESIGN: An interactive debate and conversation between a multidisciplinary cleft care team on VPI management. SETTING: A two-hour discussion within a four-day comprehensive cleft care workshop (CCCW). PARTICIPANTS: Thirty-two global leaders from various cleft disciplines. INTERVENTIONS: Cleft Summit that allows for meaningful interdisciplinary collaboration and knowledge exchange. MAIN OUTCOME MEASURES: Ability to reach consensus on a unified statement for VPI management. RESULTS: Participants agreed that a patient with significant VPI and a dynamic velum should first receive a surgery that lengthens the velum to optimize patient outcome. A global, multicenter prospective study should be done to test this hypothesis. CONCLUSION: The 1st Cleft Summit successfully distilled global expertise into actionable best-practice guidelines through iterative discussions, fostering interdisciplinary collaboration and paving the way for a transformative multi-center prospective study on VPI care.

Application of Safety Protocols for International Cleft Outreach Programs During the COVID-19 Pandemic: Global Smile Foundation Precaution Guidelines and Implications.

BACKGROUND: Since COVID-19 was declared a worldwide pandemic by the World Health Organization (WHO) in March of 2020, foundation-based cleft outreach programs to Low- and Middle-Income Countries (LMICs) were halted considering global public health challenges, scarcity of capacity and resources, and travel restrictions. This led to an increase in the backlog of untreated patients with cleft lip and/or palate, with new challenges to providing comprehensive care in those regions. Resumption of international outreach programs requires an updated course of action to incorporate necessary safety measures in the face of the ongoing pandemic. In this manuscript, the authors outline safety protocols, guidelines, and recommendations implemented in Global Smile Foundation's (GSF) most recent outreach trip to Beirut, Lebanon. METHODS: COVID-19 safety protocols for outreach cleft care and an Action Response Plan were developed by the GSF team based on the published literature and recommendations from leading international organizations. RESULTS: GSF conducted a 1-week surgical outreach program in Beirut, Lebanon, performing 13 primary cleft lip repairs, 7 cleft palate repairs, and 1 alveolar bone grafting procedure. Safety protocols were implemented at all stages of the outreach program, including patient preselection and education, hospital admission and screening, intraoperative care, and postoperative monitoring and follow-up. CONCLUSIONS: Organizing outreach programs in the setting of infectious diseases outbreaks should prioritize the safety and welfare of patients and team members within the program's local community. The COVID-19 protocols and guidelines described may represent a reproducible framework for planning future similar outreach initiatives in high-risk conditions.

Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings.

INTRODUCTION: Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. METHODS: A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. RESULTS: Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. CONCLUSION: The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.

Ergonomics for Cleft Providers: A Brief Communication.

Musculoskeletal (MSK) injuries are the most common and debilitating work-related injuries among healthcare providers. These injuries often occur due to a lack of awareness and insufficient guidance during the early years of medical training. Recognizing the need to address this issue, the Comprehensive Cleft Care Workshop (CCCW) has taken steps to integrate an ergonomics session into its curriculum. The goal of this initiative is to enhance awareness on ergonomics, improve the integration of ergonomics into daily routine, and ultimately reduce the occurrence of MSK injuries among healthcare professionals.

Emergency Response Protocols for Overseas Outreach Settings: Global Smile Foundation Strategy.

Non-governmental organizations (NGOs) aim to alleviate unmet global disease burden and promote collaboration between visiting and host countries. Well-executed emergency response protocols are foundational to providing safe and quality care in an unpredictable global setting. Global Smile Foundation (GSF) instituted a protocol in 2012 based on over three decades of cleft care experience. Here, we update this protocol and provide information on how to address special circumstances such as humanitarian crises and disease outbreaks. The GSF response protocol was developed in conjunction with surgeons, anesthesiologists, nurses, and administrators to ensure all team members are adequately prepared to respond to emergency situations in global outreach. This protocol provides information on pre-departure preparation, onsite setup, operative precautions, and post-departure debriefings. Emphasis is placed on a standardized, reproducible workflow that accounts for necessary site-specific adjustments. Strategies include emergency simulations, site-specific safety checklists, standardized operating room protocols, and well-defined individual responsibilities. The authors also provide anticipatory guidance in addressing unexpected circumstances, such as disease outbreak and natural disaster, during global outreach. In conclusion, a proactive and systematic approach to emergency response and prevention is vital to minimizing morbidity and mortality during surgical outreach initiatives. The GSF protocol represents a reproducible approach that other organizations can adopt and adapt to their unique needs.

