Early Return of Motion in Patients With Intramedullary Screw Placement for Metacarpal and Phalangeal Fracture Fixation.

INTRODUCTION: Hand fractures are associated with significant morbidity. Current management standards often result in prolonged immobilization, stiffness, and delayed return to functional use. Intramedullary (IM) compression screws offer minimal soft tissue disruption and early postoperative active motion. In this study, we describe our outcomes after intraosseous fracture fixation using IM cannulated headless screws for a multitude of fracture patterns. METHODS: This study is a retrospective review of patients who underwent IM screw placement for fixation of metacarpal and phalangeal fractures by a single surgeon from 2017 to 2022. Data were collected to include patient demographics, fracture details, postoperative complications, and follow-up. Time to range of motion and return to unrestricted motion was recorded. RESULTS: There were 69 patients with 92 fractures (n = 54 metacarpal, n = 38 phalanx). The median patient age was 45 years (range, 18-89 years) with 75.4% males. Majority presented with a single fracture (n = 50, 72.5%), and 38 patients (55.1%) had open fractures. Small finger was the most affected digit (n = 35, 37.6%). The median time to allow range of motion from surgery was 8.7 days (interquartile range, 0-32) with 32 days (interquartile range, 10-62) for unrestricted use of the hand. Thirty-five patients (50.7%) were allowed controlled motion from the first postoperative day. One patient had loss of reduction requiring reintervention for hardware removal, and 1 patient had superficial skin infection managed with oral antibiotics. CONCLUSIONS: Our findings indicate that the IM screw provides reliable fixation for a wide variety of fracture patterns with a low complication rate and offers early return to functional use.

A Model to Study Wound Healing Over Exposed Avascular Structures in Rodents With a 3D-Printed Wound Frame.

BACKGROUND: Soft tissue defects with exposed avascular structures require reconstruction with well-vascularized tissues. Extensive research is ongoing to explore tissue engineered products that provide durable coverage. However, there is a lack of controlled and affordable testbeds in the preclinical setting to reflect this challenging clinical scenario. We aimed to address this gap in the literature and develop a feasible and easily reproducible model in rodents that reflects an avascular structure in the wound bed. METHODS: We created 20 × 20 mm full thickness wounds on the dorsal skin of Lewis rats and secured 0.5-mm-thick silicone sheets of varying sizes to the wound bed. A 3D-printed wound frame was designed to isolate the wound environment. Skin graft and free flap survival along with exposure of the underlying silicone was assessed. Rats were followed for 4 weeks with weekly dressing changes and photography. Samples were retrieved at the endpoint for tissue viability and histologic analysis. RESULTS: The total wound surface area was constant throughout the duration of the experiment in all groups and the wound frames were well tolerated. The portion of the skin graft without underlying silicone demonstrated integration with the underlying fascia and a histologically intact epidermis. Gradual necrosis of the portion of the skin graft overlying the silicone sheet was observed with varying sizes of the silicone sheet. When the size of the silicone sheet was reduced from 50% of the wound surface area, the portion surviving over the silicone sheet increased at the 4-week timepoint. The free flap provided complete coverage over the silicone sheet. CONCLUSION: We developed a novel model of rodent wound healing to maintain the same wound size and isolate the wound environment for up to 4 weeks. This model is clinically relevant to a complex wound with an avascular structure in the wound bed. Skin grafts failed to completely cover increasing sizes of the avascular structure, whereas the free flap was able to provide viable coverage. This cost-effective model will establish an easily reproducible platform to evaluate more complex bioengineered wound coverage solutions.

Upper Extremity Functional Outcomes After Breast Cancer Treatment: An Analysis of DASH Score in Breast Reconstruction Patients.

