Successful Treatment of Wounds from Nonuremic Calciphylaxis with Acellular Piscine Dermis.

In this report, we present a 57-year-old man with chronic bilateral lower extremity wounds from nonuremic calciphylaxis, which were successfully reconstructed using a piscine-derived acellular dermal matrix. The acellular dermal matrix incorporated quickly, providing a wound bed that was amenable to skin grafting. We demonstrate that this is an effective off-the-shelf solution for these chronic wounds, resulting in pain reduction and complete closure of the wounds, allowing the patient to return to his previous baseline activities, and improving his quality of life.

Geographic Trends in the Neurosurgery Match During the COVID-19 Pandemic.

In the present article, the impact of the COVID-19 pandemic on geographical trends in the neurosurgery match in successfully matched applicants was analyzed. A cross-sectional analysis for the years from 2017 to 2021 was performed. Successful applicants' region, state, and medical school were compared with the location of their matched residency program. The number of applicants matching at a residency program within the same region or state as their home medical school or their own medical school was then evaluated. One hundred fifteen neurosurgery residency programs and 1066 successfully matched applicants were included in the analysis. When comparing 2021 with previous years, no significant change in the percentage of applicants matching at their home region (43.1% vs 49.7%, P = .09), home state (25.1% vs 26.3%, P = .69), or home program (19.9% vs 18.7%, P = .70) was found. The COVID-19 pandemic did not significantly affect geographic trends during the neurosurgery match in 2021. This is of note as the COVID-19 pandemic significantly affected the match in other competitive specialties, including plastic surgery, dermatology, and otolaryngology. Despite limited away rotations, it is possible that neurosurgery programs did not change their applicant selection criteria and implemented systems to virtually interact with applicants outside of their local region.

Orphan Applicants in Plastic Surgery: Where Do Medical Students Without an Affiliated Residency Program Match?

Background: The number of resident positions in integrated plastic surgery residencies are relatively few and highly sought after. Medical students interested in plastic surgery as a career are faced with the challenge of deciding where to apply for these highly competitive spots. This sense of keen competition means students are often applying to almost all available programs across the country with the idea of increasing their chance of successfully matching. Previous research has shown that exposure to specialty programs in medical school portends enhanced success in residency matches. This study focuses on medical students who come from schools without plastic surgery residencies-orphans-and the characteristics of those who successfully matched into integrated plastic surgery programs. Methods: This study evaluated trends in successfully matched applicants in integrated plastic surgery residencies from 2016-2021 by looking at applicants' medical school type, presence of plastic surgery residency associated with the medical school, and geographic region. Geographic region of residency programs, medical school of applicants, and national quality ranking of medical schools were correlated with applicant demographics. The data were tabulated and analyzed utilizing chi-square analysis. Results: Orphans who graduated from allopathic medical schools without an affiliated integrated plastic surgery residency program comprised 24.4% of successfully matched applicants, whereas those with affiliated integrated residency programs comprised 72.2%. However, at the top quartile of prestige-rated residency programs, these orphan applicants only comprised 17.4% of residents. Of all medical school applicants, 18.2% matched at a residency program affiliated with their medical school (P = 0.04). Annually, 1 to 3 osteopathic medical school graduates and 3 to 9 international medical graduates matched, representing less than 1 and 4%, respectively, of all matched applicants; these applicants had the least successful match rates. Conclusions: There continues to be a modest number of successfully matched integrated plastic surgery residents who are graduates of allopathic medical schools with no affiliated residency program but disproportionately fewer at the top quartile institutions. There are also very few osteopathic and international medical school graduates who match, which has seen no significant change over the last 6 years.

COVID-19 and the Otolaryngology Match: An Increase in Applicants Remaining Close to Home.

