Visual Perception of Breast Free Flap Size Is Influenced by Radiation Changes of Surrounding Tissue.

BACKGROUND: Microsurgical reconstruction for bilateral mastectomy defects after unilateral radiation often results in asymmetry, despite both flap tissues never being radiated. METHODS: Photos of 16 patients who received prior radiation to one breast and underwent bilateral abdominal free flap reconstruction were taken postoperatively. Layperson and expert assessment were attained via online crowdsourcing and a panel of attending surgeons and senior residents. Stratification by interflap weight differences was done for subanalysis. RESULTS: A total of 399 laypersons responded, with the majority (57.3%) reporting that the radiated breast appeared smaller than the nonradiated breast. When the photos were stratified by interflap weight differences, the photos with the radiated side flap weight over 3% more than nonradiated side were significantly more likely to be perceived by laypersons as the same size (odds ratio [OR] = 2.7; p < 0.001) and of similar aesthetic (OR = 1.9; p < 0.001) when compared with photos with same-sized flaps. Of the expert responses (n = 16), the radiated side was perceived as smaller 72.3% of the time and the nonradiated side appeared more aesthetic 52.7% of the time. Contrary to layperson responses, the experts tend to report the radiated side as smaller despite varying flap weight. Interestingly, expert raters were significantly more likely to rate the flaps of equal aesthetics when the radiated side has a flap larger by 3% or more (OR = 3.6; p < 0.001). CONCLUSION: Higher aesthetic scores were noted when larger flaps were inset to the radiated envelope by both laypersons and experts, suggesting potential technical refinement in reconstructive outcomes.

An Analysis of Male Plastic Surgery Content on TikTok.

BACKGROUND: TikTok is a powerful and popular source of patient education. However, the lack of content regulation raises concerns about the spread of medical misinformation. OBJECTIVES: We aimed to analyze the source, content, quality, and reliability of TikTok posts focusing on surgical and nonsurgical cosmetic treatments for men. METHODS: A search was conducted on TikTok with 16 popular hashtags related to male cosmetic procedures. The top 25 male-focused videos from each hashtag were chosen for analysis. Videos were categorized by content creator, video type, and descriptive metrics. Educational videos were evaluated for quality with the validated modified DISCERN (mDISCERN) score and the Patient Education Materials Assessment Tool (PEMAT) scale. Statistical analysis was performed with univariate and linear regression models. RESULTS: The included 399 videos totaled 389 million views, 16.4 million likes, 174,594 comments, and 586,743 shares. Most videos were uploaded by plastic and reconstructive surgeons (38.3%). A significant number (38%) of videos by physicians were posted by international physicians, with videos by United States physicians receiving fewer views, comments, and shares than videos posted by international physicians. Patient experience was the most common video category (48.9%). Educational videos had low overall quality, with physician-created videos demonstrating higher DISCERN and PEMAT scores but lower engagement compared to nonphysician videos. CONCLUSIONS: The quality of TikTok videos on male cosmetic surgery was generally low, emphasizing the importance of accurate information dissemination by physicians on social media. The strong presence of international physicians highlights the potential implications of social media on medical tourism.

Prejuvenation: What Social Media Tells Us About the Rising Trend.

