Differing types of fixation, diagnosis of syndrome, and multiple-suture craniosynostosis were statistically correlated to increased reoperative rates. Age at initial operation and sex were not correlated to increased reoperative rates. Finally, this institution's complication and reoperative rates compare with other published results.

Our incidence of mastectomy skin necrosis was 30%. Despite our high incidence mastectomy skin necrosis, we had no delays in adjuvant oncologic treatment. Retrospective data analysis allowed us to then develop a management algorithm for mastectomy skin necrosis. We feel it is advantageous to the patient and the reconstructive outcome to heal the breast wounds in the acute phase (within 3 weeks); and with regression analysis, we found full-thickness wounds greater than 6 cm benefit from operative intervention. Finally, patients requiring adjuvant oncologic treatment should be healed as quickly as possible so they may continue on with their oncologic care.

Abdominal scars increase the risk of complications to the free flap. Unlike previous studies, patients with abdominal scars do not appear to have a statistically significant increase for donor site complications. Using the data from our study, we developed an algorithm for abdominal flap harvest in patients with abdominal scars. The algorithm emphasizes the importance of bipedicled perforator flaps and supercharging/turbocharging when blood flow is required across scars or when a large volume of tissue is needed crossing the midline. In specific cases, where perforator viability is in question because of a previous abdominal surgical procedure, we recommend the inclusion of muscle (Muscle-Sparing-transverse rectus abdominis musculocutaneous vs transverse rectus abdominis musculocutaneous).

Although the risk of complications associated with preoperative radiation is well documented, physicians and patients should be cognizant of the increased risk of complications after mantle radiation as it represents a unique modality of radiation exposure.

Overall, residents felt this exercise should be included in the postgraduate years 1 and 2 educational curriculum.

Background Protein denaturation and collagen contraction occur when living tissue is heated to well-defined temperatures. The result is reduced volume and surface area of the heated tissue. Objective To evaluate the adverse events of procedures in which a helium-based plasma technology was used with and without ultrasound-assisted liposuction for the coagulation of soft tissue. Methods A multicenter retrospective chart review was performed in which patients (n=192) were divided into two groups: one that received only soft tissue coagulation and the other that received both soft-tissue coagulation and liposuction. Each of the two groups was subdivided into patients with and without adverse events, including seroma. Odds ratios for adverse events were calculated for both demographic and surgical subgroups. Seroma data were analyzed separately. Results No serious adverse events were observed. Forty-six (24.0%) patients reported 51 total adverse events. Seroma was the most frequently occurring adverse event with 13 patients (6.8%) reporting 17 (33.3%) events in 12 body areas. In these cases, all areas were treated with both liposuction and soft tissue coagulation. Seroma was not observed in patients receiving soft tissue coagulation alone. Patients aged 61 to 76 years and males were more likely to experience seroma or other adverse event than younger patients or females, respectively. Conclusions The use of the helium-based plasma technology for soft tissue coagulation in combination with ultrasound for liposuction is associated with non-serious adverse events. The most frequently occurring adverse event, seroma, was not observed in patients treated with helium-based plasma technology alone.

Background: Ultrasound-assisted liposuction (UAL) is a popular and minimally invasive cosmetic procedure. Third-generation devices such as the vibration amplification of sound energy at resonance (VASER)lipo system are used for body contouring with enhanced tissue specificity. Despite the widespread use of VASER UAL, published guidelines and recent expert consensus recommendations are lacking. The objective of this study is to develop an expert consensus on the recommendations for use of VASER UAL. Methods: In a modified Delphi process, a panel of five US-based, expert plastic surgeons participated in three rounds of consensus building that spanned 4 months to align on guidance statements for the use of VASER as an adjunct to liposuction. Results: After the experts responded to an online questionnaire that assessed device settings, postoperative instructions, side effects or complications, and best practices, 32 initial consensus statements were developed. By round 3, these consensus statements for VASER UAL had been reduced and refined to a total of 18. Conclusions: To improve patient outcomes, clinicians must understand key factors and best practices when using VASER UAL, including device settings, provider technique, managing side effects, potential complications, and postoperative care. The consensus statements developed herein aim to provide clinicians with expert-backed recommendations for the use of VASER UAL.

IntroductIon:The majority of pediatric palmar hand burns are managed nonoperatively. Children often reflexively withdraw their hands making a fist during a thermal burn; this protects them from deep palm burns. Acute burn issues when managed expeditiously, lead to fewer future reconstructive needs. When a need does arise, as with subsequent palmar contracture, the mainstays of therapy are split and full thickness skin grafts. Donor sites include plantar and hypothenar surfaces as well as the groin and lower abdomen. These latter donor grafts in ethnic populations tend to darken over time. Our aim was to review the outcomes of plantar split thickness skin grafts used to resurface or release palmar contractures in pediatric patients. MethodS:A retrospective chart review, looking at the treatment plan and recontracture rate of mature palmar hand burns between 2000 and 2010 resurfaced with plantar grafts. Over this ten year period 14 pediatric patients were treated specifically for palmar burns. The average age of injury was 1.5 years old. The age range for the use of glabrous grafts on the palms was 3.9-17 years. The thickness of the grafts ranged from 0.018-0.024/inch. The length of follow-up was from 6 months to 84 months. reSultS: Of the 14 patients treated with plantar grafts, at final follow-up all were noted to have acceptable function with good color match. At short-term final follow-up, 5 (35%) at 6 months showed complete graft take without contractue. However 9 (64%) of patients followed from 6-84 months, 8 (88%) developed contracture. The average time to contracture was 8 months.concluSIon: Glabrous split thickness skin grafts offer an aesthetically more pleasing reconstruction for palmar deformities due to burns. However they carry high recontracture rate and may be indicated only in the older pediatric patient population due potential need for future multiple operations.