Background:This study evaluates the diagnostic efficacy of high-resolution ultrasound (US) in identifying focal swelling and focal narrowing of the anterior interosseous nerve (AIN) fascicles within the median nerve around the elbow in spontaneous anterior interosseous neuropathy. Methods:This retrospective STROBE (Strengthing the Reporting of Observational Studies in Epidemiology)-compliant study evaluated 33 patients with spontaneous anterior interosseous neuropathy who underwent preoperative high-resolution US and surgery. Two radiologists jointly assessed the lesions, with intraoperative findings as the reference standard for calculating US diagnostic metrics. Intraclass correlation coefficients (ICCs) were analyzed for interrater reliability. Results:Surgery confirmed 4 focal swellings and 56 focal narrowings of the AIN fascicles within the median nerve around the elbow. Preoperative US correctly identified all swellings and 45 narrowings, yielding a sensitivity and overall accuracy of 81.7%, and a positive predictive value of 100%. Specificity and negative predictive value were not calculable due to zero false positives. The interrater reliability was good to excellent (intraclass correlation coefficient = 0.856). US also detected denervated muscle changes (n = 5), concomitant median nerve trunk compression (n = 2), and concomitant posterior interosseous nerve narrowing (n = 2). Conclusions:High-resolution US is a sensitive, reliable, and noninvasive modality for identifying focal swelling and focal narrowing of the AIN fascicles within the median nerve around the elbow in spontaneous anterior interosseous neuropathy. Its precision in lesion localization supports its utility as a first-line imaging technique for clinical evaluation and surgical planning.
Background: Implant-based breast reconstruction (IBR) remains the most widely used method for breast reconstruction following mastectomy. There is significant variability in the choice between subpectoral and prepectoral approaches. This study compares the frequency of secondary procedures required to improve the aesthetic outcome between subpectoral and prepectoral IBR approaches. Methods: A retrospective cohort study was conducted on patients undergoing single-stage subpectoral IBR between January 2014 and June 2017 or prepectoral IBR between November 2016 and December 2019 by a single surgeon at a tertiary breast unit. The primary outcome was the number of secondary procedures performed within 5 years to improve aesthetic outcomes. Secondary outcomes included postoperative complications. Results: A total of 388 single-stage IBRs were analyzed (194 subpectoral and 194 prepectoral). Median age was 43.0 years in both groups, with similar body mass index (22.4 kg/m 2 [interquartile range 3.1] versus 22.0 kg/m 2 [interquartile range 3.5]; P = 0.795). The overall frequency of secondary procedures at 5 years was comparable (53.1% versus 53.6%; P = 0.650). Pocket revisions were significantly more common following subpectoral reconstruction (9.3% versus 2.6%; P = 0.005), whereas implant exchange rates were not significantly different (7.7% versus 3.1%; P = 0.216). Fat grafting rates were similar (32.5% versus 37.6%; P = 0.338). Overall complication rates did not differ significantly (20.1% versus 22.2%; P = 0.709), and implant loss was low at 5.2% in both groups. Conclusions: At 5-year follow-up, prepectoral and subpectoral IBR were shown to have comparable rates of secondary aesthetic procedures and postoperative complications. These findings support prepectoral IBR as a safe and effective alternative to subpectoral reconstruction.
Background:The current understanding of thoracic outlet syndrome (TOS) as neurovascular compression fails to address multiple questions. This includes neck and upper back pain, occipital headaches, scapular protraction, higher prevalence in women, and overall inefficacy of current surgeries. The pectoralis minor (PM) uniquely carries lower trunk innervation and can persistently protract the scapula. Protraction narrows the thoracic outlet and subacromial spaces, stretches the upper trapezius and rhomboids, and irritates the occipital nerves, producing occipital headaches, upper back and neck pain, shoulder weakness, and hand numbness/tingling. We hypothesized that select TOS patients can benefit from PM tenotomy with infraclavicular plexus neurolysis (PM+ICN) alone. Methods:Patients with TOS presenting with coracoid tenderness and scapula protraction on examination were treated with PM+ICN. Outcomes included pain, shoulder abduction range of motion, headaches, scapular dyskinesis, and need for secondary neurolysis. Results:A total of 144 patients were included. The median age of patients was 50 years; 110 (76%) were women. Following PM+ICN, median pain (out of 10) decreased from 8.0 to 2.0, median shoulder abduction increased from 90 to 180 degrees, occipital headaches decreased from 120 (83%) to 2 (1%) (all P < 0.001). About 16% of patients required secondary neurolysis with only 1% at the thoracic outlet. Median follow-up was 15 months. Conclusions:In a large series of select patients with TOS, PM+ICN (with infrequent secondary neurolysis) significantly reduced pain and headaches while restoring motion. These findings suggest the PM may play a significant if not central role in TOS management, apart from neurovascular compression, by pathologizing the scapula's connections.
