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PlasmaBlade® is a thermal dissection device that may allow for improved perfusion of the mastectomy flap by limiting thermal injury. In this study we aim to compare the mastectomy flap perfusion using PlasmaBlade® versus traditional electrocautery. Patients undergoing bilateral mastectomy with immediate breast reconstruction were recruited. The right and left breasts of each patient were randomized to dissection with PlasmaBlade® or standard electrocautery. Randomization was performed using random sequences on the day of surgery and was blinded to the plastic surgeon. Mastectomy flap perfusion was assessed following completion of the mastectomy using intra-operative fluoroscopy and plastic surgeon review. Surgical site drainage and pain score were measured. Sign tests were employed to assess differences in perfusion and Wilcoxon paired test for the secondary outcomes. Twenty patients were enrolled in the study with median age of 40.5 years and median BMI of 26 kg/m2. In 18 patients (90%), perfusion was assessed to be better on the side of the PlasmaBlade® dissection. Median daily drainage over a 7-day period was 51 cc (IQR 35–61) on the PlasmaBlade® side and 44 cc (IQR 31–61) on the control side. Median pain score on the PlasmaBlade® side was 4.0 (IQR 2.3–5.9) and 4.4 (IQR 2.9–6) on the control side. No skin necrosis was noted in either groups. Use of PlasmaBlade® appears to be a safe and reliable technique to perform mastectomy and breast reconstruction with equivalent outcomes to traditional electrocautery. Although, mastectomy skin flap perfusion was rated better intra-operatively for the PlasmaBlade® group, both cohorts had comparable outcomes. ClinicalTrials.gov Identifier: NCT03711916 Level of Evidence: I (Randomized trial).

We report the case of letrozole-induced radiation recall dermatitis (RRD) in a patient with a remote history of radiation therapy. There is only one previously known case of RRD triggered by letrozole in a patient with a recent (

The purpose of this article is to compare alignment outcomes following pediatric strabismus surgery for simple horizontal strabismus in patients with state-based aid, used as a proxy for lower socioeconomic status (SES) with those with private insurance. Medical records of all children treated with horizontal strabismus surgery over a period from 2014-17 were retrospectively reviewed. Medical assistance was used as a proxy for lower SES. Patients were compared to a control population undergoing similar surgery by same surgeons in the same time period. Data points were collected at preoperative and postoperative month 6 visits. Improvement in alignment was the primary outcome variable. Improvement in fusion, amblyopia, and stereopsis were also examined. Demographic information and compliance with treatment recommendations were recorded. 69 patients met inclusion criteria from a total population of 105 patients; 36 were excluded due to loss to follow-up. This was compared to a control group with private insurance; 34 patients were identified out of a total of 38, 4 patients were lost to follow-up. Overall rate of operative success was 71.0% at POM6. Overall rate of success for control group was 73.5%. The difference failed to be statistically significant (p = 0.37). Race, sex, age at time of surgery, and type of strabismus (esotropia, exotropia) failed to correlate with success rate of surgery. Poor compliance with prescribed treatments (glasses, patching/atropine) in both groups correlated with surgical failure. 68.1% of study patients and 70.6% of control reported good compliance with treatment. We present the first analysis of the impact of SES on strabismus surgery outcomes. Overall surgical success rate in our study population failed to differ significantly from a control population and were comparable to that reported in the literature. We found that compliance with treatment influenced surgical success rates in our study population. The high rate of lost to follow-up in the study population is an important factor influencing our conclusion that no difference exists between our groups.

To assess risk factors for loss to follow-up (LTFU) and identify obstacles to follow-up care in these patients.The medical records of all children (18 years old) who underwent strabismus surgery over a 6-year period at a single institution were reviewed retrospectively. Patients were considered LTFU if they failed to attend a follow-up appointment between 3 weeks and 6 months postoperatively. Variables collected for all patients included age, sex, race/ethnicity, and insurance type. A telephone survey of parents/guardians of all patients LTFU was conducted to determine potential barriers to follow-up care. Demographic information was compared between those not LTFU and those LTFU as well as those LTFU and those LTFU who completed the survey. Reasons for LTFU were quantified and classified by category.Patients LTFU were significantly more likely to be black than white or Asian and have state or government-based insurance rather than private or employer-based insurance. The most common reasons cited for not following-up included perceived positive outcome (47%), work conflicts (37%), transportation issues (30%), travel time (30%), and having forgotten (27%).Patients were LTFU because parents or guardians perceived follow-up as unnecessary, were faced with scheduling or transportation impediments, or simply forgot to appear. Possible remedies include increasing education through teach-back, offering telemedicine appointments, and sending multiple appointment reminders.