Lip adhesion procedures have proven useful in facilitating definitive cleft lip repair in wide cleft lip defects. This article and video vignette depict the indications, benefits, and operative technique of lip adhesion by the senior author to serve as a surgical guide for cleft lip management.

Background: This study evaluates the effectiveness of the New York--Presbyterian/Weill Cornell methadone-based enhanced recovery after surgery (ERAS) protocol in reducing postoperative pain and narcotic consumption in patients undergoing deep inferior epigastric perforator flap breast reconstruction. Methods: This study includes a retrospective non-ERAS cohort (2017 to 2020) and a prospective ERAS cohort (2021 to 2024) of consecutive patients undergoing deep inferior epigastric perforator flap breast reconstruction at a single institution. Outcomes assessed included postoperative complications, length of hospital stay, vital signs, pain scores, opioid consumption, and outpatient opioid prescriptions after discharge. In addition, ERAS patients were surveyed on home opioid use for 14 days after discharge. Results: A total of 216 patients from the ERAS group and 163 patients from the non-ERAS group were included. Patients in the ERAS group had a significantly shorter length of hospital stay (2.97 versus 3.37 days, P < 0.001) and lower average pain scores (2.37 versus 3.18, P < 0.001), peak pain scores (6.23 versus 7.47, P < 0.001), heart rates (85.5 versus 95.6, P < 0.001), and incidences of tachycardia (10.7% versus 28.2%, P < 0.001). Inpatient opioid consumption decreased by 51.4% (208.02 versus 101.02 morphine milligram equivalents [MMEs]), and outpatient opioid prescriptions were reduced by 22.2% (194.21 versus 151.83 MMEs, P < 0.001). Of the 216 surveys distributed to the patients in the ERAS group, 76 responses (35.19%) were received. Postdischarge opioid use averaged 70.78 MMEs. The median time to cessation was 3.0 days. Conclusions: Implementation of the New York--Presbyterian/Weill Cornell methadone-based ERAS protocol significantly improved recovery outcomes. These findings underscore the potential of methadone to enhance traditional ERAS protocols, supporting its broader adoption in plastic surgery.

BACKGROUND:Food deserts (FDs) are areas characterized by high rates of food insecurity, limited access to healthy food, and a high concentration of unhealthy food options. This study evaluated the comorbidity burden in patients residing in FDs and assessed the impact of residing in an FD on postoperative outcomes following mastectomy. METHODS:A retrospective review was conducted of patients undergoing mastectomy between January of 2014 and November of 2018. Low food access (LFA) was defined as an area where residents lived more than 1 mile (urban) or more than 10 miles (rural) from the nearest supermarket. Primary outcomes included minor and major complications (ie, return to the operating room). RESULTS:A total of 1553 patients were included. Of these, 675 (43.5%) resided in LFA areas and 878 (56.5%) in non-LFA (NLFA) areas. The mean body mass index was 28.4 ± 8.0 and 28.6 ± 7.3 kg/m 2 , respectively ( P = 0.897). The mean Charlson Comorbidity Index score was 2.6 ± 1.3 and 2.3 ± 1.2, respectively ( P < 0.001). The LFA group experienced more minor complications than the NLFA group ( n = 190 [28.1%] versus n = 187 [21.3%]; P = 0.002). The LFA group had a higher incidence of reoperation than the NLFA group ( n = 83 [12.3%] versus n = 64 [7.3%]; P = 0.001). An LFA subanalysis revealed that patients with low income had a higher incidence of reoperation ( n = 28/158 [17.7%] versus n = 55/517 [10.6%]; P = 0.018). CONCLUSIONS:The findings suggest a potential relationship among food access, increased comorbidities, and postoperative complications. Further studies are warranted to assess the relationship between FDs and postoperative outcomes to address social determinants of health for patients undergoing breast reconstruction.