Galactocele is a benign milk retention cyst that may develop during or after lactation. In patients with breast implants, ruptured galactoceles can cause peri-implant fluid collections that mimic implant rupture or infection, creating a diagnostic challenge. This report describes a 37-year-old Asian woman, G1P1, with bilateral prepectoral smooth-surface silicone breast implants who presented 2 months postpartum with progressive left breast swelling that was initially diagnosed as mastitis. After noticing a palpable mass, the patient performed vigorous self-massage and increased breast pumping in an attempt to relieve presumed milk stasis, which precipitated acute breast enlargement. Despite antibiotic therapy, symptoms worsened, and evaluation by a radiologist and a general surgeon resulted in a diagnosis of implant rupture with infection and abscess; galactocele rupture was not considered. Surgical exploration revealed an intact implant with milk contamination of the implant pocket due to galactocele rupture and duct-capsule communication. No mature capsule was identified; the pocket was lined with granulation tissue. Fluid analysis demonstrated elevated triglyceride levels consistent with milk content, whereas bacterial cultures remained negative. Management included closure of the ductal communication, sequential antiseptic irrigation, drain placement, and lactation suppression with cabergoline. The implant was successfully salvaged, and the patient remained asymptomatic at 3-month follow-up without capsular contracture. Galactocele rupture should be considered in the differential diagnosis of peri-implant fluid collections in postpartum patients with breast implants. Vigorous manipulation over a palpable mass should be avoided, and timely lactation suppression is critical for implant salvage regardless of closure integrity.
Background:Polyurethane-coated breast implants were developed to reduce capsular contracture through enhanced implant-tissue interaction. After fluctuating clinical adoption driven by regulatory and safety concerns, renewed interest has emerged, particularly in immediate and prepectoral implant-based breast reconstruction. However, the structure and thematic evolution of the literature have not been systematically quantified. Methods:A bibliometric analysis of the Web of Science Core Collection was performed, including articles and reviews published up to January 2026. Studies on polyurethane-coated breast implants in aesthetic or reconstructive surgery were included. Bibliometric indicators were analyzed using VOSviewer and Bibliometrix to evaluate publication trends, citation patterns, and research networks. Results:A total of 136 publications (1978-2026) were identified. Output remained limited until the mid-2000s, followed by rapid growth after 2017, with publication volume peaking in 2025. Italy, the United States, and Brazil accounted for more than 60% of publications, with research concentrated in a few centers and core journals. Keyword analyses showed a shift from capsular contracture and surface biology toward prepectoral and direct-to-implant reconstruction. Breast implant-associated anaplastic large cell lymphoma emerged as a key recent topic. Conclusions:The literature has undergone a marked thematic shift toward contemporary reconstructive strategies. Despite increasing output, evidence remains dominated by small retrospective studies with limited comparative data. Prospective multicenter studies are needed to clarify long-term safety, including breast implant-associated anaplastic large cell lymphoma risk, and to define durable clinical and patient-reported outcomes.
Background:This study examines the acceptance of facial cosmetic surgery in Saudi Arabia and the influence of social, cultural, and religious factors on public attitudes. It aims to improve the understanding of these factors to support patient education and informed decision-making. Methods:A cross‑sectional study was conducted using a validated, self‑administered electronic questionnaire distributed across all 13 regions of Saudi Arabia. Saudi adults aged 18 years or older who could read Arabic and consented to participate were included, whereas non‑Saudis, individuals younger than 18 years, and questionnaires with incomplete responses were excluded. A total of 1027 eligible participants completed the survey (with a completion rate of 55.7%). The questionnaire assessed demographics, history of facial cosmetic procedures, reasons for considering surgery, religious and cultural beliefs, and surgeon preferences. Associations were analyzed using χ2 tests, with significance set at a P value of less than 0.05. Results:Acceptance of facial cosmetic surgery showed significant associations with sex, income, and occupation (P < 0.001). Religious factors demonstrated strong relationships with acceptance, including perceived alignment with Islamic teachings and prior consultation with a religious scholar (P < 0.001). Surgeon gender preference was also significantly associated with acceptance, whereas cultural influence alone did not show comparable statistical significance. Conclusions:Acceptance of facial cosmetic surgery in Saudi Arabia is shaped primarily by religious beliefs, medical necessity, and demographic factors. Religious permissibility plays a more influential role than cultural norms. These findings highlight the importance of culturally sensitive, religion‑aware counseling to support informed decision-making.
