Systematic Review of Tissue Expansion: Utilization in Non-breast Applications.

BACKGROUND: Tissue expansion is a versatile reconstructive technique providing well-vascularized local tissue. The current literature focuses largely on tissue expansion for breast reconstruction and in the context of burn and pediatric skin/soft tissue replacement; however, less traditional applications are also prevalent. The aim of this study was to systematically review the utilization of tissue expansion in such less well-characterized circumstances. METHODS: The authors conducted a systematic review of all publications describing non-breast applications of tissue expansion. Variables regarding expander specifications, expansion process, and complications were collected and further analyzed. RESULTS: A total of 565 publications were identified. Of these, 166 publications described tissue expansion for "less traditional" indications, which fell into 5 categories: ear reconstruction, cranioplasty, abdominal wall reconstruction, orthopedic procedures, and genital (penile/scrotal and vaginal/vulva) reconstruction. While lower extremity expansion is known to have high complication rates, tissue expander failure, infection, and exposure rates were in fact highest for penile/scrotal (failure: 18.5%; infection: 15.5%; exposure: 12.5%) and vaginal/vulva (failure: 20.6%; infection: 10.3%; exposure: 6.9%) reconstruction. CONCLUSIONS: Tissue expansion enables index operations by providing additional skin before definitive reconstruction. Tissue expanders are a valuable option along the reconstructive ladder because they obviate the need for free tissue transfer. Although tissue expansion comes with inherent risk, aggregate outcome failures of the final reconstruction are similar to published rates of complications without pre-expansion. Thus, although tissue expansion requires a staged approach, it remains a valuable option in facilitating a variety of reconstructive procedures.

Tip Ligament Preservation and Suspension: Why and How?

This issue of Clinics explores the concept of "preservation" rhinoplasty. At present, this topic is gaining considerable attention. As proponents of preservation suggest, a great number of problems we encounter in rhinoplasty are problems that were not present before the surgery; therefore, they can often be attributable to the deconstruction and reconstruction that took place. Preservation rhinoplasty should be viewed generally as a mindset to limit deconstructive steps in rhinoplasty when possible, understanding that these steps and those to later reconstruct provide the potential to create new problems that did not previously exist.

The Impact of COVID-19 on the Treatment of Craniomaxillofacial Trauma and Head and Neck Infections.

There is no shortage of news, information, and guidelines with regards to novel coronavirus (COVID-19). However, there is none yet that is specific to the treatment of patients who have sustained trauma or active head and neck infections-frequently encountered from oropharyngeal sources such as peritonsillar abscess or odontogenic infections. The COVID outbreak has not diminished the incidence of these conditions, and in fact has exacerbated access to care by the closing of urgent care treatment centers as well as private dental offices. The purpose of this article is to outline a protocol to protect health care providers in the provision of this care for at-risk patient populations.

Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation.

Limited visibility characteristic of cleft palate repair presents both ergonomic and educational challenges to cleft surgeons. Despite widespread recognition and reporting, posture-related spine disorders continue to represent a significant and potentially career-limiting problem for cleft/craniofacial surgeons. In addition, education and participation during palate repairs is difficult because of visual field constraints. At the authors' institution, a novel videoscope system was designed and implemented to (1) provide visualization for all surgical team members during palate operations, (2) facilitate active resident education, and (3) improve surgeon ergonomics. The authors' prior report demonstrated proof of concept for this method, which is now used in all cleft palate operations at their center. The purpose of this report is to share the detailed methodology to facilitate implementation by others and a retrospective review of the authors' experience before and after implementation. Video demonstration of the videoscope setup and a representative, recorded case are provided. The use of the videoscope was feasible in palatoplasties regardless of palatal phenotype and repair technique and did not have an effect on operative time. Subjectively, the authors report reduced procedure time in cervical flexion and subjectively improved musculoskeletal strain associated with videoscope use. Importantly, use of this system also provided complete visualization for all operating room team members and enabled enhanced resident autonomy during palate operations. Finally, it has facilitated the creation and archive of high-definition educational videos with unparalleled perspective. The equipment required to implement the system is likely already available in many medical centers. Adoption of this system may provide an opportunity to improve posture and teaching capabilities for cleft surgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, III.

Patient demand for plastic surgeons for every US state based on Google searches.

INTRODUCTION: As a profession, plastic surgeons must meet the public demand for esthetic and reconstructive procedures. Patients search for physicians using Google, which offers insights into patient needs through their search history. METHODS: The Google Trends Relative Search Volumes (RSV) were pulled for all searches for "plastic surgery" over 12 months. The number of active plastic surgeons per state was divided by Census Bureau population estimates to calculate the surgeons-per-capita value, or "surgical concentration." The Google score divided by this concentration yields a "surgical demand index" for each state. RESULTS: Florida, New York, and Connecticut had the greatest concentration of surgeons per ten-thousand people (0.220, 0.217, and 0.209, respectively), while Wyoming, Arkansas, and Vermont had the smallest (0.051, 0.071, 0.080). California exhibited the greatest number of Google searches (RSV=100), followed by Florida and Hawaii (RSV=95). Oregon (RSV=38), Virginia (RSV=52), and Alaska (RSV=58) had the fewest searches. The "surgical demand index" was greatest in Wyoming (1187.778), Oklahoma (993.751), and Arkansas (974.664) and smallest in Oregon (264.682), Virginia (320.716), and Connecticut (354.872). CONCLUSION: The distribution of US plastic surgeons is not homogeneous. The Google data suggest that some markets (e.g. Oregon) are saturated while others (e.g. Wyoming) have significant demand that is not met by the number of plastic surgeons in those states.

