While surgery is at the foundation of cancer treatment, its access is limited in low-income countries. Here, we describe development of a low-cost alternative therapy based on intratumoral ethanol injection suitable for resource-limited settings. Although ethanol-based tumor ablation is successful in treating hepatocellular carcinomas, the necessity for multiple treatments, injection of large fluid volumes, and decreased efficacy in treatment of non-capsulated tumors limit its applicability. To address these limitations, we investigated an enhanced ethanol ablation strategy to retain ethanol within the tumor through the addition of ethyl cellulose. This increases the viscosity of injected ethanol and forms an ethanol-based gel-phase upon exposure to the aqueous tumor environment. This technique was first optimized to maximize distribution volume, using tissue-simulating phantoms. Then, chemically-induced epithelial tumors in the hamster cheek pouch were treated. As controls, pure ethanol injections of either four times or one-fourth the tumor volume induced complete regression of 33% and 0% of tumors, respectively. In contrast, ethyl cellulose-ethanol injections of one-fourth the tumor volume induced complete regression in 100% of tumors. These results contribute to proof-of-concept for enhanced ethanol ablation as a novel and effective alternative to surgery for tumor treatment, with relevance to resource-limited settings.

Objective: To evaluate the impact of a Cleft Nurse Navigator (CNN) program on care for patients with cleft lip and cleft palate and assess the programs efficacy to reduce existing socioeconomic disparities in care. Design: Retrospective review and outcomes analysis (n = 739). Setting: Academic tertiary care center. Patients: All patients presenting with cleft lip and/or cleft palate (CL/P) born between May 2009 and November 2019 with exclusions for atypical clefts, submucous cleft palates, international adoption, and very late presentation (after 250 days of life). Interventions: Multidisciplinary care coordination program facilitated by the CNN. Main Outcome Measures: Patient age at first outpatient appointment and age at surgery, reported feeding issues, weight gain, and patient-cleft team communications. Results: After CNN implementation, median age at outpatient appointment decreased from 20 to 16 days ( P = .021), volume of patient-cleft team communications increased from 1.5 to 2.8 ( P < .001), and frequency of reported feeding concerns decreased (50% to 35%; P < .001). In the pre-CNN cohort, nonwhite and publicly insured patients experienced delays in first outpatient appointment ( P < .001), cleft lip repair ( P < .011), and cleft palate repair ( P < .019) compared to white and privately insured patients, respectively. In the post-CNN cohort, there were no significant differences in first appointment timing by race nor surgical timing on the basis of racial identity nor insurance type. Conclusions: A variety of factors lead to delays in cleft care for marginalized patient populations. These findings suggest that a CNN can reduce disparities of access and communication and improve early feeding in at-risk cohorts.

Background Laser skin resurfacing with erbium-doped yttrium aluminum garnet (Er:YAG) lasers is a newer alternative to CO2 laser treatment, and was developed to reduce common complications. Although Er:YAG lasers have been available for years, safety parameters for efficacious resurfacing with these devices have not previously been available. Objectives The aim of this study was to utilize one practice’s laser treatment settings and outcomes data to identify complication rates for various energies and areas of the face and to offer safe energy/depth parameters for treating each area. Methods A retrospective chart review was performed for full-field confluent laser resurfacing patients treated with a Sciton Contour Tunable Resurfacing Er:YAG laser by the senior author. The data were retroactively analyzed with a time range of 8 years (January 2007-December 2015). Results The overall complication rate for MicroLaserPeels (ablation of 50 µm or less) was 10.1% (20 of 198 treatments) and the rate for deep resurfacing treatments was 26.5% (71 of 268 cases). In MicroLaserPeel treatments the cheek area had the highest complication rate, followed by the forehead, nose, perioral, and eyelid areas, in that order (complication rate range, 0%-9.1%). In deep resurfacing treatments the perioral area had the highest complication rate, 38.6% of 145 cases. This was followed by the lids, cheek, nose, and forehead, in that order (complication rate range, 15.2%-20.9%). There is a correlation between increased depth of ablation and increased rate of complication. Conclusions The study confirmed the efficacy of Er:YAG resurfacing and provides guidance for a safer approach to excellent outcomes. Level of Evidence: 4

Objective Dedicated research time is a component of certain plastic surgery programs, and yet, there is limited research examining its impact on academic productivity and career outcomes. This study aimed to assess the effect of dedicated research time on the academic productivity of residents and the likelihood of pursuing an academic career. Methods We conducted a cross-sectional study that examined bibliometric indices of integrated plastic surgery residency graduates from 2010 to 2020. Academic productivity was determined by the number of peer-reviewed publications and h-index 1 year after residency graduation. Results were analyzed using descriptive statistics, χ2 test, t test, and logistic regression. Results Data on plastic surgery residency graduates were analyzed (N = 490 from 46 programs). The mean numbers of publications and h-index per research track graduate were 26.1 and 8.23, respectively. The mean numbers of publications and h-index per nonresearch track graduate were 15.9 and 5.97, respectively. After controlling for the University of Alabama research ranking through multilinear regression analysis, we found that pursuing dedicated research time was an independent predictor of increased h-index and publication output, although it did not predict an increased likelihood of pursuing an academic career. Conclusions Participating in dedicated research during residency increases academic productivity, irrespective of the residency program’s research rank. Given this finding, offering research years can help support the mission of fostering academic opportunities within plastic surgery.