Split thickness skin grafts (STSG) are commonly required in reconstructive surgery but may cause significant pain. The goal of this investigator-initiated trial is to evaluate the effect of liposomal bupivacaine on donor site pain and opioid consumption. A parallel, randomized, controlled trial of adult acute burn patients with <20% total body surface area burns (TBSA) was conducted to evaluate the efficacy of liposomal bupivacaine at STSG donor sites. The control group received standard subcutaneous infiltration of dilute lidocaine solution at the STSG donor site, and the experimental group received dilute liposomal bupivacaine infiltration in a similar fashion. Donor site pain scores and opioid consumption in morphine equivalents (MEE) were evaluated. A total of 25 patients were enrolled in each group. There were no statistical differences in demographic variables, and TBSA was 4.0% in both groups (p=.94). There were no statistical differences in pain scores at any time point postoperatively (mean control range 3.1/10-4.9/10, experimental range 3.3/10-4.3/10, p=.12-.96). There were no statistical differences in opioid consumption at 24, 48, or 72 hours postoperatively between the groups (mean control MEE range 49.3-71.1, experimental MEE range 63.6-75.8, p=.34-.85). The average length of stay was 7.7 days in both groups (p=.88). No adverse events occurred in either group. There is no statistical benefit to the use of liposomal bupivacaine for infiltration at STSG donor sites compared to standard of care with respect to pain control, opioid use, or length of stay when evaluated in a randomized, controlled fashion.

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strong correlation exists between obesity and breast cancer risk. 1 Obesity has also been shown to increase complications in abdominally based autologous breast reconstruction, leading to a denial of procedures for patients with obesity. 2,3 This concern for increased complications in patients with obesity may prompt clinicians to suggest bariatric surgery as a strategy to help these patients achieve weight loss in anticipation of breast reconstruction. 2,4 Given this Background: Massive weight loss (MWL) may have suboptimal effects on tissues used for autologous reconstruction. With the rising rates of obesity and bariatric surgery, more patients who have experienced MWL will be presenting for breast reconstruction. The authors hypothesize that autologous breast reconstruction in patients with a history of MWL will have more complications and require more revisions compared with reconstruction in patients without a history of MWL. Methods: A retrospective review was performed on patients who underwent autologous breast reconstruction by five microsurgeons at an academic institution from 2009 through 2020. Patients with a history of bariatric surgery or greater than 50-pound weight loss were identified and compared with patients who had not experienced MWL. Analysis compared demographics, operative details, complications, revision rates, and BREAST-Q scores. Results: Of 916 patients who underwent 1465 flaps, 39 patients with MWL (4.3%) underwent 68 flaps (4.6%), and 877 patients without MWL underwent 1397 flaps. MWL patients were more likely to require blood transfusions postoperatively (P = 0.005); experienced more surgical-site infections (P = 0.02), wound-healing complications of flap (P = 0.007) and donor sites (P = 0.03), and late partial flap losses (P = 0.03); and required more revisional surgery for flap (P = 0.009) and donor sites (P = 0.01). BREAST-Q scores were not statistically different for satisfaction with breasts or surgeon but were lower in MWL patients for psychosocial (P = 0.01) and sexual well-being (P = 0.04). Conclusions: Reconstructive surgeons should expect increased postoperative complications when performing autologous breast reconstruction in patients who have experienced MWL. These patients should be counseled on the possibility of an increased risk of postoperative complications and need for revisional surgery.

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BACKGROUND: Penile inversion vaginoplasty is a safe procedure. However, vaginal stenosis of the neovagina is a possible complication, of which the risk factors have not been described in the literature. This study aimed to identify potential causes of vaginal stenosis of the constructed neovagina, with specific attention toward identifying potentially modifiable behavioral risk factors during the postoperative period. METHODS:A single-center retrospective chart review was performed on all transfeminine patients who underwent vaginoplasty surgery between January 2016 and September 2020. Surgery type, outcome, revisional surgical history, postoperative dilating habits, medical history, and demographic data were recorded.