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Summary:. Cryptocurrency offers a decentralized alternative to traditional financial systems, facilitating peer-to-peer transactions with minimal fees and heightened security. It also transformed into a financial asset similar to gold. Despite its volatile valuation, recent developments, such as the approval of Bitcoin exchange-traded funds by the Securities and Exchange Commission, underscore its evolving role as an investment opportunity. Plastic surgery has increasingly embraced cryptocurrency as a form of payment, leveraging its speed, security, and privacy benefits. However, alongside its potential advantages, risks such as volatility, irreversibility of transactions, and regulatory uncertainties warrant careful consideration. Moving forward, the integration of blockchain technology and cryptocurrency is poised to revolutionize various aspects of plastic surgery, from patient privacy to postoperative monitoring devices, necessitating a proactive approach from surgeons to navigate this evolving landscape. This article explores the intersection of cryptocurrency and plastic surgery, delving into its current applications, risks, investment potential, and future prospects.

Summary:. Integration of artificial intelligence (AI), specifically with natural language processing and machine learning, holds tremendous potential to enhance both clinical practices and administrative workflows within plastic surgery. AI has been applied to various aspects of patient care in plastic surgery, including postoperative free flap monitoring, evaluating preoperative risk assessments, and analyzing clinical documentation. Previous studies have demonstrated the ability to interpret current procedural terminology codes from clinical documentation using natural language processing. Various automated medical billing companies have used AI to improve the revenue management cycle at hospitals nationwide. Additionally, AI has been piloted by insurance companies to streamline the prior authorization process. AI implementation holds potential to enhance billing practices and maximize healthcare revenue for practicing physicians.

Surgeons must be confident that the instruments they use do not pose risk of infection to patients due to bioburden or contamination. Despite this importance, surgeons are not necessarily aware of the steps required to ensure that an instrument has been properly sterilized, processed, and prepared for the next operation. At the end of an operation, instruments must be transported to the sterile processing unit. There, instruments are decontaminated before being sterilized by heat, chemical, or radiation-based methods. Following this, they are stored before being brought back into use. This review highlights the intricacies of the processing of surgical instruments at the conclusion of an operation so that they are ready for the next one.

Background:. The increasing patient demand for cosmetic surgeries and minimally invasive procedures has encouraged physicians without aesthetic surgery training accredited by the American Board of Medical Specialties to provide these services. This systematic review aims to determine the rate of out-of-scope practice in medical malpractice lawsuits involving cosmetic surgery or minimally invasive procedures performed by nonplastic surgeons. Methods:. Our systematic review of the Westlaw legal database from 1979 to 2022 included 64 malpractice cases. Inclusion criteria were cosmetic surgeries or minimally invasive procedures in medical malpractice lawsuits not involving board-certified plastic surgeons. Out-of-scope was defined using the procedural competencies established by the American Council for Graduate Medical Education, the Commission on Dental Accreditation, and the Council of Podiatric Medical Education. Data on legal proceedings, provider credentials and board certification, surgical interventions, and legal outcomes were collected. Results:. The majority of malpractice cases involving cosmetic surgeries or minimally invasive procedures occurred when providers were practicing out of scope (N = 34; 55.7%). The verdict was ruled in favor of the plaintiff (patient) in 34.4% of cases. Out-of-scope practice occurred most in family/internal medicine, no board certification, and obstetrics/gynecology (N = 4, N = 4, and N = 3, respectively). The most common allegation was permanent injury or disfigurement (N = 21; 21.4%). Plastic surgeons provided expert testimony 44.0% of the time. Conclusion:. Our review of the Westlaw legal database suggests that the majority of nonplastic surgeon cosmetic malpractice cases may occur in the setting of out-of-scope practice.

