Citations

Introduction: Capsular contracture (CC) is the most common complication following breast augmentation and reconstruction. Although numerous risk factors and preventive strategies have been proposed, the etiology remains poorly understood. This study employs bibliometric analysis to evaluate global research trends, collaboration networks, and emerging hotspots in CC research. Methods: We queried the Web of Science Core Collection using keywords related to breast implants and CC, including publications through December 31, 2024. Data including publication year, author, institution, citations(C), and keywords were analyzed using VOSviewer , Microsoft Excel , and Scimago Graphica to visualize trends, collaboration networks, and research foci. Results: A total of 2065 publications(P) were included. The United States led in both total publication output and citation count (P = 800, C = 27 984), with Harvard (P = 48, C = 1688) and Georgetown Universities (P = 45, C = 2750) being key contributors. Emerging contributions from Asian institutions were noted, though citation impact remained lower. Plastic and Reconstructive Surgery was the most prolific and cited journal (P = 473, C = 23 113). Recent research hotspots identified through keyword analysis include Biofilm , Acellular Dermal Matrix (ADM) , Implant placement , contamination , and inflammation . Most top-cited studies were of Level IV or V evidence. Conclusion: Research on CC is increasing, with a shift toward exploring biological mechanisms like biofilm formation and preventative measures such as ADM and implant positioning. Despite growing international interest, most evidence remains low quality. Future work should prioritize clinical studies that generate higher level of evidence and foster broader global collaboration to improve patient outcomes and refine surgical practices.

Background: The sural nerve is widely used as a nerve graft for various types of peripheral nerve repair due to its ease of harvest and acceptable donor-site morbidity. Nevertheless, certain clinical scenarios, such as cable grafting or multiple cross-face nerve grafts, require grafts longer than the typical 35 cm. This study aims to investigate the anatomic feasibility and clinical safety of an extended sural nerve harvest above the popliteal crease by interfascicular dissection. Methods: An anatomic study using 5 fresh-frozen cadaver legs was conducted, focusing on identifying the anatomic relationship of the sural nerve above the popliteal crease to its surrounding structures and nerve histopathology. A retrospective review was performed of all patients who underwent an extended sural nerve harvest, and patient outcomes, including nerve graft length and postoperative complications, were reviewed to evaluate the clinical feasibility of the extended harvest technique. Results: Anatomic dissection revealed that interfascicular dissection allowed for an additional 14.3 ± 6 cm of nerve length, achieving a total graft length of 49.1 ± 5 cm. Histologic analysis showed no significant differences in fascicle number or axon count along the nerve. A retrospective review, which included 7 adults and 2 pediatric patients, demonstrated that an extended sural nerve harvest was feasible and safe. The maximum graft length was 55 cm, and no intraoperative complications or functional deficits were reported. Conclusion: The extended sural nerve harvest above the popliteal crease with a step-incision approach was both anatomically feasible and clinically safe, providing additional graft length without increasing donor-site morbidity.

Background The management and use of antibiotics in pediatric ear lacerations lacks standardization. This study sought to provide a comprehensive review of these injuries and assess the impact of administering perioperative antibiotics on the incidence of infections after repair. Methods Retrospective review of all pediatric ear lacerations treated at our institution's emergency department (ED) between 1998 and 2024. Results A total of 246 patients (177 boys) were included. Patients aged 0–6 years were most affected (n = 117, 47.6%), with the peak between 2–5 years old (n = 78, 31.7%). Most lacerations were superficial (n = 145, 58.9%), followed by intermediate (n = 62, 25.2%), full thickness (n = 34, 13.9%), and split earlobe defects (n = 5, 2%). Most of the patients (n = 110, 54.7%) were managed by emergency medicine providers. Plastic and reconstructive surgery (n = 34, 16.9%) and otorhinolaryngology (n = 32, 15.9%) consultations were obtained when the lacerations affected cartilage (P < 0.001). Surgical repair included primary closure in 203 (82.5%), with 179 (88.2%) performed under local/topical anesthesia in the ED. Of patients with cartilage lacerations (n = 61), 48 had cartilage repair. Eight patients had preoperative intravenous antibiotics, while 105 (42.7%) received postoperative prophylactic oral antibiotics. Among those with intermediate and full-thickness injuries (n = 96), 67.7% were discharged on prophylactic oral antibiotics. Only 1 case of surgical site infection occurred in a patient with a superficial laceration. Conclusions Pediatric ear lacerations mostly affect boys aged 2–5 years and are usually repaired under local anesthesia in the ED. The incidence of infection is low, and the routine prescription of prophylactic oral antibiotics appears to have a limited impact on the overall incidence of surgical site infection. Further studies are needed to validate these findings.

