hickman-catheter-use-for-long-term-vascular-access-preclinical-swine

Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model

Central venous catheters (CVCs) are invaluable devices in large animal research as they facilitate a wide range of medical applications, including blood ...

Johns Hopkins University School of Medicine

 Breast reconstruction is becoming an increasingly important and accessible component of breast cancer care. Among the many reconstructive options available, the latissimus dorsi flap has experienced a renewal in popularity because of its favorable properties and outcomes when used for breast reconstruction. However, a limitation unique to latissimus-based reconstruction is inappropriate breast animation postoperatively, due to persistent thoracodorsal innervation of the latissimus dorsi muscle after transfer to the mastectomy site.

Latissimus Denervation: A Review of Evidence.

The purpose of this study is to (1) gather US medical student attitudes regarding pass or fail score reporting of the USMLE Step 1 exam and (2) investigate the impact of this new policy on specialty interest and redistribution of efforts to enhance individual competitiveness.

US Medical Student Perspectives on the Impact of a Pass/Fail USMLE Step 1.

Retrospective, quasi-experimental difference-in-differences investigation.

The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland.

Given the multifunctional role of the penis in daily life, penile loss can be a physically and emotionally devastating injury. Options to restore penile loss have traditionally relied on autogenous free flap, local flaps, and skin grafts. These techniques provide satisfactory outcomes but carry high rates of urologic and prosthesis-related complications. Vascularized composite allotransplantation may offer a novel solution for these patients through reconstruction with true penile tissue. Still, penile transplants pose ethical, logistical, and psychosocial challenges. These obstacles are made more complex by the limited cases detailed in published literature. A review of the literature was conducted to assay current practices for penile reconstruction. Most modern complex penile reconstructions utilize autogenous pedicled or free tissue flaps, which may be harvested from a variety of donor sites. A total of five penile transplants have been described in the literature. Of these, four report satisfactory outcomes. The advent of genital allotransplantation has recently broadened the landscape of treatment for penile loss. Reconstruction using true penile tissue through vascularized penile allotransplantation has the possibility to engender increased penile function, sensation, and overall quality of life.

Vascularized composite allotransplantation of the penis: current status and future perspectives.

Penile vascularized composite allotransplantation is a powerful tool for penile reconstruction. Traditional methods of reconstruction utilizing free tissue and prostheses have well-known complications, can require reoperation and cannot truly emulate the natural form or function of the penis. While vascularized composite allotransplantation may alleviate these difficulties, penile transplantation carries its own ethical, surgical and medical complications. To date, the procedure has only been attempted 5 times. Broader use of this procedure requires unique surgical considerations. We present the first comprehensive, detailed review of this procedure in order to present lessons learned from both our own and the global experience.

Penile Transplantation: Lessons Learned and Technical Considerations.

Despite significant advances in the management of frontal sinus fractures, there is still a paucity of large-cohort data, and a comprehensive synthesis of the current literature is warranted. The purpose of this study was to present an evidence-based overview of frontal sinus fracture management and outcomes.

Frontal Sinus Fractures: Evidence and Clinical Reflections.

The Impact of the COVID-19 Pandemic on Plastic Surgery Match Rates.

Perinatal brachial plexus palsy (PBPP) has a wide spectrum of clinical symptoms that can range from incomplete paresis of the affected extremity to flaccid arm paralysis. Although there is a high rate of spontaneous recovery within the first two years of life, it remains challenging to determine which patients will benefit most from surgical intervention. The diagnostic and predictive use of various imaging modalities has been described in the literature, but there is little consensus on approach or algorithm. The anatomic, pathophysiological, and neurodevelopmental characteristics of the neonatal and infant patient population affected by PBPP necessitate thoughtful consideration prior to selecting an imaging modality.

Radiographic imaging modalities for perinatal brachial plexus palsy: a systematic review.

This is a literature review with 3 case studies.

Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies.

Considerable controversy exists around the optimal age on which to operate for craniosynostosis. This study aims to use data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric to assess the impact of operative age on hospital stay and outcomes. After excluding patients who underwent endoscopic cranial vault remodeling, a total of 3292 patients met inclusion criteria in the National Surgical Quality Improvement Program-Pediatric between 2012 and 2019. Median age at surgery was 300 days (interquartile range: 204-494). Patients between 0 and 6 months underwent the highest proportion of complex cranial vault remodeling, Current Procedural Terminology 61,558 ( n =44, 7.7%) and Current Procedural Terminology 61,559 ( n =317, 55.1%). White blood cell counts peaked in the 12 to 18 months group, and were lowest in the 24± months group. Hematocrit was lowest in the 0 to 6 months group and rose steadily to the 24± months group; the inverse pattern was found in platelet concentration, which was highest in the youngest patients and lowest in the oldest. Prothrombin time, international normalized ratio, and partial thromboplastin time were relatively consistent across all age groups. Younger patients had significantly shorter operating room times, which increased with patient age ( P <0.001). Younger patients also had significantly shorter length of stay ( P =0.009), though length of stay peaked between 12 and 18 months. There was a significantly lower rate of surgical site infection in younger patients, which occurred in 0.7% of patients 0 to 12 months and 1.0 to 3.0% in patients over 12 to 24± months. There was no significant difference in the average number of transfusions required in any age group ( P =0.961).

Evaluation of Complications and Outcomes in Craniosynostosis by Age of Operation: Analysis of the National Surgical Quality Improvement Program-Pediatric.