Historical Tools of Anthropometric Facial Assessment: A Systematic Raw Data Analysis on the Applicability of the Neoclassical Canons and Golden Ratio.

BACKGROUND: The fundamental tenets of facial aesthetic surgery education have not changed in centuries. Research is beginning to demonstrate that the Neoclassical Canons and the Golden Ratio, Phi, have limited utilization in populations other than those of White European extraction. OBJECTIVES: The purpose of this study was to analyze comparable raw data in the literature to determine (1) if there is interethnic variability in Neoclassical Canon and Phi measurements, and (2) if the measurements in these representative samples differ from the "ideal." METHODS: A PubMed/Scopus search was performed. Manuscripts with raw data and individuals aged ≥16 were included. Measurements were extracted and employed to calculate the Neoclassical Canons and Phi. One-way analysis of variance (ANOVA) tests were conducted to compare mean measurements across 6 ethnic groups (P < 0.05). RESULTS: Twenty-seven articles were included. Every continent was represented except Antarctica and Australia. Men were less commonly studied than women. Participant ages ranged from 16 to 56. Averaged Canons 2, 6-8 measurements had significant interethnic differences in males, whereas Canons 5-8 had significant differences across ethnicities in females. For men, there was significant interethnic variability in measurements of Phi 2, 5, 8, 10, and 17. For women, Phi 1, 2, 5, 8, 10, and 17 varied across ethnicities. No ethnic/gender group showed consistent approximation of the "ideal" for both the Neoclassical Canons and Phi. CONCLUSIONS: Today, the utility of the Neoclassical Canons and Phi is limited. It is incumbent on our field to systematically study and define the anthropometric measures that define the "ideal."

Cost-effectiveness of Erenumab Versus Surgical Trigger Site Deactivation for the Treatment of Migraine Headaches: A Systematic Review.

BACKGROUND: Migraine headache is a common, debilitating condition responsible for astronomical societal burden. The chronicity of migraine headaches necessitates the use of many healthcare services. Preventative treatment remains the desirable option for this patient population. Pharmacologic advances have led to the development of erenumab, a monoclonal antibody calcitonin gene-related peptide receptor antagonist that directly interferes with the known biochemical pathway of migraine initiation. Alternatively, surgical decompression of migraine trigger sites is a historically effective preventative option for certain patients experiencing migraine headaches. As new treatments emerge, the large economic burden of migraine headaches requires cost evaluation against already available preventative modalities. METHODS: Studies evaluating the cost-effectiveness of both erenumab and surgical trigger site deactivation were found using EMBASE and MedLine. Relevant economic data was extracted from this literature and the cost of treatment with erenumab was compared with surgical decompression. RESULTS: The market price of erenumab is $6900/yr. Speculative models predicted a direct annual healthcare cost ranging from $11,404 to $12,988 for patients experiencing episodic migraine. For chronic migraine patients, this range extended to $25,604. Annual indirect costs ranged from $7601 to $19,377. Prospective and model-based studies evaluating surgical trigger site deactivation reported an average 1 time surgical cost between $6956 and $10,303. In episodic migraine, subsequent annual healthcare costs were $900. CONCLUSIONS: Erenumab has potential to be a revolutionary noninvasive preventative treatment for migraine headache. With that said, the cost-conscious option for patients receiving more than 1 year of treatment remains surgical trigger site deactivation.

Extensive Polyostotic Craniofacial Fibrous Dysplasia With Optic Nerve Impingement.

ABSTRACT: Fibrous dysplasia is a benign overgrowth of metaplastic fibrous material resulting in disorganized deposition of bony matrix. Surgical intervention is the primary treatment modality. Here the authors present the case of a 36-year-old male with extensive and severe fibrous dysplasia of the calvarium, orbit, sphenoid, and facial bones causing significant facial distortion and impingement of his optic nerve. Combined operative treatment with craniofacial plastic surgery and neurosurgery was performed. Repair consisted of extensive intra- and extracranial resection and contouring of involved bones followed by reconstruction of the superior orbital rims, forehead, orbital roof, and calvarium with custom polyetheretherketone (PEEK) implant. The authors discuss the advantages of using computer assisted design/modeling, intraoperative neuronavigation, and custom prosthetic cranioplasty for surgical treatment of extensive fibrous dysplasia; a review of the current surgical literature is provided.

