Citations

Introduction: Microtia is a complex congenital auricular deformity, with research spanning operative technique, epidemiology/genetics, biomaterials, and complications. Despite this breadth, there is limited work characterizing which studies have been most influential in shaping the field. This study aimed to identify and analyze the top 100 most-cited articles on microtia using a bibliometric approach. Methods: A comprehensive search using the Web of Science (WoS) was conducted to identify studies on microtia, and the top 100 articles were selected by citation count. Bibliometric data, study type (clinical, review, and basic science), clinical focus category, materials discussed, and sample sizes for clinical studies were extracted. Spearman correlation tests and Kruskal-Wallis tests were used to analyze citation patterns. Results: The top 100 microtia studies, published between 1957 and 2022, accumulated 12,692 total citations, with a mean of 127±84 citations per article, and were published across 49 journals. Clinical studies predominated (n=58), followed by reviews (n=28) and basic science studies (n=14). Publication year significantly differed by article type ( P =0.02), with basic science studies tending to be more recent. Newer publication year was associated with higher citations per year ( P <0.001) but fewer total citations overall ( P =0.002). Among clinical studies, technique-focused papers were most common (n=27) and were largely centered on autologous costal cartilage reconstruction (n=25). Clinical studies examining alternative materials were less represented but tended to be more recent publications. Conclusion: These findings suggest that the most-cited microtia literature has primarily included landmark clinical technique papers, but newer, rapidly cited work increasingly reflects emerging biomaterials and tissue engineering.

Craniosynostosis surgery is associated with substantial blood loss, yet the utilization of intraoperative cell saver remains variable. To evaluate patterns of cell saver utilization, the authors queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) from 2021 through 2024. Patients undergoing craniectomy for craniosynostosis were identified and stratified into single-suture craniectomy and multisuture craniectomy cohorts, and univariable and multivariable analyses were conducted to determine factors associated with transfusion volume and cell saver utilization. Among 4970 identified patients (32.4% female), 2314 were in the single-suture cohort, and 2656 were in the multisuture cohort. Blood transfusion was required in 29.3% of the single-suture cohort and 62.3% of the multisuture cohort, with average transfusion volumes of 18.5±10.3 and 23.0±16.3 mL/kg, respectively. Cell saver was used in 4.3% of transfused patients in the single-suture cohort and 8.6% of transfused patients in the multisuture cohort. Among cell saver users, average transfusion volume was 19.3±10.7 mL/kg in the single-suture cohort and 19.6±16.3 mL/kg in the multisuture cohort. Overall, 96.6% and 74.1% of cell saver users, respectively, avoided allogeneic blood entirely. Operation duration was the factor most strongly and consistently associated with blood transfusion volume and cell saver utilization in both cohorts ( P <0.001). In conclusion, the cell saver is infrequently utilized in craniosynostosis surgery, although patients who received autologous blood from a cell saver required less allogeneic blood.

Background: Polyetheretherketone (PEEK) is a commonly used material for cranioplasties due to its advantages over other materials and autologous bone grafts. PEEK has an increased malleability, which increases postoperative aesthetics and adapts well to the cranial contours; it is also associated with a lower rate of infection when compared with autologous cranioplasties. Despite these benefits, there is limited information on the practical aspects of modifying PEEK cranioplasties after their initial placement. Case Series: We present 2 cases of patients who had previously undergone PEEK cranioplasty being treated with deep-brain stimulation (DBS), which was placed through their PEEK implant. The first was an 18-year-old male who had previously undergone cranial vault closure with bone grafts following a craniotomy. Later, when a deep-brain stimulator was planned, it was discovered that the bone grafts had significant resorption and a lack of structural integrity. Therefore, bone grafts were replaced with a custom PEEK implant cranioplasty before the DBS electrodes were placed via drilling through the PEEK implant to access the brain at a later surgery. The second patient was a 39-year-old male who developed epilepsy after a stroke, requiring craniotomy. DBS was unable to be performed initially due to significant resorption of the patient’s native bone. Therefore, a PEEK cranioplasty was performed in preparation for a staged, subsequent placement of DBS electrodes through the implant. Both patients recovered uneventfully following surgery, with noticeable improvement in functional (reduction in seizure frequency) and aesthetic outcomes. Systematic Review: A literature review was conducted using PubMed with keywords related to PEEK cranioplasties. After screening titles, abstracts, and full-text papers, it was found that 3 previously documented cases have involved drilling through PEEK implants: one by Mallela et al, involving SEEG electrode placement; one by Marrone et al, concerning a burr hole for evacuating a chronic subdural hematoma; and one by Ledesma et al, regarding the placement of subdural grid electrodes. Conclusions: This case series highlights how PEEK cranioplasties can be drilled through for therapeutic procedures, such as DBS electrode implantation, without compromising their structure. These cases illustrate the versatility, safety, and adaptability of PEEK implants for additional necessary interventions.

