Background Applicants to integrated plastic and reconstructive surgery (PRS) residency in the United States spend exorbitant amounts of time and money throughout the interview process. Outside of first-hand experience through a visiting rotation, applicants utilize various resources in learning about a program. Today’s applicants are “Millennials,” the demographic cohort raised during the information age and proficient with digital technology. The authors evaluated whether programs have a presence on social media, and whether applicants are following these accounts.Methods An online survey was sent to applicants to a single integrated plastic surgery program evaluating basic demographics, social media utilization, and sources of information accessed throughout the residency application process. A manual search of popular social media platforms (Instagram, Facebook, and Twitter) was performed in October 2019. Accounts affiliated with integrated PRS programs were identified and analyzed.Results Eighty-four of 222 applicants (37.8%) completed the survey. Ninety-six percent of applicants were within the Millennial demographic. Ninety-six percent of applicants had some form of social media presence, with Facebook (90%) and Instagram (87%) being the most popular platforms. Seventy-three percent of applicants reported following a PRS residency social media account. As of October 2019, 59 integrated residency programs (73%) have active Instagram accounts.Conclusions Applicants still rely on the program website when researching potential residencies, but social media is being rapidly adopted by programs. Program social media accounts should be used as a dynamic form of communication to better inform applicants of program strengths and weaknesses.

No abstract

Introduction. Identifying a bioindicator of healing capacity would be beneficial in guiding treatment of and reducing morbidity in patients with DFU. Hypoalbuminemia is a well-established risk factor for amputation and, thus, a promising candidate. Objective. This study was conducted to examine whether albumin values over a 12-week treatment course for DFU correlated with ulcer size and outcomes. Materials and Methods. A retrospective review was conducted of 793 patients who presented to the Atrium Health Wake Forest Baptist Wound Care and Hyperbaric Center between 2010 and 2022. Sixty-two patients met the inclusion criteria. Albumin values and wound size data were collected monthly over a 12-week treatment course. Results. Initial albumin values were not significantly different between patients healed by 12 weeks compared with nonhealed patients. Healed proportion and average initial ulcer size in patients with at least 1 hypoalbuminemia value (<3.0 g/dL) were not significantly different from those in patients with normal albumin levels. Patients who trended from normoalbuminemia to hypoalbuminemia displayed significantly increased wound sizes compared to patients with albumin changes within the normal range (0.04 cm² and −1.17 cm², respectively; P < .05). Monthly changes in albumin correlated poorly with wound healing (r = 0.144, P = .240), and large negative albumin trends (>0.5 g/dL per month) did not correlate with increased wound sizes compared with stable or positive trends. Conclusion. Albumin’s utility as a bioindicator of short-term healing capability is limited to below-normal values.

We present the case of a 48-year-old male who developed tissue necrosis and subsequent necrotizing fasciitis in his right upper extremity after sustaining a puncture injury from a large black locust tree (Robinia pseudoacacia) splinter. Blood and intraoperative wound cultures revealed Streptococcus constellatus and Eikenella corrodens infection. The treatment consisted of IV antibiotics, fasciotomy, and multiple debridements, which left a 30 x 5-cm defect, requiring negative pressure wound therapy with Integra Dermal Regeneration Template (Integra Lifesciences, Plainsboro Township, NJ) and, ultimately, split-thickness skin grafts. Although uncommon, plastic surgeons should be aware of tissue necrosis associated with robin toxalbumin in cases of black locust tree puncture wounds. Robin toxalbumin causes cellular death by inhibiting protein synthesis. In this patient, the toxalbumin from the black locust tree fragment led to extensive tissue necrosis, serving as the nidus for necrotizing fasciitis.

Within the conduit, CSPGs incorporated into a nanofiber hydrogel form an interpenetrating network. Using a TMR rodent hindlimb model, we tested the effects of this device with and without CSPGs on neuroma formation. RESULTS:The significant size mismatch at the coaptation site between the sciatic nerve and tibial branch to the lateral gastrocnemius muscle resulted in neuroma formation in the TMR group, while the use of the conduit resulted in tapered reinnervation of the sciatic nerve, demonstrating the effectiveness of this device in mechanically guiding axonal growth. Pain scores elicited by mechanical stimulation at the coaptation site were significantly lower in the CSPGconduit group as compared to the Neuroma, TMR, and Empty Conduit groups (p<0.0001), suggesting successful prevention of neuroma formation. CONCLUSION:This novel bioengineered conduit presents a biologically compatible, readily translatable means by which we could optimize TMR postoperative outcomes.