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Implants with deficient papillae and black triangles are common findings. The treatment of these esthetic complications is considered to be challenging with limited predictability. Therefore, the present report aims to describe a novel technique for papilla augmentation: the "iceberg" connective tissue graft (iCTG) after extraction and interproximal bone reconstruction in the anterior region. A 35-year-old patient presented with a hopeless tooth with interproximal clinical attachment loss extending to the apical third of the adjacent tooth. Interproximal bone reconstruction was performed through alveolar ridge preservation by directly applying recombinant human platelet-derived growth factor-BB (rhPDGF-BB) to the exposed root surface of the adjacent tooth. A mixture of autogenous bone chips (obtained from the ramus) and bovine bone xenograft particles (previously mixed with the growth factor) was also used. The patient was able to return for implant therapy only 2 years later, at which time an incomplete regeneration of the interproximal bone was observed. Therefore, to compensate the interproximal deficiency, the iCTG approach was utilized, involving a double layer of CTG with different origins. Two small grafts from the tuberosity were sutured to the mesial and distal ends of a wider CTG harvested from the palate, aiming to gain additional volume at the interproximal sites. The composite graft was then sutured on top of the implant platform, and the flap was then released and closed by primary intention. After conditioning the peri-implant tissues, the case was finalized with a satisfactory outcome. The described iCTG could be an effective approach for reconstructing peri-implant papillae following interproximal bone reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: To complete a reanalysis study of two similarly designed prospective controlled studies exploring prognostic factors associated with the surgical outcomes of reconstructive treatment of peri-implantitis. Materials and Methods: Individual patient data of both studies were gathered. The initial study employed a submerged healing approach via primary wound closure with implant suprastructure removal and complete coverage of grafted sites. The second study employed a nonsubmerged healing protocol in which healing abutments were kept in place and the implants were not fully submerged. Both studies measured all prognostic factors at similar time points throughout 1 year and included clinical defect fill (DF) and radiographic defect fill (RDF), reduction of pocket depth (PDR), and bleeding on probing (BoP). Multilevel regression was used for statistical assessment of outcomes relative to the impact of site, local, surgical, and patient-related variables. Results: Overall, 59 implants (30 submerged and 29 nonsubmerged) were treated. Statistically significant higher DF (on average 0.9 mm higher), RDF (1.7 mm), and PDR (1.3 mm) were observed when a submerged reconstructive approach was performed, whereas BoP reduction was similar. After controlling for treatment (submerged/nonsubmerged), there were no other significant associations with patient-related (age, sex, smoking, prior periodontitis etc), or implant-related (previous prosthesis type, arch, keratinized tissue width [KTW], etc) factors. Conclusions: Within the study's limitations, we conclude that a submerged reconstructive approach for surgical management of peri-implantitis leads to significantly enhanced clinical and radiographic outcomes when compared to a nonsubmerged approach. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical effectiveness of regenerative treatment of intrabony defects in combination with consecutive orthodontic therapy with clear aligners in stage IV (type 2) periodontitis. Method and materials: Ten patients with a total of 103 intrabony defects were analyzed after regenerative surgery using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by orthodontic therapy with clear aligners. Changes in radiographic bone level and probing pocket depths were evaluated after 1 year (T1) and at final splinting (T2) after orthodontic tooth movement. Results: Mean radiographic bone level gain was significant, with 2.13 ± 1.64 mm at T1 and 3.02 ± 2.00 mm at T2. Mean probing pocket depth was significantly reduced from 5.40 ± 1.80 mm at baseline to 3.78 ± 1.73 mm at T1, and remained stable with 3.73 ± 1.70 mm at T2. Pocket closure (≤ 4 mm probing pocket depth) was accomplished in 76% of all defects. Tooth loss amounted to 2.9%. Conclusion: Within the limitations of the retrospective study design, the findings suggest that the interdisciplinary treatment of periodontitis stage IV by regenerative periodontal surgery and consecutive orthodontic therapy with clear aligners can lead to favorable results. [ABSTRACT FROM AUTHOR]

In both plastic surgery and burn treatment departments, the management of postoperative wounds is a crucial element of surgical care, profoundly influencing patient recovery and the broader spectrum of healthcare outcomes. The monitoring of wound flatness after surgery, although a pivotal component of this process, is frequently underemphasized. In most cases, this parameter can only be judged based on doctors' personal experience. Here, we propose a compact, fully integrated wireless sensing system encapsulated by soft biocompatible materials for quantitative assessment of wound flatness and long-term temperature. The absence of physical tethers and the ion-gel-based construction of the micro-structured sensor represent key defining features, resulting in high measurement resolution of 2 mm radius and 0.096 Ω / ° C and reliable capabilities. In addition, these sensors can be connected to the server network or mobile clients to evaluate the state of postoperative suture wounds and monitor the patient's recovery status. With our devices, detailed data on smoothness and temperature of sutured wounds can be collected, analyzed, and stored for medical assistance as well as being used to improve the quality of surgery. [ABSTRACT FROM AUTHOR]

This clinical case outlines a comprehensive digital workflow for a minimally invasive multidisciplinary treatment. The process utilizes one open-source software for digital wax-up and one low-cost software to address esthetic concerns related to teeth misalignment. The patient's function was stabilized with a digitally made occlusal splint. The application of the described digital workflow technique, incorporating open-source, lowcost, and closed software, played a pivotal role in attaining a straightforward and predictable outcome with minimally invasive treatment. Furthermore, the continual evolution of technology contributes to the growing precision of dental procedures. The presented digital workflow helped formulate a predictable treatment plan, replicate a diagnostic digital wax-up, and achieve precise teeth alignment. This approach satisfactorily addressed the patient's esthetic concerns, providing an outstanding approximation of the definitive result. [ABSTRACT FROM AUTHOR]

Guided bone regeneration (GBR) requires a tension-free flap without damaging the collateral circulation in order to secure better surgical outcomes. Topographic knowledge regarding the neurovascular bundles in the posterior aspect of the mandible can prevent complications during lingual flap design. The lingual branch (LB) of the inferior alveolar or maxillary arteries is not sufficiently illustrated or described in the literature. Nevertheless, it has an intimate relationship with the lingual nerve (LN) during ridge augmentation and implant-related posterior mandible surgery. Therefore, this study aimed to clarify the morphology and topography of the LB related to GBR surgeries. In the present human cadaveric study, the LB was analyzed in 12 hemimandibles using latex injection and corrosion casting. Two types of LB were identified based on their origin and course. The LB was found in a common connective tissue sheath close to the LN. The LB assembled several anastomoses on the posterior lingual aspect of the mandible and retromolar area. The LB acted as an anatomical landmark in identifying LN at the posterior lingual aspect of the mandible. [ABSTRACT FROM AUTHOR]

Purpose: The present study describes a new presurgical soft tissue technique in oral/maxillary bone reconstructive surgery for reducing the risk of soft tissue dehiscence and its related complications. Materials and Methods: Ten consecutive patients with Cawood and Howell type V atrophy were scheduled for CAD/CAM titanium mesh bone reconstructive surgery after applying the vascular delay technique 21 days before regenerative surgery. The surgical and healing complications were clinically assessed at nine time points, ranging from the time of bone regenerative surgery to 9 months after surgery. Surgical complications included flap damage and neurologic and vascular complications. Healing complications were subdivided into four classes. These classes comprised Class I: small membrane exposure (= 3 mm) without purulent exudate; Class II: large membrane exposure (> 3 mm) without purulent exudate; Class III: membrane exposure with purulent exudate; and Class IV: abscess formation without membrane. Results: The study sample included seven men and three women (mean age: 48.2 ± 3.5 years) with seven mandibular cases and three maxillary cases. The defect length ranged from three to six teeth, with a mean mesiodistal distance of 29.9 ± 8.5 mm and a mean volume augmentation of 2.03 ± 0.9 cm3. There were no surgical complications. One patient presented a Class I healing complication that did not affect the regeneration outcome. Conclusions: The vascular delay technique appears to reduce the risk of soft tissue dehiscence and exposure in bone regenerative surgery, though randomized studies involving larger samples and longer follow-up periods are needed in order to draw firm conclusions. [ABSTRACT FROM AUTHOR]

