Ethan D. Paliwoda

Risk factors and timing of tracheostomy for spinal cord injury (SCI) have been identified. However, how these factors are incorporated into clinical decision-making remains unclear. This study aimed to identify the factors associated with tracheostomy placement across the spinal cord and evaluate tracheostomy in high-risk patients with SCI. Patients with traumatic SCI were evaluated between January 2016 and December 2024, using univariate and multivariate logistic regression analyses. Tracheostomy timing was compared with recommendations of ≤10 days for high-risk patients with SCI. High-risk patients were those with complete SCI, injury ≤C7, injury severity score (ISS) >16, age ≥45 years, smoking history, or chronic respiratory disease. Among 674 included patients, 46 underwent tracheostomy. Diabetes (odds ratios (ORs) 3.12, 95% CI: 1.50-6.49; P =0.002), COPD (OR: 3.60, 95% CI: 1.46-8.88; P = 0.005), increasing ISS (OR: 1.22, 95% CI: 1.09-1.36; P < 0.001), primary injuries involving C5-C7 (OR: 12.36, 95% CI: 1.36-112.36; P = 0.026), and complete SCI (OR: 9.86, 95% CI: 3.03-32.08; P < 0.001) were associated with tracheostomy placement. In total, 29/46 (63%) tracheostomies occurred after 10 days, with no difference in complication rates (70.6% vs 72.4%). Cervical stabilization did not delay the tracheostomy. Posterior stabilization showed the shortest time (9.0 ± 2.9 vs 11.4 ± 5.9 days). Most high-risk patients with SCI underwent tracheostomy beyond the recommended 10-day window, highlighting challenges in translating guideline recommendations into practice. This suggests that recognized risk factors may serve as triggers for early tracheostomy.

Background: This study examines clinical outcomes of Ovine-Reinforced Hybrid Mesh (OviTex) in alloplastic breast reconstruction by a single surgeon. Methods: A retrospective chart review was conducted on patients who underwent immediate or delayed breast reconstruction with OviTex between 2019 and 2023 without indocyanine green angiography. Outcomes analyzed included reoperation rates, implant exposure, infection, seroma, and hematoma. Even in patients with thin mastectomy skin flaps, immediate reconstruction was essentially performed whenever planned. Results: Seventy-nine patients (134 breasts) were included. The majority of reconstructions involved direct-to-implant procedures (65% vs 35% tissue expander), with a predominance of immediate reconstructions (97% vs 3% delayed) and prepectoral placement (72% vs 28% dual-plane). Reoperation occurred in 29 breasts (22%), all in immediate reconstructions, primarily due to exposure (20%), infection (10%), or a combination of both (8%). Four breasts (3%) developed a seroma, two of which also required surgical intervention for exposure. No hematomas were observed. Reoperation was significantly more likely on breasts treated direct-to-implant compared to those with tissue expanders ( P < 0.001) and on the cancer side compared to prophylactic reconstructions ( P < 0.001). No significant differences in reoperation were noted regarding placement location (prepectoral vs dual-plane) or radiation treatment. Conclusion: This study provides clinical outcomes on OviTex use in alloplastic breast reconstruction. Reoperation was significantly more likely in direct-to-implant reconstruction and on the side with cancer, likely due to skin flap perfusion rather than intrinsic mesh properties. The lack of access to indocyanine green angiography, as others have reported, in all likelihood contributed to the higher-than-expected rate of reoperation. In addition, significantly smaller implants might have led to a higher rate of reconstructive success.

