Objective:We sought to explore facets of social media usage and the effect of the COVID-19 pandemic on the acceptance of cosmetic procedures.Methods:At an outpatient dermatology clinic from October 2019 to June 2022, 175 subjects who were English and Spanish speaking and aged 18 years or older were recruited. Participants completed a questionnaire including demographic information, social media usage, perceptions of cosmetic procedures, and desire to have a cosmetic procedure. Results were grouped into a pre-COVID-19 pandemic group and post-COVID-19 pandemic group due to a natural experiment that arose. Data were analyzed to ascertain the effect of social media usage and other factors that impact desire to undergo a cosmetic procedure between patients before and after the COVID-19 pandemic.Results:Factors resulting in differences in desire to have a cosmetic procedure included using photo editing applications (p=0.002), following celebrities and influencers on social media (p<0.001), and following social media accounts showing cosmetic results (p=0.013). There was a statistically significant change in number of participants that: followed social media accounts showing results of cosmetic procedures (pre-COVID: 31.9%, post-COVID: 50.6%, p=0.036); had thought about having a cosmetic procedure done (pre-COVID: 63.8%, post-COVID: 86.4%, p<0.001); had discussed cosmetic procedures with a physician, dermatologist, or other professional (pre-COVID: 43.6%, post-COVID: 67.9%, p=0.001); and believed that a cosmetic procedure would help their self-esteem (pre-COVID: 47.9%, post-COVID: 77.8%, p<0.001).Limitations:Limitations of this study include response bias, recall bias, and single institution study design, limiting generalizability.Conclusion:Our findings suggest that time spent on social media and use of photo-editing applications significantly contributes to desire to undergo a cosmetic procedure and contributed to the rise of cosmetic consultations during the COVID-19 pandemic.

Abstract Introduction Circadian rhythms are patterns responsible for physiological and behavioral changes in living organisms that follow a 24-hour cycle. Burn injuries trigger an inflammatory response which is also regulated by the circadian system. Literature on the impact of circadian rhythms on burn injury outcomes remains scarce. However, there is evidence that the migration of cells involved in the wound healing process is circadian-regulated and that the timing of the burn injury in a 24-hour period is associated with wound healing rates in burn patients. The goal of this study was to explore the relationship between time of burn injury and burn related outcomes. Methods A retrospective chart review was conducted of 442 adult burn patients admitted to the Burn Center between January 2015 and February 2022. Mean age on admission was 50.13 years, 34% were female and patients identified as Caucasian (57%), African American (35%) or other (8%). Mean TBSA was 12.85%. Data on clinical and demographic factors and times of injury were extracted from patients’ electronic medical records. Times of burn injury were categorized as daytime versus nighttime based on local sunrise and sunset times. Results Fifty-seven percent of patients were burned during daytime. When comparing those who were burned at daytime to those burned at nighttime, daytime burns had lower %TBSA, shorter length of stay and lower morphine equivalent dose during their admission to the burn center. In a regression analysis predicting morphine equivalent dose, time of burn remained a statistically significant predictor, even after controlling for %TBSA, length of stay, gender, race, and age. Conclusions Our study underscores the pivotal role of burn injury timing, revealing that nighttime burns are correlated with adverse outcomes, even after accounting for other contributing factors. This insight has profound implications for optimizing burn care and developing targeted intervention strategies. While it is possible that nighttime burns are more severe and thus are associated with poorer outcomes, we found that even when controlling for burn size, nighttime burns have higher inpatient opioid requirements. This is consistent with evidence from human and animal models suggesting that the timing of a burn injury has a unique impact on circadian rhythm, which regulates a host of immune-related responses and can influence the healing process and opioid metabolism. Applicability of Research to Practice Recognizing the time of burn injury as a significant risk can enhance clinical assessment protocols, aiding in the identification of high-risk patients. It is crucial to pursue further research to understand the biological mechanism through which timing of injury interacts with circadian function to influence burn recovery.