The use of conventional scan bodies (SBs) with an intraoral scanner (IOS) to capture the position of a complete arch of dental implants has proven to be challenging. The literature is unclear about the accuracy of intraoral scanning techniques using SBs that are connected vertically to multiunit abutments (MUAs) for numerous adjacent implants in the same arch. Recently, there has been a paradigm shift from vertical SBs to horizontal SBs, which are positioned perpendicular to the long axis of the MUAs. Most IOSs available today can capture these horizontal SBs, called scan gauges (SGs), with better accuracy and consequently acquire the position of multiple adjacent implants using an effective scan path, thus reducing stitching and the number of images. The key to implementing this novel technology is to strategically arrange the SGs to optimize horizontal overlap of multiple adjacent SGs without touching each other. By superimposing two high-resolution intraoral scans of the SGs, an artificial intelligence (AI) algorithm is employed to produce a calibrated digital best-fit model on which a passive complete-arch prosthesis can be designed and fabricated. The advantages and disadvantages of SBs and SGs are discussed, and a case report using a digital workflow is presented. [ABSTRACT FROM AUTHOR]

This randomized controlled trial aimed to determine the clinical efficacy of xenogeneic collagen membrane (XCM) derived from porcine peritoneum in combination with a coronally advanced flap (CAF) in the management of gingival recession defects and to compare the outcomes to those of connective tissue grafts (CTGs). A total of 12 systemically healthy individuals presenting with 30 isolated/multiple Cairo RT 1/2 gingival recession defects in maxillary canines and premolars were randomly treated either with CAF + XCM or CAF + CTG. Recession height (RH), gingival biotype (GB), gingival thickness (GT), width of keratinized gingiva (WKG), and width of attached gingiva (WAG) were recorded at baseline and at 3, 6, and 12 months. Patient perceptions of pain and esthetics and the modified root coverage esthetic score (MRES) were also documented. From baseline to 12 months, both groups showed a significant reduction in mean RH (CAF + CTG: 2.73 ± 0.79 mm to 0.33 ± 0.61 mm; CAF + XCM: 2.73 ± 0.88 mm to 1.20 ± 0.77 mm). At 12 months, CAF + CTG sites had a mean root coverage percentage (MRC%) of 85.60% ± 28.74%, whereas CAF + XCM sites had an MRC% of 55.13% ± 31.22%. CAF + CTG-treated sites had significantly better outcomes, with a greater number of sites achieving complete root coverage (n = 11) and higher MRES scores than the porcine peritoneal membrane group (P < .05). [ABSTRACT FROM AUTHOR]

Purpose: To assess the peri-implant and flap parameters of the prefabricated microvascular fibula flap and determine the dental implant survival rate. Materials and Methods: This retrospective study investigated a cohort of subjects who received prefabricated microvascular fibula flaps at two highly specialized tumor reconstruction centers. The subjects had all suffered atrophy or a large segmental defect of the jaws due to tumor resection or injury. Two independent surgeons determined the dental implant survival rate and assessed the peri-implant parameters and flap parameters during clinical follow-up. Results: In total, 41 subjects were treated with a prefabricated fibula flap between 1999 and 2012. Of these, 17 subjects (10 male, 7 female) with a total of 62 dental implants were examined. The other 24 subjects were unavailable for assessment and had to be excluded. Ten of the 62 dental implants (16.1%) had to be removed due to peri-implantitis before the follow-up assessment. Follow-up assessments were performed at intervals ranging from 2 to 12 years (mean: 7.2 years) after fibula flap transplantation. The dental implant survival rate was found to be 83.9%. A total of 208 dental surfaces were assessed. Overall, 96% of all surfaces had a pocket depth (PD) of ≤ 4 mm and 4% had a pocket depth of > 5 mm. An attachment level (AL) of 3 mm was measured in 48.5% of implants and ≥ 5 mm was measured in 15.9% of implants. Dental implants with a PD > 4 mm showed a significantly higher plaque index (PI) (75%; P = .0057), papillary bleeding index (PBI) (62.5%; P = .0094), and radiologic bone loss (P = .0014) compared to dental implants with a PD ≤ 4 mm. Conclusions: Reconstructive surgery using microvascular fibula flaps represents an alternative tool for oral rehabilitation in subjects suffering from a large segmental defect in the maxillary or mandibular bone compared to the conventional method. However, it appears that the different ossification processes that develop the fibula and the jawbones affect dental implant survival. [ABSTRACT FROM AUTHOR]

Purpose: To examine the stresses caused by different All-on-4 surgical techniques—conventional, a combination of monocortical and bicortical, bicortical, and nasal floor elevation—on the implant and the surrounding bone using 3D finite element analysis (FEA). Materials and Methods: A 3D bone model of the atrophic maxilla was created based on CT imaging of the fully edentulous adult patient. All implants used in the models were 4 mm in diameter, and the length was 13 mm in the anterior and 15 mm in the posterior. Implants were applied to four different atrophic maxillary models with the All-on-4 technique: anterior and posterior monocortical implants in the first model, anterior monocortical and posterior bicortical in the second model, anterior and posterior bicortical in the third model, and anterior and posterior bicortical with nasal floor elevation in the fourth model. Eight linear analyses were performed by applying force from both vertical and 45-degree oblique directions to the four models prepared in our study. Results: When the cortical and cancellous bone around the anterior implants was examined, it was observed that the oblique and vertical loading conditions and the stresses around the implant were similar in all models. When the posterior implants were examined, model 1 (ie, anterior and posterior monocortical implants) showed the greatest oblique compression, vertical compression, and vertical tension forces. According to the Von Mises stress (VMS) analysis results for anterior and posterior implants, higher values were observed in model 1 compared to models 3 and 4 under oblique and vertical forces. It was observed that bicortical placement of the implants reduced the stresses on the bone and implant-abutment system but had no significant effect on the stress on the bar. Conclusions: According to the results of our study, in the All-on-4 technique, bicortical placement of the implants reduced the stresses on the bone and implant when the anatomical limitations allowed. In addition, nasal floor elevation can be applied in the atrophic maxilla in appropriate indications. [ABSTRACT FROM AUTHOR]

For surgical craniofacial reconstruction, preoperative planning may be limited by missing 3D skeletal geometry. In forensic sciences, 'reconstruction' models the 3D facial structure from skull geometries using soft-tissue depth mapping. This work investigates 'reverse engineering' the forensics' TD Morpheus model to infer the bony shape from 3D facial surfaces by subtracting tissue depths inwards along the normal vectors. This approach using Euclidean tissue depths successfully estimated the upper and outermost skeletal regions (i.e. frontal, zygoma, and nasal bones) in 24 head CT scans, but concave skeletal surfaces were inaccurately evaluated where the face is convex yielding misshapen anatomy around the orbits and zygomatic arches. A perpendicular tissue depth algorithm was developed to probe inwards along the face's normal vectors until contacting bone, demonstrating superior performance to the Euclidean depth approach. Accurate regional tissue depths achievable with this approach may provide a useful bridge to connect the 3D face and underlying skull geometry, with the potential for application in craniofacial reconstruction. [ABSTRACT FROM AUTHOR]

Aesthetic medicine and plastic surgery encompass a broad spectrum of procedures aimed at enhancing physical appearance and psychological well-being. This field's allure lies in its potential to align external appearance with internal identity, making it profoundly relevant in contemporary society. The advancement and credibility of aesthetic medicine are anchored in Translational Medicine (TM), particularly Translational Research (TR) and Translational Science (TS). These processes translate laboratory discoveries into clinical applications, ensuring treatments are safe and effective. Despite significant progress, there remains a significant gap in understanding TS's comprehensive impact on the practical and ethical dimensions of aesthetic medicine. This study employed a literature review approach to critically examine the relationship between TM and aesthetic medicine. A systematic review was considered inappropriate due to the complex and varied nature of the research question. The existing literature comprises diverse study designs, including qualitative studies, case reports, clinical trials, and reviews. This heterogeneity necessitated a literature review to synthesise the breadth of evidence on TS's impact on aesthetic medicine effectively. The review identified substantial advancements driven by TR, including personalised interventions, regenerative therapies, and the integration of artificial intelligence. However, it also highlighted critical ethical and practical challenges. The rapid pace of innovation often surpasses the establishment of robust long-term safety data, raising concerns about patient safety and treatment efficacy. Furthermore, ethical dilemmas such as informed consent, patient autonomy, and data privacy remain inadequately addressed, necessitating stringent regulatory oversight and ethical vigilance. The future of TR in aesthetic medicine is poised for significant advancements through greater precision in treatments, interdisciplinary collaboration, and global standardisation. Nevertheless, the field must navigate the delicate balance between harmony and hype, ensuring that the pursuit of innovation does not compromise scientific integrity or ethical standards. Only by addressing these critical challenges can aesthetic medicine fulfil its promise of transformative patient outcomes and maintain public trust. Level of evidence: Not gradable [ABSTRACT FROM AUTHOR]