Background: Restrictive policies on termination of pregnancy (TOP) may lead to more infants with congenital abnormalities. This study aimed to assess the association between statewide enactment of TOP restriction and cleft lip and/or palate (CL/P) incidence, and to identify mediating demographic characteristics. Methods: The authors examined state-specific trends in CL/P incidence in infants before and after implementation of laws restricting TOP in Michigan compared with New York, where no such laws were passed. The percentage change of CL/P incidence per 1000 live births in postpolicy years (2012 to 2015) compared with prepolicy years (2005 to 2011) was compared, with adjustments for confounding factors in multivariate models. Results: The incidence of CL/P changed significantly in Michigan (19.1%) compared with New York (-7.31%). Adjusting for sex, race/ethnicity, median household income level, and expected payer, the adjusted percentage difference between Michigan and New York was 53.3% (P < 0.001). Stratification by race/ethnicity and median household income demonstrated that changes were only significant among Black (139%; P < 0.001) and Hispanic (125%; P = 0.045) patients and among those from the lowest (50.3%; P < 0.001) and second lowest (40.1%; P = 0.01) income quartiles. Conclusion: The authors' research, combined with the recent Supreme Court decision in Dobbs v Jackson Women's Health Organization allowing states to place further restrictions on TOP, suggests that more infants in the future will be born in need of treatment for CL/P.

Background Increasing concerns regarding the safety of textured surface implants have resulted in surgeons transitioning from textured tissue expanders (TEs) to smooth TEs. Given this change has only recently occurred, this study evaluated outcomes between smooth and textured TEs. Methods Women who underwent two-stage breast reconstruction using TEs from 2013 to 2022 were included. TE-specific variables, perioperative information, pain scores, and complications were collected. Chi-squared, t -test, and linear regression analyses were performed. Results A total of 320 patients received a total of 384 textured and 152 smooth TEs. Note that 216 patients received bilateral reconstruction. TEs were removed in 9 cases. No significant differences existed between groups regarding comorbidities. Smooth TEs had a higher proportion of prepectoral placement ( p < 0.001). Smooth TEs had less fills (3 +/- 1 vs. 4 +/- 2, p < 0.001), shorter expansion periods (60 +/- 44 vs. 90 +/- 77 days, p < 0.001), smaller expander fill volumes (390 +/- 168 vs. 478 +/- 177 mL, p < 0.001), and shorter time to exchange (80 +/- 43 vs. 104 +/- 39 days, p < 0.001). Complication rates between textured and smooth TEs were comparable. Smooth TE had a greater proportion of TE replacements ( p = 0.030). On regression analysis, pain scores were more closely associated with age ( p = 0.018) and TE texture ( p = 0.046). Additional procedures at time of TE exchange ( p < 0.001) and textured TE ( p = 0.017) led to longer operative times. Conclusion As many surgeons have transitioned away from textured implants, our study shows that smooth TEs have similar outcomes to the textured alternatives.

Background Smoking cessation therapy, including nicotine replacement therapy (NRT), is used perioperatively to assist patients to reduce their tobacco smoke intake and consequently decrease their risk of smoking-associated complications. There are, however, theoretical concerns that nicotine-induced peripheral vasoconstriction could impair wound healing. This study investigated the effect of NRT on postoperative outcomes in patients undergoing breast surgery. Methods A retrospective chart review of patients undergoing breast surgery within the Yale New Haven Health System from the years 2014 to 2020 was performed. Documented smoking status within 6 months before surgery, use or prescription of NRT, type of surgery, and surgical complications of infection, wound dehiscence, tissue necrosis, hematoma, seroma, fat necrosis, and return to operating room within 30 days were recorded. Demographic and complication data were compared between patients with NRT usage and those without using t-tests and chi-square analyses. Multivariable logistic regression models were created to predict the effect of NRT usage on the occurrence of any complication. Results A total of 613 breast procedures met inclusion criteria, of which 105 (17.2%) had documented NRT use. The NRT cohort and the non-NRT cohort were well balanced with respect to demographics and procedural variables. Upon multivariable modeling for risk of any surgical complication, NRT was not a significant predictor (odds ratio [OR]: 1.199, p = 0.607 and OR: 0.974, p = 0.912, respectively), whereas procedure type, increased body mass index, and increased age were. Conclusion NRT use was not associated with an increased risk of postoperative complications compared with not using NRT as part of smoking cessation therapy prior to operation.