Interdisciplinary Considerations for Nasolabial Repair During a Global Pandemic.

BACKGROUND: At the declaration of the global pandemic on March 11, 2020, many hospitals and institutions developed a tiered framework for the stratification and prioritization of elective surgery. Cleft lip and palate repair was classified as low acuity, and nasoalveolar molding (NAM) clinics were closed. Anticipating the consequences of delayed cleft care and the additional burden this would cause families, we reassessed our risk-stratification and perioperative algorithms. We hypothesized we could safely optimize nasolabial repair without burdening our care systems and without increasing COVID-19-related morbidity/mortality. METHODS: Our multidisciplinary cleft team reevaluated patient selection to maximize surgical impact. Perioperative protocols were adjusted, and COVID-19 preoperative testing was utilized before nasolabial repair and prior to suture removal under anesthesia. RESULTS: Early in the pandemic, unilateral cleft repair was prioritized and successfully completed on 9 patients. There were no complications related to COVID-19. Nasoalveolar molding clinic was reopened after total patient volume was significantly decreased. CONCLUSIONS: We offer an approach for surgical management of nasolabial clefts during a global pandemic. Although guidelines have suggested postponing all cleft care, we found that at our dedicated pediatric hospital with low burden of COVID-19 and adequate resources, we could follow a strategy to safely resume cleft care while decreasing burden on our patients' families and care delivery systems.

Sustainable Cleft Care: A Comprehensive Model Based on the Global Smile Foundation Experience.

INTRODUCTION: Clefts of the lip and palate are leading congenital facial anomalies. Underserved patients with these facial differences lack access to medical care, surgical expertise, prenatal care, or psychological support. Moreover, the disease results in significant economic strains on patients and their families. While surgical outreach programs have attempted to fill this void, significant challenges facing international comprehensive cleft care persist. OBJECTIVE: Propose a path toward international sustainable cleft care based on the Global Smile Foundation experience. RESULTS: International sustainable comprehensive cleft care can be achieved by regulating surgical outreach programs. Regulation of these missions would ensure standardized care and encourage stakeholders to cooperate and adequately allocate funding and resources. Capacity building can be achieved through "diagonal" cleft care delivery models, multidisciplinary workshops, fellowship programs, research and quality assurance, as well as leveraging emerging technologies such as Augmented Reality. CONCLUSION: International comprehensive cleft care requires continuous collaborative efforts between visiting and local teams as well as international and national organizations. Standardizing and regulating current practices as well as promoting capacity building initiatives can contribute to sustainable cleft care.

Clinically Applied Anatomy: An Impactful Initiative in the Evolution of Medical Education.

PURPOSE: Today, medical education emphasizes clinical applications of anatomic knowledge. In 2014, we instituted Clinically Applied Anatomy (CAA) within first-year Human Gross Anatomy at our university. The course was designed and overseen by academic plastic surgery. We hypothesized CAA would positively impact students' understanding, performance, and interest in human anatomy. METHODS: From 2014 to 2018, 13 CAA case-based didactics were integrated into the anatomy curriculum without changing the total anatomy-related student hours; each emphasized the clinical relevance of overlooked (or memorized) anatomic detail. Clinically Applied Anatomy instructors led associated clinical cadaver dissections. Upon course completion, students from each participating class were anonymously surveyed. RESULTS: One hundred sixty-four students completed the survey (75% response). Eighty-six percent reported CAA increased mastery of human anatomy, 77% stated CAA improved examination performance, 87% agreed CAA increased interest in anatomy itself, and 96% reported CAA increased their critical thinking of how understanding anatomy affects clinical care. Nearly half (49.4%) responded that CAA increased interest in applying for a procedurally oriented residency. When considering future integration of CAA into the medical school curriculum, 9% of students wanted less CAA, 61% wanted the same, and 30% wanted more. CONCLUSIONS: Clinically Applied Anatomy significantly impacts medical students' anatomy education. Currently, 17 CAA faculty from 7 departments/divisions participate in all 26 of our school's anatomy sessions. As per our institution, we advocate this cost-effective and impactful initiative be led by academic plastic surgeons. These clinicians possess broad and specialized anatomic expertise as well as the leadership and interdisciplinary working relationships needed to enroll a multidisciplinary team of clinical educators.