INTRODUCTION: Otolaryngology residency remains one of the most competitive surgical subspecialties to apply for with a 63% match rate in 2021. This is a difficult and stressful process for applicants in any given year, and it was even further complicated by restrictions mandated by coronavirus disease 2019 (COVID-19) protections. Analyzing geographical trends in successfully matched applicants provides prospective applicants and programs with helpful information about how previous trends were affected by the pandemic as we look toward future match cycles. METHODS: The medical schools of 1,587 successfully matched applicants from 2017-2021 were identified and compared to the 116 otolaryngology residency programs. Successful applicants' medical school state and region were then compared to the location of their matched residency program state and region. From this, we evaluated the number of applicants matching at the residency program affiliated with their medical school or at a residency program within the same state or region as their home medical school. RESULTS: A significant increase in the percentage of applicants matching at their home program and within their home state (p < 0.001) occurred in 2021 when compared to previous years. Applicants matching within their home region was not found to increase significantly (p = 0.43) in 2021 compared to previously. The regions with the greatest increase in the percentage of applicants matching to their home programs were the Northeast and Midwest (12% increase), while the Midwest had the largest increase in percentage of applicants matching within their home state (15%). CONCLUSION: The COVID-19 pandemic significantly affected the otolaryngology match in 2021 with applicants and programs alike choosing to stay closer to home with their residency match selections. Overall, regional location remains a major determinant of future residency location for otolaryngology applicants, and this did not change significantly during 2021, but applicants matched more frequently at their home medical school program. It is anticipated that the match process will be similar in 2022 given the ongoing pandemic, so the importance of home program and region will likely be emphasized again.

Successful upper extremity limb salvage using cellular- and tissue-based products in a patient with uncontrolled diabetes.

INTRODUCTION: Uncontrolled diabetes causes dysfunction in all stages of wound healing, including greatly delayed wound closure owing to impaired angiogenesis. CTPs play an important role in advanced wound care, especially in complex diabetic wounds. The 3 categories of CTP are ECMs, amniotic tissues, and composite products that combine living cells and a collagen matrix. These products are available as xenografts or allografts, or as bioengineered products. ECMs provide a biological scaffold to facilitate wound healing, and these tend to modulate the wound environment and become incorporated into the wound bed. CASE REPORT: A right-hand dominant female with uncontrolled type 2 diabetes presented with a complex nonhealing wound of the right upper extremity; the patient was treated with CTPs after surgical intervention (incision and drainage of the abscess, open carpal tunnel release, forearm fasciotomy, and excisional debridement) for a deep forearm abscess. Exposed critical structures included flexor tendons and the median nerve. The patient received a single application of a meshed dermal regeneration template, an application of minimally processed human umbilical cord membrane, and an application of acellular fish skin, resulting in successful wound reconstruction and improved function of the right upper extremity. CONCLUSION: To the authors' knowledge, this is the first described use of acellular fish skin in the setting of upper extremity reconstruction.

The Impact of COVID-19 on the Orthopaedic Surgery Residency Match.

Introduction Matching into an orthopaedic surgery residency program presents a challenging accomplishment for applicants to achieve in any given year. Due to the profound changes to the application process caused by the coronavirus disease 2019 (COVID-19) pandemic it was theorized that there would be a change in the number of graduates matching close to their home medical school region, state, and program. Methods Orthopaedic surgery residency program Web sites and social media accounts were accessed to elucidate current resident data, including graduates' medical school, and geographical location of their school. Chi-square analysis was performed to identify trends in current residents matching within their home program, state, and region associated with the 2021 orthopaedic match. These numbers were compared with previous year's successful applicants. Results In 2021, a significant 4.4% ( p =0.02) increase in successful matches within applicants' home states occurred (33.4% vs. 37.8%) and home programs ( p <0.001) when compared with previous years (21.2% vs. 27.4%). However, in 2021, there was no significant change in home region matching ( p =0.56) with 60% of successful matches occurring in home regions. This was statistically consistent with what was observed in previous years (61.4%). Conclusion The COVID-19 pandemic was associated with restrictions in travel and interview options resulting in a significant increase in the number of orthopaedic applicants who matched into their home program, or at programs in their home state compared with previous years. Although no statistically significant regional change occurred during the 2021 match, it remains the leading predictor of where successful applicants will match. With many unknowns related to the upcoming match cycles it is important for applicants and programs to have a general idea of recent trends and outcomes to best focus their efforts, especially if diversity and minority inclusion are considered in highly competitive specialties like orthopaedic surgery.

