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Background: Mechanical emulsification of adipose tissue to concentrate protein and stromal cell components (ie, nanofat) has gained considerable interest in clinical practice. Although the regenerative potential of nanofat has largely been used in aesthetic applications, these effects have considerable potential in reconstruction as well. Here, the authors investigated the therapeutic properties of nanofat injected directly into the denervated gastrocnemius after a sciatic nerve injury in Lewis rats., Methods: Muscle denervation was induced by transecting and immediately repairing the sciatic nerve. Inguinal and subcutaneous adipose was harvested from donor rodents, processed into nanofat, and then injected intramuscularly into the gastrocnemius. Gait analysis was performed weekly. Rodents were euthanized at 9 and 12 weeks, after which tetanic contraction force was measured, and gene expression, histology, and cytokine multiplexing were performed., Results: Intramuscular injection of nanofat significantly increased maximum tetanic force generation at 9 and 12 weeks. The forces of the nanofat-injected gastrocnemii were better correlated to their contralateral gastrocnemii relative to controls. Muscle repair-associated inflammatory gene expressions were significantly up-regulated in nanofat-injected gastrocnemii. Cytokines interleukin (IL)-1β, IL-18, vascular endothelial growth factor, granulocyte-macrophage colony-stimulating factor, and tissue inhibitor of metalloproteinase-1 were significantly higher in nanofat-injected gastrocnemii relative to control gastrocnemii, and the tetanic force was linearly and significantly correlated to IL-1β and IL-18 and their interacting effects., Conclusions: Intramuscular injection of emulsified adipose tissue (nanofat) significantly increased gastrocnemii contraction force after sciatic nerve injury, with prolonged reconstructive inflammation by means of CD68, inducible nitric oxide synthase, IL-1β, and IL-18 all being potential mechanisms for this recovery. This application could potentially increase the therapeutic breadth of nanofat to include muscular recovery after nerve injury., Clinical Relevance Statement: The authors' study investigates a clinically translatable therapy to mitigate muscle atrophy after nerve injury., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Background: Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees., Methods: A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05., Results: There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees' career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included "futility" (29 percent) and "fear" (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001)., Conclusions: Gender bias and sexual misconduct negatively affect female trainees' attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training., (Copyright © 2021 by the American Society of Plastic Surgeons.)

Background: Plastic surgery trainees who wish to start a family face challenges. This is the first study to collect data directly from residents and fellows to understand issues surrounding childbearing and to propose solutions., Methods: Following institutional review board approval, an anonymous survey was distributed to all current plastic surgery residents and fellows in the United States. Data regarding demographics, obstetrical complications, parental leave, breastfeeding, and use of assisted reproductive technology were collected., Results: The survey was completed by 307 trainees, for a resident response rate of 27.0 percent. Mean age of the respondents was 31.7 ± 3.8 years, 58.6 percent were married, and 35.3 percent reported at least one pregnancy for themselves or for their partner. Both male (67.4 percent) and female (76.5 percent) respondents intentionally postponed having children because of career. Women were significantly more likely to report negative stigma attached to pregnancy (70.4 percent versus 51.1 percent; p = 0.003) and plan to delay childbearing until after training. Fifty-six percent of female trainees reported an obstetrical complication. Assisted reproductive technology was used by 19.6 percent of trainees. Mean maternity leave was 5.5 weeks, with 44.4 percent taking less than 6 weeks. Mean paternity leave was 1.2 weeks. Sixty-two percent of women and 51.4 percent of men reported dissatisfaction with leave. Sixty-one percent of female trainees breastfed for 6 months and 19.5 percent continued for 12 months. Lactation facilities were available near operating rooms for 29.4 percent of respondents., Conclusions: Plastic surgery training may negatively impact fertility, obstetrical health, and breastfeeding practices. The data presented in this article provide the groundwork for identifying areas of concern and potential solutions.

Background: Adipose tissue reaches cellular stasis after puberty, leaving adipocytes unable to significantly expand or renew under normal physiologic conditions. This is problematic in progressive lipodystrophies, in instances of scarring, and in soft-tissue damage resulting from lumpectomy and traumatic deformities, because adipose tissue will not self-renew once damaged. This yields significant clinical necessity for an off-the-shelf de novo soft-tissue replacement mechanism., Methods: A process comprising separate steps of removing lipid and cellular materials from adipose tissue has been developed, creating an ambient temperature-stable allograft adipose matrix. Growth factors and matrix proteins relevant to angiogenesis and adipogenesis were identified by enzyme-linked immunosorbent assay and immunohistochemistry, and subcutaneous soft-tissue integration of the allograft adipose matrix was investigated in vivo in both the athymic mouse and the dorsum of the human wrist., Results: Allograft adipose matrix maintained structural components and endogenous growth factors. In vitro, adipose-derived stem cells cultured on allograft adipose matrix underwent adipogenesis in the absence of media-based cues. In vivo, animal modeling showed vasculature formation followed by perilipin A-positive tissue segments. Allograft adipose matrix maintained soft-tissue volume in the dorsal wrist in a 4-month investigation with no severe adverse events, becoming palpably consistent with subcutaneous adipose., Conclusions: Subcutaneous implantation of allograft adipose matrix laden with retained angiogenic and adipogenic factors served as an inductive scaffold for sustaining adipogenesis. Tissue incorporation assessed histologically from both the subcutaneous injection site of the athymic nude mouse over 6 months and human dorsal wrist presented adipocyte morphology residing within the injected scaffold.