Pediatric Mandible Reconstruction for Osteomyelitis During Largest Reported Mycobacterium Abscessus Outbreak.

In 2016, water lines at a children's dental clinic in Orange County, California were contaminated with Mycobacterium abscessus (MA), a non-tuberculosis rapidly-growing mycobacterium, leading to the largest MA outbreak ever reported. Mandatory reporting and active case finding directed by the Public Health Department was conducted in collaboration with community Pediatric Infectious Disease physicians for patients who underwent dental pulpotomies at the contaminated Dental Clinic from January 1 to September 6, 2016. Seventy-one cases (22 confirmed and 49 probable) were identified. One case that required extensive debridement and reconstruction of the mandible is presented in detail. CT maxillofacial demonstrated osteomyelitis extending from the right mandibular angle to the left ramus with multifocal periapical lucencies. CT chest and neck revealed numerous pulmonary nodules and bilateral cervical lymphadenopathy. Extraction of several involved teeth, bilateral selective neck dissection, and extensive mandibular debridement was performed, followed by mandibular stabilization with a custom pre-bent 2.0-mm locking plate. CT images 1-year post-operative showed clearance of infection and sufficient bony stability. Subsequent removal of hardware and bone grafting was performed and the patient is doing well. In the event of a future odontogenic mycobacterium outbreak, the experience at our institution can inform multidisciplinary treatment approaches. Prophylactic extraction of primary teeth that received pulpotomies with contaminated water should be performed. Early and thorough debridement of affected bone, including enucleation of secondary teeth, should be performed if necessary for early source control.

Epidemiology, Socioeconomic Analysis, and Specialist Involvement in Dog Bite Wounds in Adults.

Dog bites have been well described and characterized in the pediatric population. Comparatively, dog-bite injuries in adults and the settings in which surgeons become involved are less studied. An electronic hospital database identified all patients 18 years or older who were treated for dog bites from 2010 to 2014. Demographics, injury information, intervention type, and payer source were collected. Socioeconomic analysis was performed using Geographic Information Systems mapping. A total of 189 adults presented to the emergency department with dog-bite-related injuries. The most common injury location was the hand (n = 62, 32.8%), followed by the head and neck (n = 36, 19.1%). Of the 189 patients, 33 adults (17.5%) were forwarded to a surgical subspecialist for repair. A head and neck injury was significantly more likely to be repaired by a surgical specialist (P = 0.011). The most common breed of dog identified was pit bull (n = 29, 47.5%). The majority of pit bull attacks involved the extremities (65.5%) compared to other breeds of dogs. Pit bull victims were noted to have a lower average annual income compared to other breed victims ($64,708 versus $75,004; P = 0.16). Annual income between intervention group and no intervention group was not significantly different (P = 0.26). This study is the 1st to perform a socioeconomic analysis in the adult dog-bite population and encourages the use of a surgical specialist in the setting of a head and neck bite.

Management of Rhinophyma: Outcomes Study of the Subunit Method.

BACKGROUND: Rhinophyma causes a nasal deformity and functional airway obstruction. Partial excision (eg, tangential) with secondary healing commonly removes hypertrophic soft tissues but does not improve nasal support. The subunit method for rhinophyma uses 6 nasal flaps to provide exposure for removal of rhinophymatous tissue and enhance structure. The purpose of this study was to evaluate outcomes of subunit method. METHODS: Medical records of patients with rhinophyma treated with the subunit method between 2013 and 2016 were analyzed. The technique comprises degloving the distal half of the nose by elevating 6 subunit-based flaps; debulking phymatous tissues to perichondrium; enhancing nasal support with sutures/cartilage grafts; trimming excess skin; and redraping the soft tissues. Patient age, gender, need for cartilage grafts or skin grafts, revisions, and follow-up were assessed. RESULTS: The study comprised 8 patients (6 male). Mean age was 63 years (range 34-72). All individuals had interdomal sutures for tip enhancement and 4 patients underwent cartilage grafts (alar batten) to correct external valve collapse. One patient had 2 subunits (alar) replaced with skin graft. Average follow-up was 1.6 years (range 0.2-3.7). Six patients underwent revisional procedures primarily to modify the scar between the dorsum and tip subunits. CONCLUSION: The subunit method addresses the 3 fundamental problems of the rhinophymatous nose: hypertrophic sebaceous tissues, excess skin, and destruction of support. Most patients may benefit from a minor revisional procedure to optimize the result. Individuals should be counseled that operation will likely require 2 stages.