Background: Craniosynostosis, characterized by premature fusion of cranial sutures, can impede childhood development. This study compares outcomes between open cranial vault remodeling and endoscopic strip craniectomy with helmet therapy in children with isolated craniosynostosis of the sagittal, metopic, coronal, and lambdoid sutures. Methods: Retrospectively, 89 patients treated over 13 years were analyzed; 44 underwent endoscopic repair, and 45 underwent open surgery. Key operative variables including intraoperative blood loss, operative time, transfusion rates, and hospital stay were analyzed. Neurodevelopment was assessed at multiple postoperative intervals. Results: The endoscopic group experienced significant perioperative advantages with lower mean intraoperative blood loss (58.84 mL vs. 107.61 mL, P < 0.001), reduced operative time (96 minutes vs. 244 minutes, P < 0.001), shorter hospital stays (2.67 days vs. 4.07 days, P < 0.001), and reduced opioid prescription rates (40.9% vs. 71.1%; P = 0.004) compared to the open group. Overall developmental delay rates were similar (29.3% vs. 20.9%, P = 0.378). However, those with isolated coronal synostosis (OR, 4.81, P = 0.057) and isolated metopic synostosis (OR, 16.73; P = 0.005) had increased odds of developmental delay compared to those with sagittal synostosis. Endoscopic intervention (OR, 11.32; P = 0.044), each additional month of age at surgery (OR, 1.25; P = 0.026), and drain placement (OR, 12.59; P = 0.018) were each independently and significantly associated with greater odds of delay. Conclusions: Endoscopic repair may offer perioperative benefits yet may be an independent predictor of postoperative developmental delay alongside age and drain placement.

Background Gender-affirming top surgery is an increasingly requested procedure by individuals to address gender dysphoria. On Instagram and TikTok, “#TopSurgery” is currently the most common gender-affirming surgery hashtag, with most content being shared by patients. This study aims to analyze online posts to elucidate patient perceptions and information dissemination related to gender-affirming top surgery. Methods Instagram and TikTok were queried under “#TopSurgery.” Public patient posts discussing their gender-affirming top surgery experiences were collected. Across 808 posts made after 2020, forty-two subthemes were identified reflecting gender-Q foci and were grouped into five central motifs. Results The five central motifs were Psychosocial and Emotional Well-being (31%), Empowerment and Identity Formation (30%), Navigating the Medical Journey (17%), Physical Health and Body Image (16%), and Allies and Stigma (6%). The most common subthemes were Appearance & Body Image (587, 73%), Satisfaction and Relief (576, 71%), Empowerment & Confidence (554, 69%), Positivity & Inspiration (535, 66%), Quality of Life & Mental Health (496, 61%), Self-Esteem & Identity Affirmation (470, 58%), Milestones & Achievements (404, 50%), and Outreach & Health Literacy (306, 38%). Conclusion Significant differences existed between social media posts shared on Instagram and TikTok, those made before and after surgery, and by those of different identities. Patients use social media to share experiences with gender-affirming top surgery, including emotional, physical, and lifestyle changes. Themes of these posts vary by platform, surgical stage, and gender identity. These insights can enhance the physician–patient relationship, improving counseling, setting patient expectations, and navigating the pre/postoperative period. Level V: Observational study This journal requires that authors assign a level of evidence to each article. 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.

Nasal bone fractures represent the most common facial skeletal injury, challenging both function and aesthetics. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-based review analyzed 23 studies published within the past 5 years, selected from 998 records retrieved from PubMed, Embase, and Web of Science. Data from 1780 participants were extracted, focusing on diagnostic methods, surgical techniques, anesthesia protocols, and long-term outcomes. Ultrasound and artificial intelligence-based algorithms improved diagnostic accuracy, while telephone triage streamlined necessary encounters. Navigation-assisted reduction, ballooning, and septal reduction with polydioxanone plates improved outcomes. Anesthetic approaches ranged from local nerve blocks to general anesthesia with intraoperative administration of lidocaine, alongside techniques to manage pain from nasal pack removal postoperatively. Long-term follow-up demonstrated improved quality of life, breathing function, and aesthetic satisfaction with timely and individualized treatment. This review highlights the trend toward personalized, technology-assisted approaches in nasal fracture management, highlighting areas for future research.

Nasal fractures are common and can result in negative psychological and physical sequelae if insufficiently addressed. This study explores factors associated with corrective nasal bone repositioning among hospitalized adult trauma patients using the American College of Surgeons Trauma Quality Improvement Program database (2017-2022). Among 266,768 patients with nasal bone fractures, 20,330 (7.62%) underwent repositioning. Reduced odds of repositioning were associated with increased age, male sex (OR = 0.93, CI: 0.89-0.96), Black race (OR = 0.68, CI: 0.64-0.71), significant comorbidities, private insurance (OR = 0.90, CI: 0.86-0.93), self-pay (OR = 0.72, CI: 0.68-0.76), care at a level III trauma center (OR = 0.26, CI: 0.23-0.30), non-profit center (OR = 0.89, 0.84-0.94), or government hospital (OR = 0.42, CI: 0.32-0.56). In contrast, interfacility transfer (OR = 1.09, CI: 1.05-1.13), greater injury severity score, and concomitant facial injuries were associated with increased odds of undergoing repositioning. This large retrospective cohort study identifies factors associated with undergoing corrective treatment for nasal bone fractures and highlights demographic and treatment location disparities, necessitating standardized care protocols.

