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Background: The risks of postoperative complications in breast cancer patients vary by patient and tumor characteristics. Elevated BMI and invasive lobular carcinoma (ILC) increase risks of surgical complications and positive margins, respectively., Methods: We retrospectively analyzed patients with BMI ≥30 ​kg/m 2 from an institutional ILC database. The primary outcome was surgical complication rate by procedure type. The secondary outcome was positive margin rates by surgical approach, stratified by T stage., Results: Of 154 analyzed patients, standard BCS, lumpectomy with oncoplastic closure, and simple mastectomy had the lowest complication rates (18.2 ​%, 17.0 ​%, 11.8 ​%). Oncoplastic reduction mammoplasty and mastectomy with aesthetic closure had the highest rates (35.5 ​%, 33.3 ​%). The overall positive margin rate was 28.5 ​%, significantly higher in BCS vs. mastectomy (37.4 ​% vs. 15.0 ​%, p ​= ​0.003). Oncoplastic surgery significantly reduced positive margin rates in BCS., Conclusion: In this study, 23.4 ​% of patients experienced surgical complications, with higher rates in oncoplastic/reconstructive approaches. However, oncoplastic surgery reduced positive margins, highlighting the importance of balancing risks for optimal surgical planning., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rita A. Mukhtar reports financial support was provided by National Cancer Institute. Rita Mukhtar was supported by the National Cancer Institute Award K08CA256047 Israel Falade was supported by the UCSF Yearlong Research Fellowship 2023–2024 academic year.If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Patient-directed Electronic Health Record (EHR) messaging is used as an adjunct to enhance patient-physician interactions but further burdens the physician. There is a need for clear electronic patient communication in all aspects of medicine, including plastic surgery. We can potentially utilize innovative communication tools like ChatGPT. This study assesses ChatGPT's effectiveness in answering breast reconstruction queries, comparing its accuracy, empathy, and readability with healthcare providers' responses., Methods: Ten deidentified questions regarding breast reconstruction were extracted from electronic messages. They were presented to ChatGPT3, ChatGPT4, plastic surgeons, and advanced practice providers for response. ChatGPT3 and ChatGPT4 were also prompted to give brief responses. Using 1-5 Likert scoring, accuracy and empathy were graded by 2 plastic surgeons and medical students, respectively. Readability was measured using Flesch Reading Ease. Grades were compared using 2-tailed t tests., Results: Combined provider responses had better Flesch Reading Ease scores compared to all combined chatbot responses (53.3 ± 13.3 vs 36.0 ± 11.6, P < 0.001) and combined brief chatbot responses (53.3 ± 13.3 vs 34.7 ± 12.8, P < 0.001). Empathy scores were higher in all combined chatbot than in those from combined providers (2.9 ± 0.8 vs 2.0 ± 0.9, P < 0.001). There were no statistically significant differences in accuracy between combined providers and all combined chatbot responses (4.3 ± 0.9 vs 4.5 ± 0.6, P = 0.170) or combined brief chatbot responses (4.3 ± 0.9 vs 4.6 ± 0.6, P = 0.128)., Conclusions: Amid the time constraints and complexities of plastic surgery decision making, our study underscores ChatGPT's potential to enhance patient communication. ChatGPT excels in empathy and accuracy, yet its readability presents limitations that should be addressed., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Oncologic breast reconstruction (OBR) is a complex process that requires consideration of multiple factors, including chemoradiation, extent of cancer treatment, and surgical approach. Patients often feel uncertain about the numerous surgical options and may turn to popular social media platforms like YouTube for information. Thus, this study aims to assess the quality and reliability of YouTube videos related to OBR. We conducted a retrospective, cross-sectional analysis of YouTube videos related to OBR. Search terms were obtained from plasticsurgery.org and Google Trends. The first ten videos for each search term were analyzed. Videos were categorized by source and subject matter and independently reviewed by three evaluators using the DISCERN scale. This study examined 172 YouTube videos. Five video source categories were identified: Health Care Administrations, Physicians, Non-physician Providers, News Organizations, and Patients. Health Care Administration accounts received the highest overall DISCERN score of 3.6 ± 0.51, followed by Physicians at 2.98 ± 0.93, with News Organization accounts scoring the lowest at 2.22 ± 0.60 ( p < 0.001). Videos from academic sources (Physicians and Health Care Administrators) had higher DISCERN scores compared to non-academic sources (News Organizations and Patients), 2.98 ± 0.95 versus 2.28 ± 0.77, respectively ( p < 0.001). Our findings indicate that videos from academic sources generally exhibit higher DISCERN scores, pointing to a higher content quality and reliability standard. Given the increasing reliance on YouTube for healthcare information, our study underscores the need for healthcare professionals to engage more actively in content creation and dissemination., Competing Interests: All authors report no conflicts of interest., (© 2024 The Authors.)

