CONCLUSION:The TSD demonstrates tremendous potential for complex multi-tendon traumas by drastically reducing the learning curve, operative and warm ischemia times, overall cost, and surgeon variability based on experience and repair strength.

Background: This study aimed to analyze the association between completion of research training and career success in American plastic surgery faculty to aid trainees in their decisions to perform research fellowships. Methods: A cross-sectional analysis of attending academic plastic surgeons in the United States was conducted. Outcomes were compared between faculty who completed research training (research fellowship, PhD, or MPH) and those who did not. Outcomes included promotion to full professor and/or department chair, h-index, and attainment of National Institutes of Health funding. Outcomes were analyzed using chi-squared tests, t tests, and multivariable regressions. Results: A total of 949 plastic surgery faculty members were included, and of those, 185 (19.5%) completed dedicated research training, including 13.7% (n = 130) who completed a research fellowship. Surgeons who completed dedicated research training were significantly more likely to achieve full professorship (31.4% versus 24.1%, P = 0.01), obtain National Institutes of Health funding (18.4% versus 6.5%, P < 0.001), and have a higher mean h-index (15.6 versus 11.6, P < 0.001). Dedicated research fellowships were independently predictive of achieving full professorship (OR = 2.12, P = 0.002), increased h-index (β = 4.86, P < 0.001), and attainment of National Institutes of Health funding (OR = 5.06, P = 0.01). Completion of dedicated research training did not predict an increased likelihood of becoming department chair. Conclusion: The performance of dedicated research training was predictive of improved markers of career success in plastic surgery and should be considered beneficial in both the short and long term.

Intradetrusor onabotuli-numtoxinA (BTX-A) is a common third-line therapy for treatment of refractory overactive bladder (OAB), however several gaps exist in pre-and post-procedural standard of care. Prior studies have demonstrated BTX-A efficacy at 2-3 weeks, but there are limited data documenting when patients should begin to note symptom improvement. We performed a prospective study evaluating several factors involved in the BTX-A patient care pathway. The primary aim of this abstract was to determine patient-reported temporal improvement in symptoms following initial BTX-A therapy.METHODS: A prospective, non-randomized study of patients with non-neurogenic, refractory urgency-frequency syndrome and urgency urinary incontinence undergoing first-time BTX-A injection under local anesthesia was performed. Intradetrusor injection of 100 units BTX-A was performed by one of 3 FPMRS-trained providers using a standard 20-site template. Patients were required to discontinue their OAB medication(s) at the time of BTX-A injection for 3 weeks and complete a daily Patient Global Impression of Improvement (PGI-I) diary during this time. Data were collected at 1 month, including final satisfaction score and adverse outcomes. Descriptive analysis was performed in R programming.RESULTS: 25 patients were included (24 female, 1 male). Median age was 75 years and BMI was 34.3. Figure 1 shows a jitter plot with loess smoothed fit of patient-reported PGI-I over time following BTX-A injection. 24 patients (96%) reported symptom improvement (PGI <4) by 3 weeks, with 19 patients (76%) documenting at least "much better" (PGI >2). Median time to first improvement (PGI <4) was 1 day, at least "much better" was 4 days, and median time to maximum patient improvement was 6 days. Median final satisfaction score was PGI 2 ("much better"). Adverse outcomes included UTI in 2 patients (8%) and incomplete emptying requiring transient intermittent catheterization in 1 patient (4%).CONCLUSIONS: Patients with refractory OAB undergoing firsttime 100 units BTX-A injection reported median time to first improvement (PGI <4) at 1 day, at least "much better" at 4 days, and median time to maximum patient improvement at 6 days. These data may help further counsel patient expectations following initial BTX-A therapy.

No abstract

No abstract

No abstract

PurposeTissue-expander breast reconstruction (TEBR) is a common method of reconstruction after mastectomy but may result in complications that may necessitate removal. Although complications in TEBR have been well studied, there is a paucity of data regarding outcomes after tissue-expander loss. In this study, we examine the eventual reconstructive pathways and associated factors of patients who required tissue-expander removal after infection.MethodsThis retrospective study examines patients undergoing breast reconstruction at a single institution. Patients included underwent mastectomy, immediate TEBR, and subsequent tissue-expander loss. Patients who underwent autologous reconstruction after mastectomy or had successful TEBR were excluded. Patients were followed for an average of 7 years, with a minimum of 2 years and a maximum of 13 years.ResultsA total of 674 TEBR patients were initially screened, of which 60 patients (8.9%) required tissue-expander removal because of infection or skin necrosis. Thirty-one of these patients (group 1) did not complete reconstruction after initial tissue-expander loss, whereas the remaining 29 patients (group 2) underwent either TEBR or autologous reconstruction after tissue-expander loss. Group 1 had a significantly higher mean body mass index than group 2 (32.61 ± 8.88 vs 28.69 ± 5.84; P = 0.049) and also lived further away from our institution than group 2 (P = 0.052), which trended toward significance. There were otherwise no significant differences in demographics between the 2 groups.Among the 29 patients in group 2, 18 patients underwent a second TEBR (group 2a), and 11 patients underwent autologous reconstruction (group 2b). Patients in group 2b had a significantly greater mean number of complication related admissions (1.11 ± 0.323 vs 1.55 ± 0.688; P = 0.029) and also had higher occurrence of postmastectomy radiation therapy (16.7% vs 45.5%; P = 0.092), although this was not significant. There were otherwise no differences between the 2 groups.ConclusionOur data demonstrate the trends in breast reconstruction decision making after initial tissue-expander loss. This study elucidates the factors associated with patients who undergo different reconstructive options. Further work is needed to delineate the specific reasons between the decision to pursue different reconstructive pathways among a larger cohort of patients.

No abstract