ABSTRACT The integration of Internet of Things devices in medicine has paved the way for novel diagnostic and therapeutic solutions that offer ‘smart’ capabilities, especially for at‐home wound monitoring. Such capabilities include increasing portability, diminished gaps in care through continuous analysis, and real‐time programmable manipulation of device parameters to intervene more rapidly. This scoping review explores the landscape of Internet of Things devices, including smart bandages, wearable and skin‐interfaced sensors, and mobile app‐connected devices, specifically designed for chronic wound monitoring in a remote, at‐home setting. We reviewed literature from PubMed, IEEE Xplore, Scopus, and Web of Science, using keywords related to Internet of Things and chronic wound care. The evaluation criteria focused on biomarkers analysed, Internet of Things connectivity technology, experimental models used for device validation, and unique device strengths or weaknesses. Our review identified 52 unique studies comprising 77 data entries across five biomarker categories: gas and oxygen saturation, pH, metabolic markers, biophysical parameters of the wound microenvironment, and molecular markers of inflammation or infection. These devices span a wide landscape of biomarkers analysed to predict and monitor wound recovery, with the potential to improve patient outcomes through personalised treatment and timely interventions. However, many devices were never validated clinically on humans and faced limitations in power delivery, accuracy, stability, and reliability that challenge their potential usability in humans for wound monitoring. This review provides a comprehensive understanding of the potential and limitations of Internet of Things devices in at‐home wound care, highlighting areas for future research and development.

Background: Penile inversion vaginoplasty (PIV) is a common gender-affirming procedure for transgender women, but validated, transgender-specific patient-reported outcomes remain limited. This study evaluated long-term outcomes after PIV using the Post-Affirming Surgery Form and Function Individual Reporting Measure (AFFIRM), a validated instrument assessing appearance, urologic, and gynecologic domains. Methods: We conducted a single-institution retrospective cohort with a cross-sectional, anonymous AFFIRM survey distributed in 2024. Demographics, perioperative outcomes, and complications were obtained by chart review. AFFIRM domain scores, reported on a 0–200 scale with lower scores indicating better outcomes, were analyzed descriptively. Results: Of 193 eligible patients who underwent PIV between 2017 and 2023, surveys were delivered to 186 patients, and 47.8% responded. Median age at surgery was 34.3 years (interquartile range 26.1–49.1), with a median follow-up time of 50.0 months. Most respondents reported high satisfaction with genital appearance, and 90% strongly agreed their anatomy aligned with gender identity. Clitoral sensation was reported by 93%, most commonly as pleasurable. Urologic symptoms were generally minimally bothersome; although 59% reported a misdirected urine stream, mean bother score was low (1.64 ± 1.77). Vaginal dryness and dyspareunia were reported by 43% and 44%, respectively, with 27% describing symptoms as bothersome. Major complications occurred in 13.9% and revision surgery in 34.2%, most commonly for stenosis or depth concerns (13.5%). Conclusions: AFFIRM captured meaningful, transgender-specific, long-term outcomes after PIV, complementing traditional surgical metrics and identifying opportunities to improve preoperative counseling, surgical refinement, and postoperative management of vaginal dryness and urinary symptoms.

Although complications of autologous bone flap cranioplasty are well described, data on long-term bone flap survival and the comorbidities associated with secondary reconstruction are limited. This study aimed to quantify the need for secondary alloplastic cranioplasty within a standardized patient cohort. Patients who underwent delayed cranioplasty following craniectomy with banked, frozen autologous bone between 2012 and 2025 were identified and analyzed using Cox regression, spline analysis, and Kaplan–Meier survival analysis. A total of 367 patients with an average age of 39.2±19.7 years (range: 0.3–84.4 years) at the time of cranioplasty were included. A secondary cranioplasty was required in 13.6% of patients (n=50 of 367), with resorption (52%) and infection (42%) as the most common indications. In adjusted analyses, patients who underwent cranioplasty following a traumatic injury (HR: 2.37; 95% CI: 1.07–5.26; P =0.03) and patients younger than 18 years (HR: 2.99; 95% CI: 1.35–6.62; P =0.01) were more likely to require a secondary cranioplasty due to bone flap resorption. Increasing defect size was also associated with a higher risk of secondary cranioplasty due to bone flap resorption, becoming significant at roughly 95 cm² (HR: 2.54; 95% CI: 1.04–6.20; P =0.04). The estimated cumulative incidence of secondary cranioplasty was 37% at ten years after autologous reconstruction. These results indicate that although autologous bone flap cranioplasty is largely effective, select patients face a substantially higher risk of secondary cranioplasty, and alternative reconstructive options may be warranted.

