Peripheral nerve repair is limited by Wallerian degeneration coupled with the slow and inconsistent rates of nerve regrowth. In more proximal injuries, delayed nerve regeneration can cause debilitating muscle atrophy. Topical application of polyethylene glycol (PEG) during neurorrhaphy facilitates the fusion of severed axonal membranes, immediately restoring action potentials across the coaptation site. In preclinical animal models, PEG fusion resulted in remarkable early functional recovery.
Abstract This article provides a roadmap for plastic surgeons on how to successfully conceptualize, draft, and publish a paper. By publishing papers, authors will not only add to their professional standings but gain a deeper understanding of their topics and become artful at communicating their expertise to others. The processes of composition, submission, and revisions of manuscripts are an interlocking set of steps, and this essay describes the steps and their relationships to each other and final successful publications.
Background Immunosuppressive therapy is essential for to prevent graft rejection in renal transplant patients; however, it is associated with elevating the risk of several pathologies in these patients particularly infectious and neoplastic conditions. In this study, we explore the diagnosis and treatment of skin lesions in renal transplant patients. Methods A retrospective chart review of 12 renal transplant recipients referred to plastic and reconstructive surgery with skin lesions from 2000 to 2020 was performed. Results The mean age of the 12 patients was 49.6 years. Time to plastic surgery after renal transplantation ranged between 1 and 16 years. Nine cases of basal cell carcinoma, 2 cases of squamous cell carcinoma, and 1 case of skin and soft tissue infection of the lower extremity and cutaneous extranodal NK/T-cell lymphoma, nasal type was observed. Flaps, skin grafts, and artificial dermis grafts constitute the main reconstructive methods. There were no postoperative infections or wound dehiscence. Conclusions Cutaneous infections and skin malignancy account for most of the skin lesions developing after renal transplantation. Posttransplant lymphoproliferative disorder warrants equal attention and should not be disregarded. Early diagnosis and treatment significantly improve prognosis as patients with longer duration of transplant were found to have more aggressive tumors. Plastic and reconstructive surgery offers a safe therapeutic method of treatment in these cases.
PURPOSE: There is no consensus regarding perioperative hormone replacement therapy (HRT) for gender-affirming surgery (GAS). Continuing HRT prior to GAS may be associated with increased risk of complications such as deep vein thrombosis (DVT). Our study aimed to investigate current patterns of HRT prior to GAS using Delphi technique. METHODS: First stage of Dephi technique was implemented by sending a 27-item survey to all surgeons (total n=150, 94 Plastic surgeon, 35 Urologist, 21 OBGYN) of the World Professional Association for Transgender Health (WPATH) who perform GAS. Survey themes included: hormone type, duration, usage of DVT prophylaxis. RESULTS: Overall survey response rate was 32.7% (total n=49, n=8 for Urologist, 34 for Plastic Surgery, 7 for OBGYN). Majority of surgeons are US-based (n=38, 77.6%). About half of their patients' HRT are in injection form (n=27, 55.1%). Majority of surgeons do not stop HRT prior to GAS and do provide DVT prophylaxis to all patients<1 week after GAS. The most common procedure that surgeons discontinue HRT is feminizing bottom surgery (44.8%). For surgeons who do stop HRT prior to GAS, there is a wide variation on the time when they stop HRT. CONCLUSION: There is considerable variation in perioperative HRT patterns for GAS. Further research is needed to develop a data-driven consensus guideline to provide high quality of care for transgender and non-binary patients.