Lipofibromatosis is a rare benign soft tissue tumor that primarily affects children. There is limited cytological description and management of this rare condition in the literature which leads to misdiagnosis. The two years old patient first presented with a big, non-tender swelling on the scalp's right temporoparietal area. Despite receiving chemotherapy for misdiagnosis of small round cell carcinoma on first biopsy, the tumor continued to grow, requiring surgical removal. The histopathology report after surgical excision validated the diagnosis of lipofibromatosis. The cosmetic care of the wound was taken by plastic surgery team. The fact that this case was successfully treated shows how crucial it is to treat rare pediatric cancers with a multidisciplinary strategy that incorporates surgical precision, imaging, histopathology and aesthetic considerations. This strategy highlighted the need of preserving the patient's quality of life by cosmetic reconstruction in addition to facilitating efficient tumor removal. Emphasizing thorough diagnosis and interdisciplinary management, this case adds important context to the little existing research on lipofibromatosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: While there has been improved gender representation in dermatology, there remains areas for improvement, especially in leadership positions. Studies have evaluated diversity in various dermatology subspecialties, but evaluation of gender diversity in cosmetic dermatology is lacking. OBJECTIVE: To evaluate the temporal trends in gender diversity within the American Society for Dermatologic Surgery (ASDS) Cosmetic Dermatologic Surgery Fellowship Programs from 2013 to 2022. To discuss strategies for improvement. MATERIALS AND METHODS: The ASDS Cosmetic Dermatologic Surgery Fellowship program directors and fellows were reviewed from 2013 to 2022. Gender was determined through online professional websites and biographies. The number and proportion of each gender was determined for each year, and the change over time was calculated. RESULTS: The number of fellowship positions and program directors has increased from 2013 to 2022. Most of the fellows have been women. The average yearly rate of change for fellows is +1.67 and +0.67 for men and women. Most of the fellowship directors have been men. The average yearly rate of change is +1.56 and +0.44 for men and women. CONCLUSION: Gender inequalities remain across leadership positions and further studies are necessary to better determine why these discrepancies exist and how to improve this inequality. [ABSTRACT FROM AUTHOR]

Objective: Potential disadvantages of open technique for talocalcaneal coalition (TCC) include a risk of wound infection, opioid drug dependence, and prolonged hospitalization. The purpose of this study was to retrospectively evaluate the effectiveness and safety of endoscopic resection of the TCC. Methods: A retrospective study from June 2019 to February 2023was conducted on 16 consecutively admitted patients who were diagnosed by imaging to have TCC for whom conservative treatment had failed and who undergone arthroscopic resection. The mean age of this cohort was 31.56 ± 10.39 years (range, 16–57 years). The mean follow‐up period was 38.93 ± 15.69 months (range, 11–59 months). The site of the coalition, comorbidities, satisfaction with treatment, visual analog scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot scale scores were evaluated pre‐ and postoperatively. Preoperative magnetic resonance imaging (MRI) scans were used to categorize the coalition according to the Lim classification. Postoperative computed tomography (CT) scans were used to assess recurrence. The distribution of TCC cases according to the Lim classification was type I in one case, type II in four cases, and type III in 11 cases. Results: The site of coalition involved the middle facets in seven patients, the posterior facets in three patients, and both the above sites in six patients. All patients underwent total arthroscopic resection of TCC. An auxiliary mini‐incision was made for three patients due to serious tibial nerve compression. Radiographics showed that the coalition disappeared and pain was relieved postoperatively. The mean VAS score decreased from 4.31 ± 1.54 to 1.81 ± 0.98 points (p < 0.001). The mean AOFAS ankle‐hindfoot score improved from 65.56 ± 5.82 to 87.31 ± 6.30 points (p < 0.001). Fifteen patients were satisfied with the procedure, and one patient experienced numbness after surgery. No recurrence was reported based on CT scan and clinical results up to the end of the study. Conclusion: Surgical reconstruction employing total arthroscopic resection of TCC can achieve significant functional and radiographic improvements and symptom relief in selected patients with TCC. Auxiliary mini‐incisions were necessitated in complex situations. [ABSTRACT FROM AUTHOR]

Research on female genital cosmetic surgery usually comes from Anglophone countries. We investigated female genital cosmetic surgery in the predominantly Muslim South-East Asian country of Indonesia, aiming to identify the procedures offered by medical clinics on Instagram, how they are justified, and what they claim to achieve; and to understand what this means for women and their bodies. The 184 eligible posts from 19 clinics between 1 January to 31 March 2021 offered vaginoplasty, labiaplasty, hymenoplasty, and other procedures. Reflexive thematic analysis yielded three themes: Why you should have female genital cosmetic surgery, Indications for female genital cosmetic surgery, and What you will gain from female genital cosmetic surgery. Posts were similar to those identified in other countries, revealing implicit vulvar aesthetics, expectations that women choose to 'improve' their genitals, the need to please men, and that female genital cosmetic surgery is straightforward. Two differences from Anglophone advertising were the use of euphemisms to describe the vulva and an emphasis on physical 'virginity'. Across countries, female genital cosmetic surgery advertising appears to arise from patriarchal constructs of women's bodies and determination to control them. We contend that Indonesia shares with other countries the need for education—of medical practitioners and the general public—about sexuality and the vulva, and that the advertising of female genital cosmetic surgery should be regulated and rigorously monitored. [ABSTRACT FROM AUTHOR]

Background: Shoulder stabilization surgery has evolved over time, and bony augmentation procedures on the glenoid side are being performed more often. The Latarjet procedure modifies subscapularis anatomy because the conjoined tendon divides the subscapularis muscle fibers through a split/takedown, which has structural and functional implications. Arthroscopic anatomic glenoid reconstruction (AAGR) re-creates anatomy. This technique uses the Halifax portal to deploy and fix a distal tibial allograft (DTA) through the rotator interval, thus preserving the subscapularis anatomy. Purpose/Hypothesis: The purpose was to analyze the radiographic properties of the subscapularis muscle after AAGR. It was hypothesized that the subscapularis muscle structure remains preserved postoperatively. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed comprising a consecutive series of patients treated with AAGR with DTA between November 2012 and April 2021 for traumatic anterior shoulder instability with glenoid bone loss. Patients were excluded if they had posterior instability, glenoid fracture, missing pre- or postoperative computed tomography (CT) scans, or only CT arthrogram available. Radiographic variables measured on CT scans included estimates of subscapularis muscle volume, subscapularis/infraspinatus muscle ratio, and fatty infiltration according to the Goutallier classification. Pre- and postoperative Western Ontario Shoulder Instability index scores were collected as a secondary outcome of this study. Results: Ninety-three patients were included in the study with a clinical follow-up of 2.3 ± 1.5 years (mean ± SD). The subscapularis volume increased from 185.91 ± 45.85 mL preoperatively to 194.1 ± 49.0 mL postoperatively (P =.006). The subscapularis to infraspinatus muscle ratio showed a significant increase from 0.96 ± 0.27 to 1.05 ± 0.30 after surgery (P =.002). All patients had a Goutallier stage of 0 before and after surgery. The Western Ontario Shoulder Instability scores showed a significant improvement from 64.8 ± 15.5 preoperatively to 28.2 ± 24.0 postoperatively (P <.001). Conclusion: Patients who undergo AAGR with DTA for traumatic shoulder instability with glenoid bone loss have a preserved subscapularis muscle volume with no fatty infiltration, while showing a significant improvement in clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: The essential component of managing femoroacetabular impingement involves restoration of the original labral function. Circumferential labral reconstruction (CLR) has shown positive results. However, biomechanical studies of CLR are limited and have not established the efficacy of the modern knotless all-suture anchor (ASA) pull-through technique. Hypotheses: (1) CLR with knotless ASA fixation will restore native labral suction seal biomechanics; (2) tensioning the ASA to a high-tension state will increase the peak distractive force. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen human cadaveric hips were dissected free of all soft tissue except the native labrum and transverse acetabular ligament. On an electromechanical testing system, the hips were compressively loaded to 250 N to initiate a suction seal and distracted at a rate of 10 mm/s until rupture of the suction seal. Hips were tested in 4 states: intact labrum, full labral removal, knotless CLR with moderate anchor tension, and CLR with high anchor tension. Peak distractive force (in newtons) was compared using repeated measures analysis of variance (P <.05). Acetabular bevel angles (θ) were measured at labral clockface positions outside the transverse acetabular ligament using a 3-dimensional digitizer stylus after rim preparation. Linear regression plots compared θ and peak distractive force in the CLR state. Results: Peak force values were 138.5 ± 13.6 N (mean ± SE) for the intact labrum, 18.4 ± 2.79 N for labral excision, 95.4 ± 23.3 N for moderate-tension CLR, and 126.2 ± 27.3 N for high-tension CLR. Significant differences were observed only when full labral removal was compared with the other conditions: intact (P <.001), moderate-tension CLR (P =.016), and high-tension CLR (P =.002). Steeper acetabular bevel angles (smaller θ) were correlated with greater suction seal restoration (P <.05). Conclusion: CLR restored distractive stability on average to 82.0% of the intact value after labral deficiency. Retensioning did not significantly increase peak distractive forces. Clinical Relevance: These findings provide biomechanical validation supporting CLR using knotless ASAs in an effort to minimize volumetric bone loss and provide other surgical advantages. The prepared rim's bevel angle may be an important variable to optimize for improved suction seal restoration. [ABSTRACT FROM AUTHOR]

