Immediate Prepectoral Tissue Expander Breast Reconstruction Without Acellular Dermal Matrix Is Equally Safe Following Skin-Sparing and Nipple-Sparing Mastectomy.

BACKGROUND: Prepectoral breast reconstruction has become increasingly popular over the last decade. There is a paucity of data surrounding the impact of mastectomy type on clinical outcomes when comparing prepectoral immediate breast reconstruction without acellular dermal matrix (ADM) using tissue expansion. The purpose of this study was to compare 90-day reconstructive surgical outcomes in immediate prepectoral tissue expander reconstruction between patients with nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM). METHODS: A retrospective review of patient records was carried out on all patients undergoing NSM or SSM with immediate prepectoral tissue expander reconstruction without ADM, in a single institution, from June 2020 to December 2021. All complications were recorded, categorized, and statistically analyzed for significance. RESULTS: Seventy-nine patients (97 breasts) were studied. The mean age was 51 years old (range, 31-77). Twenty-two patients suffered complications recorded in 22 breasts (22.7%). There was no statistically significant difference in the total complications between the NSM (25.7%) and SSM (21.0%) groups or in the incidence of all major and minor complications. CONCLUSIONS: Breast reconstruction using tissue expanders without ADM has similar reconstructive outcomes in both NSM and SSM. There were no significant differences in complication rates between either groups. Breast reconstruction without ADM can confer institutional cost savings without compromising safety.

Utility and Comparative Performance of Current Artificial Intelligence Large Language Models as Postoperative Medical Support Chatbots in Aesthetic Surgery.

BACKGROUND: Large Language Models (LLMs) have revolutionized the way plastic surgeons and their patients may access and leverage artificial Intelligence (AI). OBJECTIVES: The present study aims to comparatively assess the performance of two current publically-available and patient-accessible LLMs in the potential application of AI as postoperative medical support chatbots in an aesthetic surgeon's practice. METHODS: Twenty-two simulated postoperative patient presentations following aesthetic breast plastic surgery were devised and expert-validated. Complications varied in their latency within the postoperative period, as well as urgency of required medical attention. In response to each patient-reported presentation, Open AI's ChatGPT and Google's Bard, in their unmodified and freely available versions, were objectively assessed for their comparative accuracy in generating an appropriate differential diagnosis, most likely diagnosis, suggested medical disposition, treatments or interventions to begin from home, and/or red flag signs/symptoms indicating deterioration. RESULTS: ChatGPT cumulatively and significantly outperformed Bard across all objective assessement metrics examined (66% vs. 55%, respectively; p < 0.05). Accuracy in generating an appropriate differential diagnosis were 61% for ChatGPT, and 57% for Bard (p = 0.45). ChatGPT asked an average of 9.2 questions on history, relative to 6.8 questions by Bard (p < 0.001), following which, accuracies of 91% vs. 68% at arriving at the most-likely diagnosis were noted, respectively (p < 0.01). Appropriate medical dispositions were suggested with an accuracy of 50% by ChatGPT, and 41% by Bard (p = 0.40); relevant home interventions/treatments with an accuracy of 59% and 55% (p = 0.94), and red flag signs/symptoms with accuracies of 79% and 54% (p < 0.01), respectively. Detailed and comparative performance breakdowns according to complication latency and urgency are presented herein. CONCLUSIONS: ChatGPT represents the superior LLM for the potential application of AI technology in postoperative medical support chatbots. Imperfect performance and limitations identified herein may guide the necessary refinement to facilitate adoption.

The Ever-Present Costs of Cosmetic Surgery Tourism: A 5-Year Observational Study.

