INTRODUCTION:The entrance of Generation Z (born 1997-2012) into professional life, including the practice of medicine, marks a transformational shift in priorities and values. This generation, shaped by digital immersion and a strong focus on work-life balance, is redefining the landscape of Plastic Surgery. Their preferences for inclusivity, innovation, and structured working hours challenge traditional models of mentorship, patient care, and surgical training. The aim of this survey was to explore the impact of Generation Z on the field of Plastic Surgery through insights offered by leaders of major Plastic Surgery societies in Europe and the United States, who together provide a comprehensive perspective on generational change and its implications for clinical practice, education, and healthcare systems in Plastic Surgery. METHODS:In October 2024 eight leaders of national Plastic Surgery societies and associations were invited to complete a structured questionnaire with five open-ended questions. They provided detailed responses on challenges, opportunities, and structural changes needed to address Generation Z's influence. RESULTS:Key findings highlight a generational shift in the approach to professional life, with an emphasis on digital innovation, work-life balance, and the interaction with social media. Respondents noted an increased interest in aesthetic over reconstructive surgery and a preference for private practice among younger surgeons, raising concerns about workforce shortages in public healthcare. Advances in digital learning and simulation-based training were identified as opportunities to facilitate medical education. However, the ethical challenges of misinformation on social media and a decline in hierarchical mentorship were emphasized as critical concerns. Despite generational tensions, the integration of Generation Z's strengths in technology and advocacy for systemic reform holds promise for addressing burnout and enhancing healthcare delivery. CONCLUSION:The arrival of Generation Z in Plastic Surgery represents a possible pivotal moment to reimagine traditional models of surgical education, patient care, and professional priorities. Collaboration between generations and proactive adaptation to these changes is an imperative to ensure a dynamic, inclusive, and sustainable future for the specialty.

Objective Retention rates of lipotransfer remain variable, with the underlying cause associated with tissue oxygenation and blood supply barriers. One promising new method of improving tissue oxygenation is micro/nanobubbles (MNBs), which are small gas bubbles (<100 μm) generated within a saline solution. MNBs are stable and carry a significant amount of oxygen, and because of their negatively charged surface characteristics, they are an ideal oxygen-delivery solution. Thus, we hypothesize that washing/oxygenating lipoaspirate tissue prior to transplantation in a micro/nanobubble saline solution will improve graft survival and quality compared to a saline control. Methods Human lipoaspirate samples obtained from healthy donors were washed with an oxygenated MNB or saline wash. These samples were then injected into the dorsum of sixteen 6-week-old male BALB/c mice, where each mouse received one saline and one MNB-washed graft. At 2-, 4-, 8-, and 12-week time points, the explants were harvested and weighed, and gas pycnometry was performed to assess graft volume. The tissues were also subjected to hematoxylin and eosin (HE) staining and immunohistochemistry to detect perilipin and blood vessels (CD31). These stains, as well as adipocyte count and area quantifications, were analyzed using ImageJ. Results HE staining revealed that the control group demonstrated notable adipocyte hypertrophy, while MNB-washed samples had evident adipocyte hyperplasia. This observation was confirmed by an analysis of variance (ANOVA), which showed that the control group had a larger average graft mass and volume (P < 0.01). MNB-washed grafts also exhibited significantly greater adipocyte counts and smaller adipocytes (P < 0.001). Perilipin staining was also greater in the MNB group at the 2- and 4-week time point indicating improved de novo adipogenesis following implantation. Lastly, CD31 staining revealed a significantly greater core vessel density and angiogenesis at the 4-week and 12-week time points (P < 0.01). Conclusions Our study demonstrates that MNBs enhance tissue quality as indicated by a significant increase in de novo adipogenesis, higher vessel density, and decreased adipocyte hypertrophy. Additional studies are needed to evaluate the clinical effectiveness. Nevertheless, incorporating MNBs into procedures holds great promise in tackling the ongoing challenge of inconsistent outcomes in lipotransfer.