Background: Although there has been some amount of research into the use of platelet-rich plasma (PRP) after arthroscopic rotator cuff repair, most studies have not fully demonstrated its benefits. In addition, PRP formulations containing different concentrations of leukocytes have not been directly compared for rotator cuff repair. Purpose/Hypothesis: The purpose of this article was to determine whether arthroscopic rotator cuff repair combined with PRP injection, either leukocyte-rich PRP (LR-PRP) or leukocyte-poor PRP (LP-PRP), is superior to the control. The null hypothesis was that the addition of any PRP formulation would not result in outcomes superior to the control group. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with full-thickness rotator cuff tears who underwent arthroscopic repair were assessed for eligibility. The included patients were randomized to 3 treatment groups: the LR-PRP, LP-PRP, and standard-care control groups. After the rotator cuff suture was fixed firmly, different groups of liquid PRP preparations prepared by centrifugation were injected into the tendon-to-bone interface. The functional outcomes were assessed using the University of California, Los Angeles (UCLA) score, the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale for pain during sleep and activity, and active range of motion at 3, 6, and 12 months after surgery. In addition, the visual analog scale score was obtained at weeks 2 and 6. Postoperative structural integrity was assessed by magnetic resonance imaging at 12 months using the Sugaya classification. Type III was considered partial retear, and types IV and V were considered complete retears. The safety of surgery was compared by the incidence of complications. The main analyses were performed in accordance with the intention-to-treat principle. Results: Of 150 patients initially randomized, the functional outcomes in 142 (46 LR-PRP, 47 LP-PRP, 49 control) and the structural integrity in 133 (40 LR-PRP, 46 LP-PRP, 47 control) were analyzed. There was no significant difference in the primary outcome of the UCLA score among the 3 groups (P =.169). The trends in functional outcomes and range of motion were similar for the 3 groups, with no significant differences among the groups at 12 months. However, within 6 months after surgery, the ASES score was better in the LR-PRP group than in the control group (3 months: 85.8 ± 4.1 vs 81.6 ± 8.7; P =.011; 6 months: 90.0 ± 5.4 vs 86.2 ± 6.8; P =.003). At 12 months after surgery, the overall retear rate, including partial and complete retears, was 8%. There were no significant differences in the rates of overall retear (P =.755) or complete retear (P =.633) among the 3 groups. The only surgical complication was postoperative stiffness, which occurred in 3% of patients, and the incidence did not significantly differ among the groups (P =.790). Conclusion: The study did not reveal that shoulders treated with the LR-PRP or LP-PRP formulations had any superior functional or structural outcomes at 12 months compared with those of the control group. However, LR-PRP may offer better ASES scores than the control group up to 6 months after surgery, and its clinical benefit remains to be proven. Registration: ChiCTR2100045039 (Chinese Clinical Trial Register). [ABSTRACT FROM AUTHOR]

Polysyndactyly of the foot is a common congenital malformation of the lower extremity. We introduce our surgical technique for reconstruction of polysyndactyly of the fifth toe fused with the fourth toe. The technique includes the removal of the medial hypoplastic ray, web-space reconstruction using a dorsal cross-shaped advancement flap and closure of the lateral incisions of the separated toes with a tongue-shaped flap and zigzag triangular flaps. This technique is advantageous to prevent postoperative web creep, reduce the tension of the dorsal incision closure and it is relatively easy to grasp for the inexperienced surgeon. Level of Evidence: Level V (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Current research on thumb polydactyly reconstruction focusses primarily on clinical evaluations. Details on aesthetic outcomes are relatively lacking. This study aims to address this gap by: (1) investigating the effectiveness of surgical treatment in achieving symmetrical thumb size, length and girth; (2) assessing aesthetic outcomes from a caregiver's perspective and (3) identifying key factors that influence aesthetic outcomes to inform strategies to improve surgical reconstruction. Methods: Patients who underwent thumb polydactyly reconstruction were recalled for assessment. Objective measurements of both the reconstructed and unaffected thumbs were taken. Surgical scars were evaluated by measuring their length and using the Vancouver Scar Scale (VSS). To assess the appearance of the reconstructed thumbs, we used the Visual Analogue Scale (VAS) through surveys completed by the primary caregiver of each patient. Caregivers also provided reasons for any unsatisfactory appearance outcomes and we correlated these with objective factors. Results: This study included 26 paediatric patients with 29 reconstructed thumbs. The mean VAS score for overall thumb appearance was 7.8 ± 2.2. While surgical treatment achieved symmetry in most anthropometric measures, reconstructed thumbs had smaller nail plates and greater joint angulation. Caregiver assessment of thumb width was closely related to the objective interphalangeal joint (IPJ) girth measurements, and perceived excessive angulation was related to the IPJ angle. Symmetry was not associated with nail fold width or scar location. However, perceived scar prominence was linked to VSS score and scar location. Conclusions: Thumb polydactyly reconstruction achieves symmetry in size, length and girth, but nail plate size and joint angulation remain significant challenges. Despite this, caregivers are generally satisfied with the overall appearance. Attention should be focussed on improving thumb IPJ girth, IPJ angulation and scar location to enhance overall aesthetic outcomes. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Purpose: To provide a detailed examination of the arterial blood supply to the middle third of the nasal skin through cadaveric dissections, identifying the primary arterial sources and their precise locations. Methods: Cadaveric dissections were performed on 14 hemifaces from fresh specimens. The main feeding arteries and their branches were carefully dissected under magnification. Morphometric characteristics of the specimens, along with the caliber of the arteries and their branches vascularizing the mid-third nasal skin were recorded, and statistically analyzed. Results: Four main arteries were identified as responsible for the blood supply to the mid-third of the nasal skin: the facial artery, the nasal branch of the infra-orbital artery (nbIOA), the dorsal nasal artery, and the upper branches of the columellar plexus. The lateral nasal artery (LNA) and the nbIOA were the main contributors, each providing significantly larger arterial branches than the other sources (1.8 ± 0.8 branches of 0.67 ± 0.2 mm for the LNA, p-value < 0.001–1 ± 0 branches of 0.55 ± 0.17 mm for the nbIOA, p-value < 0.01). The largest arterial branch consistently penetrated the lateral and inferior angle of the mid-third nasal skin, originated either from the LNA or nbIOA. Conclusion: The LNA and nbIOA endorse crucial roles in the arterial blood supply to the mid-third nasal skin. Despite the variability in vascular anatomy, a consistent pattern of arterial supply with convergence in the depth of the alarfacial groove was observed. Understanding these patterns is vital for improving surgical precision and reducing the risk of complications in both aesthetic and reconstructive surgeries. [ABSTRACT FROM AUTHOR]

Surgical repair or reconstruction of lateral ankle ligaments is indicated in patients with persistent ankle instability, with arthroscopic/endoscopic treatment becoming more frequent. Although presurgical imaging of the ankle is always standard procedure, more is needed to understand the evolution of the repaired ligament or the tendinous graft to help improve length of postoperative time and functional results. This review describes the normal ultrasound aspects and possible complications of repaired/reconstructed ankle ligaments after an all-inside endoscopic repair/reconstruction of the anterior talofibular ligament and the calcaneofibular ligament. [ABSTRACT FROM AUTHOR]