Background:Interrater variance in subjective grading of reconstructed breast aesthetics limits the assessment reliability and reduces the quality of training datasets for machine learning models designed for objective, image-based grading. This study aims to identify the 3-dimensional (3D) features associated with such variability across 8 aesthetic viewpoints commonly used in Japan by analyzing case pairs in which expert scoring and pairwise comparisons show disagreement. Methods:Two-dimensional (2D) and 3D images of the reconstructed breasts were obtained from 174 patients. Aesthetic outcomes were independently scored by expert raters using 2D images, and pairwise comparisons were conducted for 154 selected pairs. Several 3D geometric and color features were extracted from the 3D images; their correlation with expert scores was examined; and t tests were performed on the averaged feature values between the agreement and disagreement pairs under Benjamini-Hochberg false discovery rate correction. Results:Disagreement pairs were found irrespective of expert score differences. However, these pairs showed larger differences in the coefficient of variation between the winner and loser cases. For all the viewpoints, several 3D features revealed significant differences in their average values between agreement and disagreement pairs. These disagreement-specific features varied in both type and number across viewpoints and were different from the score-correlated features. Conclusions:Viewpoint-specific 3D features associated with interrater variance were identified. This highlights a potential limitation of training machine learning models solely on expert scoring and suggests that integrating these 3D features may help inform future model design.
Background:This study evaluates the aesthetic results and patient-reported outcomes following the use of microvascular flaps from the ear in nasal reconstruction. Methods:A retrospective cohort study was conducted on patients who underwent nasal reconstruction with a microvascular ear flap between 2011 and 2021. Eleven plastic surgeons evaluated postoperative photographs using the validated observer-rated disfigurement scale and 5-point scales assessing the shape and color of the nose and donor ear appearance. Patient satisfaction with the reconstructed nose was assessed with the FACE-Q rhinoplasty module and satisfaction with the donor ear with 6-point scales. Results:Twenty-eight patients with microsurgical ear flaps were identified. One nasal subunit was reconstructed in 16 patients and the total nose in 3. Photographs were available for 25 patients. The shape and color of the reconstructed nose, and the shape of the ear, were assessed as good by the surgeons (median scores 2 IQR 2-3]; 2 [IQR 1-2], and 2 [IQR 1-3], respectively), whereas facial disfigurement was assessed as moderate (median score 3 [IQR 3-4]). Fifteen patients completed the questionnaire, reporting high levels of satisfaction with the appearance of the nose (median score 60; IQR 54-65) and nostrils (median score 64; IQR 42-81), and acceptable symmetry of the ears (median score 2; IQR 1-3). Conclusions:Microvascular flaps from the ear are a good alternative for complex nasal reconstruction, often yielding aesthetically favorable results.
Background:Patients undergoing body contouring after massive weight loss (MWL) are at an increased risk for anemia and perioperative complications. However, data regarding transfusion patterns and procedure-related transfusion burden in this population remain limited. Methods:We retrospectively reviewed 224 MWL patients who underwent 385 procedures at a single tertiary referral center from January 2021 to December 2022. Demographic, hematologic, and surgical variables were analyzed. Procedures were categorized as lower body lift (LBL), other multiple combined procedures, or single procedures. The primary outcome was postoperative transfusion, defined by hemoglobin less than 7.5 g/dL with symptoms or persistent decline. Exploratory multivariable logistic regression analysis was performed to evaluate associations between procedure type and postoperative transfusion while accounting for the limited number of events. This study adheres to STROBE reporting guidelines. Results:Fourteen patients (6.3%) required transfusion. Most transfusions occurred in patients undergoing LBL procedures (9 of 14). In exploratory multivariable analysis, LBL remained associated with transfusion (odds ratio: 3.69; 95% confidence interval: 1.19-11.43; P = 0.024). No statistically significant associations were observed with operative time, number of procedures, or comorbidities, although the limited number of events restricted interpretation of secondary variables. Transfused patients had significantly longer hospital stays. Conclusions:Postoperative transfusion in MWL body contouring was uncommon in this optimized single-center cohort but occurred predominantly in patients undergoing LBL procedures. These findings describe procedural patterns associated with transfusion burden in extensive circumferential procedures and may contribute to perioperative awareness and planning in MWL body contouring surgery.