Background: Invasive lobular carcinoma (ILC) of the breast grows in a diffuse pattern, resulting in a high risk of positive margins at surgical resection. Oncoplastic approaches have been shown to reduce this risk, but concerns persist around the safety of immediate oncoplastic surgery for those with ILC. This study evaluated the short- and long-term oncologic outcomes of immediate oncoplastic surgery for patients with ILC., Methods: This study retrospectively analyzed an institutional database of stages I to III ILC patients who underwent breast-conserving surgery (BCS) with or without immediate oncoplastic surgery (oncoplastic closure or oncoplastic reduction mammoplasty [ORM]). The study compared positive margin rates, rates of successful BCS, and recurrence-free survival (RFS) by type of surgery., Results: For 494 patients the findings showed that the use of immediate ORM was associated with significantly lower odds of positive margins (odds ratio [OR], 0.34; 95 % confidence interval [CI], 0.17-0.66; p = 0.002). Both lumpectomy with oncoplastic closure and ORM were significantly associated with higher rates of successful BCS than standard lumpectomy (94.2 %, 87.8 %, and 73.9 %, respectively; p < 0.001). No difference in RFS was observed between those undergoing immediate oncoplastic surgery and those undergoing standard lumpectomy alone., Conclusions: The patients with stages I to III ILC who underwent immediate oncoplastic surgery had significant benefits including lower odds of positive margins and higher rates of successful BCS, with both types of immediate oncoplastic surgery showing similar RFS compared with lumpectomy alone. This supports the oncologic safety of immediate oncoplastic surgery for diffusely growing tumors such as ILC, providing it an ideal option for patients desiring BCS., (© 2024. The Author(s).)

Background: Hand infections represent a significant burden for both health care systems and their patients. Epidemiological understanding of community-acquired hand infections is limited. This study examined a cohort of hand infection patients at a large urban safety net hospital for characteristics that were associated with protective and/or risk factors for hand infections., Methods: We performed a retrospective chart review for all patients who required hand surgery consultation in the emergency department during a 1-year period (2021-2022). County-level population characteristics were obtained through the county-level data sources. We then performed a risk ratio (RR) analysis for demographic and socioeconomic characteristics., Results: A total of 125 patients were included in the study cohort. Cisgender male (RR, 4.654; P < 0.001), Black (RR, 6.062; P < 0.001) and American Indian/Alaska Native (RR, 3.293; P = 0.041) patients were found to be overrepresented in our cohort when compared to county proportions, indicating an association with increased risk of hand infections. Patients between 35 and 49 years of age were also found to have an increased risk (RR, 1.679; P = 0.005). Age over 65 years, retirement, and employment were found to be protective factors (RR, 0.341 [ P = 0.001]; RR, 0.397 [ P = 0.043]; RR, 0.197 [ P < 0.001]). In contrast, unemployment and unstable housing (unhoused or shelter) were found to have strong harmful risk for necessitating hand infection consults (RR, 7.587 [ P < 0.001]; RR, 235.715 [ P < 0.001]; RR, 29.990 [ P < 0.001])., Conclusions: There are clear risk factors at play for hand infection incidence. We found that housing status, employment, race, gender, and age were some of the most important contributors for incidence. This information can assist clinicians and public officials in developing more specific screening algorithms and prevention tools to reduce systematic burden. Further studies are required to elucidate specific etiologies associated with hand infection risk., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To use portable colorimetry to quantify color differences between facial skin and potential three head and neck microvascular free tissue transfer (MFTT) donor sites-radial forearm (RF), anterolateral thigh (ALT), and fibula (FF)-and compare these differences by pigmentation of the donor site skin and self-identified race., Methods: In this cross-sectional cohort study, healthy volunteers consented to handheld colorimeter measurements at the three potential MFTT donor sites (RF, ALT, FF) to quantify color match to the facial skin using the CIE color space (DeltaE). The comparison of ipsilateral to contralateral cheek served as control for measurements. Cross-sectional measurements in healthy volunteers were then compared to measurements obtained in postoperative head and neck MFTT patients., Results: DeltaE measurements were obtained for 128 healthy controls and 24 postoperative patients (N = 152). With increasing lightness (decreased pigmentation) of the skin at the donor site, the color match significantly worsened (higher DeltaE) across all potential MFTT donor sites (all p < 0.05). DeltaE from healthy controls closely approximated postoperative color match measurements in patients who underwent cervicofacial MFTT (DeltaE RF: 5.3 vs. 6.0, p = 0.432; DeltaE ALT: 6.2 vs. 6.4, p = 0.822; DeltaE FF: 6.0 vs. 6.4, p = 0.806)., Conclusion: Patients with decreased skin pigmentation who are undergoing head and neck MFTT may experience worse color discrepancy between cervicofacial skin and the transferred skin paddle than those with more pigmented skin. Portable colorimetry may identify patients who could benefit from interventions such as dermis-resected free tissue reconstruction with skin grafting to improve postoperative appearance., Level of Evidence: 3 Laryngoscope, 134:3581-3586, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: In the United States, over 6 million people