Introduction: Lateral skull base (LSB) and middle ear pathologies often involve the facial nerve (FN), and their treatment may require FN sacrifice. Cases with unidentifiable proximal stump or intact FN with complete FN palsy, necessitate FN anastomosis with another motor nerve in order to restore innervation to the mimicking musculature. The results of hypoglossal-to-facial nerve anastomosis (HFA) and masseteric-facial nerve anastomosis in patients with facial paralysis after middle ear and LSB surgeries, are presented and compared. Methods: Adult patients with total definitive facial paralysis after middle ear or LSB surgery undergoing facial nerve reanimation through hypoglossal or masseteric transfer anastomosis were enrolled. The facial nerve function was graded according to the House Brackmann grading system (HB). The facial function results at 3 months, 6 months, 12 months, 18 months and at the last follow up (more than 18 months) are compared. Results: 153 cases of LSB and middle ear surgery presented postoperative facial palsy and underwent facial nerve reanimation surgery with HF in 85 patients (55.5%) and MF in 68 patients (44.5%). The duration of the FN palsy before reconstructive surgery was inversely associated to better FN results, in particular with having a grade III HB (p = 0.003). Both techniques had significantly lower HB scores when an interval between palsy onset and reanimation surgery was 6 months or less (MF p = 0.0401; HF p = 0.0022). Patients who underwent a MF presented significant improvement of the FN function at 3 months from surgery (p = 0.0078). At the last follow-up, 63.6% recovered to a grade III HB and 22.7% to a grade IV. On the other hand, the first significant results obtained in the HF group were at 6 months from surgery (p < 0.0001). 67.8% of patients had a grade III HB after a HF at the last follow-up, 28.8% a grade IV. FN grading at 6 months from surgery was significantly lower in the MF group compared to the HF (p = 0.0351). The two techniques had statistically similar results at later follow-up evaluations. Discussion/Conclution: MF was associated to initial superior results, presenting significant facial recovery at 3 months, and significantly better functional outcomes at 6 months from surgery compared to HF. Although later results were not significantly different in this study, earlier results have an important role in order to limit the duration of risk of corneal exposure. [ABSTRACT FROM AUTHOR]

Rhinoplasty, which reconstructs the shape and size of the nose, is the most frequently performed cosmetic surgery procedure. Research indicates that social media is the leading influence motivating individuals to undergo rhinoplasty. Thus, we aimed to evaluate the effect of social media on the desire for rhinoplasty and to establish whether (and if so, how) social media enhances the recovery period after rhinoplasty. A retrospective study was conducted on 322 Saudi rhinoplasty patients through a questionnaire distributed online via specific rhinoplasty groups and accounts on different social media platforms containing rhinoplasty patients. The questionnaire included participants' demographic details, the factors behind undergoing the rhinoplasty and their belief about the effect of social media on their desire to undergo a rhinoplasty, and how social media affected their recovery period after undergoing rhinoplasty. The collected data were then analyzed statistically with SPSS. The associations of different variables were found using the Chi-square test. The study included 322 rhinoplasty patients with nearly equal gender distribution. The results indicate that social media highly (mean = 4.07 ± 1.07 out of 5.00, 81.4%) influenced participants' decision to undergo rhinoplasty, and it highly influenced the recovery period after surgery (mean = 3.59 ± 0.67 out of 5.00, 71.8%). A statistically significant association was observed between social media influence and participants' education level (p = 0.018) as well as place of residence (p = 0.002). Most participants reported following social media advice to deal with unforeseen post-rhinoplasty symptoms that may have arisen during the recovery phase, which is theorized as the mechanism driving shorter recovery times. [ABSTRACT FROM AUTHOR]

Objective: This case series describes the outcomes of airway management, including airway reconstruction, in 6 patients with campomelic dysplasia and tracheostomy/ventilator dependence secondary to multilevel airway obstruction. Methods: Case series and clinical guidelines are provided for the airway management of patients with campomelic dysplasia. Results: Average age of individuals is 19.4 years. Mean follow-up was 12.2 years. Four individuals underwent open airway reconstruction and achieved decannulation. One patient underwent airway reconstruction with improvement of a complete subglottic stenosis but remains ventilator dependent due to severe scoliosis. The remaining 2 patients did not require additional airway reconstruction, have been liberated from ventilator support, and are under evaluation for tracheostomy tube decannulation. Conclusion: Although campomelic dysplasia was historically considered a lethal form of congenital skeletal dysplasia, with many patients succumbing to respiratory failure due to tracheobronchomalacia in the neonatal period, airway reconstruction and long-term survivorship is feasible in children with campomelic dysplasia and significant airway disease. [ABSTRACT FROM AUTHOR]

Objectives: To assess quality of life (QOL) outcomes after canal wall up (CWU) and canal wall down (CWD) tympanomastoidectomy in the pediatric population. Methods: A retrospective review tabulated pediatric patients undergoing CWU and CWD tympanomastoidectomy for cholesteatoma by 2 senior surgeons at a single tertiary academic referral center between March 2017 and March 2023. Chronic Ear Survey (CES) and cosmetic survey outcomes were collected post-operatively. Results: A total of 77 ears in 75 patients were identified, with 35 undergoing CWU and 42 undergoing CWD as the most recent (index) otologic surgery. Seventeen patients (23%) participated in the survey. Of this cohort, the mean age was 14.6 years, 12 (71%) were male, and 10 (59%) had CWD as the most recent otologic surgery. The mean time from index surgery to survey completion was 3.4 years (range, 0.1-6.7 years). Regarding QOL outcomes, there were no statistically significant differences in total CES score, CES subscores, and cosmetic survey scores between groups when categorizing by gender or index surgery. Total CES, symptom subscale, medical resource subscale, and cosmetic survey scores showed a tendency to decrease with an increasing number of surgeries (R = −.18, −.28, −.53, and −.56, respectively). Pediatric total CES scores appeared comparable to those reported in the published adult literature. Conclusions: It does not appear that there are worse QOL outcomes for pediatric patients who undergo CWD tympanomastoidectomy compared to those who undergo CWU tympanomastoidectomy. There appears to be no difference in QOL outcomes between pediatric and adult patients undergoing tympanomastoidectomy. [ABSTRACT FROM AUTHOR]

Objectives: To describe and assess the vertical sectioning technique for mid vault dissection in patients undergoing primary and secondary rhinoplasty. Methods: A retrospective review of 208 patients undergoing primary or revision rhinoplasty utilizing the vertical sectioning technique. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to patients pre- and post-operatively. A detailed description of the technique is presented. Results: Mean follow up was 8.59 ± 7.30 months. Spreader grafts were used in 185 patients (89%), upper lateral cartilage autospreader flaps were utilized in 16 patients (7.7%), and both spreader grafts and autospreader flaps were used in 7 patients (3.4%). Ten primary rhinoplasty patients (4.8%) and 3 revision rhinoplasty patients (4.5%) complained of functional nasal obstruction post-operatively. At time of last follow-up, there was a significant improvement in mean NOSE scores for patients receiving spreader grafts (71.2 ± 21.4-21.5 ± 2.8, P <.001), autospreader flaps (69.2 ± 25.9-17.2 ± 21.5, P <.001), and both (57.9 ± 35.0-26.1 ± 20.2, P =.03). Conclusion: The vertical sectioning technique respects the anatomic, functional, and esthetic relationship of the middle vault, while maximizing cartilage preservation. [ABSTRACT FROM AUTHOR]

