Kate J. Buretta

Residents as Mentors: The Development of Resident Mentorship Milestones

BACKGROUND Mentorship of residents by more senior colleagues has been identified as important for stress management and creating an ideal learning environment. OBJECTIVE We set out to define the attributes of an ideal resident mentor and explore ways to develop these attributes during residency training. METHODS A 28-member, multi-specialty counsel of residents and fellows used 2 phases of a small group exercise. In the first phase, the group developed desirable attributes of resident mentors and explored means of developing these attributes. In the second phase, the group identified trends in the results, and in a second small group exercise with participants at a major national conference, refined these trends into Resident Mentorship Milestones. RESULTS The exercises identified 3 common themes: availability, competence, and support of the mentee. We defined milestones for mentorship in each of these areas. CONCLUSIONS The Resident Mentorship Milestones, developed by a national panel of residents, describe 3 key dimensions of mentorship: availability, defined as making time for mentorship; competence for and success in mentoring; and support of the mentee. These milestones may serve as a novel tool to develop and assess successful resident mentorship models.

A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer

Background Breast implant placement is the most common method for postmastectomy reconstruction. For patients who develop complications associated with implant‐based reconstruction, additional surgeries may be challenging. This study examined implant‐based reconstruction failure in patients undergoing salvage with abdominal free tissue transfer. Methods We conducted an Institutional Review Board approved, multicenter retrospective study of patients with implant‐based primary breast reconstruction followed by implant removal and subsequent abdominal free tissue transfer between 2006 and 2016. Patient demographics, treatment details, and complications were evaluated. Severity of implant failure was graded as either (1) not severe (delayed salvage reconstruction) or (2) severe (immediate salvage reconstruction). Results Between 2006 and 2016, 115 patients with 180 mastectomy defects underwent primary implant‐based reconstruction with subsequent implant removal and abdominally based free tissue reconstruction. Of these, 68 were delayed and 47 were immediate salvage reconstruction. Factors leading to elective removal were capsular contracture, asymmetry, and implant malposition. Factors leading to obligatory removal were infection, delayed wound healing, and implant extrusion. Postmastectomy radiation was significantly associated with immediate salvage reconstruction (p < 0.001, odds ratio = 3.9) as were large volume implants (p = 0.06). Deep inferior epigastric perforator flaps comprised 78.3% of all abdominally based free tissue reconstructions, while muscle‐sparing transverse rectus abdominus myocutaneous flaps comprised 18.3%. Overall flap failure rate was 2.6% (2.94% delayed and 2.13% immediate salvage reconstruction; p = 1.0). Conclusion Our findings suggest that abdominal free tissue transfer remains a safe and effective salvage modality for implant‐based breast reconstruction failure. Patients with severe implant failure were more likely to have received radiation. Surgeons should remain cognizant of this during care of patients.

Upper Extremity Peripheral Intravenous Line Infiltration With Concomitant Loss of Pulses Treated With Lipoaspiration: A Case Report.

Peripheral intravenous cannulation in children is associated with occasional morbidity. We present a case where a large volume of blood, administered through a small peripheral cannula in the antecubital fossa, was found to have extravasated into the soft tissues, causing catastrophic vascular compromise. The expedient removal of the extravasate using a lipoaspiration cannula restored perfusion immediately to the affected limb and negated the need for surgical fasciotomies.

Abstract P13: Abdominal versus Thigh Based Reconstruction of Perineal Defects in Cancer Patients

ConClusion: The results suggest that treatment with AMD3100 or plerixafor, alone or in combination with conventional tacrolimus therapy elevates the number of circulating HSPCs as expected. Additionally this treatment led to increases in circulating donor-derived cells in animals following hindlimb transplant. Despite the ability to increase circulating stem cells and peripheral chimerism these treatments did not significantly prolong graft survival. Further studies will explore this disconnect between chimerism and graft survival as well as explore whether variations in the dosing may be more successful in prolonging graft survival. P13 abdominal versus thigh Based reconstruction of Perineal defects in cancer Patients

Abstract 117: CUTANEOUS LYMPHATIC RECONSTITUTION OCCURS DURING THE ACUTE INFLAMMATORY PHASE IN A RAT ORTHOTOPIC HIND LIMB TRANSPLANTATION MODEL

Background: Vascularized composite allotransplantation (VCA) has become a prominent reconstructive option for patients suffering major tissue loss. Wider application is limited by the need for chronic immunosuppression. Recent data suggest that the cutaneous lymphatic system plays an important role in mediating allograft rejection. However, little is known about lymphatic reconstitution in VCA. The purpose of this study was to describe cutaneous lymphatic reconstitution in rat orthotopic hind-limb transplants using near-infrared (NIR) lymphography.

The Superior Pedicle-Nipple Graft Technique Trumps Medial Pedicle Breast Reduction with Nipple Preservation for Management of Gigantomastia

Results: 1,192 consecutive patients underwent 2156 reduction mammaplasties by 17 plastic surgeons for 10 years. For patients who had > 1 kg resection per breast (n=709), techniques included inferior pedicle/Wise pattern (n=298, 42%); superior pedicle/nipple graft (n= 236, 33.3%); and medial pedicle/nipple preservation techniques (n=159, 22.4%). Overall complications for >1 kg reductions included: wound (n= 126, 17.8 %); scar (n= 93, 13.1%); fat necrosis (n= 76, 11%); infection (n= 66, 9.3%); and seroma (n= 23, 3.2%). We also evaluated reoperation for scar (n=51, 7.2%); fat necrosis (n=12, 1.7%); and wound (n= 9, 1.3%). On multiple logistic regression analysis, relative to inferior pedicle, superior and medial pedicle techniques compared favorably for infection (p=0.017/OR = 0.41 and p= 0.027/OR = 0.39, respectively) and reoperation for scar (p=0.05/OR = 0.40 and p= 0.03/OR = 0.28, respectively). Superior pedicle demonstrated a significant advantage over medial pedicle for nonoperative wounds (p=0.002/OR = 0.41 vs. p=0.154/OR = 0.65) and wounds requiring reoperation (p=0.05/ OR = 0.16 vs. p=0.45/OR = 0.51).