Erythematous Plaques and Tense Bullae in an Infant.

Although often thought of as a disease of the elderly, bullous pemphigoid is the second most common bullous disease in infants. Infantile bullous pemphigoid is extremely rare and may be easily confused with other skin diseases such as epidermolysis bullosa and chronic bullous disease of childhood. There appears to be a paucity of literature on unique clinical presentations of infantile bullous pemphigoid. In this report, we describe a case of infantile bullous pemphigoid, which presented with tense bullae in a widespread distribution, including many labial bullae. The rash initially began on this patient's temples and ears four days prior. We believe this case will be of interest as it demonstrates a rare infantile disease with an unusual clinical presentation. It is important to consider infantile bullous pemphigoid in a patient presenting with tense bullae and initiate appropriate diagnostic studies.

Successful Prepectoral Breast Reconstruction in a Patient With Systemic Sclerosis.

Patients with connective tissue diseases have been shown to be at higher risk for complications after surgery. In this report, we describe a case of a patient with long-standing, stable systemic sclerosis (SS), diagnosed approximately 28 years ago, who underwent nipple-sparing mastectomy and immediate reconstruction with prepectoral tissue-expander placement. She subsequently had uneventful implant-based reconstruction with adjunctive fat grafting. To our knowledge, this is the first reported case of implant-based prepectoral reconstruction after mastectomy in a patient with SS.

Evaluating the Integrated Plastic Surgery Residency Match During the Novel Coronavirus Pandemic.

The COVID-19 pandemic had significant impacts on medical education and on the 2021 Match. Visiting student rotations at locations other than students' home institutions were cancelled and residency interviews were hosted virtually. This study evaluated the impact that COVID-19 had on the 2021 Match including residency programs matching applicants from within their own institution as well as from within the same region. The sex of matched applicants in the Match cycles was analyzed as well. Data were collected from residency program websites, social media accounts, and communication with current residents. Data were tabulated and chi-square analysis was performed. The overall difference in matched internal candidates pre-/post-pandemic was determined to be statistically significant (8.3% increase; p = 0.004). The Midwest was determined to exhibit a significant increase for matching residents from medical schools in the same region (15.6% increase; p = 0.04). Female applicants were also determined to be significantly more likely to match into integrated plastic surgery programs in 2021. COVID-19 significantly impacted the 2021 Match with an increased number of programs selecting internal candidates, matched female applicants, and regional selectivity, especially in the Midwest. It is our hope that applicants, programs, and the plastic surgery community will use this information to continue to improve the residency selection process in the future.

Anomalous Presentation of Venous Malformations in an Adolescent Male.

Venous malformations (VMs) may manifest clinically in a broad spectrum. Most VMs are sporadic with previous studies reporting less than 1.2% to be inherited. Conversely, multifocal lesions, such as glomuvenous malformations (GVMs), which have glomus cells in their vascular walls, have been reported to have a frequency of inheritance of 63.8%. Both VMs and GVMs may occur due to sporadic mutation and must be differentiated clinically because this will dictate their proper treatment. Sporadic GVMs involve skin and subcutis, with bluish-purple coloration, are painful to compression, and have no radiographic evidence of phleboliths. Previous studies have demonstrated that VMs are almost always associated with a single lesion that is nontender to compression and are often able to be diagnosed by the presence of phleboliths on radiographic imaging. We present a case of a 14-year-old right-hand-dominant male who presented with two distinct VMs on the dorsum of the right index finger at the proximal and middle phalanges. A previously biopsied lesion overlying the ipsilateral olecranon, which was reported as a possible glomus tumor versus vascular malformation, was present as well. Based on history, physical examination, multicentric presentation, and radiographic findings, the presumptive diagnosis was that the lesions were GVMs. However, after surgical excision and histopathologic examination, the lesions were determined to be VMs because of the absence of glomus cells. Due to the difference in treatment modalities for VMs and GVMs, the ability to accurately diagnose these lesions clinically is essential. This case represents an anomalous presentation of multiple venous malformations occurring in two distinct locations in a 14-year-old boy.