Background and Objectives: Forequarter and hindquarter amputations have traditionally been closed with local tissues, but the technique is plagued by a high rate of complication such as marginal necrosis, seroma, infection, and dehiscence. Filet of limb flaps have been used when local tissues are insufficient for closure, and despite their use in more extensive and complex wounds, outcomes seem to be better in these cases. Recognizing that filet of limb flaps not only serve to cover the wound, but also eliminate dead space, supplement at-risk and/or radiated tissue, pad underlying hard structures, and facilitate neuroma prevention with target muscle reinnervation, we have change our practice to utilize buried filet of limb flaps even when local tissues are technically "sufficient" to close the wound. The purpose of this article to organize and describe the ways in which buried filet-of-limb flaps can be used to achieve important and discrete surgical objectives in forequarter and hindquarter amputation, and to facilitate increased recognition of collaborative interdisciplinary opportunities for spare-part reconstruction. Methods: Retrospective data from the medical records of seven patients, collected between 2010 to 2023 at our single tertiary referral center, were reviewed. This included all patients for whom a buried (or partially buried) filet of limb flap was attempted for forequarter or hindquarter amputation reconstruction. Results: Five males and two females ranging 55 to 75 years of age, met the inclusion criteria. Three cases of forequarter amputation and four cases of hindquarter amputation were included. Six flaps were successfully transferred without major flap-related complications. The mean follow-up period was eight and a half months. Conclusion: Even when local tissues are technically "sufficient" to close forequarter and hindquarter amputation wounds, we have found buried filet of limb flaps to be useful in several ways. These include occupying dead space, providing double-layer coverage, padding hard structures, preventing neuromas, and reconstructing sacro- and spino-pelvic continuity. Our approach emphasizes interdisciplinary collaboration and highlights the potential advantages of buried filet of limb flaps in optimizing patient outcomes for complex limb amputations. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this systematic review is to review the functional, clinical and radiological outcomes of patients undergoing large to massive rotator cuff repair with long head of biceps tendon (LHBT) autograft, as well as compare these to standard arthroscopic cuff repair. Methods: A review of the online Medline database was conducted on 20 October 2022 according to PRISMA guidelines and registered prospectively on the PROSPERO database. Clinical studies assessing patients with large to massive rotator cuff tears undergoing LHBT autograft repair were included. All studies reported on functional outcomes, range of movement (ROM) and radiological re-tear rates. The Methodological Index for Non-Randomised Studies (MINORS) tool was used to appraise all studies. Results: The search strategy identified ten studies for inclusion including a total of 594 patients. Five studies were comparable (346 patients), assessing LHBT autograft repair against arthroscopic rotator cuff repair without autograft. A variety of techniques of LHBT autograft were used across all studies, including bridging and augmentation styles. Radiographic comparison showed lower re-tear rates in the LHBT autograft group with two studies demonstrating statistically significant results. Pain scores, functional outcomes and ROM were significantly improved post-operatively in all studies for LHBT autograft patients, with no significant difference when compared to standard arthroscopic repair. Conclusion: LHBT autograft looks to significantly improve functional scoring and range of motion in patients with large to massive rotator cuff tears. When compared to standard arthroscopic cuff repair, LHBT autograft appears to significantly reduce the re-tear rate. Further randomised studies are needed to assess the efficacy of this technique. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aims to delineate the various methods to repair or reconstruct the patellar tendon using the available literature. Methods: MEDLINE and PubMed electronic databases were searched for English language clinical studies involving patellar tendon rupture repair or reconstruction that reported patient-reported outcome scores (PROS) between January 1st, 1953 and June 17th, 2021. Data was extracted on full text articles to collect functional outcome scores and rupture category, including acute, chronic, post-total knee arthroplasty (TKA) and post-anterior cruciate ligament reconstruction (ACLR). Results: Twenty-three studies with a total of 738 patients were included. Of the 14 studies including acute repairs, mean postoperative Lvsholm scores ranged from 84 to 99.5. Knee Society Score (KSS) and knee range of motion (ROM) measurement were the most widely reported outcomes in the chronic setting. The average postoperative KSS scores ranged from 70 to 87.7. Of the six studies that included patellar tendon repairs/reconstructions in the setting of prior TKA, the most frequently reported outcomes were KSS scores and knee ROM measurements. The average postoperative KSS scores for the three cohorts reporting reconstruction with allograft ranged from 79 to 88 as compared to the average postoperative KSS score for reconstruction with autograft of 70. Conclusion: Despite this heterogeneity, we concluded: (1) in the primary setting, cerclage augmentation yields the lowest lysholm scores and should not be considered, although primary repairs with and without augmentation yield comparable postoperative lysholm scores, (2) in the chronic setting, repair with augmentation and reconstruction yielded similar results aside from in post-TKA patients where allograft reconstruction yielded superior KSS scores. [ABSTRACT FROM AUTHOR]

Background and Aims: Vaughan–Jackson syndrome, a complication of rheumatoid arthritis, presents with extensor tendon rupture, dorsal tenosynovitis, distal radioulnar synovitis, dorsal subluxation of the distal ulna, and wrist arthritis. This article aimed to present a surgical approach for Vaughan–Jackson syndrome, focusing on dorsal tenosynovectomy, distal ulnar resection and extensor tendon reconstruction. Case Description: A detailed case study is presented, highlighting the surgical technique employed for managing Vaughan–Jackson syndrome. Technical nuances and considerations are discussed. Results: The surgical technique described resulted in successful management of the patient's Vaughan–Jackson syndrome, with restoration of hand and wrist function. Conclusion: Surgical intervention involving dorsal tenosynovectomy, distal ulnar resection, and extensor tendon reconstruction is a viable option for managing Vaughan–Jackson syndrome. This article provides insights into the surgical management of this complex condition, offering guidance for clinicians encountering similar cases. [ABSTRACT FROM AUTHOR]

In lower extremity sarcoma treatment, limb salvage approaches present superior alternatives to amputation due to reduced postoperative morbidity and improved quality of life. This study provides a novel analysis of socioeconomic disparities that may affect reception of limb-sparing surgery. Patients with lower extremity bone or soft tissue sarcoma who received either limb-sparing surgery or amputation from 2007 to 2021 were identified in the Surveillance, Epidemiology and End Results (SEER) database. Demographic, socioeconomic, and oncologic variables were collected for each patient. Multivariate binary logistic regression was conducted to assess preoperative demographic and oncologic risk factors for amputation (p < 0.05). A total of 6465 patients were identified in the final cohort, 586 (9.1%) of whom received amputation. After controlling for tumor size, stage, and neoadjuvant therapy administration, non-Hispanic American Indian/Alaskan Native race/ethnicity predicted the highest odds of amputation (OR: 1.78, 95% CI: 1.12–2.85, p = 0.015). Nonmetropolitan residence (OR: 1.69, 95% CI: 1.43–2.00, p < 0.001) also conferred higher risk of amputation compared with residence in a large metropolitan area. Overall, amputation was associated with a higher risk of ten-year cancer-specific mortality (p < 0.001) even when controlled by sociodemographic and clinical characteristics. There are significant disparities in limb-sparing surgery and amputation rates in lower extremity sarcoma management, even when accounting for differences in baseline oncologic characteristics. Further study into socioeconomic drivers of these trends will allow the development of initiatives that improve disparities in reconstructive outcomes. [ABSTRACT FROM AUTHOR]

Bone and joint infection is an extremely common emergency procedure in paediatric orthopaedics. An arthrotomy is a surgical exploration of a joint and is commonly needed to be performed for septic arthritis on an emergency basis. Although there is an increasing trend towards arthroscopic irrigation and washout, open arthrotomy is still an important tool for orthopaedic surgeons. It also has other therapeutic purposes, and these include: debridement/removal of loose bodies, ligament reconstruction, fracture fixation, disarticulation, joint replacement and tumour excision. We describe the most commonly used approaches to perform arthrotomy in the hip, knee, ankle, shoulder, elbow, wrist, hand and fingers. Orthopaedic surgeons must be aware of common pitfalls and neurovascular structures present when performing an arthrotomy of common joints. This article provides an illustrative overview to approach each joint and will be a quick-reference guide especially for junior orthopaedic surgeons. [ABSTRACT FROM AUTHOR]

Analysis of skeletal, cephalometric, and volumetric changes and occlusion during long-term follow-up was performed for two patients who underwent bimaxillary facial transplantation (FT). The study material consisted of the follow-up data of two bimaxillary composite FT performed in Helsinki University Hospital, one in 2016 and the other in 2018. Serial three-dimensional computed tomography scans obtained during follow-up (6 years for patient 1, 4 years for patient 2) were analyzed. The position of the maxilla remained stable in both patients. At 4 and 6 years, the changes in the anterior maxilla were ≤1 mm, while the anterior mandible had moved 2.6–4 mm anteriorly and the mandibular midline 0.4–3.7 mm to the left side. Patient 1 underwent re-osteosynthesis 4 months after transplantation due to mandibular non-union. Patient 2 had a sagittal mandibular osteotomy at 15 months after FT due to lateral crossbite and tension created by temporomandibular joint rotation. Thereafter both patients had a stable occlusion. A continuous bone volume reduction in the mandible was noticed in both patients (6% and 9% reduction of the transplanted volume). The volume of the transplanted maxilla decreased during the early postoperative period but increased back to the original transplanted volume during the follow-up. [ABSTRACT FROM AUTHOR]

