The Utility of Telemedicine in Plastic and Reconstructive Surgery: Provider and Patient Perspectives.

Background: The use of telemedicine has become increasingly common, especially since the COVID-19 pandemic. Virtual visits can be beneficial for use in plastic surgery but are not without limitations. The purpose of this study was to better understand the utility of telemedicine in plastic surgery from both patient and provider perspectives. Methods: A survey was distributed to all patients who had a telemedicine visit at the authors' institution from April to October 2020 as well as a representative cohort of providers via the American Society of Plastic Surgeons. The survey collected various demographic data and included a Likert scale questionnaire to assess the use and overall quality of telemedicine services. Data collected for the patient and provider groups were compared using t tests, chi-square tests, and Mann-Whitney (U) tests. Results: A total of 67 patients (N = 501; 13.4%) and 160 providers (N = 2701; 5.9%) responded to the survey. Patients were significantly younger than providers (45.8 ± 11.8 vs 55.0 ± 11.6 years; P < .001). Patients responded significantly more favorably than providers in the domains of telemedicine usefulness, ease of use, interaction quality, and reliability. Patients were significantly more comfortable than providers in scheduling surgery without an in-person visit. Patients also rated higher comfort levels than providers with a virtual physical examination, including examination of sensitive body parts, such as breasts and genitals. Conclusions: Plastic surgery patients are generally comfortable and satisfied with the care provided by telemedicine. Telemedicine can provide high-quality health care and can be utilized by plastic surgeons to optimize care in their practice.

Forequarter Amputation: Reconstruction With Targeted Muscle Reinnervation to the Filet of Forearm Free Flap.

Forequarter amputation is a rarely indicated operation that has the potential for delayed wound healing, chronic pain, and dysfunction. Reconstruction in cases of skin and soft tissue loss may be particularly challenging. Here we present a 79-year-old female with recurrent, previously radiated left shoulder chondrosarcoma who underwent forequarter amputation with a 'spare parts' filet of forearm flap and targeted muscle reinnervation to the flap. The patient healed without complication and achieved reinnervation with minimal pain.

Complications in Adult Patients with Down Syndrome Undergoing Cervical Spine Surgery Using Current Instrumentation Techniques and rhBMP-2: A Long-Term Follow-Up.

Introduction Cervical spine pathologies are common in Down syndrome (DS) patients. Cervical pathologies may cause cord compression and neurologic deterioration if left untreated. Complication rates of 73-100% have been reported in DS patients after cervical spine surgery in historical studies. This study reports updated perioperative complications rates and long-term outcome in patients with DS undergoing cervical spine surgery. Methods Retrospective review of patients with DS who have undergone cervical spine surgery from 1998 to 2011 (≥ 24 months of follow-up) was undertaken. Series of 17 adults with preoperative diagnoses that included atlantoaxial instability, stenosis, spondylosis, or cervical spondylolisthesis were evaluated. Nine patients received recombinant human bone morphogenetic protein-2 (rhBMP-2). Neurologic and ambulatory status was evaluated at regular intervals included pre- and postoperative imaging, range of motion evaluation, strength/neurologic testing, ambulation observation, and patient and caretaker pain reporting. Results A total of 20 surgical procedures were performed in 17 patients. Average follow-up was 78.7 months (range: 25-156 months). Overall, 37 complications were observed including pneumonia, respiratory distress, reintubation, dysphagia, deep venous thrombosis, sepsis, wound infection, dehiscence, neurologic complications, loss of reduction (LOR), pseudarthrosis, and hardware failure. Postoperative pneumonia was most common (23.5%). Three patients developed pseudarthrosis (all in the rhBMP-2 group); three demonstrated LOR. Neurologic complications (N = 3) included spasticity, loss of ambulation, and postoperative weakness with myelomalacia. Two were transient. Respiratory complications in the rhBMP-2 group were the most common (N = 3). The anterior approach resulted in a higher likelihood of complications than the posterior (p = 0.032). Conclusions Current techniques may improve pseudarthrosis (p = 0.009), LOR (p = 0.043), and first attempt (p = 0.038) and overall fusion rates (p = 0.018) compared with historical studies. Complications continue to challenge most patients (82.4%). A total of 16 of 17 patients (94.1%) demonstrated stabilization or improvement in neurologic status. Apparent successful outcome in the majority appears to warrant the high complication risk associated with cervical spine surgery in DS patients. The anterior approach resulted in a higher risk of complications than posterior (p = 0.032). We report a higher than expected incidence of pseudarthrosis in DS patients receiving rhBMP-2, putting its benefit in DS patients into question.