Hidradenitis suppurativa (HS) is an underdiagnosed chronic, immune-mediated inflammatory skin disease that causes severe pain, drainage, and scarring, leading to significant physical and psychosocial burdens. HS is characterized by heterogenous molecular changes that are poorly understood, posing a significant challenge for drug development. Therapeutic options remain limited, and many patients experience disease relapse despite treatment. Therefore, precision medicine approaches are urgently needed to identify new therapies for HS. Here, we combine integrative transcriptomics, large-scale drug perturbational datasets, and translational immunology to identify sirolimus, pioglitazone, and fulvestrant as novel therapies for HS that can directly target and reverse the HS disease gene signature in immune cell types relevant to HS pathogenesis. Using a novel ex vivo HS skin model, sirolimus, pioglitazone, and fulvestrant inhibited T cell proliferation and activation, and suppressed the production of pro-inflammatory cytokines from HS skin. These results show that unbiased data-driven precision medicine approaches can identify novel therapies for HS and can serve more generally as a model approach for therapeutic discovery in other chronic inflammatory diseases.

Purpose:Outpatient hand clinic non-attendance is a pervasive issue, and identifying risk factors for clinic non-attendance can help inform strategies for addressing this problem. No study has evaluated risk factors for hand clinic non-attendance among emergency department (ED) patients at urban safety-net community hospitals, which are a common source of referrals for many hand providers. Methods:We conducted a one-year retrospective chart review of all ED patients at an urban safety-net community hospital for whom hand surgery consults were ordered in 2023. For patients who were deemed to require follow-up in hand clinic, bivariable and multivariable analyses were performed to identify demographic and consult-related factors associated with hand clinic non-attendance. P < 0.05 was considered significant for all analyses. Results:Of the 200 patients who required follow-up in our hand clinic, 129 (64.5%) attended their hand clinic appointment and 71 (35.5%) did not. On multivariable analysis, factors significantly associated with decreased likelihood of hand clinic attendance were being marginally housed (adjusted odds ratio (aOR) = 0.27, 95% confidence interval (CI): 0.11-0.63) and not having a primary care provider (aOR = 0.38, CI: 0.19-0.78). Factors significantly associated with increased likelihood of attendance included having a bone injury (aOR = 2.28, CI: 1.12-4.63), having a tendon injury (aOR = 7.83, CI: 1.64-37.48), or having undergone a nailbed repair (aOR = 6.24, CI: 1.28-30.38). Conclusions:Among patients referred to an urban safety-net community-based hand clinic after presentation to the ED, hand clinic non-attendance is common. Various unique factors are significantly associated with increased or decreased likelihood of clinic attendance in this setting. These factors could be used to develop strategies for improving clinic attendance for similar practices moving forward.

BACKGROUND:Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine gland-bearing areas characterized by abscesses, tunneling, scarring, and recurrent flares. Surgical excision is central in refractory disease, but perioperative protocols are variable. We evaluated whether specific perioperative medical therapies are associated with shorter time to documented postoperative wound-healing progress after HS surgery, and whether intraoperative cultures meaningfully guide antibiotic management. METHODS:We conducted a retrospective cohort study of 194 HS surgeries performed at a quaternary care center between January 1, 2013, and July 1, 2021. We abstracted perioperative medical therapies (including antibiotics and spironolactone), intraoperative culture results, postoperative antibiotics, and healing times from the medical record. Healing was defined as days from surgery to the first follow-up note documenting substantial wound-healing progress. Time to healing was analyzed with Kaplan-Meier survival curves and Cox proportional hazards models. We also examined whether intraoperative cultures were associated with postoperative antibiotic selection. RESULTS:Perioperative trimethoprim-sulfamethoxazole was associated with shorter time to documented healing [hazard ratio (HR) 2.55, 95% CI: 1.46-4.46, P =0.00099]. Preoperative cephalexin was also associated with shorter time to heal (HR: 4.17, 95% CI: 1.40-12.44, P =0.01), whereas postoperative cephalexin was not (HR: 0.89, 95% CI: 0.44-1.79, P =0.74). Perioperative spironolactone was associated with faster healing (HR: 5.72, 95% CI: 2.08-15.74, P =0.00073). Intraoperative cultures were collected in 28% of surgeries, yielded gram-positive, gram-negative, and anaerobic organisms, showed only weak, nonsignificant associations with preoperative antibiotic exposure, and were not significantly associated with postoperative antibiotic choice. CONCLUSIONS:Perioperative trimethoprim-sulfamethoxazole, cephalexin, and spironolactone were each associated with shorter time to documented wound-healing progress after HS surgery in this retrospective cohort. Routine intraoperative cultures demonstrated limited observed clinical utility in guiding immediate postsurgical antibiotics. These findings support efforts to streamline perioperative care while de-emphasizing routine intraoperative culture collection in HS surgery.