When treating patients with orthognathic surgery, there might be a risk of obstructive sleep apnoea (OSA) due to soft tissue changes in the upper airways, especially in patients treated with isolated mandibular setback or mandibular setback in combination with maxillary advancement. In the present study, we assessed respiratory function during sleep with home cardiorespiratory polygraphy in 62 patients who had not been previously been diagnosed with OSA at three times: prior to orthognathic surgery for aesthetic and functional indications, and then 3 months and 1 year after surgery. We evaluated surgical displacement based on measurements in three dimensions using pre‐ and post‐operative computed tomography. There were only minor changes in the respiratory parameters such as the apnoea‐hypopnoea index (AHI), the apnoea‐hypopnoea index in the supine position (AHIsup), the oxygen saturation index (ODI) and the snore index. There was no significant correlation between surgical displacement and the AHI, AHIsup and ODI. There was a weak but significant correlation between vertical displacement of the anterior mandible and the snore index. Within the limitations of the present study, the risk for iatrogenic obstruction of the upper airways seems to be low in patients without OSA treated with orthognathic surgery. [ABSTRACT FROM AUTHOR]

Aim: Mandibular anterior deep gingival recessions are complex to manage in individuals who lack sufficient keratinized tissue. The aim of the present study was to evaluate the clinical and esthetic outcomes and tissue stability of mucogingival procedures performed by means of a free gingival graft (FGG) or subepithelial connective tissue graft (SCTG) 2to 5-years postoperatively and to identify the esthetic outcome perception of the patients at follow-up. Materials and methods: Individuals presenting RT1 and RT2 gingival recessions treated with an FGG or SCTG in the mandibular anterior sextant were recalled to evaluate clinical outcomes and patient satisfaction postoperatively. A visual analog scale (VAS) and recession esthetic score (RES) were used for the evaluation. Results: A total of 32 consecutive individuals, 16 in each group (FGG/SCTG), responding to the follow-up appointment, entered this study. RT2 recessions were prevalent (87.5% FGG; 68.8% SCTG). Mean recession depth (RD) at baseline was 4.68 ± 0.76 (range: 4 to 6 mm) and 5.31 ± 1.35 (range: 4 to 10 mm) for the SCTG and FGG groups, respectively, and 0.18 ± 0.34 and 0.43 ± 0.49, respectively, at follow-up. Keratinized tissue width (KTW) was significantly greater in FGG individuals at follow-up: 5.25 ± 0.84 vs 2.84 ± 1.12 (P < 0.0001; confidence interval [CI]: 1.70 to 3.12). The SCTG group showed a higher RES than the FGG group, but the difference was not significant (P = 0.067, CI: 0.007 to 1.94). The patients' perception (VAS) of satisfactory esthetics was statistically significantly higher than the professional RES assessment for FGG individuals (P = 0.007, CI: 0.36 to 2.01), but the difference between the VAS and RES values was not statistically significant for the SCTG group. Conclusions: Both SCTGs and FGGs provide satisfactory esthetics and tissue stability. Patients' esthetic perception of FGGs is significantly higher than the professional evaluation. Clinical relevance: When 100% root coverage is not achieved using an FGG, satisfactory esthetic outcomes with minimal residual recessions of < 1 mm can be accomplished on the more challenging RT2 defects. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective study. Objective: The Markowitz-Manson classification system categorizes nasoorbitoethmoid (NOE) fractures by severity of injury and remaining integrity of the medial canthal tendon. However, this system does not account for direction of bony displacement (in-fracture vs out-fracture), which can greatly affect symptomatology and management. We hypothesize that NOE fractures will present differently based upon their severity: Type I injuries are likely to present with medial nasal bone displacement (in-fracture), whereas Type III fractures will be more prone to lateral displacement (out-fracture). Methods: A retrospective review was performed for all patients with NOE fractures who were evaluated by the plastic surgery department at a level 1 trauma center over a 6-year period. Computed tomography data were evaluated to assess for directionality of fracture segment displacement. Frequencies of medial, lateral, and non-displacement across NOE types were compared by Chi-Squared Goodness of Fit and Fisher's Exact Tests. Results: 111 patients met inclusion criteria. The patient population was 73.9% male and averaged 51.2 years old. When bilateral fractures were counted independently, there were 141 cases in total: 115 Type I, 20 Type II, and 6 Type III. Type I fractures were most commonly in-fractured (48.7%), while Type III injuries were consistently out-fractured (100%) (p <.001). Conclusions: While Type II and III NOE fractures have dominated clinical focus, this study highlights the prevalence of impaction within Type I fractures. These findings advocate for a more comprehensive approach to the evaluation of Type I NOE fractures and their potential risks, including traumatic hypotelorism and nasal airway obstruction. [ABSTRACT FROM AUTHOR]

Study Design: This is a retrospective study using the Nationwide Emergency Department Sample. Objective: Facial laceration repairs are one of the most common procedures performed in the emergency department (ED). The goal of this study was to describe the patient's characteristics and healthcare cost associated with ED encounters for facial lacerations using the largest nationally representative database in the United States. Methods: This is a retrospective study using the Nationwide Emergency Department Sample. The data was collected between January and December of 2019. Patients with either a primary or secondary diagnosis of facial laceration were included. The primary outcome was patient characteristics. The secondary outcomes were ED characteristics, number and type of procedures performed and total encounter charges. Diagnoses and procedures were identified using ICD-10 CM codes. Results: There were 2,548,944 ED encounters for facial lacerations in the United States. Of those, laceration was the chief complaint in 75%. 80% of lacerations were unintentional, 8% were due to assaults, and <1% due to suicidal attempts. The most common laceration location was the scalp (21%) followed by the lip (11%) and eyelid (11%). The mean patient age was 38 years. Most patients were adults (69%), male (62%), Caucasian (64%, African American 14%, Hispanic 14%, Other 4%, Asian 2%), from low income levels ($1–$45,999: 29%, $46,000– $58,999: 24%, $59,000–$78,999: 24%, $79,000 or more: 23%), with private insurance (32%, Medicaid 25%, Medicare 24%, self-pay 12%, other 6%). Most encounters were during summer (June, July, August) at large metropolitan areas with at least 1 million residents (52%, small metropolitan: 30%, micropolitan: 10%, other: 7%) at teaching hospitals (65%) located in the southern region of the United States (37%, Midwest: 23%, west: 21%, northeast: 19%). Almost half of the encounters were at non-trauma-designated hospitals (48%, Level 1 trauma center: 21%, Level 2 trauma center: 17%, Level 3 trauma center: 13%). The number of procedures during each encounter was: none: 4%, one: 17%, two: 23%, three: 11%, four: 11%, five or more: 28%. The most frequent laceration repair was a simple repair of superficial wounds of the face, ears, eyelids, nose, lips, and/or mucous membranes 2.5 cm or less, followed by simple repair of superficial wounds to the scalp, neck, axillae, external genitalia, trunk, and/or extremities 2.5 cm or less. Most emergency department visits were billed as a Level 3 encounter, followed by Level 2 then Level 4. CT scan of the head was the most common imaging modality. Of all patients, <1% were admitted to the hospital and 87% were discharged home. The average total emergency department charges were $5,733. Conclusions: Facial laceration is a common complaint in the emergency department. It is costly, and disproportionately affects the impoverished. Most lacerations are classified as simple, less than 2.5 cm, involving the scalp, unintentional, with the discharge disposition being home. Thus, exploring pathways to treat facial lacerations outside of the ED can potentially reduce both healthcare cost and ED crowding. [ABSTRACT FROM AUTHOR]

Traumatic adult brachial plexus injuries typically cause immediate loss of upper limb function. Timely multidisciplinary treatment in specialized centres often results in a useful helper arm. Both the patient and the surgical team can benefit from an open discussion to set realistic expectations. Surgical reconstruction is customized for each patient, considering their injury factors and functional objectives. Optimizing pain control, adherence to procedure indications and using meticulous surgical techniques help minimize the risk of failing to meet the patient's goals. The need for potential alternative treatment(s) if the desired result is not achieved should be detailed before the initial reconstruction. This review discusses late treatment options, including tendon transfers, joint fusions, free functioning muscle transfers and prosthetics, for managing the failed primary reconstruction of the traumatic adult brachial plexus. [ABSTRACT FROM AUTHOR]

An acid attack is a deliberate act of violence. Sulphuric acid is thrown at a person's face and body with the intention of harming and disfiguring the victim. Sulphuric acid is a dangerous weapon which can cause very serious injuries including severe skin damage, blindness, significant disfigurement and/or permanent disability. We report the case of Ioanna, a 34-year-old woman who was attacked with vitriol by a jealous woman in May 2020. Following her admission to hospital, where Ioanna was an inpatient for 85 days, she underwent nine operations. Since her discharge she has undergone ten more, with further interventions likely in the future. In addition, she has undergone various treatments and procedures to restore her skin. Ioanna's courage and strength has inspired thousands of young children and adults who cope with a variety of health problems. [ABSTRACT FROM AUTHOR]

