Karan Chopra

Early postoperative outcomes associated with the anterolateral thigh flap in Gustilo IIIB fractures of the lower extremity.

PurposeA core concept in plastic surgery has been the replacement of “like-with-like” tissue. Applying this concept to the lower extremity, the anterolateral thigh (ALT) perforator flap has become a frequently used free flap for restoration of soft tissue defects involving the distal lower extremity. The objective of this study was to evaluate the rate of early postoperative complications associated with the ALT perforator free flap for coverage of high-energy traumatic open fractures of the lower extremity (Gustilo IIIB) and explore related patient risk factors. MethodsA retrospective chart review of 74 patients undergoing free tissue transfer for lower extremity limb coverage was performed. Early postoperative complications were defined as any 1 or more of the following having occurred within 6 months from surgical reconstruction: hematoma, wound infection, deep venous thrombosis, thromboembolism, partial flap loss, complete flap loss, continued osteomyelitis, and progression to amputation occurring within the first 6 months after the injury. Statistical analyses were performed using GraphPad software. Fisher exact test was performed to identify risk factors associated with greater morbidity. ResultsOf all patients, 26 (35%) were identified as those habitually using tobacco product and 48 (64%) were identified as nonusers of tobacco product. Moreover, 10 patients (14%) had other risk factors for atherosclerotic disease and 64 patients (86%) did not have other risk factors for atherosclerosis. Mean (SD) time to reconstruction was 4.74 (1.3) days (range, 3–8 days). Of all defects, 34 (46%) were reconstructed using adipocutaneous flaps and 40 (54%) were reconstructed using fasciocutaneous flaps. The most frequent complication was partial flap loss or superficial epidermolysis 4 (5.4%). Fisher exact test was performed, showing that patients who used tobacco product (cigarette smokers) and had other risk factors for atherosclerosis were significantly more at risk for complications (P < 0.001). ConclusionsIn this retrospective review, those patients who had a positive history of tobacco use at the time of injury and those with risk factors for atherosclerosis had a significantly increased risk of flap complications. Although this is not surprising given the vasoconstrictive effects of nicotine and the impaired blood flow to the lower extremity in patients with atherosclerosis, this study will allow the surgeon to better counsel patients who have a history of tobacco use through complex reconstruction of the lower extremity. This analysis is a preliminary investigation into the safety and efficacy of the ALT fasciocutaneous or adipocutaneous flap to reconstruct high-energy open fractures of the lower extremity.

The Dawn of Transparency: Insights from the Physician Payment Sunshine Act in Plastic Surgery

Background The Physician Payments Sunshine Act (PSSA) is a government initiative that requires all biomedical companies to publicly disclose payments to physicians through the Open Payments Program (OPP). The goal of this study was to use the OPP database and evaluate all nonresearch-related financial transactions between plastic surgeons and biomedical companies. Methods Using the first wave of OPP data published on September 30, 2014, we studied the national distribution of industry payments made to plastic surgeons during a 5-month period. We explored whether a plastic surgeons scientific productivity (as determined by their h-index), practice setting (private versus academic), geographic location, and subspecialty were associated with payment amount. Results Plastic surgeons (N = 4195) received a total of US

Manson's point: A facial landmark to identify the facial artery

5,278,613. The median (IQR) payment to a plastic surgeon was US

Clinical application of the FACES score for face transplantation.

115 (US

Acellular dermal matrix reduces capsule formation in two-stage breast reconstruction†‡§

35–298); mean, US

Complex craniofacial reconstruction using stereolithographic modeling.

158. The largest payment to an individual was US

Porcine acellular dermal matrix (PADM) vascularises after exposure in open necrotic wounds seen after complex hernia repair

341,384. The largest payment category was non-CEP speaker fees (US

Superior epigastric artery perforator (SEAP) flap: A novel approach to autologous breast reconstruction

1,709,930) followed by consulting fees (US

Facial Fracture Patterns Associated with Traumatic Optic Neuropathy

1,403,770). Plastic surgeons in private practice received higher payments per surgeon compared with surgeons in academic practice (median [IQR], US

Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury

165 [US