Breast Milk Feeding Rates in Patients With Cleft Lip and Palate at a North American Craniofacial Center.

OBJECTIVE: Our study goal was to evaluate the rates of breast milk feeding among patients with oral clefts at a large North American Craniofacial Center. METHODS: Parents of patients with oral clefts born from 2000 to 2012 and treated at our center were interviewed regarding cleft diagnosis, counseling received for feeding, and feeding habits. RESULTS: Data were obtained from parents of 110 patients with oral clefts. Eighty-four percent of parents received counseling for feeding a child with a cleft. Sixty-seven percent of patients received breast milk for some period of time with a mean duration of 5.3 months (range 0.25 to 18 months). When used, breast milk constituted the majority of the diet with a mean percentage of 75%. Breast milk feeding rates increased successively over the 13-year study period. The most common method of providing breast milk was the Haberman feeder at 75% with other specialty cleft bottles composing an additional 11%. Parents who received counseling were more likely to give breast milk to their infant (P = .02). Duration of NasoAlveolar Molding prior to cleft lip repair did not affect breast milk feeding length (P = .72). Relative to patients with cleft lip and palate, patients with isolated cleft lip had a breast milk feeding odds ratio of 1.71. CONCLUSION: We present breast milk feeding in the North American cleft population. Although still lower than the noncleft population, breast milk feeding with regards to initiation rate, length of time, and proportion of total diet is significantly higher than previously reported.

Primary Premaxillary Setback and Repair of Bilateral Complete Cleft Lip: Indications, Technique, and Outcomes.

OBJECTIVE: To analyze indications and outcomes for primary premaxillary setback. DESIGN: Retrospective. SETTING: Academic children's hospital. PATIENTS: All children with bilateral complete cleft lip age ≤2 years of age who had premaxillary setback by one surgeon (1992 to 2011). RESULTS: Twenty-five patients with bilateral complete cleft lip underwent primary premaxillary setback at an average age of 9 months; the mean follow-up was 47 months. There were three indications: failed dentofacial orthopedics (n = 9), delayed referral precluding manipulation (n = 10), and intact secondary alate (n = 6). Of 19 patients with bilateral complete cleft lip/palate, primary setback was combined with nasolabial repair (n = 11), adhesions (n = 2), or palatoplasty (n = 6). Patients who had nasolabial closure and setback were significantly younger than those who had combined palatal closure and setback (6.5 versus 16 months, P = .01). No patient exhibited postoperative premaxillary instability. Serial anthropometry showed similar growth of nasolabial features after both primary setback (n = 9) and active dentofacial orthopedics (n = 35). CONCLUSIONS: Primary premaxillary ostectomy and setback permits synchronous bilateral nasolabial-alveolar closure or alveolar-palatal repair in a child with intact secondary palate. This procedure should be considered whenever dentofacial orthopedics cannot be accomplished. Speech is paramount in an older child; setback with palatal closure is scheduled before nasolabial repair. Disturbance of midfacial growth is likely following primary premaxillary ostectomy and setback in patients with bilateral complete cleft lip/palate; however, most already need maxillary advancement. Furthermore, premaxillary setback permits proper primary nasolabial design and construction in appreciation of expected changes with growth.

Is Craniosynostosis Repair Keeping Up With the Times? Results From the Largest National Survey on Craniosynostosis.

BACKGROUND: Given the great variability in perioperative management of craniosynostosis, a large-scale national survey of current practice patterns was conducted. METHODS: Using scaphocephaly as a test diagnosis, 115 craniofacial surgeons at all levels of career experience across the United States were invited to participate in an anonymous survey. RESULTS: Fifty-three surgeons (46%) completed the survey. All respondents complete repair before 1 year of age with a majority operating between 4 and 8 months. Surgeons with greater than 10 years of experience were significantly more likely to perform open repair at extremes of age (<4 months and 8-12 months) (P = 0.03) and reported shorter operative times (P = 0.01) compared with their less experienced colleagues. More than two-thirds of surgeons (68.8%) obtain preoperative imaging for every case; 83% of these prefer computed tomography scans. More than one-fourth of respondents (28%) routinely prescribe an extended course (>24 hours) of antibiotics. Overall transfusion rates remain high, with nearly 2 (65.2%) in 3 transfusing in 76% to 100% of operations. The overwhelming majority of respondents (93.6%) routinely send patients to an intensive care unit postoperatively. CONCLUSIONS: We present the largest US survey of craniosynostosis surgical practice patterns to date. General consensus exists regarding safety and emergency preparedness standards. In addition, we identified several patterns that deviate from published evidence-based guidelines. Specifically, these practices relate to the routine use of high-dose radiation imaging, long-term antibiotics, blood transfusions, and intensive postoperative surveillance. For the first time, stratifying by surgeon experience revealed significant differences in clinical practice.

