•Plugs and outlets represent potential ignition sources in operating rooms.•Increasing awareness of OR fires is the single most important prevention technique.•Careful use of alcohol and proper ...handling of surgical drapes can prevent fires.•Understanding of fire equipment can accelerate extinguishment and minimize injury.
We present the case of an 11 month old boy with history of sagittal synostosis who underwent a cranial vault reconstruction for repair. During the case, surgical irrigation spilled onto the plug in the operating room table, resulting in sparks and a small fire. The fire was contained and extinguished. The patient suffered no injury. We discuss previous cases of fires in neurosurgical operating rooms and identify a new source of ignition for fires. We also explore recommended best practices for fire prevention and safety to identify ways to prevent instances like this from occurring in the future.
Purpose:
Top surgery (i.e. mastectomy) has been shown to improve gender dysphoria and quality of life in adult transmasculine patients. However, even as an increasing number of adolescents and young ...adults present for gender-affirming surgery, the impact of top surgery on this population is not well described. Minor patients require parental consent and often face more stringent insurance restrictions. This prospective study aims to increase the body of evidence for gender-affirming top surgery in adolescents and young adults. We will measure the change in self-reported gender dysphoria, gender congruence, body image, and chest dysphoria.
Methods:
This is a prospective, multi-institutional study. Transmasculine and non-binary, designated female at birth, patients between the age of 13-25 years presenting for top surgery consultation were recruited from: Northwestern Memorial Hospital, The University of Illinois at Chicago, or Ann & Robert H. Lurie Children’s Hospital of Chicago. Patients completed four patient-reported outcomes measures at three time points: pre-operative baseline, three-months postoperative, and one-year postoperative. The questionnaires employed included the Transgender Congruence Scale (TCS), the Utretcht Gender Dysphoria Scale (UGDS), the Chest Dysphoria Measure (CDM), and the Body Image Scale (BIS). Preliminary interim analysis of mean change scores between pre- and three-month postoperative surveys was performed using paired, two-sided t-tests with confidence level at 95%.
Results:
Thirty nine patients have been enrolled to date. At interim analysis, ten patients, mean age 18.6±2.9, range 15-24 years, had completed 3-month follow-up. Eight identified as transmasculine, one non-binary/genderqueer, and one identified as ‘other.’ Mean change from baseline to three-months of the TCS appearance congruence sub-scale was 7.3 points (p = 0.002), mean change of the internal congruence sub-scale was 0.1 points (p = 0.859), and total score scale was 7.4 points (p = 0.002). The UGDS demonstrated a mean change of -2.1 points at three-months (p = 0.099). The Chest Dysphoria Measure demonstrated mean change of -28.3 points at three-months (p < 0.001). The BIS total score mean change was -12.3 points at three-months (p = 0.011). Among the BIS subscales, the primary sexual characteristics score had a mean change of -5.5 points (p=0.003), secondary sexual characteristics had a mean change of -4.0 points (p = 0.047) and neutral characteristics had a mean change of -1.6 points (p = 0.259) at three months.
Conclusion:
Our preliminary findings demonstrate that gender-affirming chest surgery improves chest dysphoria, appearance congruence, and overall gender congruence in transmasculine and non-binary adolescents and young adults. We anticipate that the final data will inform clinical practice guidelines for transgender and non-binary patients seeking mastectomy and chest masculinization.
Limited data exist regarding industry financial relationships in plastic surgery. The Sunshine Act Open Payments Database currently represents the largest repository of these data, but is limited ...primarily to queries of individual providers. The purpose of this study was to analyze these data and present them in a manner that better delineates these relationships, and to compare plastic surgery with other surgical subspecialties.
A review of the Open Payments Database was performed for the period from January 1, 2014, to December 31, 2014. These data were analyzed with respect to types of payments, characteristics of plastic surgeons and companies, and comparison with other surgical subspecialties.
A total of 49,053 payments from 274 companies were identified that were made to 4812 plastic surgeons (475 academic and 4337 private practice). The total value of payments was $17,091,077. Food and beverage represented the most common type of payment (82.2 percent). Royalties and licensing represented the highest valued type of payment (35.7 percent), but were received by only a minority of plastic surgeons (0.5 percent). No significant differences were identified between academic and private practice plastic surgeons in the value or quantity of payments. Plastic surgery (54.5 percent) exhibited the lowest prevalence of industry financial relationships compared with otolaryngology (57.9 percent), orthopedics (62.4 percent), neurosurgery (87.8 percent), and urology (63.1 percent) (p < 0.001).