The pharyngeal arches are the foundation of face and neck development. Impaired development of these embryologic structures can result in craniofacial abnormalities. Surgeons who manage head and neck pathology will invariably encounter conditions associated with aberrant pharyngeal arch anatomy, and a thorough understanding of the normal development of these structures is paramount to accurate diagnosis and treatment. This manuscript is the second of a four-part series written for plastic surgeons, focusing on the abnormal development of pharyngeal arches leading to pathologic ear and neck anomalies seen in clinical practice.

ABSTRACT OBJECTIVE To understand the effects of nutrition security and social determinants of health (SDOHs) on pressure injury (PI) progression through a scoping review and retrospective review of patients reporting to New England’s largest healthcare system. METHODS Authors performed a scoping review for full-text, original articles reporting outcomes data specific to PIs in patients with socially informed nutrition insecurity. Investigators also performed a retrospective review of all patients from 2012 to 2021 to search for patients with PI documentation and International Classification of Diseases, Tenth Revision Z codes related to the SDOHs. RESULTS A full-text review of 2,323 articles from 1965 to 2020 failed to locate any eligible studies. Investigators identified 1,044 patients who met the inclusion criteria; 50.7% were men, 74.3% were White, and 13.3% had evidence of detrimental SDOHs. The average PI duration was 12.13 days (interquartile range, 6 days). Multivariate regression analysis revealed that PI duration was longer in men, Black patients, and patients with evidence of detrimental SDOHs compared with their converse counterparts ( P < .0001). The presence of detrimental SDOHs independently predicted an increased duration of disease by 13.07 days (95% CI, 8.99–17.15; t = 6.29, P < .0001). CONCLUSIONS A patient’s SDOH history has a significant and considerably stronger correlation with disease progression than predictors that are traditionally studied such as sex, race, or body mass index. These findings are novel, as highlighted by the absence of data uncovered in the literature. These data carry relevance for plastic surgeons wishing to prevent early recurrence following operative closure of PI-related wounds.

Point-of-care photography and photo sharing optimize patient outcomes and facilitate remote consultation imperative for resident surgeons. This literature review and external pilot survey study highlight the risks associated with current practices concerning patient privacy and biometric security. In a survey of 30 plastic surgeon residents and attendings, we found that the majority took photos of patients with their iPhones and shared them with colleagues via Apple iMessage. These findings corroborate previous reports and highlight a lack of physician user acceptance of secure photo-sharing platforms. Finally, we frame a successful example from the literature in the context of a postulated framework for institutional change. Prioritizing the privacy and safety of patients requires a strategic approach that preserves the ease and frequency of use of current practices.

BACKGROUND:Previous work has identified an association between de novo and transmitted loss-of-function mutations in genes under high evolutionary constraint with neurodevelopmental delays in nonsyndromic craniosynostosis (NSC). The authors sought to quantify the neurocognitive effect of these genetic lesions.METHODS:In a prospective, double-blinded cohort study, demographic surveys and neurocognitive tests were administered to patients recruited from a national sample of children with sagittal NSC. Scores for academic achievement, Full-Scale Intelligence Quotient (FSIQ), and visuomotor skills were directly compared between patients with and without damaging mutations in genes with a high probability of loss of function intolerance using two-tailed t tests. Analysis of covariance was also used to compare test scores while controlling for surgery type, age at surgery, and sociodemographic risk.RESULTS:Fifty-six patients completed neurocognitive testing, 18 of whom had a mutation in a highly constrained gene. There was no significant difference between groups in any sociodemographic factors. After controlling for patient factors, patients with high-risk mutations had poorer performance compared with patients without high-risk mutations in every testing category, with significant differences in FSIQ (102.9 ± 11.4 versus 110.1 ± 11.3; P = 0.033) and visuomotor integration (100.0 ± 11.9 versus 105.2 ± 9.5; P = 0.003). There were no significant differences in neurocognitive outcome when stratifying groups based on type of surgery or age at time of surgery.CONCLUSIONS:Even after controlling for exogenous factors, the presence of mutations in high-risk genes led to poorer neurocognitive outcomes. High-risk genotypes may predispose individuals with NSC to deficits, particularly in FSIQ and visuomotor integration.CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, II.