Introduction: In proximal injuries of mixed sensory-motor nerves, delayed nerve regeneration can cause debilitating muscle atrophy. Topical application of polyethylene glycol (PEG) during neurorrhaphy prevents Wallerian degeneration and has been shown to accelerate functional recovery in animals. Currently, there are no human studies on PEG-fusion in mixed sensory-motor nerve injuries. Methods: This study compares patients treated with PEG with demographically matched historical controls previously treated at our institution. Patients with median or ulnar nerves injuries were treated with our novel PEG-fusion protocol. Participants followed up at 2 weeks, 1 month, 3 months, 6 months, and 1 year postoperatively. Sensory recovery was assessed at each timepoint using Semmes-Weinstein monofilaments and static two-point discrimination. Medical Research Council Classification (MRCC) scores for sensory and motor recovery were calculated using sensory assessments and blinded clinician assessment. Results: A total of 18 patients (6 PEG, 12 control) with a total of 20 transected nerves (10 median, 10 ulnar) were analyzed. Patients treated with PEG demonstrated significantly greater sensation at 2 weeks (p < 0.000), 1 month (p < 0.000), 3 months (p < 0.000), 6 months (p < 0.000), and 1 year (p = 0.028) compared to historical controls. Patients in both cohorts demonstrated similar MRCC motor scores in the early postoperative period, however at 1 year postoperatively PEG patients significantly outperformed their control counterparts in motor function (p < 0.000). Conclusion: PEG-fusion accelerates sensory recovery following the repair of a mixed sensory-motor nerve and allows for superior motor function later in recovery.
Feminizing top surgery, or mammaplasty augmentation, has multiple variables that surgeons can adjust to work synergistically with patient anatomy including plane of implant placement, pocket size, and inframammary fold (IMF) location. In the gender diverse population receiving this procedure to reduce symptoms of gender dysphoria, surgeons should be aware of differing anatomy and surgical approaches for feminizing top surgery.
PURPOSE: Chondrolaryngoplasty, or tracheal shave, is a consistent facet of facial feminization surgery (FFS). This procedure involves debulking of the laryngeal prominence of the thyroid cartilage. The present study describes technical aspects of performing this surgery safely and investigates the outcomes and complications of this procedure. METHODS: A retrospective analysis of patient records was conducted to assess the outcomes of chondrolaryngoplasty performed at our center. Vital intraoperative measures for ensuring patient safety were identified. RESULTS: Over five years, 31 patients underwent chondrolaryngoplasty. One patient reported a noticeable scar 81 days post-surgery. None of the patients noted hoarseness, altered vocal tonality, or other subjective postoperative symptoms. There were no instances of postoperative infections, wound separation, or surgical site complications. Only one patient underwent chondrolaryngoplasty as a standalone procedure; the remainder received it in conjunction with other FFS. The key safety measures include precise identification of the thyroid cartilage, intraoperative pinpointing of the true vocal cord location both before and after cartilage reduction using endoscopy, and excising the thyroid cartilage sub-perichondrially rather than supra-perichondrially. A layered closure is recommended for optimal scar healing. CONCLUSION: Chondrolaryngoplasty is a reliable and safe procedure in facial feminization. Through meticulous endoscopic assessment and precise dissection, it offers significant feminizing outcomes with minimal associated risks.
PURPOSE: Gender-affirming mastectomy is a crucial procedure for transmasculine individuals seeking to alleviate gender dysphoria. However, many surgeons refuse to operate on obese patients. While common practice, research to support this guideline is lacking. METHODS: This study is a retrospective analysis of the impact of BMI on postoperative complications in patients undergoing gender-affirming mastectomy. Patients were classified as normal, overweight, Class I obese, Class II obese, and Class III obese. Additionally, patients with obesity were organized as metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO). Patients were monitored for postoperative complications for 30 days after surgery. RESULTS: 644 patients were included (187 normal, 175 overweight, 130 Class I obese, 75 Class II obese, and 77 Class III obese). Univariate analysis revealed a difference in total hematoma rates (p = 0.037). Upon multivariate analysis, BMI was not associated with an increased risk of any complications. Diabetes was associated with increased rates of total hematoma (Odds ratio (OR): 6.33, 95% CI: 1.76 - 22.84, p = 0.005), and hematoma requiring evacuation (OR: 5.36, 95% CI: 1.20 - 23.97, p = 0.028). Of the 282 obese patients, 240 patients had MHO, while 42 had MUO. MUO patients had a higher incidence of total hematoma (p = 0.005). In a logistic regression, MUO was associated with an increased risk of hematoma formation (OR: 3.60, 95% CI: 1.01 - 12.87, p = 0.048). CONCLUSION: BMI alone should not exclude patients from receiving gender-affirming mastectomy, but other factors, such as pre-existing comorbidities, should be considered.
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