BackgroundPatient-directed discharge (PDD) poses a significant challenge in healthcare. Prior studies have shown associations of PDD with factors like race, housing, psychiatric illness, socioeconomic status, and intravenous drug use (IVDU). This study aims to identify factors contributing to PDD in hand infection patients at a public safety-net hospital and to investigate the long-term consequences through readmissions or returns to the emergency department (ED).MethodsA retrospective analysis was conducted on adult patients presenting with hand infections at San Francisco's main public hospital over 1 year. Data collected included demographics, housing status, social support, psychiatric diagnoses, and IVDU. Statistical analysis involved Mann-Whitney U tests, Fisher's exact tests, and logistic regression with odds ratios (ORs).ResultsA total of 131 patients were included, comprising 95 (73%) conventionally discharged and 36 (27%) PDD patients. Positive correlations were found between PDD and several factors, including unemployment, unstable housing, living alone, lack of a phone number on file, alcohol use, and IVDU. However, in the multivariate analysis, IVDU emerged as the sole statistically significant predictor (OR, 4.22; CI, 1.18-15.05; P = 0.026). Further regression analysis identified unstable housing (OR, 4.39; CI, 1.17-16.44; P = 0.028) and living alone (OR, 4.45; CI, 1.25-15.89; P = 0.021) to be positively correlated with IVDU. PDD had higher ED revisits (P = 0.025) and readmission rates (P = 0.014).ConclusionsThis study underscores the critical role of socioeconomic factors, particularly IVDU, in influencing PDD among hand infection patients. The findings highlight the need for integrated healthcare strategies addressing medical and social determinants to reduce PDD and improve patient outcomes.

Background:Artificial intelligence (AI) has significantly influenced various medical fields, including plastic surgery. Large language model (LLM) chatbots such as ChatGPT and text-to-image tools like Dall-E and GPT-4o are gaining broader adoption. This study explores the capabilities and limitations of these tools in hand surgery, focusing on their application in patient and medical education. Methods:Utilizing Google Trends data, common search terms were identified and queried on ChatGPT-4.5 and ChatGPT-3.5 from the following categories: "Hand Anatomy", "Hand Fracture", "Hand Joint Injury", "Hand Tumor", and "Hand Dislocation". Responses were graded on a 1-5 scale for accuracy and evaluated using the Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool (PEMAT), and DISCERN instrument. GPT 4o, DALL-E 3, and DALL-E 2 illustrated visual representations of selected ChatGPT responses in each category, which were further evaluated. Results:ChatGPT-4.5 achieved a DISCERN overall score of 3.80 ± 0.23. Its responses averaged 91.67 ± 0.29 for PEMAT understandability and 54.67 ± 0.55 for actionability. Accuracy was 4.47 ± 0.52, with a Flesch-Kincaid Grade Level of 9.26 ± 1.04. ChatGPT-4.5 consistently outperformed ChatGPT-3.5 across all evaluation metrics. For text-to-image generation, GPT-4o produced more accurate visuals compared to DALL-E 3 and DALL-E 2. Conclusions:This study highlights the strengths and limitations of ChatGPT-4.5 and GPT-4o in hand surgery education. While combining accurate text generation with image creation shows promise, these AI tools still need further refinement before widespread clinical adoption.