Cleft lip and palate (CLP) are among the most common congenital craniofacial anomalies impacting feeding, speech, and facial appearance. Comprehensive management involves multidisciplinary care, including surgical interventions, orthodontics, speech therapy, and psychosocial support. This study examines demographic, clinical, and economic factors influencing hospital charges and outcomes associated with CLP management in the United States. Using ICD-10-CM/PCS codes and data from the National Inpatient Sample (NIS) for 2016 and 2017, this study included patients primarily or secondarily treated for combined CLP. Baseline demographics and outcomes were analyzed using descriptive statistics, and multivariable logistic regression was used to identify factors influencing non-home discharges and extended length of stay (LOS). The study population comprised 4205 patients (60.2% male and 39.8% female). The majority were White (44.3%) and Hispanic (29.3%). Most patients were privately insured (47.0%) or on Medicaid (42.7%). The mean cost of care was $13,291, and total hospital charges averaged $49,229, inflation adjusted. The average LOS was 1.981 days (SD=6.850), and 1.3% of patients experienced non-home discharges. Native American patients and those with higher risks of mortality showed higher odds of non-home discharge, whereas patients in the West had lower odds of non-home discharge. Those of unspecified racial background, treated at urban non-teaching hospitals, or with higher risks of mortality experienced higher odds of extended LOS. This study highlights sociodemographic and geographic disparities in CLP care. Addressing systemic barriers and standardizing care protocols are essential to improving outcomes and reducing financial burdens.

Background: Craniosynostosis, a condition involving the premature fusion of cranial sutures, can impair brain development and potentially lead to developmental delays. This study compares open cranial vault remodeling versus endoscopic strip craniectomy treatment for isolated sagittal craniosynostosis, primarily focusing on development outcomes. Methods: A retrospective cohort study was conducted at a tertiary pediatric surgery center, involving all 45 patients treated surgically for isolated sagittal craniosynostosis from 2013 to 2024. Patients were categorized into 2 groups based on surgical intervention: open cranial vault remodeling (n=17) and endoscopic strip craniectomy (n=28). Data collected included patient demographics, intraoperative specifics, and postoperative outcomes. Developmental outcomes were assessed using postoperative progress notes. Results: Of the 45 patients, those undergoing open surgery were older (10.7 mo and 9.4 kg versus 3.3 mo and 6.4 kg, PPPP=0.009), longer stays (3.3 versus 2.6 d, P=0.011), and higher opioid prescription rates (82% versus 43%, P=0.013) compared to the endoscopic group. Within 12 months postoperatively, social delays were more common in the open group (19 versus 0%, P=0.049), and, postoperatively in general, cognitive delays were more common in the open group (31% versus 4%, P=0.023) when compared to the endoscopic group. Conclusions: Endoscopic cranial vault remodeling produces preferentially better hemodynamic, postoperative, and hospital stay outcomes. Although inferences into long-term developmental delay outcomes were limited due to sample size, a preferential benefit toward endoscopic intervention may exist.

Objective: The study objective was to characterize shared online experiences surrounding craniosynostosis. Methods: Isolated and syndromic craniosynostosis-related consecutive posts (N = 700) made by patients and caregivers were extracted from TikTok and Instagram between 2017-2024. A cross-sectional qualitative analysis following guidelines for practical thematic analysis was performed. Results: The majority of posts were by caregivers (96%) and by females (97%). Forty categorical subthemes from social media posts were synthesized into 4 predominant themes. Overarching thematic trends included Emotional and Psychological Support (47%), Medical Information and Treatment (27%), Family and Social Dynamics (15%), and Awareness, Education, and Advocacy (12%). Conclusion: Social media is used by caregivers, primarily mothers, for emotional support, processing health information, sharing experiences, raising awareness, and celebrating “cranioversaries.” Male and patient perspectives were underrepresented. Physicians may use social media to gain insights, disseminate quality health information, and connect with patients.