BACKGROUND: Patients undergoing postoncologic breast reconstruction can experience upper extremity (UE) functional deficits. OBJECTIVES: In this study, we utilized the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire to identify patient factors that impact UE functional recovery. METHODS: Patients who underwent oncologic followed by reconstructive surgery by a single surgeon from 2014-2019 and completed the DASH survey were included. A DASH score was calculated for each patient with values ranging from 0 (no impairment) to 100 (severe impairment). Regression analysis was conducted to identify significant predictors for DASH score with a significance level for entry and stay set at p=0.15. RESULTS: Among 289 patients who underwent post breast reconstruction, 157 completed the questionnaire. The average patient age was 52.6yrs ± 8.6 at the time of reconstruction. 111 had implant-based reconstruction, 15 had autologous reconstruction, and 24 had a combination of both. Average DASH score was 7.7 (range 0.0-52.5), with 74.1% of patients having a score greater than 0. Regression analysis showed five variables associated with significantly higher DASH scores: age between 50-60 years (p=0.13), history of radiation (p=0.01), placement of a sub-pectoral implant (p=0.06), postoperative complications (p=0.10), and lymphedema (p<0.01). Autologous breast reconstruction (p=0.04) was associated with a significantly lower DASH score. CONCLUSIONS: Implant-based reconstruction, radiation history, postoperative complications, and age at reconstruction were associated with increased UE functional impairment in patients undergoing breast reconstructive surgery. Identification of these factors can inform areas for potential practice changes and improve patient counseling for postoperative expectations.

Analyzing the Impact of Social and Psychiatric Factors in Patients Who Undergo Body Contouring Procedures.

BACKGROUND: As the prevalence of obesity increases, the number of patients seeking body contouring procedures after bariatric surgery for massive weight loss is increasing. Although the positive impact of bariatric surgery on physical and emotional health is well-described, few studies have reported on the psychosocial well-being of patients undergoing body contouring procedures. Psychosocial well-being can impact patient satisfaction and maintenance of weight loss, and is an important area to study. OBJECTIVE: The aim of this study was to characterize social and psychiatric factors of patients undergoing body contouring surgery, and to evaluate their impact on maintenance of weight loss. METHODS: A retrospective review was performed of patients who presented to a single institution for body contouring procedures between 2002 and 2018. Demographic details, medical history, psychosocial support, and operative details were collected. Univariate analysis and multinomial logistic regressions were performed with R statistical software (version 1.3.1093). RESULTS: A total of 1187 patients underwent at least 1 body contouring procedure during the study time frame. Mean BMI at presentation was 31.21 ± 10.49 kg/m2. Patients diagnosed with obesity at age 18 or older had significantly greater odds of suffering from generalized anxiety disorder (odds ratio [OR] 1.08 [95% CI, 1.02-1.15], P = .008). Patients with spousal support had 1.93 times higher odds of having maintained postbariatric weight loss at their 6-month follow-up (OR 1.93 [95% CI, 1.84-2.01], P = .028). CONCLUSIONS: Social support and age of obesity diagnosis impact psychological well-being and maintenance of weight loss following body contouring procedures.

Repigmentation of the Nipple-Areolar Complex Following Free Nipple Grafting.

INTRODUCTION: Free nipple grafting (FNG) is a technique historically used during breast reduction and gender dysphoria top surgery to minimize nipple areolar complex (NAC) hypoperfusion and subsequent loss. One drawback of this approach is NAC hypopigmentation. This study seeks to quantify long-term pigmentation changes in the NAC following FNG. METHODS: A retrospective review of patients who underwent reduction mammoplasty or simple mastectomy with FNG from 2000-2020 at our institution was conducted. Patients were included if they had pre-operative, early, and late post-operative images. Images were analyzed using NIH Image J software for pigmentation changes over time. RESULTS: Of the 151 patients identified, 56 patients (111 breasts) had complete imaging (macromastia n=47; oncologic n=4; gender dysphoria n=5). All patients had NAC hypopigmentation on early imaging, with 25.5% (SD 18.1%) of the NAC affected. On late imaging, 83 NAC (74.7%) experienced repigmentation with only 8.7% (SD 7.3%) of the NAC area remaining hypopigmented. This represents a 67.2% resolution of pigmentation (p<0.001). 10 NAC (9.0%) had progression of hypopigmentation, and 17 NAC (15.3%) had no change. In a subset analysis by race, Caucasian patients had significantly greater area of NAC hypopigmentation on early post-operative imaging (Caucasian, 29.3% (SD 18.8%) vs Black, 18.3% (SD 14.0%), p<0.01). However, resolution of hypopigmentation was similar between both. CONCLUSION: While partial hypopigmentation of the NAC is nearly universal following FNG, a majority of patients experience repigmentation with low residual hypopigmentation at 1 year. These findings are useful for counseling patients with early pigmentation changes in addition to guiding surgical decisions about breast surgery with FNG.