Background:The hand is essential for daily function, yet war-related injuries can cause complex damage leading to disability or amputation. This issue is particularly pronounced in resource-limited settings. In light of these challenges, this article examines the epidemiology, types of injuries, surgical interventions, and complications of combat-related hand injuries in Sudan. Methods:This prospective cohort study was conducted at a single hospital from January 2024 to January 2025. Fifty-three patients with combat-related hand injuries underwent reconstructive surgery, and data were collected on demographics, mechanism of injury, anatomical zones, surgical procedures, and outcomes. To evaluate complications and recovery, patients were followed up for 6 months. Results:Most patients were male (79.2%), with manual laborers and students being the most affected groups (32% each). Gunshots (52.8%) and explosions (47.2%) were the leading causes. Fractures occurred in 92.4% of cases, most of which were treated with K-wires (77.3%). Flap coverage was the main reconstructive method (64.1%), followed by delayed primary closure (32%) and skin grafting (5.6%). A single-stage procedure was performed in 77.4% of cases. Finger amputation occurred in 24.5%, most commonly the index finger. Infection was the leading complication (42%). Conclusions:War-related hand injuries primarily affect young males and often involve fractures and tissue loss. Despite limited resources, functional preservation is achievable using traditional techniques, and single-stage surgery has been proved to be effective. Careful planning and physiotherapy optimize outcomes, even in patients with amputations.
Background:Oronasal fistula (ONF) remains a common complication following primary palatoplasty, particularly in wide clefts. The use of pedicled bilateral buccal fat pad flaps (BFPFs) has shown promise in reducing ONF incidence, but clear indication criteria are lacking. This study evaluates the efficacy of BFPF interposition in primary palatoplasty and explored the use of the palatal index (PI) as a quantitative tool for flap indication. Methods:A systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines identified studies reporting bilateral BFPF use during primary palatoplasty. Additionally, a retrospective cohort analysis was conducted on 139 patients undergoing primary cleft palate repair (2017-2024) at a single institution. Following a protocol revision in 2021, BFPF was selectively used based on intraoperative assessment. In the post-2021 cohort, PI and cleft width were measured to determine their association with BFPF use and ONF incidence. Results:The systematic review revealed limited studies with inconsistent reporting on cleft severity and BFPF indication. In the institutional cohort, ONF incidence dropped significantly from 15.5% (group A) to 2.5% (group B; P = 0.005). BFPFs were used in 46.9% of post-2021 cases, primarily in severe clefts (PI ≥ 0.43). PI was significantly higher in patients receiving BFPF (P < 0.001), and no ONFs occurred above the 0.43 PI threshold. Conclusions:Bilateral BFPF interposition significantly reduces ONF incidence in primary palatoplasty. The PI is a useful, objective criterion to guide its use, with a PI value of 0.43 or higher proposed as an effective threshold. These findings support incorporating BFPF into standardized protocols for primary palatoplasty.
Background:Enhanced recovery after surgery (ERAS) pathways can decrease hospital length of stay (LOS) and oral morphine equivalent (OME) use after autologous breast reconstruction. Ketorolac is a powerful nonsteroidal anti-inflammatory drug used in our ERAS pathway. The purpose of this study was to analyze the safety and efficacy of scheduled low- versus high-dose intravenous (IV) ketorolac. Methods:A retrospective study of patients who underwent abdominally based breast reconstruction with our ERAS protocol was conducted from July 2015 to June 2020. Controls (group A) received no IV ketorolac, whereas cases received at least 3 doses of either low-dose (15 mg, group B) or high-dose (30 mg, group C) IV ketorolac. Outcomes of interest included LOS, OME use, acute kidney injury, 30-day return to operating room, and blood transfusion. Results:A total of 159 patients were included (group A = 62, group B = 43, group C = 54). The 3 groups differed only in mean age (group A = 52.6 y, group B = 50.9 y, group C = 46 y; P = 0.0018). Compared with controls (group A = 297.6 mg, 5.16 d), the administration of scheduled low- and high-dose ketorolac was associated with a significant reduction in mean OME use (group B = 120.3 mg, P = 0.0003; group C = 176.9 mg, P = 0.0415) and LOS (group B = 4.21 d, P < 0.0004; group C = 4.22 d, P = 0.001). Ketorolac use was not associated with a significant increase in complications. Conclusions:Scheduled postoperative ketorolac administration significantly reduces opioid consumption and LOS, without adverse effects, in patients undergoing abdominally based breast reconstruction.