Use of safety measures, including the modified world health organization surgical safety checklist, during international outreach cleft missions.

International surgical outreach missions have become increasingly common within the surgery community. Untoward events in this setting, although rare, can be prevented by careful planning and the use of quality assurance guidelines designed to prevent such complications. The surgical safety checklist is widely accepted in most developed health care practices, but is used variably by international mission groups. This article outlines the quality assurance guidelines used, including a modified World Health Organization safety checklist and illustrated patient instruction forms, to provide a standardized means of delivering sound surgical care in the setting of short-term international cleft lip and/or palate missions.

Validation of ChatGPT 3.5 as a Tool to Optimize Readability of Patient-facing Craniofacial Education Materials.

Background: To address patient health literacy, the American Medical Association recommends that readability of patient education materials should not exceed a sixth grade reading level; the National Institutes of Health recommend no greater than an eigth-grade reading level. However, patient-facing materials in plastic surgery often remain at an above-recommended average reading level. The purpose of this study was to evaluate ChatGPT 3.5 as a tool for optimizing patient-facing craniofacial education materials. Methods: Eighteen patient-facing craniofacial education materials were evaluated for readability by a traditional calculator and ChatGPT 3.5. The resulting scores were compared. The original excerpts were then inputted to ChatGPT 3.5 and simplified by the artificial intelligence tool. The simplified excerpts were scored by the calculators. Results: The difference in scores for the original excerpts between the online calculator and ChatGPT 3.5 were not significant (P = 0.441). Additionally, the simplified excerpts' scores were significantly lower than the originals (P < 0.001), and the mean of the simplified excerpts was 7.78, less than the maximum recommended 8. Conclusions: The use of ChatGPT 3.5 for simplification and readability analysis of patient-facing craniofacial materials is efficient and may help facilitate the conveyance of important health information. ChatGPT 3.5 rendered readability scores comparable to traditional readability calculators, in addition to excerpt-specific feedback. It was also able to simplify materials to the recommended grade levels. With human oversight, we validate this tool for readability analysis and simplification.

Results of a Pilot Virtual Microsurgery Course for Plastic Surgeons in LMICs.

Background: The Plastic Surgery Foundation's Surgeons in Humanitarian Alliance for Reconstruction, Research and Education (SHARE) program seeks to expand surgical capacity worldwide through mentorship and training for local plastic surgeons. This study aims to define the need for microsurgery training among SHARE global fellows and describe results of a pilot course. Methods: Ten participants of the SHARE Virtual Microsurgical Skills Course were asked to complete an anonymous survey. Pre- and post-course response rates were 100% and 50.0%, respectively. Results: There was a high incidence of microsurgical problems encountered in the clinical setting. Resource availability was varied, with high access to loupes (100%), yet limited access to microsurgery instruments (50%), medications (40%), operating microscope (20%), skilled nursing (0%) and appropriate peri-operative care settings (0%). Participants identified vessel preparation, instrument selection, and suture handling as priority learning objectives for a microsurgery skills course. Post-course satisfaction with learning objectives was high (60% "very good," 40% "excellent"). Participants reported high levels of improvement in suture handling (Likert 4.60±0.55), end-to-end anastomosis (4.40±0.55), instrument selection (4.20±0.45), vessel preparation (4.20±0.45), and economy of motion (4.20±0.45). Conclusions: This study demonstrates a high frequency of reconstructive problems encountered by global fellows yet low access to appropriate resources to perform microsurgical procedures. Initial results from a pilot virtual microsurgery course demonstrate very high satisfaction and high self-rated improvement in key microsurgical skills. The virtual course is an effective and accessible format for training surgeons in basic microsurgery skills and can be augmented by providing longitudinal opportunities for remote feedback.