ABSTRACT Hidradenitis suppurativa (HS) is a relatively common and highly morbid inflammatory skin disease. Due to the relatively limited understanding of HS's pathogenesis, there are currently insufficient treatment options available, and many patients' medical needs are not being met. This is partly due to the historical scarcity of ex vivo assays and animal models that accurately recapitulate the disease. Thus, we have developed a standardised whole‐tissue explant model of HS to examine its pathogenic mechanisms and the efficacy of potential treatments within intact human tissue. We measured cytokine protein and RNA within whole tissue maintained in an agar‐media solution, finding that IL‐6 and IL‐8 concentrations trended upwards in both HS explants and healthy controls, while IL‐17A, IL‐1β, and TNF‐α exhibited increases in HS tissue alone. We also show that the explants were responsive to treatment with both dexamethasone and IL‐2. Not only do our results show that this model effectively delivers treatments throughout the explants, but they also elucidate which cytokines are related to the explant process regardless of tissue state and which are related to HS tissue specifically, laying the groundwork for future implementations of this model.

BACKGROUND:Patient-directed discharge (PDD) poses a significant challenge in healthcare. Prior studies have shown associations of PDD with factors like race, housing, psychiatric illness, socioeconomic status, and intravenous drug use (IVDU). This study aims to identify factors contributing to PDD in hand infection patients at a public safety-net hospital and to investigate the long-term consequences through readmissions or returns to the emergency department (ED). METHODS:A retrospective analysis was conducted on adult patients presenting with hand infections at San Francisco's main public hospital over 1 year. Data collected included demographics, housing status, social support, psychiatric diagnoses, and IVDU. Statistical analysis involved Mann-Whitney U tests, Fisher's exact tests, and logistic regression with odds ratios (ORs). RESULTS:A total of 131 patients were included, comprising 95 (73%) conventionally discharged and 36 (27%) PDD patients. Positive correlations were found between PDD and several factors, including unemployment, unstable housing, living alone, lack of a phone number on file, alcohol use, and IVDU. However, in the multivariate analysis, IVDU emerged as the sole statistically significant predictor (OR, 4.22; CI, 1.18-15.05; P = 0.026). Further regression analysis identified unstable housing (OR, 4.39; CI, 1.17-16.44; P = 0.028) and living alone (OR, 4.45; CI, 1.25-15.89; P = 0.021) to be positively correlated with IVDU. PDD had higher ED revisits ( P = 0.025) and readmission rates ( P = 0.014). CONCLUSIONS:This study underscores the critical role of socioeconomic factors, particularly IVDU, in influencing PDD among hand infection patients. The findings highlight the need for integrated healthcare strategies addressing medical and social determinants to reduce PDD and improve patient outcomes.

Methods for describing and reporting the clinical and histologic characteristics of cutaneous tissue samples from patients with hidradenitis suppurativa (HS) are not currently standardized, limiting clinicians' and scientists' ability to uniformly record, report, and communicate about the characteristics of tissue used in translational experiments. A recently published consensus statement outlined morphological definitions of typical HS lesions, but no consensus has been reached regarding clinical characterization and examination of HS tissue samples. In this study, we aimed to establish a protocol for reporting histopathologic and clinical characteristics of HS tissue specimens. This study was conducted from May 2023 to August 2023. Experts in clinical care, dermatopathology, and translational research were recruited, and a modified Delphi technique was used to develop a protocol for histologic reporting and clinical characterization of submitted tissue specimens from patients with HS. A total of 27 experts participated (14 dermatologists, 3 fellowship-trained dermatopathologists, 3 plastic surgeons, 3 general surgeons, and 4 research scientists) in creating and reviewing protocols for the clinical and histopathological examination of HS tissue specimens. The protocols were formatted as a synoptic report and will help to consistently classify specimens in biobanks on the basis of histologic features and more accurately report and select samples used in translational research projects.

