Kashyap Komarraju Tadisina

A comprehensive examination of topographic thickness of skin in the human face.

BACKGROUND Knowledge of topographic skin thickness is important to plastic surgery of the face as it may guide resection and restoration in oncologic, aesthetic, and reconstructive procedures. OBJECTIVE The purpose of this study is to report the relative thickness of the face throughout 39 distinct subunits. METHODS Full-thickness punch biopsy samples were obtained at 39 predetermined anatomic locations of the face from 10 human cadaveric heads. Tissue was fixed in paraffin-embedded slides and analyzed using triplicate measurement of dermis and epidermis using computerized measurements. Data were analyzed using univariate statistical analysis and expressed as mean thickness values and relative thickness (RT) values based on the thinnest portion of the face. RESULTS The area of the face with the thickest dermis was the lower nasal sidewall (1969.2 µm, dRT: 2.59), and the thinnest was the upper medial eyelid (758.9 µm, dRT: 1.00). The area with the thickest epidermis was the upper lip (62.6 µm, eRT: 2.12), and the thinnest was the posterior auricular skin (29.6 µm, eRT: 1.00). Our results confirm that eyelid skin is the thinnest in the face. The thickest portions of the skin appeared to be in the lower nasal sidewall, but the measurements are comparable to those in the ala and posterior auricular skin, which are novel findings. CONCLUSIONS The greatest epidermal, dermal and total skin thickness are found in the upper lip, right lower nasal sidewall, and left lower nasal sidewall respectively. The least epidermal skin thickness is in the posterior auricular skin. The least dermal skin thickness, and the least total skin thickness, are both in the upper medial eyelid.

The “Weekend Effect” in Plastic Surgery: Analyzing Weekday Versus Weekend Admissions in Body Contouring Procedures from 2000 to 2010

BACKGROUND Body contouring operations are a quickly becoming the most commonly performed operations by American plastic surgeons, mirroring the increase in bariatric surgery in the US over the last decade. Despite previous studies showing worse patient outcomes on weekend admissions for non-emergent cases (spine, breast, and hernia), there is no comparative data reported regarding body contouring procedures. OBJECTIVE The authors aimed to determine whether body contouring surgery results in worse outcomes when performed on weekends versus weekdays. METHODS A serial cross-sectional study of body contouring patients was performed using the Nationwide Inpatient Sample database from 2000 to 2010. Data were gathered using international classification of diseases, ninth revision codes for liposuction and reduction of adipose tissue (86.83) for weekday and weekend admissions, including demographics, hospital charges, and patient outcomes. RESULTS A total of 50,346 hospital admission cases of inpatient body contouring were examined over the 11-year period, 98% of which were on a weekday. When compared to weekday admissions, weekend admissions were associated with a statistically significant increase in hospitalization costs (

Applying to Integrated Plastic Surgery Residency Programs: Trends in the Past 5 Years of the Match.

35,481, p < 0.000) and in hospital length of stay (5.68 days, p < 0.000). Mortality rates were found to be higher on weekend admissions (3.7%) versus weekdays (0.5%) as well. CONCLUSIONS Although outcomes are multifactorial, in body contouring patients, weekday admission is associated with favorable outcomes in terms of length of stay and hospital charges. LEVEL OF EVIDENCE 4 Risk.

Nationwide incidence, cost, and epidemiologic trends in facial rhytidectomy: an examination of inpatient facelifts using the Nationwide Inpatient Sample (NIS) database.

Background: The average integrated plastic surgery applicant spends over

Submission Bias and the Rise of Open Access Journals

6000 for interviews. The average program director reviews over 200 applications per cycle. It is important to make the application process efficient and cost effective for both applicants and programs. The authors analyzed recent trends and the literature in an attempt to increase the likelihood that applicants match, suggest means of reducing applicants’ costs, and improve the process. Methods: A cross-sectional study of the National Residency Matching Program Charting Outcomes and results and data for the years 2009 to 2014 was performed. Applicant profile elements were examined for differences between matched/unmatched U.S. senior medical students. In addition, a literature review was performed. Results: The number of integrated plastic surgery positions rose from 69 in 2010 to 130 in 2014. Both matched and unmatched U.S. senior medical students have higher Step 2 scores, research and volunteer experiences, than 5 years ago. The likelihood of matching into an integrated plastic surgery residency has increased (2009, 52 percent; 2011, 44 percent; and 2014, 71 percent). Successful match rates were associated with Alpha Omega Alpha status and graduating from a top-40 ranked medical school (p < 0.05). Applicants with a lower number of ranked programs had increased match rates in 2014 than in previous years. Literature review revealed that program directors also value strong recommendation letters, publications, persistent work ethic (“grit”), away rotations, and an accurate curriculum vitae. Conclusions: Within the setting of increased applicant competitiveness, the authors recommend maximizing subjective qualities in order to differentiate themselves from a highly eligible applicant pool. In addition, applicants should diversify the types of programs at which they interview to maximize their chances of matching.