BACKGROUND: "Prejuvenation," a practice gaining enormous popularity among younger adults, can largely attribute its explosive growth to TikTok, the platform on which many first encounter this trend. Despite the rising usage of prejuvenation, however, there is a lack of clarity regarding its clinical practice and efficacy. OBJECTIVES: To investigate the understandability, reliability, and actionability of prejuvenation-related TikTok content. METHODS: TikTok was queried using 13 hashtags consisting of popular colloquial terms associated with prejuvenation treatments, and the top 25 videos meeting inclusion criteria for each hashtag were analyzed. For each video, poster credentials and video type were determined. Videos considered "educational" were analyzed using the validated modified DISCERN score and the Patient Education Materials Assessment Tool scales. Creator's prejuvenation recommendations were recorded. Univariate and linear regression models were utilized for analysis. RESULTS: A total of 303 videos amassed over 61,000,000 million views, 3,957,091 likes, 24,455 comments, and 71,697 shares. Nonphysicians posted the most videos (n = 257, 84.8%) and had significantly higher median views, likes, comments, and engagement than physician videos. Analysis of "educational" videos showed that most videos (50, 67%) supported the use of prejuvenation treatments, 18 (24%) were neutral, and 6 (8%) were opposed. CONCLUSIONS: Prejuvenation content on TikTok varies widely in terms of quality and recommendations, calling for more standardization regarding the practice. Physician-generated prejuvenation content was more reliable, but distinguishing it from nonphysician content was challenging, underscoring the need for platform-specific verification tools.

Prevalence and Risk Factors for Missed Short-term Follow-up After Primary Total Shoulder Arthroplasty.

INTRODUCTION: The importance of consistent postoperative follow-up has been established for collecting patient-reported outcomes and surveilling for potential complications. Despite this, the prevalence of and risk factors for missed short-term follow-up after elective shoulder arthroplasty remain limited. METHODS: A retrospective review of consecutive primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty cases with a minimum of 12-month follow-up performed by a single, fellowship-trained shoulder surgeon was undertaken from January 2015 to December 2021. Demographic patient and surgical data, including age, sex, marital status, self-identified race, body mass index, American Society of Anesthesiologists score, age-adjusted Charlson Comorbidity Index, prior ipsilateral shoulder surgery and/or contralateral arthroplasty, distance from home to clinic, smoking status, and hospital length of stay, were collected. The follow-up at 1 week, 6 weeks, 6 months, 12 months, and 24 months and beyond was determined. Patient-related and surgical predictors for missing the 12-month and 24-month follow-up were identified. RESULTS: There were 295 cases included (168 aTSA and 127 reverse total shoulder arthroplasty), of whom 199 (67%) were women. Of the total cases, 261 (86%) were eligible for 24-month follow-up. Patients undergoing aTSA, those of younger age, those of male sex, and those who missed their 6-week and 6-month follow-up were significantly more likely to miss the 12-month follow-up visit. Following multivariable analysis, a missed 6-month follow-up (OR 10.10, 95% CI 5.32 to 19.16, P < 0.001) was associated with 12-month visit nonattendance, and increasing age (per year) (OR 0.96, 95% CI 0.93 to 0.99, P = 0.011) was associated with improved 12-month follow-up. Not having a surgical complication within 6 months postoperatively, not undergoing ipsilateral revision arthroplasty, and missing the 1-week and 12-month follow-up were significantly associated with missing the 24-month follow-up. After multivariable analysis, missing the 1-week (OR 3.07, 95% CI 1.12 to 8.41, P = 0.029) and 12-month (OR 3.84, 95% CI 2.11 to 6.99, P < 0.001) follow-ups was associated with missing the 24-month visit, whereas having a postoperative complication was associated with increased attendance at 24 months (OR 0.38, 95% CI 0.14 to 0.99, P = 0.047). DISCUSSION: Strategies for preventing missed short-term follow-up should be focused on ensuring that patients undergoing TSA attend the 6-month and 12-month visit, particularly among younger patients and those with an uneventful postoperative course.

Does Morbid Obesity (BMI ≥40 kg/m2) Impact Operative Time, Blood Loss, Length of Stay, or Complications Following Anatomic Total Shoulder Arthroplasty?

