Pearl Shah

Background As the digital age progresses, individuals are increasingly seeking online websites for the dissemination of information. YouTube, the most popular free video streaming platform worldwide, garners over 2 billion users. Plastic surgery information is widely available on YouTube and acts as a common interface for the distribution of plastic surgery-related information. This investigation aimed to identify trends in YouTube videos describing common plastic surgery search terms based on narrator gender, channel type, and language patterns. Methods Top-ranking videos for six common plastic surgery search terms were queried. Video characteristics and transcripts for each video were extracted. Transcripts were subsequently analyzed using the Linguistic Inquiry and Word Count software. Comparisons were performed using various statistical analysis methods. Results Significant differences in audience engagement were noted by search topic (p < 0.05). Speakers in plastic surgery videos were predominantly male only (108 [60%]), with notable variation observed across channel type and search topic. Significant differences were found for videos on medical professional channels (p = 0.004) and videos regarding gynecomastia (p < 0.05). Linguistic pattern analysis revealed that female speakers used more authentic (p = 0.01) and emotional (p = 0.012) language than male speakers. Conclusion With YouTube being the most visited online video platform website worldwide, plastic surgeons must understand trends to appropriately tailor their content and maximize their social media reach. Also, while plastic surgery is making strides in the right direction, continued work should be done in promoting adequate representation among online material. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

After decades of quality improvement efforts, surgical site infections and abnormal wound healing remain intermittent complications in surgery. In both cases, the complication and abnormality may be superficial, restricted to the skin, or deeper within the tissue. The synthesis of connective tissue proteins, critical for structural support as part of the extracellular matrix, is under the control of multiple genes, forming a complex adaptive network. We report an unusual case of delayed and abnormal wound healing with chronic infection in a 16-year-old patient following surgery for scoliosis. Skin patch test showed that he is allergic to cobalt, a component of fixation hardware used in his surgery. He underwent evaluation by clinical genetics with whole exome sequencing (WES) which showed two (maternally and paternally inherited) variants in the TNXB ( Tenasin XB) gene. These two variants are variants of uncertain significance (VUS). TNXB encodes tenascin-XB which is an extracellular matrix glycoprotein located primarily in the basement membrane. Autosomal recessive pathogenic and likely pathogenic variants in TNXB cause TNXB-related classical-like Ehlers-Danlos Syndrome. At present, there are no causal linkages of these VUSs in TNXB to abnormal wound healing. However, as WES becomes more affordable, its use will increase and therefore it is important that we start to document such associations.

Cutaneous wounds, both acute and chronic, begin with loss of the integrity, and thus barrier function, of the skin. Surgery and trauma produce acute wounds. There are 22 million surgical procedures per year in the United States alone, based on data from the American College of Surgeons, resulting in a prevalence of 6.67%. Acute traumatic wounds requiring repair total 8 million per year, 2.42% or 24.2 per 1000. The cost of wound care is increasing; it approached USD 100 billion for just Medicare in 2018. This burden for wound care will continue to rise with population aging, the increase in metabolic syndrome, and more elective surgeries. To heal a wound, an orchestrated, evolutionarily conserved, and complex series of events involving cellular and molecular agents at the local and systemic levels are necessary. The principal factors of this important function include elements from the neurological, cardiovascular, immune, nutritional, and endocrine systems. The objectives of this review are to provide clinicians engaged in wound care and basic science researchers interested in wound healing with an updated synopsis from recent publications. We also present data from our primary investigations, testing the hypothesis that cannabidiol can alter cutaneous wound healing and documenting their effects in wild type (C57/BL6) and db/db mice (Type 2 Diabetes Mellitus, T2DM). The focus is on the potential roles of the endocannabinoid system, cannabidiol, and the important immune-regulatory wound cytokine IL-33, a member of the IL-1 family, and connective tissue growth factor, CTGF, due to their roles in both normal and abnormal wound healing. We found an initial delay in the rate of wound closure in B6 mice with CBD, but this difference disappeared with time. CBD decreased IL-33 + cells in B6 by 70% while nearly increasing CTGF + cells in db/db mice by two folds from 18.6% to 38.8% (p < 0.05) using a dorsal wound model. We review the current literature on normal and abnormal wound healing, and document effects of CBD in B6 and db/db dorsal cutaneous wounds. CBD may have some beneficial effects in diabetic wounds. We applied 6–mm circular punch to create standard size full-thickness dorsal wounds in B6 and db/db mice. The experimental group received CBD while the control group got only vehicle. The outcome measures were rate of wound closure, wound cells expressing IL-33 and CTGF, and ILC profiles. In B6, the initial rate of wound closure was slower but there was no delay in the time to final closure, and cells expressing IL-33 was significantly reduced. CTGF + cells were higher in db/bd wounds treated with CBD. These data support the potential use of CBD to improve diabetic cutaneous wound healing.