In academic craniofacial surgery, gender disparities exist across various metrics including faculty positions, leadership roles, and conference representation. This study benchmarks the academic productivity of craniofacial surgeons in 2022 and surveys their perspectives regarding diversity, equity, and inclusion (DEI). Total, first author, and senior author PubMed publications in 2022 were recorded for 193 craniofacial attendings and fellows. Craniofacial surgeons were also surveyed regarding academic experience, leadership roles, and DEI perceptions. Electronic 26 craniofacial attendings Total, first author, and senior author publication counts in 2022 Women comprised 27% (n = 53) of the craniofacial surgeon cohort. Men led total publications (81% vs 19%, p < 0.001), senior-author publications (84% vs 16%, p < 0.001), average total publications (6.6 vs 4.0, p = 0.043), and average senior-author publications (3.1 vs 1.5, p = 0.02). Sub-analysis of craniofacial fellows showed a higher proportion of women (65%) with no statistical difference in total or average publication counts. Survey responses (n = 26) included a perceived lack of female representation in academic and leadership roles. Barriers included inadequate support from current leadership, systemic issues, and biases. Recommendations for improvement included mentorship programs, targeted recruitment, and equitable conference speaker selection. Ongoing gender disparities are evident in craniofacial surgery, particularly in academic metrics. However, trends in younger cohorts exhibit more balanced gender representation, publication records, and leadership positions, indicating potential improvements. Further studies are needed to examine these cohorts more comprehensively and longitudinally. Sustained commitment, including mentorship programs and enhanced DEI efforts, is needed to continue this progress.

Purpose Our goals were to characterize associations of author number, author gender, and institutional affiliation on ratings and acceptances of abstracts submitted to one surgical education conference over 5 years. Methods We retrospectively reviewed all abstracts submitted between 2017 and 2021 to the annual meeting of the Association for Surgical Education (ASE). Abstract data included average rater scores, acceptance status, author lists, and institutional affiliations. We cross-referenced last author affiliation with top-40 National Institutes of Health (NIH)-funded institutions and used a gender determination software to code first and last author genders. Results We analyzed 1,162 abstracts. Higher reviewer scores demonstrated positive, weak associations with more authors [r(1160) = 0.191, p < 0.001] and institutions [r(1160) = 0.182, p < 0.001]. Significantly higher scores were noted for abstracts with last authors affiliated with top-40 NIH-funded institutions [4.18 (SD 0.96) vs. 3.72 (SD 1.12), p < 0.001]. Women were first authors (51.8%) ( n = 602) and last authors (35.4%) ( n = 411) of the time. Abstracts were rated significantly higher with women rather than men as first authors [3.98 (SD 0.99) vs. 3.82 (SD 1.12), p = 0.011] or last [4.01 (SD 1.04) vs. 3.82 (SD 1.10), p = 0.005]. Across all years, abstracts were accepted more often as podium or plenary presentations when submitted by women first [ n = 279, 59.7% ( p = 0.002)] or last [ n = 183, 38.4% ( p = 0.095)] authors. Conclusion Abstracts whose last authors were affiliated with top-40 NIH-funded institutions received significantly higher scores, possibly indicating increased tangible or intangible resources contributing to research efforts. Abstracts with women first and last authors scored higher and were more frequently invited for plenary and podium presentations.

PURPOSE: Variations in population-derived nasal anthropometric measures-such as the nasolabial angle (NLA) which determines tip position in relation to the base-contribute to observable ethnic nasal morphologies. Our goal was to better characterize quantitative differences in nasal measures among Asian and Oceanian populations as it relates to ethnic rhinoplasty. METHODS: We conducted a systematic review and meta-analysis to identify and compare nasal anthropometric measurements among ethnic populations in this region. Databases included PubMed, Cochrane, Web of Science, Embase, and Scopus. Studies that met inclusion criteria were: 1) gender specific, 2) anthropometric studies, and 3) investigated Asian and/or Oceanian populations. Data was analyzed using Student’s t-test and Bonferroni correction. RESULTS: 1709 articles were uploaded to Covidence and screened by 4 reviewers, with disputes resolved by a third. After full-text review, 5 studies met inclusion criteria, each with a sample size of n ≥40. Among the female ethnic populations, Turks (119.2°), Persian Iranians (80.06°), and Deutero Malays (90.4°) displayed unique NLAs when compared to other female populations (p ≤.005). Similar NLAs were observed in Indian Malaysian women (97.9°) and Han Chinese women (98.97°; p =.18). Among male populations, the NLAs of Indian Malaysians (93.4°) was unique (p ≤.005), while Han Chinese men (103.1°) and Turkish men (100.99°) displayed similarities (p =.54). CONCLUSION: Our study demonstrates objective differences and similarities in NLAs of Asian and Oceanian ethnic groups. Population-derived nasal measurements are useful as a foundation for ethnic rhinoplasty, allowing one to more precisely maintain or alter certain features.

Establishing normative data for operative skills during residency training can help identify residents whose performance lags behind or exceeds that of their peers. We performed the current study using Operative Entrustability Assessment (OEA) data to map operative progress of plastic surgery residents by post-graduate year (PGY). OEA data were abstracted from MileMarker®, a web-based program that captures resident self-assessments and associated attending assessments of CPT-coded procedures. Ratings are based on a 5-point scale (1 = “observed case,” 5 = “can take junior resident through case”). Data were collected from 7 academic plastic surgery programs. We identified 14,272 completed OEAs assessing 916 unique CPT codes; of these, 28 procedures (comprising 7,157 OEAs) contained > 100 assessments (range: 101–599). Examples of procedures in which resident skills are mastered at different training levels include split-thickness skin grafts (early, junior residents), ulnar nerve release (late, senior residents), and breast reduction (linearly). Establishing normative data for high-volume cases can facilitate recognition of residents whose operative skills are outside the expected range, thereby enabling more individualized learning in surgical education. Using these data, we have identified 28 sentinel procedures that may be used to identify excelling, competent, and struggling residents in the early, middle, and late stages of training. Further studies will be performed to determine if competency maps can be used to predict future performance.

Abstract Introduction Burn injuries cost the USA ~$976.6 million annually. Physician reimbursement has lagged despite years of lobbying by physician groups. The Centers for Medicare and Medicaid Services plan to cut physician reimbursement by 4.2% in 2023. Evaluating reimbursement data for hospital-based procedures is timely, including burn procedures. We hypothesized Medicare reimbursement trends for common burn procedures decreased from 2010-2022. Methods We obtained pricing data from the publicly-available Medicare Physician Fee Schedule Look-Up Tool for 26 Current Procedural Terminology (CPT) codes: “Burns–preparation of wound bed” (15002-15005), “Burns–split thickness skin graft” (15100-15101 & 15120-15121), “Burns–skin substitute” (15271-15278), “Cultured epidermal autograft” (15150-15152 & 15155-15157), and “Cell Suspension Epidermal Autograft” (15110-15111 & 15115-15116). We calculated percent differences for reimbursement; compound annual growth rate (CAGR); and percent differences for work, facility, non-facility, and malpractice relative value units (RVUs). Analysis was conducted in R 4.1.2. Results The three largest reimbursement increases were for CPT codes 15272 (24.6%), 15155 (23.7%), and 15003 (10.9%); the three largest decreases were for 15121 (-16.8%), 15120 (-6.1%), and 15275 (-5.0%). The three largest CAGR increases were for CPT codes 15272 (2.2%), 15155 (1.8%), 15274 (0.9%), and 15003 (0.9%); the three smallest were for 15121 (-1.5%), 15120 (-0.5%), and 15275 (-0.5%). Table 1 shows trends of RVUs. Conclusions Our 12-year analysis of Medicare reimbursement trends for 26 burn procedures demonstrated an overall increase in hospital reimbursement and parallel net decrease in physician work RVUs. Reimbursements were increasingly allocated away from surgeons to facility fees and malpractice insurance. Cultured epidermal autograft to the head, neck, hands, and feet (15155) saw the largest increase in Medicare reimbursement with no change in direct physician reimbursement while split-thickness skin grafts to the head, neck, & genitals (15120 & 15121) showed decreased rates. Future work is needed to understand why these trends are occurring to advocate against physician reimbursement cuts. Applicability of Research to Practice Studies contributing to price transparency allow stakeholders to focus on why burn surgeons are receiving lower reimbursements.