Objectives: There have been conflicting reports regarding the effects of obesity on both surgical time and blood loss following anatomic shoulder arthroplasty. Varying categories of obesity has made comparison amongst existing studies difficult. Methods: A retrospective review of consecutive anatomic shoulder arthroplasty cases (aTSA) was undertaken. Demographic data, including age, gender, body mass index (BMI), age-adjusted Charleson Comorbidity Index (ACCI), operative time, hospital length of stay (LOS), and both POD#1 and discharge visual analogue score (VAS) was collected. Intra-operative total blood volume loss (ITBVL) and need for transfusion was calculated. BMI was categorized as non-obese (<30 kg/m2), obese (30-40 kg/m2) and morbidly obese (≥40 kg/m2). Unadjusted associations of BMI with operative time, ITBVL and LOS were examined using Spearman correlation coefficients. Regression analysis was used to identify factors associated with hospital LOS. Results: There were 130 aTSA cases performed, including 45 short stem and 85 stemless implants, of which 23 (17.7%) were morbidly obese, 60 (46.2%) were obese and 47 (36.1%) were non-obese. Median operative time for the morbidly obese cohort was 119.5 minutes (IQR 93.0, 142.0) versus 116.5 minutes (IQR 99.5, 134.5) for the obese cohort versus 125.0 minutes (IQR, 99.0, 146.0) for the non-obese cohort. (P=0.61) The median ITBVL for the morbidly obese cohort was 235.8 ml (IQR 144.3, 329.7) versus 220.1 ml (IQR 147.7, 262.7) for the obese cohort versus 216.3 ml (IQR 139.7, 315.5) for the non-obese cohort. (P=0.72). BMI ≥40kg/m2 (IRR 1.32, P=0.038), age (IRR 1.01, P=0.026), and female gender (IRR 1.54, P<0.001) were predictive of increased LOS. There was no difference with regards to in-hospital medical complications (P=0.13), surgical complications (P=1.0), need for re-operation (P=0.66) and 30-day return to the ER (P=0.06). Conclusion: Morbid obesity was not associated with increased surgical time, ITBVL and perioperative medical or surgical complications following aTSA, though it was predictive of increased hospital LOS.

TransTok - An analysis of surgical gender affirmation content on TikTok.

PURPOSE: Social media platforms are popular sources of medical information but may harbor harmful misinformation. This study aims to evaluate the effect of TikTok on the transgender population, which may be more likely to seek information from non-traditional sources because of high medical mistrust. METHODS: Twenty gender affirmation related hashtags were queried, with the top 25 videos per hashtag included for analysis. Videos were categorized based on the content and creator. Variables included likes, comments, shares, and video views. All "educational" videos were analyzed for reliability of information using a modified DISCERN (mDISCERN) score and the Patient Education Materials Assessment Tool (PMAT). Kruskal-Wallis H tests, Mann-Whitney U tests, and simple linear regression models were used in analysis. RESULTS: A total of 429 videos amassed 571,434,231 views, 108,050,498 likes, 2,151,572 comments, and 190,9744 shares. Patients were the majority of content creators (74.88%), with patient experiences being the majority of videos (36.07%). Non-physician creators had significantly higher likes and comments when compared to physicians (6185 vs. 1645, p = 0.028; 108 vs. 47, p = 0.016 respectively). Sixty "educational" videos were included in information reliability analysis. There were no significant differences between video characteristics of different content creators, even after stratifying according to physician status. Significant differences were observed in the reliability of information according to PMAT and mDISCERN scores, with physician created videos being significantly higher rated than non-physician created videos (0.90 vs. 0.84, p < 0.001; 3 vs. 2, p < 0.001, respectively). CONCLUSION: Lower quality information is associated with non-physician content creators. We encourage physicians to be continuously involved in creating quality information on TikTok.

An Analysis of Cosmetic Facial Injectable Treatment Content on TikTok.