Objective Several severity metrics have been developed for metopic craniosynostosis, including a recent machine learning-derived algorithm. This study assessed the diagnostic concordance between machine learning and previously published severity indices. Design Preoperative computed tomography (CT) scans of patients who underwent surgical correction of metopic craniosynostosis were quantitatively analyzed for severity. Each scan was manually measured to derive manual severity scores and also received a scaled metopic severity score (MSS) assigned by the machine learning algorithm. Regression analysis was used to correlate manually captured measurements to MSS. ROC analysis was performed for each severity metric and were compared to how accurately they distinguished cases of metopic synostosis from controls. Results In total, 194 CT scans were analyzed, 167 with metopic synostosis and 27 controls. The mean scaled MSS for the patients with metopic was 6.18 ± 2.53 compared to 0.60 ± 1.25 for controls. Multivariable regression analyses yielded an R-square of 0.66, with significant manual measurements of endocranial bifrontal angle (EBA) (P = 0.023), posterior angle of the anterior cranial fossa (p < 0.001), temporal depression angle (P = 0.042), age (P < 0.001), biparietal distance (P < 0.001), interdacryon distance (P = 0.033), and orbital width (P < 0.001). ROC analysis demonstrated a high diagnostic value of the MSS (AUC = 0.96, P < 0.001), which was comparable to other validated indices including the adjusted EBA (AUC = 0.98), EBA (AUC = 0.97), and biparietal/bitemporal ratio (AUC = 0.95). Conclusions The machine learning algorithm offers an objective assessment of morphologic severity that provides a reliable composite impression of severity. The generated score is comparable to other severity indices in ability to distinguish cases of metopic synostosis from controls.

Background: Helmet therapy for deformational plagiocephaly has an ideal window for treatment, and timely access to care is vital to achieving optimal benefit. The authors evaluated the hypothesis that patients insured through Medicaid experience decreased access to helmet therapy. Methods: This was a retrospective analysis of referrals for helmet therapy to Cranial Technologies, Inc. between 2014 and 2020 across 21 states. Outcome measures were likelihood of receiving a helmet, receiving a second helmet, receiving delayed treatment, and having delayed presentation. Results: From 2014 to 2020, a total of 219,869 patients were referred and 141,513 of these received a helmet. Patients with Medicaid were less likely to receive treatment (OR, 0.63; P < 0.001) and more likely to present late (OR, 1.55; P < 0.001) or receive delayed treatment (OR, 3.24; P < 0.001) compared with the commercially insured. Patients with Medicaid were less likely to receive helmet therapy in nine states, with the strongest association in Texas (OR, 0.32; P < 0.001), and more likely to receive helmet therapy in five states, with the strongest association in Colorado (OR, 1.89; P < 0.001). Medicaid was associated with late presentation and delayed treatment in all states. Conclusions: Patients with Medicaid presented later and were less likely to receive helmet therapy. Findings reflected state-specific Medicaid policies, with patients in some states more likely to receive a helmet with Medicaid than with commercial insurance. However, late presentation and delays in treatment with Medicaid were observed across all states. State-specific Medicaid restrictions are likely a driving factor in determining access to helmet therapy.

•Nutritional workup is inconsistently accomplished and without standardization.•Not all patients with malnutrition receive nutrition consults and interventions.•Patients with malnutrition experience more revisional operations.•Care of this patient population necessitates an interdisciplinary team.

Background: The updated ICD-10 coding system introduced partway through 2015 offers codes with increased granularity for disease and procedure types. This is the first study to use ICD-10 codes to investigate disparities in the surgical management for craniosynostosis. Methods: Using the Kids' Inpatient Database univariable analyses were performed to compare the relative odds of undergoing strip craniectomy, either endoscopic (ESC) or open (OSC), or calvarial vault remodeling (CVR) based on a variety of demographic and hospital-level variables. Results: Of the 2,874 patients identified, 2,352 underwent CVR while 522 underwent SC. Of those undergoing SC, 295 and 228 had an endoscopic and open procedure, respectively. A greater proportion of patients who had private insurance (58.14% versus 47.49%) or were self-pay (8.06% versus 6.28%) underwent SC, whereas a higher percentage who were covered under Medicaid (46.23% versus 32.8%; P< 0.001) received CVR. ESC patients were 2.16 times more likely to have private insurance and 2.07 times more likely to be from the highest income quartile compared to OSC patients. However, there were no differences in terms of insurance type or income level between those undergoing CVR compared to OSC. Conclusions: Our study found that the difference between CVR and SC can be attributed to the difference in the endoscopic versus open approaches to SC. Although the socioeconomic disparities persisted in the comparison between ESC and OSC, with patients receiving ESC coming from wealthier and commercially insured families, the same differences were not observed when comparing CVR with OSC.

Background Oculo-orbital disproportion in patients with craniosynostosis have similarities and dissimilarities between syndromic and nonsyndromic cases. We hypothesize these two conditions have specific individual influences as it relates to development of the orbital and periorbital skeletons. Method A total of 133 preoperative CT scans (nonsyndromic bicoronal synostosis, n=38; Apert syndrome bicoronal synostosis subtype, n=33; Crouzon syndrome bicoronal synostosis subtype, n=10; controls, n=52) were included. Craniometric and volumetric analyses related to the orbit and periorbital anatomy were performed. Results The orbital cavity volume is mildly restricted in nonsyndromic bicoronal synostosis (7%, p=0.147), but more so in Apert and Crouzon syndromes, 17% (p=0.002) and 21% (p=0.005), respectively. The sphenoid side angle in Apert syndrome is wider than when compared to Crouzon syndrome (p=0.043). The ethmoid side angle in Apert patients however is narrower (p=0.066) than that in Crouzon patients. Maxilla anteroposterior length is more restricted in Apert syndrome than Crouzon syndrome (21%, p=0.003) and nonsyndromic cases (26%, p<0.001). The posterior nasal spine position is retruded in Crouzon syndrome (39%, p<0.001), yet the anterior nasal spine position is similar in Apert and Crouzon syndromes. Conclusion Orbit and periorbital malformation in syndromic craniosynostosis is likely the combined influence of syndromic influences and premature suture fusion. Apert syndrome expands the anteriorly contoured lateral orbital wall associated with bicoronal synostosis, while Crouzon syndrome has more infraorbital rim retrusion, resulting in more severe exorbitism. Apert syndrome develops maxillary hypoplasia, in addition to the maxillary retrusion, observed in Crouzon syndrome and nonsyndromic bicoronal synostosis patients.

Background: Nonsyndromic craniosynostosis is one of the most common anomalies treated by craniofacial surgeons. Despite optimal surgical management, nearly half of affected children have subtle neurocognitive deficits. Whereas timing and type of surgical intervention have been studied, the possibility of genetic influence on neurodevelopment in nonsyndromic craniosynostosis patients remains unexplored. Methods: The authors performed whole-exome sequencing for 404 case-parent trios with sporadic nonsyndromic craniosynostosis. Statistical analyses were performed to assess the burden of de novo mutations in cases compared to both expectation and 1789 healthy control trios. Individuals with and without each mutation class were analyzed, and the presence or absence of various types of neurodevelopmental delay were recorded alongside demographic information. Results: The authors identified a highly significant burden of damaging de novo mutations in mutation-intolerant [probability of loss of function intolerance (pLI) >0.9] genes in nonsyndromic craniosynostosis probands (p = 5.9 × 10−6). Children with these mutations had a two-fold higher incidence of neurodevelopmental delay (p = 0.001) and a more than 20-fold greater incidence of intellectual disability (p = 7.2 × 10−7), and were 3.6-fold more likely to have delays that persisted past 5 years of age (p = 4.4 × 10−4) in comparison with children with nonsyndromic craniosynostosis without these mutations. Transmitted loss of function mutations in high-pLI genes also conferred a 1.9-fold greater risk of neurodevelopmental delay (p = 4.5 ×10−4). Conclusions: These findings implicate genetic lesions concurrently impacting neurodevelopment and cranial morphogenesis in the pathoetiology of nonsyndromic craniosynostosis and identify a strong genetic influence on neurodevelopmental outcomes in affected children. These findings may eventually prove useful in determining which children with nonsyndromic craniosynostosis are most likely to benefit from surgical intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Introduction: While there is extensive literature investigating surgical outcomes in free flaps for adults, there is a dearth of information on the efficacy of flap use in the pediatric population. This study is the first to measure complication rates following pediatric free flap reconstruction on a national level. Methods: All pediatric free flap cases between 2012 and 2018 were identified and stratified by type of flap using current procedural terminology codes assigned to the primary procedure in the National Surgical Quality Improvement Program database. Each entry included the recipient location of the flap, postoperative complications, and demographics. Chi-square analysis was used to compare complication rates across various flap groupings. In addition, univariate and multivariate analyses were used to identify independent predictors of flap complications or failure. Results: Multivariate regression analysis demonstrated that compared to bone flaps, there is increased risk of nonbleeding complications in skin (Odds Ratio (OR) =7.7, P = 0.029), muscle (OR = 10.6, P = 0.012), and osteocutaneous flaps (OR = 10.8, P = 0.018). Flap of the trunk (OR = 40.9, P = 0.003) and upper extremities (OR = 32.9, P = 0.041) had a higher odds of bleeding complications compared to head-and-neck flaps. Regression analysis also showed that older age is associated with bleeding complications, with patients aged 5–11 years (OR = 38.5, P = 0.027) and 12–17 years (OR = 30.6, P = 0.038) having greater rates compared to patients under the age of 2. The pediatric flap reoperation rate was found to be 3.6%–4.7%, with the highest flap anastomotic complication rate in the head-and-neck region (6.9%–8.0%). Conclusion: Free flap reconstruction across flap type, anatomic location, and age ranges are safe and efficacious in the pediatric population.

Background: Although nonsyndromic craniosynostosis has been associated with neurodevelopmental sequelae, a lesser amount of emphasis has been placed on the need for related supportive services. This study assessed the prevalence of such services among children surgically treated for nonsyndromic craniosynostosis and identified predictors of service use. Methods: Parents of children with nonsyndromic craniosynostosis were recruited from an online craniosynostosis support network and surveyed regarding their child's use of various outpatient and school-based services. Multiple stepwise regression was performed to identify predictive variables for each type of intervention. Results: A total of 100 surveys were completed. Of these, 45 percent of parents reported use of one or more outpatient support services for their children. The most commonly used services were speech therapy (26.0 percent) and physical therapy (22.0 percent), although the use of services such as psychology/psychiatry increased among older children (18.2 percent in children aged 6 to 10 years). Among school-age children (n = 49), the majority of parents (65.3 percent) reported school-based assistance for their children, most commonly for academic (46.9 percent) or behavioral (42.9 percent) difficulties. Significant predictive variables (p < 0.05 following stepwise regression) for increases in various outpatient and school-based services included male sex, African American race/ethnicity, higher parental income, the presence of siblings in the household, increased age at the time of surgery, and sagittal synostosis. Conclusions: Parents of children with nonsyndromic craniosynostosis reported frequent use of outpatient and school-based supportive services throughout childhood. These services may incur a significant burden of care on families. The multifactorial nature of predictive models highlights the importance of cross-disciplinary collaboration to address each child's longitudinal needs.