The field of plastic surgery is increasingly influenced by consumer demand, digital media, and patient-driven decision-making, requiring practices to adopt strategic marketing approaches to remain competitive. This article highlights the expanding role of marketing in plastic surgery and presents a comprehensive framework for building an effective marketing strategy. Key components include defining SMART (specific, measurable, actionable, relevant, and time-bound) objectives, identifying target populations and stakeholders, assessing the competitive landscape (eg, through SWOT [strengths, weaknesses, opportunities, threats] analysis), and translating insights into a clear unique value proposition. We also discuss market-aware, value-consistent pricing considerations, structured budgeting, and performance measurement using analytics and conversion metrics to guide resource allocation. Finally, we provide practical considerations such as leveraging social media for patient engagement, evaluating the benefits and risks of partnering with specialized marketing firms, and maintaining ethical and legal compliance. By applying these evidence-based approaches, plastic surgery practices can enhance patient engagement, strengthen credibility, and achieve sustainable growth in a digitally driven, consumer-focused field.
Many plastic surgery trainees enter private or group practice, yet there is little guidance on financing strategies when starting or joining a practice. The aim of this article is to provide physicians starting or joining a private practice with a clear, evidence-based resource on financing options. Common funding avenues are described, ranging from traditional bank and Small Business Administration loans to equipment leasing, hospital joint ventures, and equity-based investments. Comparisons are made to characterize differences in control, cash flow burden, regulatory considerations, and long-term sustainability and to provide an overview of the advantages, limitations, and situational appropriateness of each option. Specific loan requirements, guarantees, and regulatory considerations are outlined, with an additional focus on legal guardrails and trade-offs associated with hospital partnerships and private equity. Physicians entering private practice face a critical early decision: how to secure the capital needed to launch and sustain their business. A wide range of financing options exist, and each comes with distinct advantages, limitations, and implications for autonomy and long-term growth. Ultimately, the right solution depends on factors such as capital needs, tolerance for risk, desired level of control, and future growth strategy.
Background:Skin grafting with dermal regenerative templates (DRTs) has emerged as an effective option within the reconstructive ladder for coverage of full-thickness wounds. This approach reduces the need for flap reconstruction, shortens hospitalization, and minimizes wound-related morbidity while improving functional and aesthetic outcomes. We present a case series of patients treated with a novel hydrogel-based DRT (hDRT) composed of type I bovine collagen microspheres embedded within a lower density type I bovine collagen hydrogel. We describe outcomes of wounds treated using this template. Methods:A retrospective chart review of patients who underwent definitive coverage of full-thickness skin defects with an hDRT was performed. Results:Thirteen defects in 10 patients underwent reconstruction. Defect locations included the face, scalp, and extremities. Wound etiologies included oncological, traumatic, and donor-site defects. Exposed tissues included tendon, bone, nerve, and galea. Defect size ranged from 2 to 100 cm2. Wounds were managed using hDRT with immediate skin grafting, hDRT with delayed skin grafting, and hDRT alone without grafting. All patients displayed wound bed vascularization 8 days after application. Mean total time to healing (T total) was 8 days for immediate skin grafting, 15 days for delayed skin grafting, and 18 days for secondary intention. All healed defects were aesthetically acceptable, with minimal to no contour deformity. Conclusions:This novel dual-density hDRT demonstrated favorable results in wound reconstruction as a result of accelerated vascularization leading to reduced treatment time and patient morbidity. Larger studies are required to compare the efficacy with other products on the market.
Plastic surgeons, particularly those in residency and early career, face unique situations that require financial literacy to navigate. Yet, most residency programs lack personal finance education, leaving trainees inadequately prepared to manage student loans, negotiate employment contracts, or participate in long-term financial planning. This article aims to bridge this educational gap by providing a concise overview of essential financial principles tailored to plastic surgery trainees and early practice surgeons. Key topics addressed include student loan and debt management, early saving and investment strategies, insurance and risk protection, and retirement planning. Practical considerations for career transitions include implications of different employment models, insurance considerations, and contract negotiation. Additional focus is placed on career-stage considerations, such as financial advisor selection. Improving financial literacy at the trainee level is critical for physician well-being and professional development. By offering actionable recommendations, trainees and early-career surgeons will be better equipped with the skills necessary to build a financially secure and successful future.