Approximately half of all plastic surgeons have industry financial relationships. The prevalence of these relationships is comparatively less than in other surgical subspecialties.
Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria, which is associated with depression and anxiety. Top surgery may be ...performed to treat chest dysphoria.
To determine whether top surgery improves chest dysphoria, gender congruence, and body image in TGNB DFAB AYA.
This is a nonrandomized prospective cohort study of patients who underwent top surgery between December 2019 and April 2021 and a matched control group who did not receive surgery. Patients completed outcomes measures preoperatively and 3 months postoperatively. This study took place across 3 institutions in a single, large metropolitan city. Patients aged 13 to 24 years who presented for gender-affirming top surgery were recruited into the treatment arm. Patients in the treatment arm were matched with individuals in the control arm based on age and duration of testosterone therapy.
Patients in the surgical cohort underwent gender-affirming mastectomy; surgical technique was at the discretion of the surgeon.
Patient-reported outcomes were collected at enrollment and 3 months postoperatively or 3 months postbaseline for the control cohort. The primary outcome was the Chest Dysphoria Measure (CDM). Secondary outcomes included the Transgender Congruence Scale (TCS) and Body Image Scale (BIS). Baseline demographic and surgical variables were collected, and descriptive statistics were calculated. Inverse probability of treatment weighting (IPTW) was used to estimate the association of top surgery with outcomes. Probability of treatment was estimated using gradient-boosted machines with the following covariates: baseline outcome score, age, gender identity, race, ethnicity, insurance type, body mass index, testosterone use duration, chest binding, and parental support.
Overall, 81 patients were enrolled (mean SD age, 18.6 2.7 years); 11 were lost to follow-up. Thirty-six surgical patients and 34 matched control patients completed the outcomes measures. Weighted absolute standardized mean differences were acceptable between groups with respect to body mass index, but were not comparable with respect to the remaining demographic variables baseline outcome measures. Surgical complications were minimal. IPTW analyses suggest an association between surgery and substantial improvements in CDM (-25.58 points; 95% CI, -29.18 to -21.98), TCS (7.78 points; 95% CI, 6.06-9.50), and BIS (-7.20 points; 95% CI, -11.68 to -2.72) scores.
Top surgery in TGNB DFAB AYA is associated with low complication rates. Top surgery is associated with improved chest dysphoria, gender congruence, and body image satisfaction in this age group.
The purpose of this study was to determine the existence and strength of association between chest dysphoria and mental health in transmasculine and nonbinary adolescents.
This is a cross-sectional ...cohort study of transmasculine and nonbinary adolescents designated female at birth between 12 and 18 years old. None had undergone prior top surgery. Patients complete the Chest Dysphoria Measure and Youth Inventory-4 (YI-4) upon presentation to our institution. Outcomes were retrospectively reviewed. The primary outcome of interest was the association between chest dysphoria and anxiety and depression symptom severity, as measured by the YI-4.
One hundred fifty-six patients met inclusion criteria. Mean age was 15.3 years (standard deviation SD = 1.7). Most patients identified as transmasculine (n = 132); 18 identified as nonbinary and 6 as questioning. Mean (SD) YI-4 symptom severity scores were 10.67 (6.64) for anxiety and 11.99 (7.83) for depression. Mean (SD) Chest Dysphoria Measure composite score was 30.15 (9.95); range 2–49. Chest dysphoria was positively correlated with anxiety (r = .146; p = .002) and depression (r = .207; p < .001). In multivariate linear regression models, chest dysphoria showed a significant, positive association with anxiety and depression, after accounting for gender dysphoria, degree of appearance congruence, and social transition status.
Chest dysphoria is associated with higher anxiety and depression in transmasculine and nonbinary adolescents designated female at birth. This association is independent of level of gender dysphoria, degree of appearance congruence, and social transition status. Treatment options aimed at alleviating chest dysphoria should be made accessible to adolescents and tailored to individual needs.
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