Introduction: The onset of the COVID-19 pandemic resulted in significant changes to the surgical caseload for various surgery departments across the United States. As medical institutions prioritized resources for the expected increase in patient volumes due to the SARS-CoV-2 viral infection, surgical departments saw a decrease in nonemergent and elective surgical procedures. Reduction mammoplasties, which are largely covered by insurance, are among the elective procedures that provide significant revenue to the hospital. This expected decline in procedures suggests a potential decline in revenue provided by the plastic surgery department of a hospital. The purpose of this study was to analyze the loss of revenue experienced by a single academic medical institution due to changes in breast reduction mammoplasty volumes during the COVID-19 pandemic. Methods: Upon institutional review board approval, using the Augusta University Medical Center's Financial Billing Data, 373 patients who underwent bilateral reduction mammoplasty were queried. A time horizon of March 2019 to February 2022 was used to determine the pre- and post-COVID case load and charges that were incurred. Statistical analysis to compare the prior 12 months and after 24 months of COVID was conducted using 2 samples of equal variance t test and F test confirming equal variance. Results: There was a statistically significant increase in the number of reduction mammoplasties performed per month from the year before the onset of COVID-19 (March 2020) to the 2 years after (6.6–11.4 per month, P = 0.0024). There was a statistically significant increase in the per-month charges from the AU Health system for reduction mammoplasties for the same period ($31,780.92–$52,113.34 per month, P = 0.0054). Although there was an increase in per-month revenue from reduction mammoplasties, this increase failed to reach statistical significance ($7,059.95–$10,423.51 per month, P = 0.064). Conclusions: The plastic surgery department saw a statistically significant increase in reduction mammoplasty cases and subsequent charges in the post-COVID cohort. These findings suggest that the emergence of a nationwide pandemic did not necessarily lead to a decrease in the volume of nonemergent surgical cases despite an expected decrease in caseload due to the need to reallocate hospital resources. On the contrary, there was an increase in caseload suggesting that there may be other factors contributing to patients' pursuance of reduction mammoplasty post-COVID including convenience, resulting from time off due to pandemic, meeting insurance-covered reduction criteria, and projected recovery time.

Background: Infantile hemangiomas (IHs) are the most common benign tumor of infancy. These tumors may have wide-ranging effects on functional and cosmetic outcomes for patients. With variations in recommendations for surgery among providers, it can be difficult to counsel patients and their families on potential surgical treatment. Through the development of the Case Western Hemangioma Intervention Predictor (CHIP) score, this study aims to improve the consistency of counseling regarding surgery and timing of surgical referral. Methods: This was a retrospective review of all patients (179) treated for IHs at a single tertiary care center over 17 years. Patients were divided equally into 2 cohorts. Descriptive statistics and correlation plots were performed on the first cohort to evaluate which disease factors (including size, location, and complications) and patient factors significantly correlated with the decision to pursue surgical treatment (surgical risk). These factors were used to form a CHIP score, which was then validated through logistic regression with length of medical management as a covariate against the second cohort of patients. Results: After controlling for length of medical management to treat IH, lack of medical management, functional impairment, and ulceration were found to be significantly correlated with the risk of surgical intervention ( P < .05). When validated against the second half of our cohort, a CHIP score of 3 (of a maximum score of 3) was found to have a specificity of 92% and a sensitivity of 81% in predicting risk of surgical intervention. Conclusion: IHs can have clinical characteristics that may be predictors of complexity and surgical intervention. The CHIP score can assist in educating patients and families on surgery as a treatment option and guiding appropriate referrals.