Background: In an attempt to investigate physician compensation in academic practice, financial reimbursement models of departments and/or divisions of plastic surgery within an academic university setting were evaluated. Method: Thirteen divisions or departments of plastic surgery were surveyed to obtain information regarding reimbursement models for plastic surgery. Results: Of the 13 plastic surgery groups surveyed, 11 were divisions within the department of surgery. The department chairs/chief and/or chief administrative officers were questioned regarding the following areas: (1) total compensation, 2) bonus and incentive compensation models, and (3) cosmetic and cash reimbursement. There were no regional differences that could be identified. As such, we grouped institutions into Western, Midwest, and Eastern regions. COVID-19 did not change any of the financial models that were established before the pandemic. Discussion: There is no ideal model for compensation, which varied among the institutions surveyed. All of these financial models were established before COVID-19 and did not significantly change with the pandemic. It appears that within this small sample size, compensation is based mainly on a $/wRVU model. Funding for research and educational teaching remains a challenge, which is not reimbursed well. Although faculty compensation may vary based on the institutions, the decision to enter and remain in academic practice includes a series of decisions. However, compensation is a significant factor, which should not be minimized.

Background: Autologous fat grafting is commonly used for soft-tissue repair (approximately 90,000 cases per year in the United States), but outcomes are limited by volume loss (20% to 80%) over time. Human allograft adipose matrix (AAM) stimulates de novo adipogenesis in vivo, but retention requires optimization. The extracellular matrix derived from superficial fascia, interstitial within the adipose layer, is typically removed during AAM processing. Thus, fascia, which contains numerous important proteins, might cooperate with AAM to stimulate de novo adipogenesis, improving long-term retention compared to AAM alone. Methods: Human AAM and fascia matrix proteins (back and upper leg regions) were identified by mass spectrometry and annotated by gene ontology. A three-dimensional in vitro angiogenesis assay was performed. Finally, AAM and/or fascia (1 mL) was implanted into 6- to 8-week-old male Fischer rats. After 8 weeks, the authors assessed graft retention by gas pycnometry and angiogenesis (CD31) and adipocyte counts (hematoxylin and eosin) histologically. Results: Gene ontology annotation revealed an angiogenic enrichment pattern unique to the fascia, including lactadherin, collagen alpha-3(V) chain, and tenascin-C. In vitro, AAM stimulated 1.0 ± 0.17 angiogenic sprouts per bead. The addition of fascia matrix increased sprouting by 88% (2.0 ± 0.12; P < 0.001). A similar angiogenic response (CD31) was observed in vivo. Graft retention volume was 25% (0.25 ± 0.13) for AAM, significantly increasing to 60% (0.60 ± 0.14) for AAM/fascia ( P < 0.05). De novo adipogenesis was 12% (12.4 ± 7.4) for AAM, significantly increasing to 51% (51.2 ± 8.0) for AAM/fascia ( P < 0.001) by means of adipocyte quantification. Conclusions: Combining fascia matrix with AAM improves angiogenesis and adipogenesis compared to AAM alone in rats. These preliminary in vitro and pilot animal studies should be further validated before definitive clinical adoption. Clinical Relevance Statement: When producing an off-the-shelf adipose inducing product by adding a connective tissue fascial component (that is normally discarded) to the mix of adipose matrix, vasculogenesis is increased and, thus, adipogenesis and graft survival is improved. This is a significant advance in this line of product.

Management of lateral abdominal wall hernias presents a surgical challenge, and best management is controversial. Flank hernias as a surgical sequela occur more commonly, whereas flank hernias resulting from trauma are a rare occurrence. In this article, we present a review of the literature and a case of flank hernia presenting after trauma and recurring after repair. An anchored suture repair was performed and reinforced by the addition of a polyester underlay mesh.

