ABSTRACT
Background: There is a trend toward matching in a different region than previous training for the independent plastic surgery match cycles from 2019 to 2021, which differs from the trend to match within the same region for integrated plastic surgery programs. Notably, residency interviews transitioned from in-person to virtual in 2020 due to the coronavirus pandemic. Therefore, we compared in-person versus virtual interview match trends from 2019 to 2023. Methods: Zip codes and regions of each successfully matched plastic surgery applicant's medical school, residency, and plastic surgery program were gathered from publicly available data for the 2019 and 2020 in-person interview cycles and 2021, 2022, and 2023 virtual interview cycles. Results: Although regions did not differ significantly in the proportions of positions each year (P = 0.85), there was a trend toward fewer positions in each region from 2019 to 2022. Overall, applicants were more likely to match in a different region as their medical school or residency during virtual compared with in-person interviews (P = 0.002 and P = 0.04). Applicants matched to programs further from their medical school zip code in virtual interview years (P = 0.02). There was no significant difference in distance between surgical residencies and plastic surgery residencies between the two time periods (P = 0.51). Conclusions: Trends toward matching into a different region than prior training after the switch to virtual interviews could be attributed to applicant accessibility to interview broadly. However, this could also be due to the decreased number of independent residency positions over the years, requiring applicants to move regions and travel further from where they began their training.
ABSTRACT
Immediate expander/implant-based breast reconstruction after mastectomy has become more sought after by patients. Although many patients choose this technique due to good aesthetic outcomes, lack of donor site morbidity, and shorter procedure times, it is not without complications. The most reported complications include seroma, infection, hematoma, mastectomy flap necrosis, wound dehiscence, and implant exposure, with an overall complication rate as high as 45%. Closed incision negative pressure therapy (ciNPT) has shown value in wound healing and reducing complications; however, the current literature is inconclusive. We aimed to examine if ciNPT improves outcomes for patients receiving this implant-based reconstruction. Methods: This is a retrospective single-institution study evaluating the ciNPT device, 3M Prevena Restor BellaForm, on breast reconstruction patients. The study was performed between July 1, 2019 and October 30, 2020, with 125 patients (232 breasts). Seventy-seven patients (142 breasts) did not receive the ciNPT dressing, and 48 patients (90 breasts) received the ciNPT dressing. Primary outcomes were categorized by major or minor complications. Age, BMI, and final drain removal were summarized using medians and quartiles, and were compared with nonparametric Mann-Whitney test. Categorical variables were compared using chi-square or Fisher exact test. Results: There was a statistically significant reduction in major complications in the ciNPT group versus the standard dressing group (P = 0.0247). Drain removal time was higher in the ciNPT group. Conclusion: Our study shows that ciNPT may help reduce major complication rates in implant-based breast reconstruction patients.
ABSTRACT
Acute pulmonary edema is a rare but severe complication of hyperbaric oxygen therapy. While patients with known cardiovascular problems may be able to withstand this therapy, rapid decompensation can still occur. Here, we present a case of a patient with known low ejection fraction and severe mitral regurgitation who developed acute pulmonary edema during the first hyperbaric treatment for a foot ulcer. This case highlights the importance of identifying patients that are high risk, such as those with moderate-to-severe cardiac disease, and pursuing other treatment options to avoid this complication.
ABSTRACT
INTRODUCTION: The coronavirus disease (COVID) created an abrupt change to virtual experiences and interviews for both the integrated and independent plastic surgery match cycle of 2021. Studies have shown that during the 2021 match cycle, integrated applicants were more likely to match at their home institution and region of medical school. These geographic and location trends for the 2021 match cycle have not been explored yet for the independent plastic surgery match. METHODS: Information for independent plastic surgery applicants that successfully matched was gathered using publicly available data for the 2019 and 2020 pre-COVID and 2021 COVID match cycles. Zip codes for applicant medical school, applicant residency program, and plastic surgery program were gathered to compare regional and distance outcomes between the pre-COVID and COVID match cycles. RESULTS: Data was collected on 182 applicants from 42 programs. There was no significant difference in the breakdown of gender percentages between the COVID match cycle (63.2% males) and the pre-COVID match cycles (72% males) (p=0.23). The COVID match cycle had 38.6% of applicants match at a plastics program within the same region as their residency, while the pre-COVID match cycles had 47.2% of applicants match the same region (p=0.28). These results continued to be nonsignificant when stratified by the regions of the west, south, midwest, and northeast (p=1.00). With regional matches with respect to medical school, the COVID match cycle had 33.3% of applicants match at a plastics program within the same region as their medical school, while the pre-COVID match cycles had 43.6% (p=0.20). These results continued to be nonsignificant when stratified by the four regions (p=1.00). When comparing the median distances between the COVID match cycle and the pre-COVID match cycle, no region of the United States showed a significant difference in travel distance to a plastics program with respect to medical school or residency (p=1.00). CONCLUSION: Transitions to virtual interviews and cancellation of away rotations during the COVID match cycle for the independent plastic surgery match did not significantly affect an applicant's ability to match outside of their region of previous medical school or residency. This may represent diminished program preference for applicants within the same region as their plastic residency.
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ABSTRACT: Controversy remains whether to perform a pharyngeal flap simultaneously with a tonsillectomy in patients with velopharyngeal insufficiency. The aim of this study is to revisit the speech outcomes and complications associated with the combined superiorly based pharyngeal flap and tonsillectomy procedure, while comparing pain outcomes. We hypothesize that the combined procedure will improve speech outcomes with minimal complications, but patients will experience more pain in the combined procedure.A 5-year retrospective review of registry data from Boys Town National Research Hospital was conducted from 2014 to 2019. Data collection included age, surgeries performed, length of stay, pain medication administration occurrences, immediate postoperative complications, postoperative speech outcomes specifically related to articulation (audible nasal airway emissions) and resonance (hypernasality).Eighty-eight patients had a superiorly based pharyngeal flap over this 5-year period. Eighteen patients (20%) had a simultaneous procedure performed. There were no patients who had immediate postoperative complications such as upper airway obstruction or bleeding complications that necessitated a reoperation. One of the patients had a pharyngeal flap dehiscence that required a revision pharyngeal flap in the combined group. Nasal airway emissions and hypernasality were eliminated in 58.3% and 75%of the combined patients, respectively. The total number of narcotic administration occurrences were significantly higher in the combined group than the pharyngeal flap only group (9.0 versus 7.0; Pâ=â0.03).A number of velopharyngeal patients will present with hypertrophied tonsils. We believe that it is safe and beneficial to perform the combined procedure in the same setting.
