Background Prevention of nosocomial coronavirus disease 2019 (COVID-19) infection for patients undergoing flap-based reconstructive surgery is crucial to providing care and maintaining operative volume and income to support plastic surgery programs. We conducted this study to (1) determine the postoperative incidence of COVID-19 among patients undergoing flap reconstruction from December 1, 2019 to November 1, 2020 and (2) compare 30-day outcomes between patients who underwent surgery before and during the early pandemic. Methods We conducted an 11-month retrospective cohort study of all patients who underwent flap reconstruction across our institution. We abstracted patient demographics, intraoperative management, COVID-19 testing history, and 30-day postoperative complications from electronic health records. Nosocomial COVID-19 infection was defined as reverse transcription polymerase chain reaction (RT-PCR) viral ribonucleic acid detection within 30 days of patients' postoperative course or during initial surgical admission. We used chi-squared tests to compare postoperative outcomes between patients who underwent surgery before (prior to March 12, 2021, when our institution admitted its first COVID-19 patient) versus during (on/after March 12, 2021) the pandemic. Results Among the 220 patients (mean [standard deviation] age = 53.8 [18.1] years; female = 54.8%) who underwent flap reconstruction, none had nosocomial COVID-19 infection. Five (2%) patients eventually tested COVID-19 positive (median time from surgery to diagnosis: 9 months, range: 1.5–11 months) with one developing partial flap loss while infected. Between patients who underwent free flap surgery before and during the pandemic, there were no significant differences in 30-day takebacks (15.6% vs. 16.6%, respectively; p > 0.999), readmissions (9.4% vs. 12.6%, respectively; p = 0.53), and surgical complications (e.g., total flap loss 1.6% vs. 2.1%, p = 0.81). Conclusion Robust precautions can ensure the safety of patients undergoing flap surgeries across an academic medical institution, even during periods of high COVID-19 admission rates. Further studies are needed to generate evidence-based guidelines that optimize infection control and flap survival for patients undergoing reconstruction.
Background Improvements in skin erythema and elasticity have been observed with topical application of platelet-rich plasma after fractional laser (FXD) treatment. Injections of nanofat via small needles into the dermis improves tissue thickness, discoloration and wrinkle depth. Objectives The aim of this study was to evaluate improvements in skin following a nonablative FXD treatment combined with the application of a novel topical nanofat biocrème, called neo-U. Methods Fifty patients were treated with a nonablative FXD followed by application of a topical nanofat biocrème. Harvested fat was processed into nanofat, which was compounded with a transdermal liposomal delivery vector to produce a topical biocrème. In 2 patients, postauricular skin punch biopsies were performed before and after treatment and examined for histologic changes. Photographs of a historical group treated with only the FXD were compared with photographs of patients treated with a combination of topical nanofat biocrème and FXD. Skin types were evaluated for improvements in nasolabial folds, wrinkles, and skin texture. Results Findings from postauricular skin biopsies show the skin exposed to FXD with nanofat biocrème had more elastin fibers and a slight increase in the thickness of the epidermis. Patients treated with FXD plus nanofat biocrème had a statistically significant improvement in the degree of wrinkles, nasolabial fold depth, and texture compared with historical controls. Conclusions Transdermal delivery of nanofat topical biocrème applied after FXD treatment can serve as a delivery system to improve fine lines, nasolabial fold depth, and overall texture of the tissue to a greater degree than laser resurfacing alone.
PSTM Top Abstractsmicrosomia (HFM). Eye-tracking was used to register visual fixations. Four areas of interest (AOIs) were defined on each face: cheek and ear, forehead and orbit, mandible and chin, and nose and lips. Linear mixed effects models (LMEMs) in R Studio tested whether locations of participant fixations were affected by surgical correction of HFM and influenced by IAT, EBQ, or social disposition scores. RESULTS:Sixty participants (38 women) were prospectively enrolled. LMEMs revealed participants with higher IAT scores fixated significantly less on the cheek and ear region preoperatively compared to postoperatively (β = 0.115, SE = 0.040, z = 2.855, p = 0.004). Participants with higher scores on empathic concern fixated more on the forehead and orbit preoperatively compared to postoperatively (β = -0.107, SE = 0.053, z = -2.007, p = 0.045) and participants with higher scores in perspective taking fixated more on the nose and lips (β = -0.085, SE = 0.038, z = -2.215, p = 0.027) preoperatively compared to postoperatively. EBQ scores and other social disposition scores did not significantly influence visual fixations in any AOIs based on better fit to the null models.CONCLUSION: Levels of biases, empathic concern, and other social dispositions may influence visual attention toward people with facial anomalies. Those with higher levels of implicit bias may avoid looking at anomalous anatomy, while those with higher levels of empathic concern and perspective taking do not show similar avoidance behaviors. These findings may have neural underpinnings with amygdala reactivity modulating visual activity in response to facial anomalies. This study has implications for the experience of patients with craniofacial anomalies and for characterizing neurologic mechanisms of the 'beauty-is-good' and 'anomalous-is-bad' biases.
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