PURPOSE: Advances in microtia reconstruction, including ear scaffolding and prosthesis, have a high failure rate due to the avascular nature of cartilage, loss of structure, and immunogenic reaction to foreign material.1 Improvements in bioengineered materials and scaffolding have started to tackle these issues, but there is a noticeable gap in the microtia and auricular cartilage literature. Little testing has been performed on the biomechanical characteristics of microtia cartilage and how it compares to phenotypically normal auricular cartilage.2-4 Thus, we characterized the biomechanical properties of distinct sections of microtia cartilage relative to anatomical regions of normal adult auricular cartilage. We hypothesized that the biomechanical properties of microtia cartilage would be uniform throughout and not different from the healthy adult auricular cartilage. METHOD: Healthy adult and juvenile microtia ear cartilage, initially stored at -80°C, were thawed at 4°C overnight and dissected at room temperature. For the adult normal cartilage, 3mm punch biopsies were taken from the concha, helix, anti-helix, tragus, anti-tragus, and scapha. For the microtia ears, 4mm punch biopsies were taken from the superior, middle, and inferior regions as topographical regions could be not appreciated. Creep indentation testing was performed to determine the compressive stiffness of the specimens. Using an automated system, an indenter tip (0.5mm for adult, 1mm for microtia) was applied to samples under various appropriate weights to achieve 10 - 15% strain within the tissue. A semi-analytical, semi-numerical, linear biphasic model and finite element analysis were used to obtain the aggregate modulus and shear modulus from the experimental data. Tensile properties were also measured. After samples were trimmed to forma dog-bone shape, they underwent uniaxial tensile strain at 1% gauge length per second until sample failure. Force data were normalized to sample cross-sectional area to generate a stress-strain curve from which tensile Young’s modulus and ultimate tensile strength were obtained. The data was analyzed by using one-way ANOVA. RESULTS: Our study found that the tensile and compression properties of the superior, middle, inferior regions of microtia tissue were not statistically different from each other (p > 0.05 for all measures). When comparing the tensile Young’s modulus (5.26 MPa vs. 5.81 MPa), ultimate tensile strength (3.99 MPa vs. 3.46 MPa), aggregate modulus (154.2 kPa vs. 172.0 kPa), and shear modulus (80.6 kPa vs. 85.5 kPa) of the microtia ear to those of the adult ear, respectively, the upper portion of a healthy adult ear, including the helix and concha, was not significantly different than the microtia tissue. In contrast, the permeability of the microtia tissue (7.8 vs. 36.1 1015*m4/N.s) was significantly different than all regions of a healthy adult ear (p < 0.05). CONCLUSION: These results have added to our understanding of microtia tissue and elucidated a possible relationship with specific regions of the healthy adult ear. We plan to combine biomechanical data with biochemical and histological data to form a more complete understanding of microtia tissue and normal auricular cartilage. REFERENCES: 1. Bly RA, Bhrany AD, Murakami CS, Sie KC. Microtia Reconstruction. Facial Plast Surg Clin North Am. 2016;24(4):577-591. doi:10.1016/j.fsc.2016.06.011 2. Huwe LW, Brown WE, Hu JC, Athanasiou KA. Characterization of costal cartilage and its suitability as a cell source for articular cartilage tissue engineering. J Tissue Eng Regen Med. 2018 May;12(5):1163-1176. doi: 10.1002/term.2630. Epub 2018 Jan 21. PMID: 29286211; PMCID: PMC5948132. 3. Zopf DA, Flanagan CL, Nasser HB, et al. Biomechanical evaluation of human and porcine auricular cartilage. Laryngoscope. 2015 Aug;125(8):E262-8. doi: 10.1002/lary.25040. Epub 2015 Apr 17. PMID: 25891012; PMCID: PMC4512857. 4. Griffin MF, O’Toole G, Sabbagh W, Szarko M, Butler PE. Comparison of the compressive mechanical properties of auricular and costal cartilage from patients with microtia. J Biomech. 2020 Apr 16;103:109688. doi: 10.1016/j.jbiomech.2020.109688. Epub 2020 Feb 25. PMID: 32145904.

