Oren Ganor

Online patient resources for breast reconstruction: an analysis of readability.

Background: Online resources for health information are commonly used by many patients. The discrepancy between functional health literacy and available patient information is recognized as an important contributor to health disparities. To provide understandable patient information, the National Institutes of Health and the American Medical Association have advised that health literature for patients be written at a sixth-grade reading level. This study identifies the most popular, online, patient-targeted resources for breast reconstruction information, and evaluates readability of these sites in the context of literacy in the United States. Methods: A Web search for “breast reconstruction” was performed using the two largest Internet search engines, and the top 10 websites common to both were identified. Patient-targeted content was downloaded from all relevant articles immediately available from the main sites. A total of 114 articles were assessed for readability using 10 established analyses. Readability scores were also calculated for the groups of articles arranged by website for comparison. Results: The average reading level was 11.5 across all evaluated sites (Coleman-Liau, 11.8; Flesch-Kincaid, 10.9; FORCAST, 10.7; Fry, 12; Gunning Fog, 12.7; New Dale-Chall, 10.6; New Fog Count, 9.7; Raygor Estimate, 12; and Simple Measure of Gobbledygook, 13). Readability comparison by individual website demonstrated disparity in average reading level from 9.7 to 14.9. Conclusions: Online patient resources for breast reconstruction exceed recommended reading levels and are too difficult to be understood by a large portion of the population. Significant variability between sites provides an opportunity to direct patients to appropriate websites for their level of health literacy.

Academic Productivity of Faculty Associated With Craniofacial Surgery Fellowship Programs

Background: The H-index is increasingly being used as a measure of academic productivity and has been applied to various surgical disciplines. Here the authors calculate the H-index of craniofacial surgery fellowship faculty in North America in order to determine its utility for academic productivity among craniofacial surgeons. Methods: A list of fellowship programs was obtained from the website of the American Society of Craniofacial Surgery. Faculty demographics and institution characteristics were obtained from official program websites and the H-index was calculated using Scopus (Elsevier, USA). Data were assessed using bivariate analysis tools (Kruskal–Wallis and Mann–Whitney tests) to determine the relationship between independent variables and career publications, H-index and 5-year H-index (H5-index) of faculty. Dunn test for multiple comparisons was also calculated. Results: A total of 102 faculty members from 29 craniofacial surgery fellowship programs were identified and included. Faculty demographics reflected a median age of 48 (interquartile range [IQR] 13), a predominantly male sample (88/102, 89.7%), and the rank of assistant professor being the most common among faculty members (41/102, 40.2%). Median of career publications per faculty was 37 (IQR 52.5) and medians of H-index and H5-index were 10.0 (IQR 13.75) and 3.5 (IQR 3.25), respectively. Greater age, male gender, Fellow of the American College of Surgeons membership, higher academic rank, and program affiliation with ranked research medical schools were significantly associated with higher H-indices. Conclusions: Variables associated with seniority were positively associated with the H-index. These results suggest that the H-index may be used as an adjunct in determining academic productivity for promotions among craniofacial surgeons.

Effects of statins on ischemia–reperfusion complications in breast free flaps

BACKGROUND Administration of statins or other cardiovascular medications (CVMs) could potentially protect against the development of ischemia-reperfusion (I/R) injury in free flap reconstruction. The aim of this study was to examine whether the use of statins and other CVMs decreased the rate of I/R injury in autologous free flap breast reconstruction. METHODS Retrospective chart review was performed on women who had undergone mastectomy and autologous free flap breast reconstruction between 2004 and 2010. Patient characteristics, use of statin and/or CVMs, and I/R-related complications were ascertained. Multivariable logistic regression was used to identify associations between independent risk factors and specific complications. RESULTS There were 702 free flap breast reconstructions included in this study; 45 performed in patients on statins, 70 in patients on CVMs, and 38 in patients on both. Overall complication rate in patients on statins and patients on CVMs was significantly higher than those not on any medication (46.7% versus 31.5%, P=0.037 and 45.7% versus 31.5%, P=0.017, respectively). When I/R complications were pooled, there were no significant differences between patients not on any medications and those on statins (P=0.26), CVMs (P=0.18), and both (P=0.83.) CONCLUSIONS Although there may be theoretical pharmacologic benefits of statins and/or CVMs to reduce the incidence of IR injury in autologous free flap breast reconstruction, the results of this study showed no clear advantages when these drugs were used.

Abstract: Preoperative Genital Surgery Priorities in Transgender Men

BACKGROUND: Nerve transfer is the main reconstructive option for facial reanimation in short-term facial paralysis when the main trunk of the facial nerve is damaged, but distal nerve branches remain functional and mimetic muscles are still viable. The use of fibrin glue for peripheral nerve repair was relatively uncommon until the first commercially available fibrin sealant was introduced in the 1980s . In this article we describe the use of fibrin sealant for nerve coaptation without sutures in masseter-to-facial nerve transfer; and the results obtained utilizing this technique in a series of eleven patients.

Abstract 37. Pediatric Orbital Floor Fractures: Clinical and Radiological Predictors of Tissue Entrapment and the Effect of Operative Timing on Ocular Outcomes

37. Pediatric Orbital Floor Fractures: Clinical and Radiological Predictors of Tissue Entrapment and the Effect of Operative Timing on Ocular Outcomes The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Firriolo, Joseph M., Nicole C. Ontiveros, Carolyn M. Pike, John G. Meara, Arin K. Greene, Oren Ganor, Amir Taghinia, and Brian I. Labow. 2017. “Abstract 37. Pediatric Orbital Floor Fractures: Clinical and Radiological Predictors of Tissue Entrapment and the Effect of Operative Timing on Ocular Outcomes.” Plastic and Reconstructive Surgery Global Open 5 (2 Suppl): 40-41. doi:10.1097/01.GOX.0000513452.31374.f3. http:// dx.doi.org/10.1097/01.GOX.0000513452.31374.f3. Published Version doi:10.1097/01.GOX.0000513452.31374.f3 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:32072205 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-ofuse#LAA

Pediatric Orbital Floor Fractures: Clinical and Radiological Predictors of Tissue Entrapment and the Effect of Operative Timing on Ocular Outcomes

Abstract Orbital floor fractures can produce acute constitutional symptoms and poor ocular outcomes. This study aims to determine the clinical and radiological predictors of tissue entrapment in pediatric orbital floor fractures and to explore the effect of operative timing on ocular outcomes. The authors reviewed medical records from pediatric patients with orbital floor fractures from 2007 to 2015. One hundred fifty-two patients with 159 orbital floor fractures were included. One hundred twenty-two (80.3%) patients were male, and the mean age was 12.2 years. Twelve patients sustained orbital floor fractures with tissue entrapment. At presentation extraocular movement (EOM) restriction, diplopia, nausea, and vomiting were all associated with tissue entrapment (P < 0.001). Among patients with trapdoor fractures (determined by facial computed tomography), the presence of nausea and/or vomiting was predictive of tissue entrapment: positive predictive value 80%, negative predictive value 100%. For all the patients, regardless of fracture configuration, the presence of nausea and/or vomiting was valuable in ruling out tissue entrapment: sensitivity 83.3%, negative predictive value 98.1%. In tissue entrapment patients, poorer ocular outcomes (EOM restriction and diplopia) were associated with the length of operation (P = 0.007), but not the time interval to operation (P = 0.146). The authors conclude that nausea and vomiting are valuable predictors of tissues entrapment, particularly when EOM restriction and diplopia are equivocal. In the authors’ study, radiological findings were also predictive of entrapment, but inconsistent language in this area limits the external validity of these results. The authors’ study draws attention to the relationship between operation length and poorer ocular outcomes, suggesting that case severity/complexity and surgeon technique/experience may influence outcomes.