The Use of Emotional Artificial Intelligence in Plastic Surgery.

BACKGROUND: The use of social media to discuss topics related to and within plastic surgery has become widespread in recent years; however, it remains unclear how to use this abundance of largely untapped data to propagate educational research in the field of plastic surgery. In this prospective, observational study, the authors aimed to delineate which plastic surgery-related topics evoked a significant emotional response within the study population and to assess the utility of motivational artificial intelligence within the field of plastic surgery. METHODS: Over a 4-month period (January to April of 2018), Cognovi Lab's artificial intelligence technology was used to search and analyze emotional reactions to several commonly hashtagged words. This innovative software uses several key metrics to describe its findings, including awareness, engagement, and motivation. RESULTS: Of the search terms examined, "nose job" had the most awareness during the study period, and the topic that most engaged consumers emotionally was "liposuction." Interestingly, "liposuction" ranked only fifth in terms of awareness. Consumers showed the strongest positive motivation toward the subjects of "plastic surgery" and "cosmetic surgery," and the lowest motivation toward the topic of "tummy tucks." CONCLUSIONS: This analysis by Cognovi Labs is the first quantitative effort to use the plethora of data on social media to interpret patient motivations and subsequent behavior. Moving forward, artificial intelligence technology will make it possible to predict which plastic surgery products, procedures, and practices will be successful. The findings presented in this article describe the unique viewpoint and power that this technology can deliver.

Maximizing Plastic Surgery Education Impact: Lessons from Resident Learning Styles and Experiential Learning Theory.

Residents in many surgical disciplines express a strong preference for hands-on learning, but no studies have focused on plastic surgery. This initial study aims to ascertain the learning styles of plastic surgery residents, and identify potential trends that may better guide curriculum development. METHODS: Kolb Learning Style Index v. 3.1 was administered to plastic surgery residents across all training levels at three residency programs. The Kolb Learning Style Index is a 12-item questionnaire that characterizes an individual's learning style into 1 of 4 major categories: converging; accommodating; assimilating; and diverging. RESULTS: The surveyed cohort of plastic surgery residents (n = 45) demonstrated a diverse mix of learning styles: converging (38%, n = 17); accommodating (24%, n = 11); diverging (20%, n = 9); and assimilating (16%, n = 7). One resident was balanced between converging and accommodating (2%, n = 1). Despite varied learning styles, the majority (64%, n = 29) demonstrated a preference for "active experimentation," for example, hands-on learning. CONCLUSIONS: A preliminary assessment of learning styles among plastic surgery residents suggests that they have mixed learning styles. This contrasts with the existing literature from other surgical specialties where a single learning style dominates. However, like these other specialties, active experimentation is particularly valued. As such, it behooves the plastic surgery educator to continue to strive for balance between book learning and hands-on experience for residents at all levels of training, to engage residents with all learning styles.

Modeling fade patterns of nipple areola complex tattoos following breast reconstruction.

BACKGROUND: Nipple-areolar complex (NAC) tattoos are an effective cosmetic solution for creating a finished look following breast reconstruction procedures. NAC tattoos are prone to significant fading, leading patients to seek revisions. This study was designed to quantify changes in NAC tattoo appearance over time. METHODS: A total of 71 images of 39 patients were analyzed for NAC tattoo color and shape by 5 blinded medical student graders using a customized scoring system. Subsequently, each image was analyzed using ColorPic software (Iconico, New York, NY). Red/green/blue and hue/saturation/value color parameters were collected. Color quantities were normalized to the individual patient's skin tone to control for variability in lighting. Spearman correlations and nonlinear regressions were calculated utilizing GraphPad Prism 6.0 (GraphPad, La Jolla, CA). RESULTS: The length of time after tattoo placement inversely correlated with color score (P < 0.0001) and shape score (P = 0.0007). The time following tattoo placement was also inversely correlated with all quantitative color parameters. Each color parameter fit a 1-phase exponential decay model. CONCLUSIONS: The decline in qualitative color and shape score agrees with clinical experience of tattoo quality declining over time. The color qualities of the tattoo approach those of the patient's skin over time, ultimately reaching a plateau. This can be modeled using a 1-phase decay equation. In practice, tattoo colors may be selected that compensate for the predictable changes that will occur. The results of this study will help optimize tattoo color and may alleviate the need for NAC tattoo revisions.