The utilization of stem cells for applications in a variety of fields related to regenerative medicine and tissue engineering is an exciting research topic. An assortment of mesenchymal stem cells (MSCs), including adipose-derived stem cells (ASCs) and bone marrow-derived stem cells (BMSCs), provide an ideal source for tissue engineering applications due to the absence of ethical concerns, their high availability, and the increasing number of methods for their isolation and expansion. ASCs and BMSCs possess the same multipotency, but substituting adipose tissue for bone marrow, as a source of stem cells for regenerative medicine, is greatly advantageous. ASCs are simple to procure via a method that is less invasive compared to BMSCs. In addition, the percentage of cells from adipose tissue with multipotency is high, mass culture is simple, and the cells function in a manner that is similar, and often better, than BMSCs. Thus human ASCs hold great potential in the field of regenerative medicine. In this chapter, we examine the utilization of ASCs for cartilage tissue engineering, to combat fibrosis/scarring, to improve fat grafting techniques, and further explore utilizing the ASC secretome as a cell-free modality for tissue engineering. Altogether, the regenerative potential of ASCs for tissue engineering is clear, and ultimately, further studies on these topics will provide innovative mechanisms for alleviating some of the limitations that are currently faced in the tissue engineering arena.

PURPOSE: Bioengineering advances have been made in the field of auricular reconstruction, but many challenges still exist due to the lack of compatible biomaterials, the unique characteristics of cartilage, and its avascular nature. Decellularized tissue has gained popularity as a biomaterial scaffold for repopulating human cells.1 While decellularizing human auricular cartilage has been performed and proven in many bioengineering material studies, our protocol was developed with the goal of maintaining the optimal cell structure and integrity for recellularization. Many current protocols focus on complete decellularization, but not preservation of the components and structure of the cartilage itself, including the maintenance of glycosaminoglycans (GAGS).2-5 Other studies, however, have shown very time-intensive or expensive methods to ensure structural integrity of the cartilage. Therefore, we hypothesize that the optimization of auricular cartilage decellularization will be beneficial in the clinical setting as human decellularized tissue will become more commonly used in reconstructive procedures, such as the treatment of microtia. METHOD: Human adult auricular cadaver cartilage was obtained. The skin and perichondrium were removed to create a uniform structure. After an initial dry 12-hour freeze, the specimen was thawed at room temperature. The sample was then placed in phosphate-buffered solution (PBS) at -20°C and subsequently washed in deionized water. For the decellularization, the cartilage was agitated with 4% sodium deoxycholate at room temperature and washed with PBS. Next, the sample was placed in 2% deoxyribonuclease followed by 0.25% trypsin at room temperature. This process was repeated for 14 cycles in total. Trypsin was only utilized for the initial 4 cycles. The tissue was analyzed histologically to show complete decellularization and preservation of the cartilaginous structure. The overall structure and cellular content were assessed by hematoxylin and eosin (HE) staining. Alcian blue staining was performed to assess the presence of GAGs, Masson’s Trichrome for collagen fibers, and Verhoeff Van Geison’s stain for elastic fibers. RESULTS: Our histological data showed complete decellularization when analyzed with HE staining with preservation of the cartilaginous structure when analyzed with Masson’s Trichrome. There were preserved extracellular matrix (ECM) components with well-defined structures that were comparable to those seen prior to decellularization. CONCLUSION: Decellularization was successful with the new protocol. These new changes are significant in that our protocol utilizes inexpensive resources to process a human auricular ear with optimal preservation of structural integrity. Compared to current protocols, trypsin was optimized to ensure proper decellularization without interrupting surrounding ECM and removal of GAGs. The updated protocol will allow us to utilize a structure closer to the native scaffold. The next step is to recellularize the decellularized scaffold to create a structure for clinical use. REFERENCES: 1. Schwarz S, Koerber L, Elsaesser AF, et al. Decellularized cartilage matrix as a novel biomatrix for cartilage tissue-engineering applications. Tissue Eng Part A. 2012 Nov;18(21-22):2195-209. doi: 10.1089/ten.TEA.2011.0705. Epub 2012 Jul 20. PMID: 22690787. 2. Al-Qurayshi Z, Wafa EI, Rossi Meyer MK, Owen S, Salem AK. Tissue Engineering the Pinna: Comparison and Characterization of Human Decellularized Auricular Biological Scaffolds. ACS Appl Bio Mater. 2021 Sep 20;4(9):7234-7242. doi: 10.1021/acsabm.1c00766. Epub 2021 Aug 31. PMID: 34568774; PMCID: PMC8456428. 3. Gilpin A, Yang Y. Decellularization Strategies for Regenerative Medicine: From Processing Techniques to Applications. Biomed Res Int. 2017;2017:9831534. doi:10.1155/2017/9831534 Rahman S, Griffin M, Naik A, Szarko M, Butler PEM. 4. Optimising the decellularization of human elastic cartilage with trypsin for future use in ear reconstruction. Sci Rep. 2018 Feb 15;8(1):3097. doi: 10.1038/s41598-018-20592-x. PMID: 29449572; PMCID: PMC5814427. Utomo L, Pleumeekers MM, Nimeskern L, et al. 5. Preparation and characterization of a decellularized cartilage scaffold for ear cartilage reconstruction. Biomed Mater. 2015 Jan 13;10(1):015010. doi: 10.1088/1748-6041/10/1/015010. PMID: 25586138.

