Reconstruction of Acquired Defects of the External Genitalia: A 24-Patient, Single-Institution Experience.

PURPOSE: Patients undergoing resection of the external genitalia are often faced with significant deformity and decreased quality of life. Plastic surgeons are tasked with the challenge of reconstructing these defects to minimize morbidity and increase patients' quality of life. The authors have set out to investigate the efficacy of local fasciocutaneous and pedicled perforator flaps in external genital reconstruction. METHODS: A retrospective review was conducted of all patients undergoing reconstruction of acquired defects of the external genitalia from 2017 to 2021. In total, 24 patients met inclusion criteria for the study. Patients were allocated into 2 cohorts: patients with defects reconstructed using local fasciocutaneous flaps (FF) versus patients with defects reconstructed using pedicled islandized perforator flaps (PF). Comorbid conditions, ablative procedures, operative times, flap size, and complications were compared across all groups. Fisher exact test was used to analyze differences in comorbidities, while independent t tests were used to analyze age, body mass index, operative time, and flap size. Significance was set at P < 0.05. RESULTS: Of the 24 patients included in the study, 6 underwent reconstruction with islandized PFs (either profunda artery perforator or anterolateral thigh), and 18 underwent reconstruction with FFs. The most common indication for reconstruction was vulvectomy for vulvar cancer, followed by radical debridement for infection, and lastly penectomy for penile cancer. The PF cohort had a significantly higher percentage of previously irradiated patients (50% vs 11.1%, P = 0.019). Although mean flap size was larger in the PF cohort, this difference did not reach statistical significance (176 vs 143.4 cm2, P = 0.5). Perforator flaps had significantly longer operative times when compared with FFs (237.33 vs 128.99 minutes, P = 0.003). Average length of stay was 6.88 days in FF and 5.33 days in PF (P = 0.624). Complication profile including flap necrosis, wound healing delays, and infection were similar between groups despite a significantly higher rate of prior radiation in the PF cohort. CONCLUSIONS: Our data suggest that PFs such as profunda artery perforator and anterolateral thigh flaps are associated with longer operative times but may offer a suitable option for reconstruction of acquired defects of the external genital compared with local FFs, especially in the setting of prior radiation.

Pediatric Shoulder Arthroscopy is Effective and Most Commonly Indicated for Instability, Obstetric Brachial Plexus Palsy, and Partial Rotator Cuff Tears.

Purpose: The purpose of this review was to systematically evaluate the literature on pediatric shoulder arthroscopy and outline its indications, outcomes, and complications. Methods: This systematic review was carried out in accordance with PRISMA guidelines. PubMed, Cochrane Library, ScienceDirect, and OVID Medline were searched for studies reporting the indications, outcomes, or complications in patients undergoing shoulder arthroscopy under the age of 18 years. Reviews, case reports, and letters to the editor were excluded. Data extracted included surgical techniques, indications, preoperative and postoperative functional and radiographic outcomes, and complications. The methodological quality of included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results: Eighteen studies, with a mean MINORS score of 11.4/16, were identified, including a total of 761 shoulders (754 patients). Weighted average age was 13.6 years (range, 0.83-18.8 years) with a mean follow-up time of 34.6 months (range, 6-115). As part of their inclusion criteria, 6 studies (230 patients) recruited patients with anterior shoulder instability and 3 studies recruited patients with posterior shoulder instability (80 patients). Other indications for shoulder arthroscopy included obstetric brachial plexus palsy (157 patients) and rotator cuff tears (30 patients). Studies reported a significant improvement in functional outcomes for arthroscopy indicated for shoulder instability and obstetric brachial plexus palsy. A significant improvement was also noted in radiographic outcomes and range of motion for obstetric brachial plexus palsy patients. The overall rate of complication ranged from 0% to 25%, with 2 studies reporting no complications. The most common complication was recurrent instability (38 patients of 228 [16.7%]). Fourteen of the 38 patients (36.8%) underwent reoperation. Conclusion: Among pediatric patients, shoulder arthroscopy was indicated most commonly for instability, followed by brachial plexus birth palsy, and partial rotator cuff tears. Its use resulted in good clinical and radiographic outcomes with limited complications. Level of Evidence: Systematic review of Level II to IV studies.

Where Do Orthopaedic Surgery Applicants Match on Their Rank Lists? A Survey of Incoming Residents.

The National Resident Matching Program reports match results by rank list position for all specialties in aggregate, but these data have not been previously reported for orthopaedic surgery specifically. The purpose of this study was to determine where orthopaedic applicants match on their rank lists in comparison to the national average for all specialties and to evaluate which factors may influence match results. Methods: This was a cross-sectional survey study distributed to all applicants to a single institution's orthopaedic surgery residency program. Metrics such as match result, USMLE scores, Alpha Omega Alpha (AOA) status, and research productivity, in addition to other applicant-specific traits were captured. Results were stratified by match status and rank list position, with subgroup analyses completed for applicants matching at highly ranked programs (1-3) vs. lower ranked programs (≥ 4). Results: The survey was distributed to 698 applicants with a response rate of 32% (n = 224), with a match rate of 85% (n = 191). Thirty-four percent of respondents matched at their top choice program, 15.2% at their second choice, 9.9% at their third, and 40.8% at their fourth or lower. When comparing the matched to unmatched applicant cohorts, there was a significant difference in number of programs ranked, AOA status, and sex. When comparing applicants who matched at highly ranked (1-3) vs. lower ranked (≥ 4) programs, there was a significant difference in USMLE board scores. Conclusions: Orthopaedic surgery residency applicants are significantly less likely to match at their first choice or within their top 3 choices when compared to the national average for all specialties. Number of contiguous ranks, AOA status, and female sex were found to be associated with successfully obtaining an orthopaedic residency position, whereas USMLE board scores were associated with matching higher on one's rank list, thus resulting in greater match satisfaction. Level of Evidence: III.

Evaluation of the National Institutes of Health-Supported Relative Citation Ratio Among Fellowship-Trained American Orthopaedic Joint Reconstruction Surgery Faculty: A New Bibliometric Measure of Scientific Influence.

BACKGROUND: The relative citation ratio (RCR), a novel National Institutes of Health-Supported measure of research productivity, allows for accurate interdisciplinary comparison of publication influence. This study evaluates the RCR of fellowship-trained adult reconstructive orthopaedic surgeons with the goal of analyzing potentially influential physician demographics. METHODS: Adult Reconstruction Accreditation Council for Graduate Medical Education fellowship-trained faculty for orthopaedic residency programs were identified via departmental websites. The National Institutes of Health's iCite database was retrospectively reviewed for mean RCR, weighted RCR, and publication count by surgeon. Multivariate analyses were performed using the Wilcoxon rank-sum tests and analyses of variance testing to compare sex, career length, academic rank, and professional degrees in addition to an MD or DO. Significance was considered P < .05. RESULTS: A total of 488 fellowship-trained adult reconstruction faculty from 144 programs were included in the analysis. Overall, the faculty recorded a median RCR of 1.65 (interquartile range: 1.01-2.28) and a median weighted RCR of 16.59 (interquartile range: 3.98-61.92). The weighted RCR and total number of publications were associated with academic rank and career longevity, while the mean RCR was associated with academic rank. The median RCR ranged from 1.12 to 1.87 for all subgroups. CONCLUSION: Adult reconstruction faculty are exceptionally productive and generate highly impactful studies as evidenced by the high median RCR value relative to the National Institutes of Health standard value of 1.0. Our data have important implications in the assessment of grant outcomes, promotion, and continued evaluation of research influence within the hip and knee community.