Navigating the labyrinthine process of securing higher speciality training poses formidable challenges for doctors in training. Achieving success in this endeavour demands more than a mere grasp of the prerequisites; it necessitates meticulous preparation and foresight. Dermatology, as a medical speciality, stands out on account of its appeal, encompassing a diverse patient population, expansive scope of work, work-life balance, a plethora of procedural variety, intellectual stimulation, and abundant research opportunities. Despite the evolving landscape of medical professions, dermatology maintains its appeal as an exceptionally sought-after speciality in the year 2023/2024. This is evident in the escalating competition ratios, rising from 5.46 in 2021 to 7.53 in 2023 for dermatology training posts. Notably, this fervent competition is not exclusive to dermatology, as evidenced by the competition ratios such as Emergency Medicine ST3 (competition ratio 10.95), Immunology ST3 (competition ratio 6.00), Occupational Medicine (competition ratio 7.14), and Plastic Surgery ST3 (competition ratio 4.23) in the 2023/2024 application cycle. In light of this intensifying competition, this article seeks to furnish aspiring candidates with current and invaluable insights, serving as a guide to clinching a coveted national training number in their preferred speciality. While the landscape of higher speciality training encompasses numerous possibilities, this article concentrates primarily on dermatology, intertwining its guidance with relevance to other medical and surgical specialties. Through this exploration, readers will gain essential perspectives to navigate the intricacies of the application process and emerge as competitive contenders in the higher speciality training application process. [ABSTRACT FROM AUTHOR]

Consumer interest in cosmetic surgery has grown tremendously in recent years. However, despite the long‐lasting implications of cosmetic surgery decisions on consumer well‐being, existing insights on these decisions remain limited and scattered across various fields. Through an interdisciplinary bibliometric review, we identify that previous research has primarily focused on five aspects shaping consumers' decisions in cosmetic surgery: (1) differing perspectives, (2) social drivers, (3) individual drivers, (4) online media content, and (5) influences relevant to labiaplasty. These investigations stem from the fields of psychology, sociology, communication, and healthcare and aim to understand especially consumer intentions to undergo surgery at the pre‐consumption stage. In this research, we delineate how marketing researchers can advance insights along the entire consumer surgery journey (i.e., pre‐consumption, consumption, and post‐consumption stage) through a better understanding of (i) the phenomenon and its different treatments, (ii) the role of identity, (iii) stakeholder interactions, and (iv) how social media and technology shape cosmetic surgery decisions. Finally, we highlight how studying these topics can contribute to marketing theory through novel insights on the self and identity, the body's meaning in consumption, and self‐enhancement practices. [ABSTRACT FROM AUTHOR]

Purpose: Over the last decade there is an increased awareness that the need for surgical care in under-resourced countries is contributing to significant health inequities and financial hardship across the globe. Plastic surgery has long been recognized as a surgical discipline that has been successful in deploying resources to help address these inequities but to be sustainable there must be a lasting commitment through teaching and education. The purpose of this study is to answer the question "In plastic and reconstructive surgical residents, how does participation in global health initiatives influence independent clinical practice and their perceptions of global health?" Methods: A survey was administered through Redcap to 59 total eligible current or previous Wake Forest School of Medicine plastic and reconstructive surgical residents. Results: About 33 out of 34 participants have had some kind of global health exposure with the majority being through mission trips, volunteering, and external rotations. There was a 33.3% improvement in awareness of global surgical disease burden (P =.000093 <.05), 23.5% improvement in obligations to create global change (P =.00021 <.05), 26.3% improvement in comfortability with language and cultural barriers (P =.0013 <.05), and 20.9% improvement in doctor-patient relationships with patients of differing backgrounds (P =.0019 <.05) when comparing participant's views prior and after residency training. Overall, participants were inclined to continue with global health initiatives in the future as 75.8% see themselves participating in another global health experience and 90.9% believed participating in global health has an impact on independent clinical practice and professional development post-residency. Conclusions: Global health initiatives within surgical residency curriculums have had tremendous effects on the perceptions of global health amongst plastic and reconstructive surgical residents, which may improve physician shortage and global health needs in the future. [ABSTRACT FROM AUTHOR]

Background: For decades, clinicians have cited telemedicine as a useful and effective tool for delivering care in surgical specialties. This study aims to investigate the direct impact of telemedicine on a pediatric plastic surgery practice, examining patient satisfaction and visit efficiency. Methods: Between March 2020 and May 2021, patient families were surveyed online regarding their visit, with questions surrounding convenience, ease of communication, ability to demonstrate physical exam findings, and likelihood of recommending the encounter format. Responses were compared between in-person and telemedicine visits. The duration of encounters during the study time period was also documented from the electronic medical record. Results: Ninety families (15.1%) completed the survey. Telemedicine visits were rated as more convenient than in-person visits (3.77 ± 0.51 vs 3.36 ± 0.94, P <.001). The ability to communicate in telemedicine was rated as similar to in-person (P =.104), as was the likelihood to recommend that format (P =.189). Quality of the physical exam was rated as worse for the telehealth visits (3.37 ± 0.89 vs 3.89 ± 0.35, P <.001). Of telemedicine participants, 7.5% also described connectivity issues and 3.8% reported audiovisual problems. Regarding visit efficiency, telehealth visits were shorter across all encounter types including follow-up (34.3 ± 81.1 vs 55.7 ± 44.1 minutes, P =.01), new patient (29.3 ± 25.5 vs 65.1 ± 43.4 minutes, P <.001), and postoperative (24.9 ± 22.9 vs 61.3 ± 48.8 minutes, P <.001) visits. Conclusion: Telemedicine provides an excellent modality for care delivery in the pediatric plastic surgery setting, minimizing time and inconveniences associated with presenting in-person. However, there remains clear concern about the efficacy of the physical examination and technological reliability from the patient's perspective. [ABSTRACT FROM AUTHOR]

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Objective: This study sought to explore the unexamined capabilities of ChatGPT in describing the surgical steps of a specialized operation, the Fisher cleft lip repair. Design: A chat log within ChatGPT was created to generate the procedural steps of a cleft lip repair utilizing the Fisher technique. A board certified craniomaxillofacial (CMF) surgeon then wrote the Fisher repair in his own words blinded to the ChatGPT response. Using both responses, a voluntary survey questionnaire was distributed to residents of plastic and reconstructive surgery (PRS), general surgery (GS), internal medicine (IM), and medical students at our institution in a blinded study. Setting: Authors collected information from residents (PRS, GS, IM) and medical students at one institution. Main Outcome Measures: Primary outcome measures included understanding, preference, and author identification of the procedural prompts. Results: Results show PRS residents were able to detect more inaccuracies of the ChatGPT response as well as prefer the CMF surgeon's prompt in performing the surgery. Residents with less expertise in the procedure not only failed to detect who wrote what procedure, but preferred the ChatGPT response in explaining the concept and chose it to perform the surgery. Conclusions: In applications to surgical education, ChatGPT was found to be effective in generating easy to understand procedural steps that can be followed by medical personnel of all specialties. However, it does not have expert capabilities to provide the minute detail of measurements and specific anatomy required to perform medical procedures. [ABSTRACT FROM AUTHOR]

Background: Coarctation of the aorta (CoA) is a congenital disease with an incidence of 4 out of 10,000 live births, therefore proper education of its treatment is essential. Understanding the disease and the wide array of treatment options is often difficult. Additive manufacturing technology can be used to produce 3D printed hands-on surgical training tools (HOSTT), which can be used for the education and practical training of CoA. This study aimed to investigate the effectiveness of a 3D printable HOSTT for the simulation of coarctation surgery, and it' possible role in practical education. Methods: Participants were medical students of Semmelweis University between the second and sixth academic year. A virtual 3D model of an aorta with CoA was generated from a computed tomography angiography scan. Each participant received a 3D-printed aorta phantom and performed either one of four surgical treatment modalities. The simulated surgeries included end-to-end anastomosis, end-to-side anastomosis, prosthetic patch, and subclavian flap aortoplasty. Participants provided feedback, evaluating their understanding of the disease and its treatment by the four surgical reconstruction modalities on a seven-point Likert scale before and after the sessions. Results: 21 medical students participated in this study. Participants' average rating of their understanding of CoA disease and it treatment options before practical training was 4.62 ± 1.07. After training, their average rating increased to 6.19 ± 1.08, showing statistically significant difference. Conclusions: Within this study's limitations, the applied HOSTT, manufactured using 3D printing, was effective for the practical training of CoA's surgical treatment methods for medical students. [ABSTRACT FROM AUTHOR]