are affected by chronic wounds. Patients often rely on the Internet for treatment information; however, these educational materials typically exceed the average eighth-grade health literacy level. This study aimed to assess the readability and language accessibility of online patient education materials on wound care strategies., Methods: A search was conducted on Google for articles related to wound care strategies. The first 12 unique websites from each search strategy were selected for further analysis. Readability was assessed using 11 tests, with the mean scores calculated for each., Results: A total of 66 articles pertaining to wound care strategies were retrieved from 43 websites. All articles had an average reading grade level of 13.5 ± 2.5 and an average reading age of 18.7 ± 2.5 years. Websites were categorized by the following sources: academic (34.9%), reagent/biologic manufacturers (27.9%), wound care (18.6%), news media organizations (14%), and other (4.7%). Flesch Reading Ease Score, graded from 0 for most difficult to 100 for least difficult, was found to be highest for academic websites (44.2, P = .01) and lowest for news media websites (24.9, P = .01). Academic websites were available in the more languages compared to all other website categories (P < .01)., Conclusion: Online materials related to wound care strategies often exceed the National Institute of Health recommended eighth-grade reading level. This study emphasizes the need for healthcare providers to create more accessible educational materials to address the gap in health literacy and optimize patient care., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Incisional negative pressure wound therapy (iNPWT) is an adjunctive treatment that uses constant negative pressure suction to facilitate healing. The utility of this treatment modality on vascular operations for critical limb-threatening ischemia (CLTI) has yet to be elucidated. This study compares the incidence of postoperative wound complications between the Prevena Incision Management System, a type of iNPWT, and standard wound dressings for vascular patients who also underwent plastic surgery closure of groin incisions for CLTI., Method: We performed a retrospective cohort study of 40 patients with CLTI who underwent 53 open vascular surgeries with subsequent sartorius muscle flap closure. Patient demographics, intraoperative details, and wound complications were measured from 2015 to 2018 at the University of California San Francisco. Two cohorts were generated based on the modality of postoperative wound management and compared on wound healing outcomes., Results: Of the 53 groin incisions, 29 were managed with standard dressings, and 24 received iNPWT. Patient demographics, comorbidities, and operative characteristics were similar between the 2 groups. Patients who received iNPWT had a significantly lower rate of infection (8.33% vs 31.0%, P = 0.04) and dehiscence (0% vs 41.3%, P < 0.01). Furthermore, the iNPWT group had a significantly lower rate of reoperation (0% vs 17.2%, P = 0.03) for wound complications within 30 days compared with the control group and a moderately reduced rate of readmission (4.17% vs 20.7%, P = 0.08)., Conclusions: Rates of infection, reoperation, and dehiscence were significantly reduced in patients whose groin incisions were managed with iNPWT compared with standard wound care. Readmission rates were also decreased, but this difference was not statistically significant. Our results suggest that implementing iNPWT for the management of groin incisions, particularly in patients undergoing vascular operations for CLTI, may significantly improve clinical outcomes., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Artificial intelligence (AI) and machine learning have transformed health care with applications in various specialized fields. Neurosurgery can benefit from artificial intelligence in surgical planning, predicting patient outcomes, and analyzing neuroimaging data. GPT-4, an updated language model with additional training parameters, has exhibited exceptional performance on standardized exams. This study examines GPT-4's competence on neurosurgical board-style questions, comparing its performance with medical students and residents, to explore its potential in medical education and clinical decision-making., Methods: GPT-4's performance was examined on 643 Congress of Neurological Surgeons Self-Assessment Neurosurgery Exam (SANS) board-style questions from various neurosurgery subspecialties. Of these, 477 were text-based and 166 contained images. GPT-4 refused to answer 52 questions that contained no text. The remaining 591 questions were inputted into GPT-4, and its performance was evaluated based on first-time responses. Raw scores were analyzed across subspecialties and question types, and then compared to previous findings on Chat Generative pre-trained transformer performance against SANS users, medical students, and neurosurgery residents., Results: GPT-4 attempted 91.9% of Congress of Neurological Surgeons SANS questions and achieved 76.6% accuracy. The model's accuracy increased to 79.0% for text-only questions. GPT-4 outperformed Chat Generative pre-trained transformer (P < 0.001) and scored highest in pain/peripheral nerve (84%) and lowest in spine (73%) categories. It exceeded the performance of medical students (26.3%), neurosurgery residents (61.5%), and the national average of SANS users (69.3%) across all categories., Conclusions: GPT-4 significantly outperformed medical students, neurosurgery residents, and the national average of SANS users. The mode's accuracy suggests potential applications in educational settings and clinical decision-making, enhancing provider efficiency, and improving patient care., (Copyright © 2023 Elsevier Inc. All rights reserved.)