Purpose: To review cases of lateral brow dermoid cysts and gain insight into the utility of preoperative imaging, incidence of intraorbital extension, and recurrence rate. Methods: This is a retrospective study of all patients who underwent excision of lateral brow dermoid cysts at the authors' academic center over a 37-year period. Results: A total of 136 patients were included. The median age at presentation was 5.6 months [interquartile range (IQR) 3–16.5], and the median age at removal was 1.5 years (IQR 0.9–3.4). Preoperative imaging was performed in 44 patients. Intraorbital communication was predicted in 4 patients who underwent imaging and confirmed in 6 patients (4.4%) intraoperatively. Superficial dermoids were the most common depth (n=79, 58.1%), followed by periosteal (n=37, 27.2%) and intraosseous (n=14, 10.3%). Two patients (1.4%) presented with postoperative hematoma that required surgical evacuation. Recurrence was seen in 2 patients (1.4%). Among those who completed a follow-up, the median follow-up time was 1 month (IQR 0.44–5.8 months). Conclusion: The authors' study revealed that the majority of lateral brow dermoid cysts are either superficial or involve the periosteum, with orbital involvement being rare. None of our patients demonstrated intracranial communication. Imaging did not seem to add clinical value in patients for whom there was no clinical suspicion for the involvement of the deeper tissues, so careful consideration of ordering preoperative imaging would help decrease health care costs and avoid radiation exposure, which is particularly concerning for pediatric patients. The recurrence rate of lateral brow dermoid cyst seems to be low but studies with longer follow-ups are needed.

Objective Dermoid cyst (DC) is a congenital cyst with the potential to have intracranial extension (ICE). This study aims to evaluate the imaging yield and surgical outcomes of nasal, medial brow, forehead, and scalp DCs. Design Retrospective review of craniofacial DCs treated at our institution between 1992 and 2024. Results A total of 117 patients (57 females) were included. The median age at cyst detection and removal were 4.8 months (IQR 3.6-9.6) and 1.8 years (IQR 0.9-5.3), respectively. In 42 patients, parents have noticed the presence of the cyst immediately after birth. Cyst wall rupture during surgical removal was reported in 15.4%. The median follow-up time was 1.3 months (IQR 0.5-12.2). Three patients experienced recurrence. No postoperative complication was reported. The regions with the highest prevalence of ICE were the forehead, frontotemporal scalp, and nasal region. The lateral frontal/temporal scalp had a 33.3% rate of ICE. Midline forehead/scalp lesions demonstrated a higher risk of ICE compared to their lateral equivalents (54.5% vs 17.5%, P = .03). The sensitivity and specificity of magnetic resonance imaging (MRI) were 100% and 95.7%, while for computed tomography (CT scans) were 72.7% and 96.5%. The Area Under the Curve for MRI was 0.978, and for CT was 0.846. The sensitivity and specificity of ultrasound were 50% and 100%. Conclusions Midline forehead/scalp DCs are more prone to extend intracranially than lateral DCs. MRI had a higher sensitivity and specificity than CT scans in detecting ICE. Routine screening imaging should be considered in midline forehead/scalp, lateral frontal/temporal, and nasal DCs.

Background: In 2020, the American Board of Plastic Surgeons announced an update in the leave policy for plastic surgery trainees, extending personal leave to 12 weeks without delay in graduation. Simultaneously, the Accreditation Council for Graduate Medical Education announced their update in lactation policy. This study sought to understand the influence of the policy change on plastic surgery trainees’ goals for family planning and lactation. Methods: An online 32-question survey was developed to evaluate plastic surgery trainees’ perceptions of family planning and perceived program support in the United States. The survey was approved by the American Council of Academic Plastic Surgeons Research Committee and sent out to a total of 216 plastic surgery programs. Results: One hundred thirty plastic surgery trainees completed the survey. Most respondents were women, between the ages of 30 and 34 years, and married. Forty-five (34.6%) respondents or their partners had experienced pregnancy or live birth during their training. More than 70% did not feel that they had adequate time for leave. Female trainees faced more barriers than men, including having a partner in training, concern for their pregnancy, and burdening their co-residents during leave. The majority stated that their decision to apply to plastic surgery residency was influenced by program support for family planning compared with policy changes. Conclusions: This survey highlighted that the new policies benefit trainees who consider starting a family during training. Despite this, there are still challenges that need to be addressed to help foster a fair environment for trainees to work and have a family.

Objective Recalcitrant palatal fistulas in patients with cleft palate history sometimes require free flap reconstruction. This study reviews the literature on described flaps and outcomes. Design A systematic review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Setting All study designs were included. Non-English articles were excluded. Patients and Participants Patients with a history of cleft palate who underwent free flap reconstruction for a oronasal fistula. Interventions Free tissue transfer for a palatal fistula repair. Main outcomee measures Information regarding defect and flap characteristics were reviewed. Surgical outcomes such as flap loss rates, rates of recurrent fistula formation, and speech outcomes were also obtained. Results Our search returned 894 articles, of which 23 were included. All studies were retrospective case series and reports. A total of 65 patients were described with an average age of 19.3 (range 3–55) years and a median fistula size of 8.00 cm 2 (range 2.54 cm 2 – 24 cm 2 ). The most common flap was the radial forearm flap (n = 37). Nine patients (13.8%) had recurrent fistula formation with surgical revision successful in all cases in which the patient returned to the operating room. There were two partial flap losses and no total flap losses. Speech outcomes showed improvement in 27 patients across 10 studies. Conclusions Palatal fistula repair with free tissue transfer is safe with an acceptable risk profile and low flap loss rate. Early recurrence due to partial flap necrosis and dehiscence are successfully managed with flap readvancement.