ChatGPT Is Equivalent to First-Year Plastic Surgery Residents: Evaluation of ChatGPT on the Plastic Surgery In-Service Examination.

BACKGROUND: ChatGPT is an artificial intelligence language model developed and released by OpenAI (San Francisco, CA) in late 2022. OBJECTIVES: The aim of this study was to evaluate the performance of ChatGPT on the Plastic Surgery In-Service Examination and to compare it to residents' performance nationally. METHODS: The Plastic Surgery In-Service Examinations from 2018 to 2022 were used as a question source. For each question, the stem and all multiple-choice options were imported into ChatGPT. The 2022 examination was used to compare the performance of ChatGPT to plastic surgery residents nationally. RESULTS: In total, 1129 questions were included in the final analysis and ChatGPT answered 630 (55.8%) of these correctly. ChatGPT scored the highest on the 2021 exam (60.1%) and on the comprehensive section (58.7%). There were no significant differences regarding questions answered correctly among exam years or among the different exam sections. ChatGPT answered 57% of questions correctly on the 2022 exam. When compared to the performance of plastic surgery residents in 2022, ChatGPT would rank in the 49th percentile for first-year integrated plastic surgery residents, 13th percentile for second-year residents, 5th percentile for third- and fourth-year residents, and 0th percentile for fifth- and sixth-year residents. CONCLUSIONS: ChatGPT performs at the level of a first-year resident on the Plastic Surgery In-Service Examination. However, it performed poorly when compared with residents in more advanced years of training. Although ChatGPT has many undeniable benefits and potential uses in the field of healthcare and medical education, it will require additional research to assess its efficacy.

Further evidence for sustained systemic inflammation in xenograft recipients (SIXR).

INTRODUCTION: In pig-to-baboon heart/artery patch transplantation models, adequate costimulation blockade prevents a T-cell response. After heart transplantation, coagulation dysfunction (thrombocytopenia, reduced fibrinogen, increased D-dimer) and inflammation (increased C-reactive protein [CRP]) develop. We evaluated whether coagulation dysfunction and/or inflammation can be detected following pig artery patch transplantation. METHODS: Baboons received heart (n = 8) or artery patch (n = 16) transplants from genetically engineered pigs and a costimulation blockade-based regimen. Heart grafts functioned for 15-130 days. Artery recipients were euthanized after 28-84 days. Platelet counts, fibrinogen, D-dimer, and CRP were measured. RESULTS: Thrombocytopenia and reduced fibrinogen developed only in recipients of hearts not expressing a coagulation-regulatory protein (n = 4), but not in other heart or patch recipients. However, in heart recipients (n = 8), there were sustained increases in D-dimer (<0.5 to 1.9 ug/ml [P < 0.01]) and CRP (0.26-2.2 mg/dl [P < 0.01]). In recipients of artery patches, there were also sustained increases in D-dimer (<0.5 to 1.4 ug/ml [P < 0.01]) and CRP (0.26 to 1.5 mg/dl [P < 0.001]). An IL-6R antagonist suppressed the increase in CRP, but not D-dimer. CONCLUSION: The pig artery patch model has proved valuable for determining immunosuppressive regimens that prevent sensitization to pig antigens. This model also provides information on the sustained systemic inflammation in xenograft recipients (SIXR). An IL-6R antagonist may help suppress this response.