As of January 26, 2022, the United States Medical Licensing Examination(USMLE) Step 1 score reporting will be changed from a numeric scoring system to pass/fail. Although the new scoring policy is expected to benefit medical students, there is concern that it will also amplify preexisting disadvantages and worsen disparities for students applying in the already-competitive plastic surgery match. Whether the reporting change will tangibly benefit applicants to plastic surgery has yet to be elucidated.

USMLE Step 1 Pass/Fail is Here: Are Plastic Surgery Applicants Really Better Off?

Since 2006, five penis transplants have been performed worldwide. Mixed outcomes have been reported, and two of the five penile transplants have required explantation. However, the long-term outcomes have been encouraging when compliance is implemented, whether standard induction and triple therapy maintenance, or single therapy maintenance. Follow-up monitoring of transplant recipients has enabled a synthesis of technical considerations for surgical success and has shown stable leukocyte counts and renal function after a donor bone-marrow-based immunomodulatory regimen followed by tacrolimus monotherapy as long as 3 years post-transplant, as well as continuous nerve regeneration of penile allografts 3 years post-transplant. Areas of uncertainty include the ethics of donor-recipient colour mismatch, surveillance for sexually transmitted infections and how to optimize patient compliance. Questions also remain with respect to the long-term immunological sequelae of penile tissue, functional outcomes, psychosocial implications and patient selection. Patient counselling should be modified to mention the possibility of long-term improvement in nerve regeneration and sufficient renal function with single-therapy maintenance, and to build a longitudinal dialogue and partnership between the patient and the multidisciplinary care team regarding the risks of sexually transmitted infection instead of surveillance.

Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria.

Children are uniquely vulnerable to injury because of near-complete dependence on caregivers. Unintentional injury is leading cause of death in children under the age of 14. Burns are one of the leading causes of accidental and preventable household injuries, with scald burns most common in younger children and flame burns in older ones. Education is a key tool to address burn prevention, but unfortunately these injuries persist. Critically, there is a paucity of literature investigating adult comprehension with respect to potential risks of household burns. To date, no study has been performed to assess management readiness for these types of injuries without seeking medical care.

Public perception of household risks for pediatric burn injuries and assessment of management readiness.

In 2022, the plastic and reconstructive surgery (PRS) match faced unprecedented system-wide transitions that have redefined conventional measures of applicant success. This challenges the equitable assessment of student competitiveness and diversity in the field.

The Impact of Socioeconomic Factors on the 2022 Plastic Surgery Match.

Prepectoral implant-based breast reconstruction is often supplemented by autologous fat grafting to optimize aesthetic outcomes. This usually entails several rounds of modest fat transfer to minimize risk of necrosis; however, the limits of fat grafting at expander exchange are not known.

Optimizing Prepectoral Implant Placement and Concomitant Fat Grafting After Tissue Expansion.

As the second cycle impacted by COVID-19, the 2022 Plastic and Reconstructive Surgery (PRS) Match maintained virtual interviews while offering a modest lift of subinternship restrictions. The residency application process continues to evolve, with changes such as pass/fail United States Medical Licensing Examination Step 1 reporting prompting programs to reconsider metrics of applicant success. It is critical to address the impact of board scores, mentorship, and resource availability on a diverse applicant population in the PRS Match.

Article	Year
Latissimus Denervation: A Review of Evidence. Journal of reconstructive microsurgery\| PubMed ID: 31067584	2019
US Medical Student Perspectives on the Impact of a Pass/Fail USMLE Step 1. Journal of surgical education\| PubMed ID: 34602379	2022
The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland. Craniomaxillofacial trauma & reconstruction\| PubMed ID: 34707791	2021
Vascularized composite allotransplantation of the penis: current status and future perspectives. International journal of impotence research\| PubMed ID: 34711953	2022
Penile Transplantation: Lessons Learned and Technical Considerations. The Journal of urology\| PubMed ID: 35239430	2022
Frontal Sinus Fractures: Evidence and Clinical Reflections. Plastic and reconstructive surgery. Global open\| PubMed ID: 35450261	2022
The Impact of the COVID-19 Pandemic on Plastic Surgery Match Rates. Plastic and reconstructive surgery\| PubMed ID: 35468105	2022
Radiographic imaging modalities for perinatal brachial plexus palsy: a systematic review. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery\| PubMed ID: 35536348	2022
Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies. Craniomaxillofacial trauma & reconstruction\| PubMed ID: 35633764	2022
Evaluation of Complications and Outcomes in Craniosynostosis by Age of Operation: Analysis of the National Surgical Quality Improvement Program-Pediatric. The Journal of craniofacial surgery\| PubMed ID: 35949013	2023
USMLE Step 1 Pass/Fail is Here: Are Plastic Surgery Applicants Really Better Off? Journal of surgical education\| PubMed ID: 36463007	2023
Lessons learned from the first 15 years of penile transplantation and updates to the Baltimore Criteria. Nature reviews. Urology\| PubMed ID: 36627487	2023
Public perception of household risks for pediatric burn injuries and assessment of management readiness. Burns : journal of the International Society for Burn Injuries\| PubMed ID: 36732102	2023
The Impact of Socioeconomic Factors on the 2022 Plastic Surgery Match. Annals of plastic surgery\| PubMed ID: 36880766	2023
Optimizing Prepectoral Implant Placement and Concomitant Fat Grafting After Tissue Expansion. Annals of plastic surgery\| PubMed ID: 36921323	2023
Mentorship is Critical: An Analysis of the 2022 Plastic Surgery Match. Annals of plastic surgery\| PubMed ID: 36921340	2023

Christopher D. Lopez

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