Vascular compromise and blindness are reported but rare complications of facial soft tissue filler injections. Stroke is an even rarer complication resulting from intraarterial injection of fillers. We present a case of a patient suffering all 3 complications following hyaluronic acid filler injection: forehead skin vascular compromise, unilateral blindness, and ipsilateral subclinical strokes. Were it not for a stroke workup protocol, the incidental strokes may have otherwise gone undetected, suggesting the incidence of stroke from intraarterial injection may be higher than reported. Further, we review the literature and recommendations for prevention and management of threatened tissue ischemia and vision loss from facial filler injection. Level of Evidence: 5

Body: Background: Although there has been an increase in the number of women pursuing plastic surgical training, women continue to be underrepresented in academic plastic surgery. The objective of the present study was to characterize the trends in women representation at national plastic surgery meetings. Methods: A retrospective review of all scientific session moderators and panelists at the following annual meetings from 2015 to 2019 were reviewed: American Association of Plastic Surgeons (AAPS), American Society of Plastic Surgeons (ASPS), and the Plastic Surgeon Research Council (PSRC). Total and unique women representation by meeting, scientific session topic, and year were evaluated. Proportion of men-only panels over time were also analyzed. Chi-square tests were used for bivariate analysis and Cochran–Armitage for trend analysis. p<0.05 was considered significant. Results: There were 833 moderators and panelists at national plastic surgery meetings from 2015 to 2019. There was a total of 171 women moderators and panelists (20.5%). Only 121 unique women made up all women moderators and panelists, averaging 1.4 moderated sessions per woman. When categorized by year, 2018 had the highest (30.3%) percentage of women representation. From 2015 to 2019, women representation in moderator positions generally increased from 9.5% to 24.6%, and this trend was significantly different (p<0.0001). Trends across meetings were also statistically significant (AAPS, p=0.0007 and PSRC, p=0.0012), however ASPS did not show a significant difference in women representation over the five years. When categorized by specialty of the scientific session, breast surgery (35.4%) had the highest percentage of women representation. There was no appreciable trend associated with the proportion of women representation with any of the specialties except for aesthetic surgery (p=0.0145). Men-only sessions or panels significantly decreased over the five-year period from 73.2% to 51.4% (p=0.0007). Conclusions: Women continue to constitute a minority of moderator and panelist positions at academic plastic surgery conferences. However, improvements have been made in women representation over the past five years. While these findings are encouraging, efforts to continue increasing diversification and women representation at national plastic surgery meetings must continue. Further evaluation of these trends is necessary and tracking of progress should be standardized.

Debated topics and new and evolving techniques in breast surgery are discussed in this chapter. Antibiotics and the use of closed-suction drains vary among surgeons, but the existing evidence favours discontinuation of antibiotics within 24 hours in most cases, and the indications for drains are limited but include breast reconstruction with acellular dermal matrix (ADM). ADM is a biological tissue substitute with many applications in breast surgery. The product selected and surgical technique used are often case specific; cost and patient anatomy play major roles. Although not suitable for all patients, ADM is an asset to prosthetic breast reconstruction. In addition, ADM is useful in the correction of breast surgery complications, including malpositioning and capsular contracture. It may be combined with fat grafting to mask rippling. Fat grafting, or lipomodelling, is an evolving science with promising results. Technique is critical for good results, and is described in this chapter. Radiographic changes after fat grafting are usually discernible from suspicious lesions, and growing evidence supports the oncological safety of this procedure