Vitiligo is an autoimmune condition that causes patchy skin depigmentation. Although the mechanism by which vitiligo induces immunocompromise is unclear, other related autoimmune diseases are known to predispose those affected to infection. Individuals with vitiligo exhibit epidermal barrier disruption, which could potentially increase their susceptibility to systemic infections; patients with renal disease also show a predisposition to infection. Nevertheless, there is little research addressing the risk of infection in dialysis patients with vitiligo in comparison to those without it. A retrospective analysis was performed on patients with end-stage renal disease (ESRD) in the United States Renal Data System who started dialysis between 2004 and 2019 to determine if ESRD patients with vitiligo are at an increased risk of bacteremia, cellulitis, conjunctivitis, herpes zoster, or septicemia. Multivariable logistic regression modeling indicated that female sex, black compared to white race, Hispanic ethnicity, hepatitis C infection, and tobacco use were associated with an enhanced risk of vitiligo, whereas increasing age and catheter, versus arteriovenous fistula, and access type were associated with a decreased risk. After controlling for demographics and clinical covariates, vitiligo was found to be significantly associated with an increased risk of bacteremia, cellulitis, and herpes zoster but not with conjunctivitis and septicemia.

Introduction: We seek to evaluate the financial impact of the COVID-19 pandemic on pediatric craniomaxillofacial surgeries for cleft lip and/or palate. These surgeries are carefully timed for optimal outcomes, but the pandemic necessitated postponement or cancellation of elective procedures. Our study quantifies the decline in cases and associated charges at a single academic medical center before and after the pandemic.Methods: After receiving Institutional Review Board approval, we analyzed the financial billing data of 83 patients who underwent cleft lip and/or palate repair at an academic medical center. The caseload and charges incurred in the year before the COVID-19 pandemic (March 2019 to February 2020) were compared to the 2 years following the pandemic’s onset (March 2020 to February 2022). Statistical analysis was conducted using paired t-tests and the Wilcoxon signed-rank.Results: In the year following the onset of the pandemic, we observed a significant decrease in the number of cleft lip and/or palate repairs performed per month (from 2.75 to 1.42 per month, P-value .021) and a decrease in per-month charges for these procedures ($13 334.75 to $7237.17 per month, P-value .036). However, when examining data over the 2 years post-COVID, these differences no longer remain statistically significant ( P-value .25 for cases and P-value .32 for charges), indicating a return to pre-COVID baseline.Conclusion: There was a statistically significant decrease in cleft lip/palate repair surgeries in the 12 months following the start of the COVID-19 pandemic. Both the caseload and total charges decreased after March 2020, with a subsequent return to baseline after 2 years. These findings emphasize that the pandemic had a transient impact on pediatric craniomaxillofacial surgical volume at our institution. While acknowledging our study’s external validity, we advocate for a nuanced approach, with flexible staffing crucial in facilitating a swift return to normal elective volumes.