Purpose: Craniosynostosis has been associated with a variety of neurocognitive deficits. This is the largest cohort of postoperative craniosynostosis patients to undergo formal neurocognitive testing at school age. Methods: Patients diagnosed with sagittal, metopic, and coronal synostosis completed age-normalized intelligence quotient (IQ) and visuomotor skills tests between 2016 – 2021. Associations between synostosis sub-type and IQ, VMI scores, age at surgery, age at testing, sex, race, breastfeeding, premature birth, and maternal and paternal education were evaluated using ANOVA for continuous variables and chi-square tests for categorical variables. Results: 203 patients completed neurocognitive testing (141 sagittal, 36 metopic, 22 coronal and 4 lambdoid). 109 (54%) of the cohort was male, and 148 (73%) were White. The mean IQ was 106.08 ± 14.04 and the mean age at surgery and testing was 8.96 ± 12.22 and 181.17 ± 119.27 months respectively. Sagittal craniosynostosis patients had higher scores in every testing category than metopic craniosynostosis patients, with significant differences in verbal IQ (109.35 ± 15.70 vs 100.81 ± 10.38), full-scale IQ (108.31 ± 14.37 vs 99.39 ± 11.88), visuomotor integration (101.55 ± 13.56 vs 92.09 ± 12.15), visual perception (103.57 ± 12.59 vs 96.03 ± 11.22), and motor coordination (90.29 ± 15.51 vs 84.91 ± 16.03). Significant differences were found between patients with sagittal and coronal craniosynostosis in visuomotor integration (101.55 ± 13.56 vs 94.95 ± 10.24) and visual perception (103.57 ± 12.59 vs 94.82 ± 12.75). There were no significant differences between groups in terms of age at surgery, age at testing, parental education level, prematurity, and sex. Conclusion: Compared to patients with sagittal synostosis, those with metopic synostosis exhibited lower testing scores in verbal IQ, full-scale IQ, visuomotor integration, visual perception, and motor control after surgical correction. This suggests that the frontal constriction due to premature fusion of the metopic suture may have lasting impacts on brain function. Patients with coronal synostosis exhibited lower visuomotor integration and visual perception scores when compared to patients with sagittal synostosis. This suggests that constriction of the brain by premature fusion of the coronal suture may have an effect on visual information processing.

Introduction: Melanoma occurs most commonly in non-Hispanic White patients; however, Black and Hispanic patients experience greater morbidity and mortality. This study assesses how race and socioeconomic factors influence rates of reconstructive procedures and hospital-based outcomes in melanoma patients.Methods: Data were extracted from the National Inpatient Sample database from the years 2010-2015. Patients with melanoma who underwent a reconstructive procedure were iden-tified. Univariate and multivariate logistic regression analysis was used to identify the rela-tionship between dependent variables and various patient/hospital components for patients undergoing reconstructive procedures.Results: Black and Hispanic patients had a greater length of stay (LOS) than non-Hispanic White patients (OR: 2.252, p = 0.0307, and OR: 2.592, p = 0.0014), and Hispanic patients were less likely to receive more complex reconstructive procedures (OR: 0.449, p = 0.0487). Patients living in rural areas were less likely to receive complex reconstructive procedures than those in both urban teaching and non-teaching hospitals (OR: 3.313, p = 0.0135, and OR: 3.505, p = 0.0074). Pedicled or rotational flaps were less likely to be performed at medium-or large -sized hospitals (OR: 0.610, p = 0.0296, and OR: 0.496, p = 0.0002).Conclusion: Race and socioeconomic factors are important predictors of access to complex reconstructive procedures and hospital-based outcomes following extirpation in melanoma pa-tients.(c) 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by El-sevier Ltd. All rights reserved.