BACKGROUND: TikTok is a powerful and popular source of patient education. However, the lack of content regulation allows for the potential spread of medical misinformation. OBJECTIVES: The aim of this study was to analyze the source, content, quality, and reliability of TikTok posts regarding nonsurgical cosmetic facial injectable treatments, including Botox and fillers. METHODS: The TikTok application was queried with 14 popular hashtags related to nonsurgical facial injectable treatments. The top 25 search result videos from each hashtag were included in the analysis. Videos were categorized based on content creator, video type, and descriptive metrics collected for each result. Educational videos were further analyzed for content quality with the validated modified DISCERN score and the Patient Education Materials Assessment Tool (PEMAT) scales. Univariate and linear regression models were utilized for content analysis between groups. RESULTS: The included 340 videos totaled 306,552,644 views; 22,715,689 likes; 220,072 comments; and 352,614 shares. Most videos were uploaded by nonphysician healthcare providers (n = 126, 37.1%), and patient experience (n = 130, 38.2%) was the most common video category. Healthcare team content creators had significantly lower median views, likes, comments, shares, and engagement when compared to non-healthcare team content (P < .001). DISCERN scores for information reliability were significantly higher in physician-created videos than nonphysician and nonphysician healthcare provider created videos (2 vs 1.5, P < .001, 2 vs 1.5 P = .001, respectively). CONCLUSIONS: The overall quality of TikTok videos regarding nonsurgical cosmetic facial injectable treatments was low, which may stem from a lack of content from physician content creators.

Language Disparity Predicts Poor Patient-Reported Outcome and Follow-Up in Microsurgical Breast Reconstruction.

BACKGROUND: Patients with limited English proficiency (LEP) have starkly different health care experiences compared with their English-proficient counterparts. The authors aim to examine the link between LEP and postoperative outcomes in patients undergoing microsurgical breast reconstruction. METHODS: A retrospective review of all patients who underwent abdominal-based microsurgical breast reconstruction at our institution between 2009 and 2019 was performed. Variables collected included patient demographics, language status, interpreter usage, perioperative complications, follow-up visits, and self-reported outcomes (Breast-Q). Pearson's χ 2 test, Student's t-test, odds ratio analysis, and regression modeling were used for analysis. RESULTS: A total of 405 patients were included. LEP patients comprised 22.22% of the overall cohort with 80% of LEP patients utilizing interpreter services. LEP patients reported significantly lower satisfaction with an abdominal appearance at the 6-month follow-up and lower physical and sexual well-being scores at the 1-year follow-up (p = 0.05, 0.02, 0.01, respectively). Non-LEP patients had significantly longer operative times (539.6 vs. 499.3 minutes, p = 0.024), were more likely to have postoperative donor site revisions (p = 0.05), and more likely to receive preoperative neuraxial anesthesia (p = 0.01). After adjusting for confounders, LEP stats was associated with 0.93 fewer follow-up visits (p = 0.02). Interestingly, compared with LEP patients who did not receive interpreter services, LEP patients who did had 1.98 more follow-up visits (p = 0.02). There were no significant differences in emergency room visits or complications between the cohorts. CONCLUSION: Our findings suggest that language disparities exist within microsurgical breast reconstruction and underscore the importance of effective, language-conscious communication between surgeon and patient.

The Impact of Prior Infection With SARS-Cov-2 on Surgical Outcomes in Patients Undergoing Abdominal Body Contouring Procedures.

BACKGROUND: There is evidence of increased postoperative complications in patients who have recovered from SARS-CoV-2. However, previous studies have not examined this effect in abdominal contouring procedures. METHODS: A retrospective review was conducted for all patients who underwent abdominoplasty or panniculectomy at our institution from March 2020 to November 2021. Patients were separated into cohorts via preoperative history of SARS-CoV-2 infections. Variables collected include demographic data, concurrent comorbidities, postoperative complications, readmission/reoperation, and length of stay. Parametric, nonparametric, and multivariable regression modeling was used for analysis. RESULTS: Of the 181 patients included, 14 (7.7%) had a prior SARS-CoV-2 infection. Average time from infection to surgery was 250 days. The mean age and Charlson Comorbidity Index for nonexposed and exposed patients were 45.4 and 45.9 years, and 1.24 and 1.36 points. Patients with prior SARS-CoV-2 infection were more likely to have chronic kidney disease (odds ratio [OR], 6.79; P = 0.017) and undergo abdominoplasties compared with panniculectomies (OR, 4.43; P = 0.039). There were no other significant differences in patient or operative characteristics between the cohorts. Compared with those with no history of infection, patients with prior infections had increased odds of postoperative complications such as delayed wound healing (OR, 27.67; P < 0.001). No other significant associations were found between prior SARS-CoV-2 infection and perioperative outcomes. CONCLUSION: Prior SARS-CoV-2 infections may be associated with increased incidence of delayed wound healing despite a significant time lag between the time of infection and operation. Further studies are needed to elucidate the exact relationship and mechanism of action behind these findings.