Background: Hand infections represent a significant burden for both health care systems and their patients. Epidemiological understanding of community-acquired hand infections is limited. This study examined a cohort of hand infection patients at a large urban safety net hospital for characteristics that were associated with protective and/or risk factors for hand infections. Methods: We performed a retrospective chart review for all patients who required hand surgery consultation in the emergency department during a 1-year period (2021-2022). County-level population characteristics were obtained through the county-level data sources. We then performed a risk ratio (RR) analysis for demographic and socioeconomic characteristics. Results: A total of 125 patients were included in the study cohort. Cisgender male (RR, 4.654; P < 0.001), Black (RR, 6.062; P < 0.001) and American Indian/Alaska Native (RR, 3.293; P = 0.041) patients were found to be overrepresented in our cohort when compared to county proportions, indicating an association with increased risk of hand infections. Patients between 35 and 49 years of age were also found to have an increased risk (RR, 1.679; P = 0.005). Age over 65 years, retirement, and employment were found to be protective factors (RR, 0.341 [P = 0.001]; RR, 0.397 [P = 0.043]; RR, 0.197 [P < 0.001]). In contrast, unemployment and unstable housing (unhoused or shelter) were found to have strong harmful risk for necessitating hand infection consults (RR, 7.587 [P < 0.001]; RR, 235.715 [P < 0.001]; RR, 29.990 [P < 0.001]). Conclusions: There are clear risk factors at play for hand infection incidence. We found that housing status, employment, race, gender, and age were some of the most important contributors for incidence. This information can assist clinicians and public officials in developing more specific screening algorithms and prevention tools to reduce systematic burden. Further studies are required to elucidate specific etiologies associated with hand infection risk.

Purpose The benefits of paraspinous flaps in adult complex spine surgery patients are established in the literature; however, their use in pediatric patients has not been well described. This study compares clinical outcomes with and without paraspinous muscle flap closure in pediatric patients who have undergone spine surgery. Methods We conducted a retrospective review of all pediatric spine surgeries at the University of California, San Francisco from 2011 to 2022. Patients were divided into 2 cohorts based on whether the plastic surgery service closed or did not close the wound with paraspinous muscle flaps. We matched patients by age, American Society of Anesthesiology classification, prior spinal surgical history, and diagnosis. Surgical outcomes were compared between the 2 cohorts. Results We identified 226 pediatric patients who underwent at least one spinal surgery, 14 of whom received paraspinous flap closure by plastic surgery. They were matched in a 1:4 ratio with controls (n = 56) that did not have plastic surgery closure. The most common indication for plastic surgery involvement was perceived complexity of disease by the spine surgeon with concern for inadequate healthy tissue coverage (78.6%), followed by infection (21.4%). Postoperative complications were similar between the two groups. The plastic surgery cohort had a higher rate of patients who were underweight (57.1% vs 14.3%, P < 0.01) and had positive preoperative wound cultures (28.6% vs 8.9%, P = 0.05), as well as a higher rate of postoperative antibiotic usage (78.6 vs 17.9%, P < 0.01). There was no difference in recorded postoperative outcomes. Conclusions Spine surgeons requested paraspinous flap closure for patients with more complex disease, preoperative infections, history of chemotherapy, or if they were underweight. Patients with paraspinous flap coverage did not have increased postoperative complications despite their elevated risk profile. Our findings suggest that paraspinous muscle flaps should be considered in high-risk pediatric patients who undergo spine surgery.