Background:The molecular regulators driving melanoma pathogenesis remain incompletely defined. Although plasma proteins show associations with melanoma, their causal relationships are unclear. Methods:We performed Mendelian randomization (MR) using proteomic data from the UK Biobank Pharma Proteomics Project and deCODE genetics to identify plasma proteins causally linked to melanoma. Colocalization, summary data-based MR, heterogeneity in dependent instruments, and MR-phenome-wide association study analyses identified druggable targets. Transcriptome profiling of melanoma tissues and single-cell functional validation assessed the target roles. Results:Poly(adenosine diphosphate-ribose) polymerase 1 (PARP1) was established as a causal risk factor and druggable target for melanoma. Elevated PARP1 expression in melanoma tissues correlated with poor patient survival. Functional analyses revealed that PARP1 coordinates protumorigenic functions with cell-specific roles. Conclusions:In conclusion, our results demonstrate that PARP1 is a key driver of melanoma pathogenesis and represents a potential specific molecular target for therapeutic intervention.
The Fujiyama procedure is a surgical technique designed for patients undergoing conversion from implant-based breast reconstruction to autologous tissue reconstruction. Conventional implant-to-flap conversion often fails to reproduce natural breast ptosis and lower pole projection because of biomechanical differences between implants and autologous tissue and an insufficient lower pole skin envelope after long-term implant placement. This technique applies the inverted-T mastopexy concept in reverse and introduces a geometric redesign strategy, in which a triangular skin paddle is intentionally exposed at the lower pole. This design allows redistribution of the skin envelope while providing adequate lower pole volume and skin supply, both of which are essential for restoring a natural ptotic contour. Following implant and capsule removal, the pectoralis major muscle is repositioned to the chest wall, and a prepectoral pocket is created to optimize softness and contour. The transferred flap is inserted into this plane, and the exposed skin paddle forms the "Fujiyama-shaped" lower pole. Intraoperative assessment in sitting position under negative pressure enables contour adjustment. When necessary, the inframammary fold is reinforced using multiple tacking sutures. Seven patients (9 breasts) underwent reconstruction using pedicled or free abdominal flaps and profunda artery perforator flaps. Complete flap survival without major or minor complications was achieved in all cases. Stable inframammary fold reconstruction, natural breast ptosis, and lower pole projection were achieved without secondary revisions. The Fujiyama design represents a structural lower pole redesign rather than simple implant replacement and offers an option for restoring natural breast morphology in secondary autologous reconstruction.
Background: Selection of applicants for plastic surgery training is based on multiple criteria, with an increasing emphasis on scholarly productivity. However, it is unclear whether research productivity before training predicts future academic success in residency or practice. This study examines the association between research productivity before residency and subsequent career trajectory in the modern era. Methods: We conducted a cross-sectional analysis of graduates from all Accreditation Council for Graduate Medical Education-accredited integrated and independent plastic surgery training programs between 2020 and 2024. Collected variables included demographic characteristics, training program attributes, and posttraining career trajectory. Research productivity was assessed by the number of peer-reviewed publications at the time of application, during integrated or independent residency, and after training. Results: A total of 1049 plastic surgeons were included in the study. Applicants pursuing independent pathways had significantly fewer publications at the time of general surgery residency application than those applying for integrated programs, but had accumulated more publications at the time of plastic surgery application than integrated applicants. The completion of a 1-year fellowship predicted a long-term career in academia versus private practice ( P < 0.001), whereas early research productivity ( P = 0.659) and fellowship subspecialty ( P = 0.051) did not reach significance. Conclusions: Scholarly productivity has assumed an increasingly prominent role in the evaluation of plastic surgery applicants. However, research productivity before residency may not predict future academic success or practice. Further work to evaluate the relationship between research productivity and clinical skills may help elucidate the usefulness of this metric in the residency selection process.
Dynamic distraction external fixation (DDEF) is commonly used for proximal interphalangeal joint fractures based on the principle of ligamentotaxis. However, this mechanism may be limited when fracture fragments lack soft tissue attachment. We present a 14-year-old girl with a depressed intra-articular fracture of the proximal phalanx head and joint stiffness, treated 5 weeks after injury using DDEF. Despite delayed treatment and minimal ligamentous connection, the fragment was successfully elevated and healed. We propose the so-called “vacuum phenomenon” as a hypothesis-generating concept that may represent a supplementary mechanism in fracture reduction under distraction. This effect may be particularly relevant in cases where ligamentotaxis alone does not fully explain fragment repositioning, and may help broaden the understanding of DDEF in managing such injuries.