Prevalence, Prevention, and Treatment of Work-Related Musculoskeletal Disorders Among Microsurgeons.

BACKGROUND: While work related musculoskeletal disorders have been well recognized among all surgeons, and microsurgeons in particular; their prevention and treatment are presently unknown. Our study aims to define the impact of musculoskeletal ailments on microsurgeons and investigate trends in microsurgeon musculoskeletal injury treatment. METHODS: An electronic survey was sent to all members of the American Society of Reconstructive Microsurgery. The survey solicited surgeon demographics, microsurgical volume, equipment usage, history of musculoskeletal injury, impact of injury, and interventions / treatment modalities used to address / prevent these issues. RESULTS: Of the 883 microsurgeons surveyed, 203 responded (23% response rate). The average age was 45 years (IQR 39-52 years). Most microsurgeons were male (80.8%). Musculoskeletal injury or symptoms related to microsurgery were reported by 137 respondents (67.0%). Fifty surgeons (37.9%) reported that their musculoskeletal injury had adversely affected their practice. Formal medical intervention was sought by 53 respondents (26.1%), with 17 surgeons (8.4%) undergoing surgical intervention. Self-treated was used by 127 microsurgeons (62.6%) for musculoskeletal ailments. Preventative treatments such as strength training, stretching, yoga, massages, and diet were the most beneficial, each with utilization scores of 4 out of 5. CONCLUSION: A majority of microsurgeons experience musculoskeletal injury, and some even require surgery to treat their musculoskeletal pathology. Prophylactic practices such as strength training, stretching, yoga, massages, and diet maintenance, are the superior treatment for musculoskeletal injury. Microsurgeons should incorporate training routines in their lives as injury prophylaxis to improve their career longevity and patient care.

A 20-Year Analysis of Global Authorship Trends in Craniofacial Literature: Is the United States Falling Behind?

INTRODUCTION: Recent advances in craniofacial surgery have occurred in conjunction with a global proliferation of research. Although previous studies have examined geographic publication trends, little is known about these trends in the craniofacial literature. METHODS: All craniofacial articles published from 2000 to 2020 in 3 premier craniofacial surgery journals were evaluated in 5-year increments. Geographic origin, manuscript type, and authorship characteristics were collected. Changes in publication output, geographic origin, and content were analyzed. RESULTS: In total 3864 articles were analyzed, with the United States (U.S.) (33.46%) accounting for the majority, followed by Asia (27.04%), the Middle East (16.23%), and Europe (14.65%). The proportion of articles from the U.S. decreased significantly in the in the 20-year span (48.28% versus 33.53%, P < 0.001), whereas those originating from Asia and the Middle East increased significantly (18.62% versus 31.41% and 10.34% versus 15.66%, respectively, P < 0.001). After stratifying and selecting for regions with the greatest changes in publication output, the authors observed significant trends for the number of original investigations from 2000 to 2020 in the U.S. (Odds Ratio [OR] 1 versus 2.4, P < 0.001) and in Asia (OR 1 versus 1.8, P = 0.0052). Additionally, a significant trend in editorial/correspondence publications originating in the U.S. (OR 1 versus 0.74, P = 0.0102), Europe (OR 1 versus 0.38, P = 0.0186), and Asia (OR 1 versus 0.48, P = 0.0051) was observed. CONCLUSIONS: Despite rising craniofacial publications over the past 2 decades, there has been a diminishing proportion originating from the U.S.