The current prospective, blinded, randomized cohort study aims to delineate the relative contribution of different surgical treatments for frontal migraines.
Patients undergoing migraine surgery in ...the frontal region (site I) were prospectively enrolled and blindly randomized into one of the following four groups: (1) myectomy alone, (2) myectomy and foraminotomy/fasciotomy, (3) myectomy and arterectomy, and (4) foraminotomy/fasciotomy alone. Pre- and post-surgical migraine headache severity, duration, Migraine Headache Index (MHI) score, and migraine-free days (MFDs) were obtained.
Thirteen patients agreed to participate in the study. For all patients, the mean pre- and post-operative MHI scores demonstrated a significant improvement from 52.6 (3.8–85) to 4.7 (0–21.3) (p = 0.0001). Thirty-one percent of patients required a site I revision that included an arterectomy. Patients who had an arterectomy at their initial surgery demonstrated statistically significant improvement in both frequency (12 vs. 6.11; p = 0.02) and MHI scores (51.71 vs. 5.55; p < 0.01). Arterectomy patients also demonstrated a significant improvement in the number of MFDs following surgery, from 18 to 24 MFDs (p = 0.021). Those patients not undergoing arterectomy demonstrated statistically significant improvements in the number of MFDs after their initial surgery (13.25 MFDs, p = 0.01), but the improvement was significantly less when compared to the arterectomy group (13.25 vs. 24 MFDs; p = 0.026). Following revision arterectomy, both groups had statistically equivalent improvement in MFDs (20.75 vs. 24 MFDs; p = 0.178).
These findings suggest that arterectomy is necessary for successful treatment of frontal migraines (site I).
Background
Political contributions from healthcare providers are essential to shaping healthcare policy and allow physicians to expand their influence on a national level. Political Action Committees ...in particular provide a useful avenue for unifying contributions for the interest of a specific community. This study examined the geographical distribution, temporal pattern, and overall nature of the political contributions made by plastic surgeons.
Methods
The Federal Election Commission was analyzed for political contributions made by plastic surgeons from 2003 to 2021 using the search terms “plastic surgeon,” “microsurgeon,” and “craniofacial” as well as physician contributions to PlastyPAC. Contributions were categorized based on political parties (Democratic, Republican, and independent parties), and further analyzed based on state distribution and year of contribution. Spatial distribution data were then visualized using heatmaps for each state.
Results
The total sum of contributions between 2003 and 2021 from plastic surgeons was $5,306,605, with $1,737,178.51 for the Republican party, $962,773.26 for the Democratic party, and $2,604,149.86 for independent parties. Political funding of PlastyPAC consisted of 47.3% of the overall political contributions. There was no significant trend through the years in the overall contribution amount. The states with the most political contributions were California, New York, Florida, and Texas.
Conclusions
The temporal stagnation of total political contributions and decline in recent PlastyPAC funding from plastic surgeons support an increased political awareness for new plastic surgeons.
Level of evidence V
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
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Use of acellular dermal matrices (ADMs) for tissue expander breast reconstruction remains controversial with an uncertain safety and efficacy profile. This study analyzes the rates and factors for ...reoperation and postoperative infection in patients who underwent tissue expander breast reconstruction with and without ADM.
Patients who underwent breast reconstruction with and without ADM were identified from the National Surgical Quality Improvement Program database utilizing CPT codes. Covariates included patient demographics, preoperative comorbidities, and operative characteristics, while outcomes of interest were postoperative infection and reoperation. Univariate and multivariate analyses were performed to identify predictors of adverse outcomes.
There were 8334 patients in the ADM cohort and 12,451 patients who underwent tissue expander breast reconstruction without ADM. There were significantly fewer reoperations in the non-ADM cohort (5.4%) compared to the ADM cohort (7.7%) (
< 0.0001), with infection and hematoma as the most common etiologies in both cohorts. Surgical infections were also more prevalent in the ADM cohort (4.7%) compared with the non-ADM cohort (3.6%) (
< 0.0001). Univariate and multivariate analysis of the tissue expander breast reconstruction cohort revealed race, obesity, hypertension, smoking status, albumin, and operative time as predictive for infection risk, while race, obesity, hypertension, smoking, albumin, operative time, and age were significant for reoperation.
Our study of 20,817 patients revealed significantly higher risk of infection and reoperation in patients who underwent breast reconstruction utilizing ADM versus without ADM. Patients considering ADM for breast reconstruction should engage in discussion with their surgeon about complications, aesthetics, and cost.
TMR (targeted muscle reinnervation) or RPNI (regenerative peripheral nerve interface) have been the standard after nerve injuries. In this case report, we explain our approach in combining these two ...techniques (TMRpni) for a patient undergoing left above-the-knee amputation. Using this method, both phantom and nerve pain were reduced in our patient's case. As this technique becomes more well understood and widely adopted, amputee patients may achieve a greater quality of life post operation.
Targeted muscle reinnervation offers an approach to regain use of the affected extremity through electronic prosthesis while limiting phantom pain and neuroma limb production or pain. In this case ...report, we present the first reported case of leveraging the rectus flap for targeted muscle reinnervation. The case herein is of a 28-year-old woman who sustained a severe right upper extremity crush injury while being involved in a vehicular roll-over collision requiring right transhumeral amputation. Plastic surgery, orthopedic surgery, and vascular surgery were consulted to manage the right upper extremity injury.
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