PURPOSE:Resection of sacral neoplasms such as chordoma and chondrosarcoma with subsequent reconstruction of large soft tissue defects is a complex multidisciplinary process. Radiotherapy and prior abdominal surgery play a role in reconstructive planning; however, there is no consensus on how to maximize outcomes. In this study, we present our institution's experience with the reconstructive surgical management of this unique patient population. METHODS:We conducted a retrospective review of patients who underwent reconstruction after resection of primary or recurrent pelvic chordoma or chondrosarcoma between 2002 and 2019. Surgical details, hospital stay, and postoperative outcomes were assessed. Patients were divided into 3 groups for comparison based on reconstruction technique: gluteal-based flaps, vertical rectus abdominus myocutaneous (VRAM) flaps, and locoregional fasciocutaneous flaps. RESULTS:Twenty-eight patients (17 males, 11 females), with mean age of 62 years (range, 34-86 years), were reviewed. Twenty-two patients (78.6%) received gluteal-based flaps, 3 patients (10.7%) received VRAM flaps, and 3 patients (10.7%) were reconstructed with locoregional fasciocutaneous flaps. Patients in the VRAM group were significantly more likely to have undergone total sacrectomy (P < 0.01) in a 2-stage operation (P < 0.01) compared with patients in the other 2 groups. Patients in the VRAM group also had a significantly greater average number of reoperations (2 ± 3.5, P = 0.04) and length of stay (29.7 ± 20.4 days, P = 0.01) compared with the 2 other groups. The overall minor and major wound complication rates were 17.9% and 42.9%, respectively, with 17.9% of patients experiencing at least 1 infection or seroma. There was no association between prior abdominal surgery, surgical stages, or radiation therapy and an increased risk of wound complications. CONCLUSIONS:Vertical rectus abdominus myocutaneous flaps are a more suitable option for patients with larger defects after total sacrectomy via 2-staged anteroposterior resections, whereas gluteal myocutaneous flaps are effective options for posterior-only resections. For patients with small- to moderate-sized defects, local fasciocutaneous flaps are a less invasive and effective option. Paraspinous flaps may be used in combination with other techniques to provide additional bulk and coverage for especially long postresection wounds. Furthermore, mesh is a useful adjunct for any reconstruction aimed at protecting against intra-abdominal complications.

Hidradenitis suppurativa (HS) is a chronic skin condition affecting approximately 1% of the US population. HS skin lesions are highly inflammatory and characterized by a large immune infiltrate. While B cells and plasma cells comprise a major component of this immune milieu, the biology and the contribution of these cells in HS pathogenesis are unclear. We aimed to investigate the dynamics and microenvironmental interactions of B cells within cutaneous HS lesions. Combining histological analysis, single-cell RNA sequencing, and spatial transcriptomics profiling of HS lesions, we defined the tissue microenvironment relative to B cell activity within this disease. Our findings identified tertiary lymphoid structures (TLSs) within HS lesions and described organized interactions among T cells, B cells, antigen-presenting cells, and skin stroma. We found evidence that B cells within HS TLSs actively underwent maturation, including participation in germinal center reactions and class switch recombination. Moreover, skin stroma and accumulating T cells were primed to support the formation of TLSs and facilitate B cell recruitment during HS. Our data definitively demonstrated the presence of TLSs in lesional HS skin and point to ongoing cutaneous B cell maturation through class switch recombination and affinity maturation during disease progression in this inflamed nonlymphoid tissue.

Introduction Perilunate injuries and dislocations, typically caused by high-impact trauma, can lead to acute compression of the median nerve and subsequent complications if left untreated. This study examines the epidemiology, injury mechanisms, immediate treatment, and need for carpal tunnel release in such cases. Methods Perilunate injuries at a single level 1 trauma center were retrospectively reviewed from 2014 to 2023. Data on patient demographics, injury mechanism, initial management, and operative management were collected. Results Thirty-three cases were analyzed, averaging 33.9 years in age. Injury mechanisms included falls (24% each from 0 to 10 feet and >10 feet, and motor vehicle accidents), bicycle-auto collisions or assaults (10%), pedestrian-auto collisions (5%), and 1 crush injury (3%). Most cases involved trans-scaphoid perilunate dislocation (predominantly Mayfield 3). Initial reduction in the emergency department succeeded in 60% of cases, with 48% showing median nerve paresthesias. Thirty-three percent underwent surgery within 24 hours, and 95% required operative intervention, including open reduction internal fixation (56%), open reduction with percutaneous pinning (30%), and closed reduction with percutaneous pinning (7%). Fifty-two percent needed carpal tunnel release. Conclusions Prompt evaluation and treatment are crucial for perilunate injuries. If initial reduction fails, urgent operative intervention is warranted, although delayed management may be appropriate in some cases. Various operative fixation methods exist for realigning carpal bones, emphasizing the importance of tailored approaches to individual cases.