Background: Microtia is an inherited condition that results in varying degrees of external ear deformities; the most extreme form is anotia. Effective surgical reconstruction techniques have been developed. However, these usually require multistage procedures and have other inherent disadvantages. Tissue engineering technologies offer new approaches in the field of external ear reconstruction.In this setting, chondrocytes are cultured in the laboratory with the aim of creating bioengineered cartilage matrices. However, cartilage engineering hasmany challenges, including difficulty in culturing sufficient chondrocytes. To overcome these hurdles, the authors propose a novel model of cartilage engineering that involves co-culturing chondrocytes and adipose-derived stem cells on an allograft adipose-derived extracellular matrix scaffold. Methods: Auricular chondrocytes from porcine ear were characterized.Adipose-derived stem cells were isolated and expanded from human lipoaspirate.Then, the auricular chondrocytes were cultured on the allograft adipose matrix either alone or with the adipose-derived stem cells at different ratios and examined histologically. Results: Cartilage induction was most prominent when the cells were co-culturedon the allograft adipose matrix at a ratio of 1:9 (auricular chondrocyte-to-adipose-derived-stem cell ratio). Furthermore, because of the xenogeneic nature of the experiment, the authors were able to determine that the adipose-derived-stem cells contributed to chondrogenesis by means of a paracrine stimulation of the chondrocytes. Conclusions: In this situation, adipose-derived stem cells provide sufficient support to induce the formation of cartilage when the number of auricular chondrocytes available is limited. This novel model of cartilage engineering provides a setting for using the patient's own chondrocytes and adipose tissue to create a customized ear framework that could be further used for surgical reconstruction.

Background: Digit replantation affords the opportunity to restore hand function following amputation. To date, however, few studies have evaluated functional outcomes following replantation. Therefore, it was the objective of this study to perform a meta-analysis to better characterize the predictors of hand function. Methods: A literature search was performed using the PubMed database to identify studies that focused on digit amputation/replantation and functional outcomes. Studies were evaluated for patient- and injury-related factors and their respective effects on clinical outcomes of sensation, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Statistical analysis was conducted across the pooled data set to identify significant trends. Results: Twenty-eight studies representing 618 replanted digits were included in this study. We found the average grip strength was 78.7% (relative to contralateral), the average 2-point discrimination (2PD) was 7.8 mm, and the average DASH score was 12.81. After conducting statistical analysis, we found patients with more proximal injuries had lower grip strength scores (P < .05). We found 2PD scores were influenced by age, mechanism of injury, and amputation level (P < .05). Finally, we found DASH scores after replantation were predicted by mechanism of injury and level of amputation (P < .05). The following variables did not influence outcomes: gender, tobacco use, ischemia time, and digit number. Conclusions: Digit replant does not restore premorbid hand function but does result in adequate hand function. Expected functional outcomes following replant should be considered in the decision-making process. These data can help risk-stratify patients, guide postreplant expectations, and influence the decision for replantation.

PURPOSE:We evaluate outcomes of our single center using vertical rectus abdominis myocutaneous (VRAM) flaps for reconstruction after abdominoperineal resection (APR). Our goal was to analyze factors that may affect perineal wound healing, a problematic complication with APR reconstructions due to location and high frequency of neoadjuvant chemoradiation. METHODS:This single-center, retrospective study analyzed all VRAM flap perineal reconstruction patients after APR defect over a 10-year period (from July 2008 to June 2018). Outcome measures focused on factors that may affect perineal wound healing complication rates: cancer stage (I/II vs III/IV), neoadjuvant chemoradiation, surgeon's years in practice (<5 years vs >5 years), and pelvic closed suction drain use. RESULTS:Twenty-eight patients met inclusion criteria. The overall major perineal wound complication rate was 14.3% (4 patients). Lack of perioperative closed suction pelvic drain use was associated with a significantly higher rate of major perineal wound complications (28.6% vs 0% and p = 0.031). All four major wound complications occurred in patients who did not have a pelvic drain. The major perineal wound complication rate for patients who underwent neoadjuvant chemoradiation was 22% vs 0% with no neoadjuvant chemoradiation (p = 0.107). CONCLUSION:While our cohort represents a relatively small single-center study, our 14.3% rate of major perineal wound complications is consistent with previous studies in the literature. Our findings show that perioperative pelvic closed suction drain use is associated with a lower rate of perineal wound complications. While neoadjuvant chemoradiation trended toward a higher incidence of perineal wound complications, it did not reach statistical significance.