BACKGROUND: Cosmetic surgery tourism is an ever-growing industry. Despite its associated risks, an increasing number of patients are presenting to NHS services with resulting complications. This study aims to evaluate the current presentation patterns for complications in cosmetic surgery tourism, and the financial burden to the NHS reported by a single UK level one trauma centre in Birmingham, UK. METHODS: From 2015 to 2020, all patients presenting to the department of plastic surgery with complications of cosmetic surgery performed outside of the UK were included. Data were collected for patients' characteristics including demographics, performed procedures, complications and treatment. A cost analysis was performed for each patient using published "National Schedule of NHS Costs." RESULTS: A total of 26 patients presented to our hospital within the study period. All patients were female, with the mean age being 35.1 years (range 22-55years). A total of 32 cosmetic procedures were undertaken, with the majority performed in Turkey (n = 14). Abdominoplasty was the most common procedure, followed by gluteal enhancement surgery. The total financial cost to the NHS from all cosmetic surgery-related complications was £152,946, with an average cost per patient of £5,882.54 (range £362-£26,585). CONCLUSION: Patients seek out medical tourism for multiple reasons including cost savings, shorter waiting times and surgical expertise. The costs displayed should predominantly be viewed as a reflection of the detrimental effect these complications can have on patients' lives. Global governing bodies should focus efforts on educating patients and raising awareness on this ever-prevalent issue. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The effect of COVID-19 lockdown on the incidence of deliberate self-harm injuries presenting to the emergency room.

OBJECTIVE: The World Health Organization declared COVID-19 a pandemic on 11th March 2020. The UK government introduced strict social distancing measures on 23rd March 2020, with the country put into a full lockdown to further halt the spread of the virus.The aims of this article are to ascertain whether there was a rise in the incidence of deliberate self-harm (DSH) presentations to the emergency department at a level one trauma center associated with the introduction of lockdown measures. METHOD: An observational study from a level one trauma center was carried out. Retrospective data from 23rd March 2020 to 1st May 2020 was collected and compared to the same time period in 2019. Data was collected from coded electronic patient records. RESULTS: Total attendances to the Emergency Department (ED) reduced from 2019 to 2020 (5198 and 3059 respectively). There was a significant increase in the total number of self-harm presentations between 2019 and 2020 (103 vs 113, p-value <0.001) as well as paracetamol, NSAID and opiate overdoses, with more cases requiring hospital admission in 2020 vs 2019. CONCLUSIONS: Societal lockdown measures secondary to the COVID-19 pandemic have had a significant effect on the mental health of patients. One way this can be detected is through an increased incidence and severity of deliberate self-harm injuries presenting to the ED. These findings, in conjunction with the available, literature provide valuable implications for community and emergency physicians and psychiatrists for any future wave of disease or pandemic.

Successful penile replantation after complete amputation and 23 hours ischaemia time: the first in reported literature.

Complete penile amputation is a rare and poorly documented injury with severe physical and psychosocial implications. Our institution presents a case of successful penile replantation following 23 hours of ischaemia time in a 34-year-old man with a history of paranoid schizophrenia who sustained a complete penile amputation during an act of deliberate self-harm. To the best of our knowledge, this is the longest documented ischaemia time for a successful penile replant in literature. The patient was able to achieve a full erection as early as 6 weeks postoperatively. Skin necrosis was noted as a common complication and this was successfully managed with debridement and skin grafting. Penile amputation injuries should be managed in a specialist centre with urological and plastic surgeons with expertise in microsurgical reconstruction. Penile replantation should be attempted, even if ischaemia time is prolonged, despite lower success rates given the significance of the injury to an individual.

The benefits of latex-free gloves in the operating room environment.

Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.

Properties and use of a honey dressing and gel in wound management.

Wound management is a major clinical challenge and puts a significant financial burden on the NHS. Because of the rise in long-term conditions including diabetes, obesity and an ageing population, practitioners regularly encounter a wide variety of wound types. In recent years, there has been a resurgence of interest in the use of medical-grade honey in the management of wounds. Honey is anti-inflammatory in action and has the capability to treat local infection, promote autolytic debridement, deodorise wounds and promote granulation tissue. Revamil is a recent addition to the range of honey dressings available and is intended to manage the majority of problems that may arise during wound care episodes. The attributes of Revamil will be illustrated through four case studies.