PURPOSE: Electronic messaging has been associated with increased physician burnout, and these messages have only increased in quantity since the COVID-19 pandemic. We aim to assess the efficacy of ChatGPT, an artificial intelligence (AI) chatbot, compared to healthcare providers in answering patient-directed messages related to breast reconstruction. METHODS: Ten de-identified questions pertaining to breast reconstruction were extracted from electronic messages. They were presented to ChatGPT3, ChatGPT4, physicians, and advanced practice providers for responses. ChatGPT3 and ChatGPT4 were also prompted to give brief responses. Using 1-5 Likert scoring, accuracy and empathy were graded by an expert and two medical students, respectively. Readability was measured using Flesch Reading Ease (FRE). Grades were compared using 2-tailed t-tests. RESULTS: 80 responses were analyzed and recorded. FRE for combined provider responses was better than combined AI responses (53.33±13.27 vs. 35.97±11.62, p<.001) and brief-AI responses (53.33±13.27 vs. 34.68±12.81, p<.001). However, all providers were given lower empathy scores than all AI responses (2.013±0.74 vs. 2.875±0.75, p<.001) and brief-AI responses (2.013±0.74 vs. 2.875±0.75, p<.001). Furthermore, while advanced practice providers had similar accuracy scores to brief-AI responses (4.50±0.99 vs. 4.75±0.44, p=.333), physicians had lower accuracy (4.16±1.07 vs. 4.75±0.44, p=.035). CONCLUSION: We provide insights into AI chatbot efficacy, suggesting a complementary role for AI in healthcare, particularly in delivering empathetic and accurate responses. Further refinement in the readability of AI-generated information is needed.

Purpose: Resection of sacral neoplasms such as chordoma and chondrosarcoma with subsequent reconstruction of large soft tissue defects is a complex multidisciplinary process. Radiotherapy and prior abdominal surgery play a role in reconstructive planning; however, there is no consensus on how to maximize outcomes. In this study, we present our institution's experience with the reconstructive surgical management of this unique patient population. Methods: We conducted a retrospective review of patients who underwent reconstruction after resection of primary or recurrent pelvic chordoma or chondrosarcoma between 2002 and 2019. Surgical details, hospital stay, and postoperative outcomes were assessed. Patients were divided into 3 groups for comparison based on reconstruction technique: gluteal-based flaps, vertical rectus abdominus myocutaneous (VRAM) flaps, and locoregional fasciocutaneous flaps. Results: Twenty-eight patients (17 males, 11 females), with mean age of 62 years (range, 34-86 years), were reviewed. Twenty-two patients (78.6%) received gluteal-based flaps, 3 patients (10.7%) received VRAM flaps, and 3 patients (10.7%) were reconstructed with locoregional fasciocutaneous flaps. Patients in the VRAM group were significantly more likely to have undergone total sacrectomy (P < 0.01) in a 2-stage operation (P < 0.01) compared with patients in the other 2 groups. Patients in the VRAM group also had a significantly greater average number of reoperations (2 +/- 3.5, P = 0.04) and length of stay (29.7 +/- 20.4 days, P = 0.01) compared with the 2 other groups. The overall minor and major wound complication rates were 17.9% and 42.9%, respectively, with 17.9% of patients experiencing at least 1 infection or seroma. There was no association between prior abdominal surgery, surgical stages, or radiation therapy and an increased risk of wound complications. Conclusions: Vertical rectus abdominus myocutaneous flaps are a more suitable option for patients with larger defects after total sacrectomy via 2-staged anteroposterior resections, whereas gluteal myocutaneous flaps are effective options for posterior-only resections. For patients with small- to moderate-sized defects, local fasciocutaneous flaps are a less invasive and effective option. Paraspinous flaps may be used in combination with other techniques to provide additional bulk and coverage for especially long postresection wounds. Furthermore, mesh is a useful adjunct for any reconstruction aimed at protecting against intra-abdominal complications.