Artificial intelligence (AI) is becoming increasingly relevant and integrated into the medical space. Current adoption in AI is distinct from prior attempts, as computer processing power, larger data storage libraries, and current AI workforce talent outweigh previous capabilities. These advances have enabled AI-based systems to flourish within health care. In a report produced by Accenture, it is estimated that AI, by 2026, has the potential to save the health care industry over $150 billion annually.[1] Plastic surgery specifically could leverage AI to optimize patient care. Given this rapid expansion of AI in the literature, it is necessary to identify the most salient articles in the field. Traditionally, bibliometric analyses have enabled identification of seminal articles through quantification of citation count. However, citation count, while useful, fails to account for social dissemination. We provide an alternative perspective from traditional bibliographic analysis by using Altmetric Attention Scores (AAS) to determine the online social influence of AI-related plastic surgery articles. Intended to be complementary to traditional, citation-based metrics, AAS reflects the digital attention a research article is garnering across multiple sources, including, but not limited to Twitter, news outlets, Facebook, Google + , LinkedIn, Reddit, etc.[2] The Web of Science database was searched with a combination of Boolean operators and descriptive terms to identify articles relevant to AI and plastic surgery. Articles were manually examined to ensure relevance to the present analysis. In total, 285 articles were identified from the database search and 266 were eligible for screening after removing duplicates. After eliminating irrelevant articles, 141 articles remained. AAS, which measures the social dissemination of an article, was determined using Altmetric Explorer. Articles were ranked by citation count and AAS, and their characteristics were analyzed using the Pearson correlation coefficient, Mann–Whitney U test, Kruskal–Wallis test, and Fisher's exact test, where appropriate. p < 0.05 was considered statistically significant. The mean AAS of the 50 most disseminated articles online was 11.3 ± 19.2, primarily driven by mentions on Twitter (12.2 ± 16.5). No correlation was identified between AAS and citation count (r = 0.13; p = 0.38). No articles were published prior to 2014, with 68% published between 2020 and 2022 ([Supplementary Table S1], available in the online version only). Forty-two percent of articles were open access, a similar proportion relative to the 50 most cited articles (44%; p > 0.99). Plastic and Reconstructive Surgery was the most common journal of publication for the 50 most disseminated articles online (26%) and articles published in this journal accrued greater AAS relative to other journals (p = 0.04). A majority of articles (64%) were multi-institutional collaborations and 34% were multinational collaborations ([Supplementary Table S2], available in the online version only). The most common subspecialty of social interest was general/burn (28%; [Supplementary Table S3], available in the online version only). First authors were predominantly male (84%) and from the United States (54%). As noted by Elmore in 2019, AAS presents with certain limitations, including but not limited to an absence in the ability to analyze the quality of an article and difficulty with field normalization. Additionally, the Altmetric algorithm uses sites like Facebook, Reddit, and Twitter, but does not use TikTok or Instagram. It is also important to note that AAS is not related to the scientific importance of an article but rather the social influence. However, analyzing the social influence acts as an important complementary measure to traditional, citation-based metrics.[2] The collaborative effort of plastic surgeons in AI-related research was a notable finding of our analysis. Most of the plastic surgery articles analyzed were multi-institutional and greater than one-third were multinational. Moreover, while female authorship percentages in plastic surgery have been increasing according to Silvestre et al,[3] only 16% of articles published in the plastic surgery/AI space cross-section were female. Interestingly, 22% of employees in the AI workspace are female, closely mirroring our findings and pointing to a potential coexisting male bias in the field of AI.[4] There is limited literature available on this topic. Our analysis of plastic surgery-related AI papers revealed 266 articles within the Web of Science database, with 141 articles ultimately analyzed. Conversely, in a recent paper that analyzed AAS of AI in the ophthalmology literature, the authors identified 2,927 total articles.[5] Although plastic surgery is a field that prides itself on innovation, approximately one-tenth the number of articles regarding AI in plastic surgery was initially identified relative to ophthalmology. We hypothesize that the lack of available literature is due to the novelty of the subject and its potentially unclear role within the field of plastic surgery. As such, lest plastic surgeons fall behind, it is paramount for the field to discover novel means of integrating and leveraging AI within the specialty, either in clinical or business operations. Conceptualization: All authors. Methodology: All authors. Writing original draft: B.B., P.S., P.A.P., and C.B. Writing review edit: B.B., P.S., P.A.P., and C.B. No IRB approval required for this study. Received: 11 May 2023 Accepted: 30 November 2023 Accepted Manuscript online: 06 December 2023 Article published online: 29 January 2024 © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited....