Exploring Trends in Immediate Postresidency Career Paths: A Multi-year Analysis of Plastic Surgery Resident Graduates Across the United States.

Background: Plastic surgery is one of the most diverse specialties in medicine. Because of the competitiveness of plastic surgery residency, applicants are entering the field with increased experience and more developed interests in specific specialties. Programs and prospective applicants may find it beneficial to know trends in the career paths of recent graduates. Objectives: To identify trends in postresidency career paths for plastic surgery graduates. Methods: Data from all integrated plastic surgery residency programs were analyzed from 2013 to 2022. Eighty-eight residency programs were analyzed for review. Residency websites were the primary source of data. Postresidency career paths were categorized into subspecialty fellowships, academic practice, or private practice. Secondary data included program rank, size of the program, associated fellowship program, associated independent program, and program location. Results: Seventy-three programs met the inclusion criteria. Private practice was the most common immediate postgraduation path. Microvascular and aesthetic fellowships demonstrated maximum growth in the last 10 years, followed by hand fellowships. Programs ranked in the top 25 by Doximity reputation were significantly associated with graduates going into craniofacial (P = .05) and microvascular fellowship (P = .021), and immediate academic practice (P = .011). Lower-ranked programs were correlated with higher levels of graduates entering directly into private/community hospital practice (ρ = 0.327). Conclusions: Life after residency is a necessary consideration for training physicians. Understanding trends in postresidency career paths could help programs and prospective applicants make more informed decisions on what programs may offer the best opportunities to pursue their desired career path.

The use of patient-derived breast tissue explants to study macrophage polarization and the effects of environmental chemical exposure.

Ex vivo mammary explant systems are an excellent model to study interactions between epithelium and stromal cell types because they contain physiologically relevant heterotypic interactions in the background of genetically diverse patients. The intact human mammary tissue, termed patient-derived explant (PDE), can be used to investigate cellular responses to a wide variety of external stimuli in situ. For this study, we examined the impact of cytokines or environmental chemicals on macrophage phenotypes. We demonstrate that we can polarize macrophages within human breast tissue PDEs toward M1 or M2 through the addition of interferon-γ (IFNγ) + lipopolysaccharide (LPS) or interleukin (IL)-4 + IL-13, respectively. Elevated expression levels of M(IFNγ + LPS) markers (HLADRA and CXCL10) or M(IL-4 + IL-13) markers (CD209 and CCL18) were observed in cytokine-treated tissues. We also examined the impact of the endocrine-disrupting chemical, benzophenone-3, on PDEs and measured significant, yet varying effects on macrophage polarization. Furthermore, a subset of the PDEs respond to IL-4 + IL-13 through downregulation of E-cadherin and upregulation of vimentin which is reminiscent of epithelial-to-mesenchymal transition (EMT) changes. Finally, we were able to show immortalized nonmalignant breast epithelial cells can exhibit EMT characteristics when exposed to growth factors secreted by M(IL-4 + IL-13) macrophages. Taken together, the PDE model system is an outstanding preclinical model to study early tissue-resident immune responses and effects on epithelial and stromal responses to stimuli found both endogenously in the breast and exogenously as a result of exposures.

Beard reconstruction using hair grafts in a free flap.

Hair transplantation using micrografts or minigrafts is a standard procedure used for hair restoration in androgenic, burn scar and cicatricial alopecia. These grafts have also been used to reconstruct the eyebrow, eyelash, mustache, beard and pubic escutcheon. A patient who underwent successful micrograft and minigraft hair transplantation into a free osteocutaneous mandibular flap reconstruction is presented. The patient was very satisfied with his reconstruction, and the hair transplants provided excellent camouflage for the flap.