Abstract Introduction The complex nature of burn pain has debilitating effects on burn patients’ physiological and psychological wellbeing. Characterized by its overwhelming intensity and extensive duration, burn pain involves inflammatory and neuropathic components. These pain responses vary in depth, severity, and sensation during and after the healing process. Despite best efforts, burn pain remains a widespread challenge for providers to effectively predict and address. Methods A retrospective chart review of 442 patients admitted to the Burn Center for treatment of burn injuries between January 2015 and February 2022 was conducted. Charts of patients age >18 and length of stay >4 days were included in the analysis. Mean age on admission was 50.13±17 years and 34% of the sample were female. Data on clinical and demographic factors was extracted electronically and manually from patients’ electronic medical records. Numerical pain scale ratings documented by nursing were averaged for the first and last 48 hours of patients’ hospital stay. Linear regression analysis was performed to assess significant predictors of pain prior to discharge. Results We controlled for TBSA, length of stay, gender and psychiatric diagnosis and discovered that pain within the first 48 hours of admission and age were statistically significant predictors of average pain prior to discharge. Specifically, younger age was associated with increased pain ratings. When comparing average pain levels between the first and last 48 hours, 22% reported an increase of more than 1 point in their pain, 42% had no difference in average pain ratings, and 36% reported a decrease of more than 1 point. Prior to discharge, 36% of the sample reported pain higher than 6 and 17% reported pain greater than 7. Conclusions Heightened pain is challenging in burn injuries even prior to discharge, especially for younger patients and those who report initial high levels of pain. For many burn survivors, pain remains the same or worsens from admission to discharge, putting them at risk for negative outcomes such as chronic pain, PTSD, suicidality, sleep disturbances, and reduced function. Future research is needed to determine if early intervention can serve to mitigate these risks and improve long term recovery and quality of life. Applicability of Research to Practice Patients at risk for increased pain upon discharge can be identified by understanding the factors contributing to this phenomenon during early treatment. Early, targeted, evidence-based interventions during treatment and following discharge will allow effective management of pain. Younger patients and patients with higher initial pain should be closely monitored and given multimodal pain interventions, thereby enhancing their comfort and overall recovery process.

Women are less likely to be senior authors, invited to write in scientific journals, and to be cited in high impact journals. The aim of this study was to investigate trends in authorship and gender differences in peer-reviewed burn literature over 13 years. We performed a retrospective analysis of original research articles published from January 2009 to September 2021 in three burn journals. A gender determination application was used to categorize the gender of the first and senior author. Of the 3908 articles analyzed, 42.5% had a woman first author and 27.6% had a woman senior author. We identified 2029 unique senior authors, 29.0% of whom were women. Woman senior authorship was associated with increased odds of woman first authorship [OR = 2.31 (95% CI: 2.00, 2.67); P < .001]. The percentage of papers with a woman senior author increased from 17.8% in 2009 to 35.7% in 2021. If this 1.0% (95% CI: 0.50-1.51%) linear trend increase per year in woman senior authorship continues, we will expect to see equal proportions of woman and man senior authors in the included journals starting in 2037. The field of burn care is far from reaching gender parity with respect to authorship of peer-reviewed publications. Supporting and encouraging gender-concordant and discordant first:last authorship dyads in mentorship as well as redistributing obligations that may detract from authorship opportunities are potential ways to improve parity in authorship and academia.