Apparent Age is a Reliable Assessment Tool in 20 Facelift Patients.

Facelifts are consistently one of the most common aesthetic operations performed by plastic surgeons in the United States (US). In 2013, 133,320 procedures were recorded, a rise of 6% compared with the previous year, making facelift the fifth most commonly performed cosmetic procedure.1 Further, rhytidectomy has been found to be safe in a wider, older range of patients,2 making it more popular with the aging baby boomer generation. However, despite the expansive number of procedures performed, authors and aesthetic surgeons alike acknowledge the lack of comprehensive data on current trends in facial rejuvenation.3 Alsarraf et al noted the severe lack of data on cost outcomes/trends in facial plastics or the market forces behind them.4 The authors aimed to report current national data and recent trends in inpatient facelifts over the last decade using the Nationwide Inpatient Sample (NIS) database. A retrospective serial cross-sectional study of data from the NIS database for the 2000 to 2010 time period was performed.5 The database was queried in January 2014. Sponsored by the Agency for Healthcare Research and Quality, the NIS contains all payer discharge data from inpatient hospitalization from roughly 20% of all hospitals in 37 participating US states. The NIS utilizes data from roughly 1000 hospitals each year to create a sample representing >95% of the US population.6 Hospital admissions involving facial rhytidectomy were examined. Data were extracted using ICD-9 codes for facial rhytidectomy (86.82), and relevant data were obtained. Data collected included patient and hospital demographics, hospital outcomes, and …

Squamosal Craniosynostosis: Defining the Phenotype and Indications for Surgical Management

Substantial growth continues to occur in open access publishing.1 This developing trend in medical literature comes with the potential to accelerate the spread of knowledge worldwide, create a more informed public and ultimately improve health care through the dissemination of knowledge. However, it also brings inherent challenges that must be considered to ensure established standards of research are upheld. In particular, standalone open access journals must gain credibility as reliable outlets of quality research. Standalone open access journals often times lack the foundation and resources of hybrid journals, which are linked to traditional subscriber based publications. Plastic surgeons should be aware of the nuances accompanying open access publishing in order to successfully shepherd this relatively …

Abstract: Ex Vivo Normothermic Limb Perfusion and Limb Specific Monitoring Evaluation of Perfusion Quality

Background: Although the literature is replete with favorable facelift results, there are few validated facial rejuvenation outcome measures. Apparent age (AA), a visual estimate of age by objective observers, has been utilized in several studies; although attractive, AA lacks validation. Objective: The aim of this study is to examine the reliability of AA, highlighting the importance of the exclusive use of validated outcome measures in future studies. Methods: Ten blinded reviewers assessed pre‐ and postoperative photographs of 32 patients who underwent facelift. Each reviewer completed 3 surveys at 3‐month intervals composed of 40 randomly ordered photos; totaling 1200 photographs assigned an AA. The intra‐class correlation coefficient was classified as “excellent,” “good,” “fair,” or “poor.” The accuracy of assigned AA, agreement within 5 years, and reduction in AA were also evaluated. Results: The mean difference of preoperative true age from assigned AA was 2.74 ± 4.36 years. Forty‐three percent of raters were within 5‐years (±2.5) of the mean. Intra‐rater reliability preoperatively and postoperatively were 0.77 (95% CI, 0.82‐0.72) and 0.75 (95% CI, 0.79‐0.71), respectively. Inter‐rater reliability preoperatively was 0.98 (95% CI, 0.99‐0.96), while postoperatively was 0.95 (95% CI, 0.99‐0.95). Mean AA reduction was 5.23 ± 2.81, with an intra‐rater reliability 0.15 (95% CI, 0.03‐0.34) and inter‐rater reliability 0.65 (95% CI, 0.84‐0.38). Conclusion: Using current statistical measures and analysis, AA is an acceptable tool for pre‐ and postoperative facial evaluation when assessed by a group of 10 reviewers. Therefore, apparent age represents a reliable and valid objective observer assigned measure for evaluation of facelift outcomes.