Purpose: The benefits of paraspinous flaps in adult complex spine surgery patients are established in the literature; however, their use in pediatric patients has not been well described. This study compares clinical outcomes with and without paraspinous muscle flap closure in pediatric patients who have undergone spine surgery. Methods: We conducted a retrospective review of all pediatric spine surgeries at the University of California, San Francisco from 2011 to 2022. Patients were divided into 2 cohorts based on whether the plastic surgery service closed or did not close the wound with paraspinous muscle flaps. We matched patients by age, American Society of Anesthesiology classification, prior spinal surgical history, and diagnosis. Surgical outcomes were compared between the 2 cohorts. Results: We identified 226 pediatric patients who underwent at least one spinal surgery, 14 of whom received paraspinous flap closure by plastic surgery. They were matched in a 1:4 ratio with controls (n = 56) that did not have plastic surgery closure. The most common indication for plastic surgery involvement was perceived complexity of disease by the spine surgeon with concern for inadequate healthy tissue coverage (78.6%), followed by infection (21.4%). Postoperative complications were similar between the two groups. The plastic surgery cohort had a higher rate of patients who were underweight (57.1% vs 14.3%, P < 0.01) and had positive preoperative wound cultures (28.6% vs 8.9%, P = 0.05), as well as a higher rate of postoperative antibiotic usage (78.6 vs 17.9%, P < 0.01). There was no difference in recorded postoperative outcomes. Conclusions: Spine surgeons requested paraspinous flap closure for patients with more complex disease, preoperative infections, history of chemotherapy, or if they were underweight. Patients with paraspinous flap coverage did not have increased postoperative complications despite their elevated risk profile. Our findings suggest that paraspinous muscle flaps should be considered in high-risk pediatric patients who undergo spine surgery.

Background Incisional negative pressure wound therapy (iNPWT) is an adjunctive treatment that uses constant negative pressure suction to facilitate healing. The utility of this treatment modality on vascular operations for critical limb-threatening ischemia (CLTI) has yet to be elucidated. This study compares the incidence of postoperative wound complications between the Prevena Incision Management System, a type of iNPWT, and standard wound dressings for vascular patients who also underwent plastic surgery closure of groin incisions for CLTI. Method We performed a retrospective cohort study of 40 patients with CLTI who underwent 53 open vascular surgeries with subsequent sartorius muscle flap closure. Patient demographics, intraoperative details, and wound complications were measured from 2015 to 2018 at the University of California San Francisco. Two cohorts were generated based on the modality of postoperative wound management and compared on wound healing outcomes. Results Of the 53 groin incisions, 29 were managed with standard dressings, and 24 received iNPWT. Patient demographics, comorbidities, and operative characteristics were similar between the 2 groups. Patients who received iNPWT had a significantly lower rate of infection (8.33% vs 31.0%, P = 0.04) and dehiscence (0% vs 41.3%, P < 0.01). Furthermore, the iNPWT group had a significantly lower rate of reoperation (0% vs 17.2%, P = 0.03) for wound complications within 30 days compared with the control group and a moderately reduced rate of readmission (4.17% vs 20.7%, P = 0.08). Conclusions Rates of infection, reoperation, and dehiscence were significantly reduced in patients whose groin incisions were managed with iNPWT compared with standard wound care. Readmission rates were also decreased, but this difference was not statistically significant. Our results suggest that implementing iNPWT for the management of groin incisions, particularly in patients undergoing vascular operations for CLTI, may significantly improve clinical outcomes.