PURPOSE:Two-stage tissue expander (TE) to implant breast reconstruction is commonly performed by plastic surgeons. Prepectoral implant placement with acellular dermal matrix (ADM, e.g., AlloDerm®) reinforcement is evidenced by minimal postoperative pain. However, the same is not known for TE-based reconstruction. We performed this study to explore the use of complete AlloDerm® reinforcement of breast pocket tissues in women undergoing unilateral or bilateral mastectomies followed by immediate, two-stage tissue expansion in the prepectoral plane.METHODS:Patients (n = 20) aged 18-75 years were followed prospectively from their preoperative consult to 60 days post-TE insertion. The pain visual analog scale (VAS), Patient Pain Assessment Questionnaire, Subjective Pain Survey, Brief Pain Inventory-Short Form (BPI-SF), postoperative nausea and vomiting (PONV) survey, BREAST-Q Reconstruction Module, and short-form 36 (SF-36) questionnaires were administered. Demographic, intraoperative, and 30- and 60-day complications data were abstracted from medical records. After TE-to-implant exchange, patients were followed until 60 days postoperatively to assess for complications.RESULTS:Pain VAS and BPI-SF pain interference scores returned to preoperative values by 30 days post-TE insertion. Static and moving pain scores from the Patient Pain Assessment Questionnaire returned to preoperative baseline values by day 60. The mean subjective pain score was 3.0 (0.5 standard deviation) with seven patients scoring outside the standard deviation; none of these seven patients had a history of anxiety or depression. Median PONV scores remained at 0 from postoperative day 0 to day 7. Patient-reported opioid use dropped from 89.5% to 10.5% by postoperative day 30.BREAST-Q:Sexual well-being scores significantly increased from preoperative baseline to day 60 post-TE insertion. Changes in SF-36 physical functioning, physician limitations, emotional well-being, social functioning, and pain scores were significantly different from preoperative baseline to day 60 post-TE insertion. Five participants had complications within 60 days post-TE insertion. One participant experienced a complication within 60 days after TE-to-implant exchange.CONCLUSIONS:We describe pain scores, opioid usage, patient-reported outcomes data, and complication profiles of 20 consecutive patients undergoing mastectomy followed by immediate, two-stage tissue expansion in the prepectoral plane. We hope this study serves as a baseline for future research.

Abstract Introduction The importance of gender equity and gender representation in academic publications has long been emphasized in medicine. It has been established that women represent a smaller proportion of primary and senior authors in high-impact medical journals than men and that original research articles written by women as primary and senior authors are less frequently sited than those authored by men. Currently, there is limited data evaluating whether this gender bias is present in plastic surgery and burn publications. We used bibliometric analysis of original research publications to analyze gender bias against women in one burn journal. Methods Using the journal, Burns, we conducted a bibliometric analysis of research publications from 2009 to 2020. A gender determining application was used to characterize the gender of the first and senior author. Ratios of male:male, female:male, male:female, and female:female were obtained and analyzed. Results Of the 1677 publications included, 40% have female first authors and 25.5% had female senior authors. Male:male authorships had the highest number of publications. Female:female authorship had the lowest number of publications of all the other ratios from 2009-2012, however there was a steep increase in 2013 in which male:female authorship had the lowest number of publications. Male senior authorship was associated with 2.9-fold increase in male first authorship [OR=2.99(95% CI 2.39, 3.76); p < 0.0001). Conclusions Female representation in senior authorship positions in burn and wound care publications is increasing, however is still far from reaching gender parity. By analyzing authorship ratios by gender, we recommend a new way to evaluate gender disparity in burn and wound care academia.

Background: This study investigates the effect of prophylactic perioperative antibiotic use on patients with small burns [≤20% total body surface area (TBSA)] on rates of infection, graft loss, or readmission. Methods: A retrospective chart review was conducted on patients admitted to our institution’s burn center between January 2020 and July 2021. Patients were included if they had a 20% or less TBSA burn with 1 or more operating room visit for burn excision and were excluded if a preoperative infection was present. Data were gathered regarding patient demographics, burn mechanism, burn characteristics, and outcome measures including infection, graft loss, and readmission. Statistical analysis was conducted by Mann–Whitney U and Fisher exact tests, and P values reported at two-sided significance of less than 0.05. Results: There were no significant differences in age, body mass index, TBSA, percent third-degree burn, or comorbidities between patients who received (n = 29) or did not receive (n = 47) prophylactic perioperative antibiotics. There was a nonsignificant trend toward higher length of stay in the prophylactic antibiotic group, possibly driven by a nonsignificant trend toward higher rates of flame injuries in this group. There was no difference in infection (P = 0.544), graft loss (P = 0.494), or 30-day readmission (P = 0.584) between the two groups. Conclusion: This study finds no significant difference in postoperative infection, graft loss, or 30-day readmission in two similar patient cohorts who received or did not receive prophylactic perioperative antibiotics for acute excision of small (≤20% TBSA) burns.