Cultured Skin Autograft in Subtotal Pediatric Scalp Avulsion.

ABSTRACT: Pediatric scalp avulsions represent a reconstructive challenge because of the unique features of scalp tissue. When microsurgical reimplantation is not feasible, alternative approaches such as skin grafting, free flap transfer with latissimus flap, or tissue expansion are considered. Generally, there is no consensus regarding management of this trauma, and, oftentimes, multiple reconstructive techniques may be needed for definitive coverage. This case study describes the reconstruction of a pediatric subtotal scalp avulsion using a dermal regeneration template and novel autologous homologous skin construct. This case was complicated by the absence of original tissue for reimplantation, excessive size of the defect relative to body habitus, and family concerns for future hair-bearing function. The reconstruction successfully provided definitive coverage and significantly reduced the size of the donor site and associated compilations. However, the hair-bearing potential of the tissue has yet to be determined.

Innovative scheme for high-repetition-rate imaging of CN radical.

We have employed, to the best of our knowledge, a novel excitation scheme to perform the first high-repetition-rate planar laser-induced fluorescence (PLIF) measurements of a CN radical in combustion. The third harmonic of a Nd:YVO4 laser at 355 nm due to its relatively large linewidth overlaps with several R branch transitions in a CN ground electronic state. Therefore, the 355 nm beam was employed to directly excite the CN transitions with good efficiency. The CN measurements were performed in premixed CH4-N2O flames with varying equivalence ratios. A detailed characterization of the high-speed CN PLIF imaging system is presented via its ability to capture statistical and dynamical information in these premixed flames. Single-shot CN PLIF images obtained over a HMX pellet undergoing self-supported deflagration are presented as an example of the imaging system being applied towards characterizing the flame structure of energetic materials.

A randomized study on the value of self-directed versus traditional mentor-led microsurgical training.

Objective: Analyze efficacy of self-directed resident microvascular training versus a mentor-led course. Study Design: Randomized, single-blinded cohort study. Setting: Academic tertiary care center. Methods: Sixteen resident and fellow participants were randomized into two groups stratified by training year. Group A completed a self-directed microvascular course with instructional videos and self-directed lab sessions. Group B completed a traditional mentor-led microvascular course. Both groups spent equal time in the lab. Video recorded pre and post-course microsurgical skill assessments were performed to assess the efficacy of the training. Two microsurgeons, blinded to participant identity, evaluated the recordings and inspected each microvascular anastomosis (MVA). Videos were scored using an objective-structured assessment of technical skills (OSATS), a global rating scale (GRS), and quality of anastomosis scoring (QoA). Results: The pre-course assessment identified that the groups were well matched with only "Economy of Motion" on the GRS favoring the mentor led group (p = .02). This difference remained significant on the post assessment (p = .02) Both groups significantly improved in OSATS and GRS scoring (p < .05). There was no significant difference in OSATS improvement between the two groups (p = .36) or improvement in MVA quality between groups (p > .99). Time to completion of MVA significantly improved overall by a mean of 8 min and 9 s (p = .005) with no significant difference between post training times to complete (p = .63). Conclusion: Different microsurgical training models have previously been validated as effective methods for improved MVA performance. Our findings indicate that a self-directed microsurgical training model is an effective alternative to a traditional mentor driven models. Level of Evidence: Level 2.

Expected Impact of the Pass/Fail Scoring System for USMLE Step 1 on the Plastic Surgery Residency Selection Process: A National Survey of Plastics Program Directors.

BACKGROUND:  Traditionally, the United States Medical Licensing Examination (USMLE) Step 1 3-digit score has been used as a metric to stratify plastic surgery residency candidates. The transition to a pass/fail exam may impact the manner in which integrated plastic surgery residency program directors (PS-RPD) evaluate candidates. It may also limit opportunities for applicants to differentiate themselves from their counterparts. METHODS: A 14-question survey was distributed via email to 76 PS-RPDs collected from the American Medical Association (AMA) residency program site, FRIEDA. It was sent three times from March 3 - March 14, 2020. McNemar tests were performed on the current metrics of evaluation in comparison to metrics expected to be used in the absence of a 3-digit Step 1 score, assuming a P < 0.05 level for statistical significance.  Results: Of the 76 integrated plastics programs surveyed, 24 PS-RPDs responded (31.6% response rate); 91.3% of PS-RPDs strongly disagree or disagree that Step 1 should be pass/fail; 78.3% of PS-RPDs strongly disagree or disagree that diversity will increase. The top five evaluation metrics PS-RPDs expect to utilize following the transition to pass/fail are: letters of recommendation (87.0%; CI 72% - 100%; p=0.500), Step 2 score (78.3%; CI 60% - 96%; p=0.001), research (56.5%; CI 35% - 78%; p=0.125), elective rotation (56.5%; CI 35% - 78%; p=1.000), and personal knowledge of the applicant (52.2%; CI 30% - 74%; p=0.500).  Conclusions: In the absence of a Step 1 score, PS-RPDs may require more holistic metric(s) to evaluate the best fit for their program. This study found that PS-RPDs expect their candidate evaluation process to remain highly similar with the only statistically significant change being an increased emphasis on the candidate's Step 2 score.

Will Residency Program Directors Look at My United States Medical Licensing Examination (USMLE) Step 1 Score During the 2022-2023 Application Cycle? A National Survey of Program Directors.

Background The 2022-2023 residency match cycle will be the first cycle that program directors will have to consider some applicants with a numerical United States Medical Licensing Examination (USMLE) Step 1 score while other applicants will only report pass/fail for USMLE Step 1. Previous studies have explored how USMLE Step 1 becoming pass/fail will alter the residency selection process, but it is not yet known when program directors from each specialty expect those changes to be implemented. Methods Residency program director's contact information was extracted from the American Medical Association (AMA) residency program site, Fellowship and Residency Electronic Interactive Database (FREIDA). Of the 5190 programs, 4877 were determined eligible for this study of which 1274 (26.8%) responded. Results Of the 1274 US residency program directors included in this survey, 77.0% do not intend to adjust their usage of USMLE Step 1 as a metric in candidate evaluation until the score is no longer reported. Conclusion Residency candidates applying during the upcoming cycle can expect the majority of residency programs will not significantly alter their previous utilization of an applicant's USMLE Step 1 score during the current 2022-2023 residency match cycle.

Neuroanatomy of the normal prostate.

BACKGROUND: The prostate is a richly innervated organ, but its neuroanatomy has not been thoroughly mapped and analyzed quantitatively. METHODS: We selected prostates from autopsy cases of cancer-free patients aging from their 40's to 70's, and histologic sections were immunostained with S-100. Nerve density hotspots were mapped, photographed, and analyzed for nerve area. RESULTS: Innervation of the peripheral zone was found to be significantly greater than the transition zone (P < 0.0006), which is in turn significantly more innervated than BPH (P < 0.007). The posterior capsule has significantly more nerve area than the anterior capsule (P < 0.0001). Highest innervation was seen in the neurovascular bundles and seminal vesicles, with the lowest in transition zone and BPH. When compared to increasing patient age, both peripheral zone and overall innervation tended to decrease. CONCLUSIONS: These results are quantitative in nature, performed in cancer-free patients ranging over four different decades of age. We plan to soon compare this profile with our developing profile of cancerous prostates, hoping to learn more about interactions between nerves and prostate cancer.