Assessment of Lymphaticovenous Drainage Through Vascularized Lymph Node Flaps Using Real-Time High-Resolution Fluorescent Imaging.

Background Squamosal craniosynostosis is seldom reported in the craniofacial literature. Given that this is an uncommon diagnosis, phenotype and management remain unclear. The authors present a case series and review the literature to define the phenotype and management of these patients. Methods We retrospectively reviewed 7 patients from our institution and systematically reviewed all published cases of squamosal craniosynostosis. Demographics, medical history, imaging, clinical presentation, subsequent workup, and treatment were examined and analyzed. Results A comprehensive review of the literature yielded a total of 31 cases (including our new series) of squamosal craniosynostosis. Average age of presentation was 25.3 months, 52% of female patients, 74% of cases with bilateral squamosal involvement, 44% syndromic, 39% isolated squamosal (vs 61% multisutural). Overall, 56% of cases were handled surgically, whereas 44% were managed conservatively. Thirty-three percent of surgical cases required multiple operations. One patient with isolated bilateral squamosal craniosynostosis developed elevated intracranial pressure, requiring cranial vault remodeling. Conclusions Squamosal craniosynostosis frequently presents in a delayed fashion with nonsyndromic, bilateral involvement. In isolated bilateral squamosal cases, the associated phenotype is frontal prominence, occipital flattening, scaphocephalic tendency (low-end normocephalic cranial index), and superior parietal cornering. Evaluation of clinical signs and computed tomography imaging guides management, as evidence of increased intracranial pressure may indicate need for cranial vault expansion. Although previous literature suggests that nonsyndromic cases are nonsurgical, the majority of cases reviewed required surgical intervention, including our case of isolated bilateral squamosal craniosynostosis. We recommend vigilant management in patients with squamosal craniosynostosis, even those with isolated squamosal involvement.

Who Is Publishing in Hand Surgery? A Citation Analysis Across Specialties Over Five Decades.

PSTM Abstract Supplement practice and associated with angiogenesis and accelerated wound healing. This experimental model evaluated topical negative pressure as a mechanism for non-inva-sive preconditioning for perforator flap microvascularity and perfusion. MethodS: Two gluteal perforator flaps (matched control and intervention) were designed on sixteen 400g Sprague-Dawley male rats. NPWT was applied to the flap area directly continuously at-125mmHg for 7 days, after which the rats were divided into two principal groups. Group A (n=8) underwent 4D computed tomographic and angiography (CTA) with a body volume perfusion protocol after NPWT and euthanized. Group B (n=8), control and intervention flaps were raised, isolated on a single pedicle and laid back down and monitored for a further 7 days. Group B flaps were assessed using laser-assisted indocyanine fluorescence angiography before surgery, following flap harvest and at 7 days prior to euthanasia. Half of all rats in each group were analyzed with Micro-CT to assess the microvasculature. All paired specimens were assessed histologically with H&E and immunohistochem-istry (IHC). ReSultS: There was a 17% increase in CT tissue perfu-sion in skin treated with NPWT versus matched controls (P=0.001). LA-ICGFA demonstrated higher perfusion following NPWT treatment (P=0.006), however no significant difference immediate post flap harvest (P=0.19) but a difference was seen 7 days postoperatively (P=0.03). Micro-CT evaluation showed an increase in average vessel volume (%) from 0.005 in control to 0.009 in the NPWT flaps (P=0.04).H&E analysis showed significant difference in the epidermal thickness (P<0.001), but comparable dermal thickness (P=0.34).Quantitative analysis of CD31 IHC demonstrated a mean area fraction percentage of 4.30 and 2.68 in the NPWT and control flaps respectively (P=0.002).There was partial necrosis in the control (n=3) and NPWT flaps (N=1), however this was <5% in the NPWT flap. ConCluSion: We present novel multimodal approaches using static and dynamic imaging and histological assessment to provide a proof of concept on the use of NPWT for non-invasive conditioning of flaps. The study provides the basis for further investigation and clinical studies with potential for direct translation into clinical practice. Disclosure/Financial support: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. PuRPoSe: Ischemia time represents a significant limitation for successful extremity replantation and transplantation because of the rapid deterioration of ischemic muscle. Static cold storage (SCS) of the limb is the standard clinical practice. Normothermic ex vivo perfusion system has the potential to prolong viability …