Biparietal osteodystrophy, also known as bilateral parietal calvarium bone thinning, is a rare calvarial condition characterized by loss of diploic bone within the parietal region. Although historically described in anthropologic and radiologic literature, current understanding of its epidemiology, pathogenesis, clinical relevance, and management remains fragmented. This review synthesizes current evidence and highlights emerging studies on biparietal osteodystrophy. Epidemiologic reports indicate that biparietal osteodystrophy affects a broad age range but appears most frequently in older adults, with several series suggesting a slight female predominance. Prevalence is difficult to estimate due to incidental detection, though modern imaging has increased recognition of the condition. Histologically and anatomically, biparietal osteodystrophy is marked by thinning of the outer table and loss of the diploic space, with little osteoblastic or osteoclastic remodeling. Proposed pathogenic mechanisms include chronic degenerative change, impaired vascular supply to the diploë, and other theories, although no single explanation fully accounts for its complete presentation. Clinically, most patients remain asymptomatic, with complications such as calvarial fractures and traumatic brain injury being rare but highlighting the structural vulnerability associated with severe thinning. Management strategies are not standardized, and the use of anti-osteoporotic drugs and cranioplasty has been reported to offer benefit in select cases, although no treatment has been formally validated for biparietal osteodystrophy. As the understanding of biparietal osteodystrophy continues to evolve, future research is needed to clarify its natural history, identify potential etiologic pathways, and establish evidence-based management guidelines.

Objective We sought to characterize factors associated with postoperative complications in patients undergoing primary cleft lip repair (CLR). Design The National Surgical Quality Improvement Program-Pediatric database was queried to identify patients under 12 months old undergoing CLR using CPT codes. Multivariable analysis was conducted to characterize complications and associated comorbidities. Setting A multicenter sample. Patients/Participants A total of 11 957 cases (81.9% unilateral CLR and 18.1% bilateral CLR) were identified. Interventions None. Main Outcomes/Measures The postoperative outcomes of significance were surgical site infection (SSI), wound dehiscence, and unplanned reintubation within 30 days of CLR. Results The cohort had a mean age of 4.7 ± 2.0 months and a median American Society of Anesthesiologists classification of 2. SSIs occurred in 0.6% of cases and were independently associated with bilateral cleft anatomy (OR 2.16, P = .003) and longer anesthesia time (OR per minute: 1.004, P = .009). Wound dehiscence occurred in 0.4% of patients and was independently associated with bilateral cleft anatomy (OR 4.03, P < .001) but was associated with shorter anesthesia duration (OR per minute: 0.991, P < .001). Unplanned reintubation occurred in 0.2% of cases, with these patients having significantly higher rates of multiple comorbidities. Conclusion Wound dehiscence, SSI, and unplanned reintubation were rare complications following CLR. Patients with a bilateral cleft lip had increased odds of both SSI and wound dehiscence.

Introduction Hypergranulation tissue (excess granulation tissue) is a common complication following penile inversion vaginoplasty (PIV). It often requires repeated treatment with silver nitrate using a speculum to access the neovagina. This study evaluates whether adding betamethasone suppositories to silver nitrate treatment improves the resolution of hypergranulation tissue after PIV. Methods A retrospective chart review was conducted on patients who received supplemental betamethasone suppositories in addition to silver nitrate treatment (betamethasone group) between 01/2023 and 12/2024 and matched to a cohort of patients treated with silver nitrate alone (silver nitrate group). Outcomes, number of treatments, and severity of hypergranulation tissue were compared using t tests for continuous variables and Fisher's exact tests for categorical variables. Results There were 16 patients in each group, with similar average follow-up times: 8.5 ± 5.5 months (silver nitrate group) and 7.8 ± 4.7 months (betamethasone group) ( P = 0.70). At the most recent follow-up, moderate and severe hypergranulation resolved more often in the betamethasone group (86%, 50%) than in the silver nitrate group (60%, 25%). Patients in the betamethasone group with moderate or severe hypergranulation tissue required fewer median treatments for resolution (2 vs 3.5 and 4 vs 5, respectively). After excluding cases that required cauterization under anesthesia, patients in the betamethasone group were significantly more likely to have resolution of their hypergranulation tissue compared to patients in the silver nitrate group ( P = 0.035). Conclusions Betamethasone is an effective addition to silver nitrate for the treatment of hypergranulation tissue, with our results indicating it can improve resolution and lessen treatment burden in patients' post-PIV.

Objective: To characterize pediatric patients experiencing unplanned intraoperative extubation (UIE) during cleft lip (CL) and cleft palate (CP) repair and assess postoperative outcomes. Design: Retrospective cohort study using the 2019–2023 National Surgical Quality Improvement Program–Pediatric database. Setting: Multicenter surgical registry of pediatric operations. Patients: Children undergoing CL repair (<1 year) or CP repair (<3 years). Interventions: Not applicable. Main Outcome Measure(s): Incidence of UIE, demographic and operative characteristics, and 30-day postoperative complications. Results: Among 17 047 cases, UIE occurred in 0.37% of CL repairs and 0.20% of CP repairs. Patients who experienced UIE had similar baseline characteristics to those without UIE but demonstrated significantly longer operative and anesthesia times for both procedures. Despite these intraoperative events, no cases of death, pneumonia, or unplanned reintubation occurred postoperatively, and overall 30-day complication rates remained low. Conclusions: UIE during CL and CP repair is rare and not associated with major postoperative complications.