Abstract Implant-based breast reconstruction has become the predominant type of breast reconstruction, consisting of two-stage immediate, two-stage delayed, and direct-to-implant reconstruction. Both preoperative and intraoperative considerations guide appropriate choice among these reconstructive options and are discussed. Outside of the United States, greater diversity exists for both tissue expanders and breast implants. Techniques including total submuscular and partial subpectoral pocket creation, acellular dermal matrix use, SPY Elite™ use, pocket and inframammary fold revisions, and timing of reconstructive steps are discussed. With expanding criteria for post-mastectomy radiation, consideration of effects and timing of radiation treatment is essential. Other risk factors associated with complications, such as obesity, smoking, and age, should be utilized for risk stratification and reconstructive decision-making. The future of implant-based breast reconstruction will rely on minimizing costs without sacrificing aesthetics, as well as continued research on fat grafting and biological scaffolds.

BACKGROUND:The role of surgical reconstruction following melanoma extirpation is well recognized. Although technical considerations depend on patient anatomy and surgeon preference, the optimal timing of reconstruction remains unclear. This study aims to evaluate clinical and oncologic outcomes in melanoma extirpation followed by immediate reconstruction.METHODS:We retrospectively identified patients who underwent immediate reconstruction following head and neck melanoma excision at our institution between January 2013 and December 2016. Demographic and clinical characteristics, operative variables, and outcome data were extracted.RESULTS:Overall, 197 patients (male 70.6%) underwent excision followed by immediate reconstruction. Of the 70 patients with a history of cutaneous malignancy, 46 (65.7%) had a prior melanoma and 26 (37.1%) had 2 or more types of skin cancers. Of the 202 lesions resected, 138 (68.3%) were invasive, whereas 64 (31.7%) were in situ. The most frequent anatomic location involved was the cheek (34.2%), followed by scalp (31.2%). Reconstruction technique varied, with 116 (57.4%) lesions repaired by adjacent tissue transfer, 24 (11.9%) by full-thickness skin graft, 23 (11.4%) by complex primary closure, 17 (8.4%) by split-thickness skin graft, and 22 (10.9%) by more than 1 technique. On postoperative pathologic assessment, 2 patients had positive margins and 5 experienced local recurrence (mean follow-up: 2.3 years). In an unadjusted bivariate analysis, history of melanoma (P = 0.015) was significantly associated with local recurrence.CONCLUSIONS:Reconstruction at time of excision is an oncologically safe approach for the management of patients with malignant melanoma. A prior history of melanoma may be associated with local recurrence.

Introduction Hand and digit replantations can be complicated by vascular insufficiency necessitating revision of the original replantation. To date, few studies have evaluated outcomes in secondary revascularizations following replantation. Therefore, the objective of this study was to evaluate the incidence, etiology, and survival rates following secondary revascularization after hand and digit replantations. Materials and Methods A literature search was performed on NCBI for studies documenting secondary revascularization procedures following hand and digit replant. Studies were evaluated for the etiology of vascular failure, frequency of secondary revascularization, and survival rates following intervention. Statistical analysis was conducted across the pooled dataset. Results A total of 16 studies including 1,192 amputations were analyzed. We found that 16.9% (201/1,192) of replants were complicated by vascular compromise. The frequency of vascular compromise was not statistically different between arterial and venous etiologies. The survival rate following secondary revascularization was 55.6%, with no significant difference between the arterial and venous groups. Secondary arterial revascularization was often treated with arterial revision (nine of nine studies) and/or with vein grafting (two of nine studies). Secondary revascularization for venous insufficiency resulted in different survival rates for nonsurgical modalities (58%) versus vein revision (37.5%) versus vein grafting (100%). Conclusion Survival rates following secondary revascularization are lower; however, they may be improved using vein grafts following venous insufficiency. These data can be used to better understand the etiology of replant failure and guide decision-making.