A detailed understanding of the fundamental processes that govern mechanical transduction in covalent polymer mechanochemistry is essential to advance innovation in this field. In contrast to progress in the development of new mechanophores, the influence of polymer structure and composition on mechanochemical activity has received relatively little attention. In order to address this gap in knowledge, a continuous flow system with synchronous UV−vis absorption capabilities was designed to quantify the ultrasound-induced mechanical activation of a spiropyran mechanophore in real-time. Measurements of reaction kinetics with polymer tethers of varying repeating unit structure demonstrate that degree of polymerization is the key descriptor of mechanochemical activity, independent of molecular weight and pendant group constitution. These results have important implications for the rationalization of mechanochemical properties and the design of new mechanochemically active polymer systems.

IMPORTANCE Nasal defects commonly are a result of removal of skin lesions, and reconstruction presents a cosmetic challenge to surgeons. Conventional thought and study results have held that cosmetic outcomes of local flap reconstructions may be superior to those of skin grafts. However, local flap reconstructions require more adjunctive procedures. We propose that in select cases, skin grafts can provide aesthetic outcomes equal to those of local flaps with fewer adjunctive procedures. OBJECTIVE To evaluate the cosmetic outcomes of skin grafts vs local flaps in the reconstruction of nasal defects. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective review of medical records for 103 patients who underwent nasal reconstruction with either skin graft (n=39) or local flap (n=64) between 2005 and 2013. All patients were treated by a single surgeon at an academic medical institution. Patients who had defects larger than 30 × 35 mm or a history of adjacent reconstruction that would detract from the cosmetic outcome of the procedure under analysis were excluded. MAIN OUTCOMES AND MEASURES Cosmetic outcome was graded using a visual analog scale (VAS) score based on an ordinal 5-point Likert scale (1, excellent; 5, poor) by 4 independent raters blinded to reconstruction technique. Information was collected regarding patient demographics, defect size, pathology, type of reconstruction, and any postoperative procedures performed. RESULTS The mean VAS score for the skin graft group was 2.18, while the mean score for the flap group was 2.12 (P = .43). The 39 patients with graft reconstruction had a total of 11 triamcinolone acetonide injections and 8 dermabrasion sessions postoperatively. The 64 patients with local flap reconstruction had a total of 259 triamcinolone acetonide injections and 13 dermabrasion sessions postoperatively plus 39 additional staged surgical procedures. CONCLUSIONS AND RELEVANCE Skin grafts are a valuable reconstructive option that provide aesthetic outcomes comparable to those of local flap procedures and with less need for additional postoperative interventions in properly selected nasal defects. LEVEL OF EVIDENCE 3.

Three-dimensional (3D) imaging is a relatively new method of objectively evaluating surgical results, allowing the surgeon to accurately measure postsurgical changes with little inconvenience to the patient. Its accuracy and reliability has been consistently demonstrated in the literature. This article describes updated methods that we use with 3D imaging software to assess rhinoplasty results at our institution. The measurements described include the assessment of symmetry, tip projection, rotation, volume, width, and topographic width. We also apply these techniques to assess the surgical changes of patients with unilateral clefts who underwent secondary rhinoplasty performed by the senior author.

Ninety-six wrists (56 right and 40 left) in 96 patients (36 males and 60 females, mean age 38, range 15–77 years) underwent repair of ulnotriquetral ligament split tears between 2007 and 2016. Mayo wrist scores, visual analogue scale pain scores, and objective measures including grip strength and range of motion were obtained. Patients were assessed after a mean follow-up of 21 months (range 6–112 months). Ulnotriquetral split tear repair resulted in substantial improvements in pain and function. The mean Mayo wrist score improved from 57 preoperatively to 81 postoperatively, with 84% of patients achieving a good or excellent outcome. Pain scores decreased from 5.8 to 1.2. Grip improved from 25 kg to 29 kg. There was no significant change in range of motion of the wrist. Complications were noted in eight patients, with three experiencing continued pain, four with dysaesthesia of the dorsal sensory ulnar nerve, and one superficial infection. Arthroscopic ulnotriquetral split tear repair significantly reduced pain and improved Mayo wrist scores. Level of evidence: IV

Introduction Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution’s results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations. Methods A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes. Results The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%). Conclusion The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications. Level of Evidence Level IV