Background: Breast reconstruction often requires multiple surgeries, which demands additional expense and time and is often contrary to the patient’s expectation. The aim of this study was to review the number of operations that were needed for completion of breast reconstruction and to determine patient and clinical factors that influenced this number. Methods: We retrospectively reviewed the medical records of 254 cases of breast reconstructions (in 185 patients) that were performed between February 2005 and August 2009. We investigated the numbers of operations that were performed for individual case of breast reconstruction and analyzed the influence of variable factors. The purpose of the additional operations was also analyzed. Results: The mean number of operations per breast was 2.37 (range, 1–9). The mean number of operations for mound creation was 2.24. Factors associated with an increased number of operation were use of an implant, contralateral symmetrization, complications, and nipple reconstruction. Considering the reconstruction method, either the use of a primary implant or the use of free abdominal tissue transfer demonstrated fewer surgeries than the use of an expander implant, and the number of operations using free transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps was less than the number of operations using pedicled transverse rectus abdominis musculocutaneous flaps. Conclusions: These data will aid in planning breast reconstruction surgery and will enable patients to be more informed regarding the likelihood of multiple surgeries.

Purpose: Penile inversion vaginoplasty (PIV) is the most common gender affirming genital procedure for transfeminine patients. The purpose of this study was to investigate the impact of tranexamic acid (TXA), an antifibrinolytic, on bleeding and bleeding-related complications in vaginoplasty surgery. Methods: Retrospective chart review was performed on patients undergoing PIV from February 2018 through March 2020 by the senior author (K.G.) at the University of Wisconsin Hospital and Clinics. Patients who received TXA received a combination of topical and intravenous TXA. Data collected includes patient demographics (age, body mass index, race, comorbidities, and tobacco and illicit drug use), intraoperative data (duration of surgery, estimated blood loss, fluid administration, TXA use and dose, and complications), and postoperative data (drain output, complications within 30 days, and revision surgery). Subgroup analysis on the effect of TXA was performed using independent sample t-test. Results: Seventy-four patients were included in this study with 56 patients receiving TXA and 18 patients who had surgery prior to initiation of TXA protocol. There were no thromboembolic events observed in the TXA or the non-TXA group. Ninety percent of all complications were Clavien-Dindo Grade 1 and did not require intervention. There was a significantly lower EBL in the TXA group compared to the no TXA cohort (299.1 ± 64.3 vs. 347.2 ± 84.8, p=0.013). Patients who received TXA had significantly fewer wound related complications than those who did not receive TXA (21.4% vs. 66.7%, p

Summary:. Fenestrated acellular dermal matrix (ADM) has improved patient outcomes in both direct-to-implant and 2-stage tissue expander/implant breast reconstruction. This technical alteration utilizes optimal fenestration overlap to enhance the breast reconstruction experience. We present a novel, surgeon-designed shaped fenestrated ADM, placed in the recently repopularized prepectoral pocket for anterior coverage of implants in direct-to-implant and 2-stage breast reconstruction. A retrospective review of 10 patients (18 breasts) who underwent direct-to-implant or 2-stage breast reconstruction utilizing fenestrated shaped ADM in the prepectoral plane at a major academic institution in 2016 was conducted. Sixteen breasts (88.9%) underwent direct-to-implant reconstruction, and 2 breasts (11.1%) received tissue expanders. All reconstructions were performed using FlexHD Pliable ADM with surgeon-designed shape and fenestrations. The average implant size was 544.4 cc (±137.2 cc). The average intraoperative tissue expander fill volume measured 450 cc (90% of tissue expander size). The single expander case utilized 1 office fill (day 21) for full expansion. Major complications requiring reoperation within 90 days postoperatively were observed in 22.2% (4 breasts) of reconstructions. Three breasts (16.7%) due to partial mastectomy flap necrosis, 1 breast (5.5%) explantation due to infection. There was no seroma or capsular contracture. Prepectoral reconstruction with shaped fenestrated ADM is safe with high intraoperative fill volumes and facilitates more direct-to-implant reconstructions. Patients undergo fewer postoperative expansions, experience less time to full expansion, and subjectively report less pain. Patients benefit from improved cosmetic outcomes with better shape and no functional loss or animation deformity.