One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites.

There is an increasing trend of nonplastic surgeons performing breast surgery. Within, we evaluate the representation of plastic surgeons listed for breast reconstruction on major hospital system websites within the United States. Methods: The website search engines for the top 20 US medical centers according to the US News and World Report's Hospital Rankings from 2020 to 2021 were queried for search terms pertaining to breast reconstruction. Information collected for search results included gender, if they were a physician, medical specialty, medical school and residency attended, and each individual's position within the search results. Results: Across 80 distinct search attempts, 27 searches (34%) produced no results. The search term "breast reconstruction" yielded the most plastic surgeon search results, with plastic surgeons composing 39% of all search results. The search term "mastectomy" generated the least number of plastic surgeon results, with a 16% representation of plastic surgeons. Nearly two-thirds of physicians identified were nonplastic surgeons (67%). Other surgeons represented 47% of search results and obstetricians/gynecologists, 2%. Nonsurgeons represented 18% of queries. On average, plastic surgeons appeared higher on search lists than nonplastic surgeons, 13th to 39th, respectively (P < 0.001). Conclusions: Plastic surgeons composed only a third of physicians identified, and a third of searches produced no results. Patients interested in breast reconstruction may encounter difficulty finding an appropriate plastic surgeon. Inadequate search engines on hospital websites introduce inefficiencies for the entire health care systems and may negatively impact hospital and physician bottom line.

The effect of procedural end-tidal CO2 on infarct expansion during anterior circulation thrombectomy.

BACKGROUND: Carbon dioxide is a potent cerebral vasodilator that may influence outcomes after ischemic stroke. The objective of this study was to investigate the effect of intraprocedural mean end-tidal CO2 (ETCO2) levels on core infarct expansion and neurologic outcome following thrombectomy for anterior circulation ischemic stroke. METHODS: A retrospective review was conducted of consecutive patients from March 2020 to June 2021 who underwent mechanical thrombectomy for acute anterior circulation ischemic stroke under general anesthesia and achieved successful recanalization (Thrombolysis in Cerebral Infarction [TICI] ≥ 2b). Only patients with CT perfusion, procedural ETCO2, and postoperative MRI data were included. Segmentation software was used for multi-parametric image analysis. Normocarbia defined as mean ETCO2 of 35 mmHg was used to dichotomize subjects. Univariate and multivariate statistics were applied. RESULTS: Fifty-eight patients met criteria for analysis. Of these, 44 had TICI 3 recanalization, 9 had TICI 2c, and 5 had TICI 2b. Within this combined recanalization group, patients with mean ETCO2 > 35 had significantly higher rates of functional independence at 90 days. Although patients tended to salvage more penumbra and experience smaller final infarcts when ETCO2 exceeded 35 mmHg, this did not reach statistical significance. CONCLUSIONS: Stroke patients who underwent successful thrombectomy with general anesthesia achieved higher rates of functional independence when procedural ETCO2 exceeded 35 mmHg. Further studies to confirm this effect and investigate optimal ETCO2 parameters should be considered.

Three-Dimensionally Printed Skin Substitute Using Human Dermal Fibroblasts and Human Epidermal Keratinocytes.

INTRODUCTION: Wound healing affects millions of people annually. After injury, keratinocytes from the wound edge proliferate, migrate, and differentiate to recapitulate the 3-dimensional (3D) structure needed to provide a barrier function. If the wound is too large, skin grafting may be required. We are interested in discovering novel strategies to enhance the wound healing process. It may be possible to recreate a viable and histologically accurate skin tissue using 3D printing. We hypothesize that keratinocytes and dermal fibroblasts can be bioprinted into a viable skin substitute. METHODS: Adult human dermal fibroblasts (HDFa) and adult human epidermal keratinocytes (HEKa) were cultured and subsequently printed with a 3D bioprinter within a hydrogel scaffold. After printing the HDFa and HEKa separately, cell viability and histological appearance were determined by sectioning the printed tissue and performing hematoxylin and eosin staining. The stained histological sections were analyzed for tissue morphology. RESULTS: The HEKa and HDFa cells suspended in the hydrogel were successfully printed into 3D scaffolds that resembled skin with hematoxylin and eosin staining. CONCLUSIONS: The HEKa and HDFa cells can be grown on 3D-printed hydrogels successfully. In addition, HEKa and HDFa cells can survive and grow when suspended in a hydrogel and 3D printed. Future potential applications of these results could lead to the creation of viable skin tissue for wound healing and surgical repair.