Most Cited Articles in Body Contouring: A Bibliometric Analysis of the Past 45 Years

Introduction: The purpose of this study is to produce a bibliometric review of the 30 most cited articles related to 6 major domains of body contouring-abdominoplasty, thighplasty, brachioplasty, gluteoplasty, body lift, and liposuction-for resident and fellow education. Methods: The authors utilized the Web of Science Citation Index to identify the 30 most cited articles related to surgery for body contouring published from 1975 to 2020. Articles were classified according to their level of evidence, type of study, and country of publication. Results: A total of 336 articles were reviewed to compile our list. The mean number of citations across the articles was 114.7 ±  SD 86.1. The highest prevalence of the papers was published between 2000 and 2009 (n = 15, 50%). The country with the highest number of contributions was the United States (n = 22, 73%). Plastic and Reconstructive Surgery served as the main journal of publication for these papers (n = 22, 73.3%). The majority of articles were designated for clinical-type studies (n = 26, 86.7%). No basic science or prevalence study design papers were listed. In terms of level of evidence (LoE), most papers were assigned IV (n = 11, 36.7%) and III (n = 7, 23.3%). Conclusions: Our study reveals that the most cited papers in body contouring are of LoE III and IV. Although the LoE of plastic surgery research, in general, has improved, in the past decade, a call for higher quality papers remains. Overall, this analysis provides an easy, electronic starting point for residents and fellows interested in understanding the field's evolution.

The Utility of the Omentum Flap for Complex Intrathoracic Problems

Introduction: Omentum flap is a viable reconstructive option for complex chest wall and mediastinal reconstruction. The impact of vasoconstrictors and the laminar pattern of blood flow associated with left ventricular assist devices (LVADs) on the outcomes of reconstructions has not been thoroughly evaluated. Methods: A retrospective review of all patients who underwent chest wall or mediastinal reconstruction using pedicled omentum flaps between 2003 and 2019. Results: Forty patients (60% males) underwent chest wall or mediastinal reconstruction using a pedicled omentum flap at a mean age of 58 years. The median follow-up was 24.3 months. The most common indication was the reconstruction of anterior chest wall/sternal defects (n = 16), followed by coverage of repaired bronchopleural fistula (n = 6), osteoradionecrosis of the anterolateral chest wall (n = 5), reconstruction of anterior/lateral chest wall following oncologic resections (n = 5), coverage of replaced infected LVAD (n = 4), and coverage of exposed/replaced aortic root vascular grafts (n = 4). Vasoconstrictors were used in 26 patients (65%). Eight flaps had partial necrosis, and none of the flaps had complete necrosis. There was no difference in flap complication rates in patients who received vasoconstrictors during the case compared to those who did not (P = 1.0). Thirteen (33%) flaps were skin grafted at a median of 13 days with 100% skin graft viability. Abdominal incisional hernia developed in 8 patients. In patients with LVADs, the omentum remained viable during the follow-up period. Conclusion: The ability of the omentum to easily reach various regions in the chest and the low failure rate make this flap a reliable reconstructive method.

Transnasal tension suture of external nasal splints: A reliable, novel technique

BACKGROUND

We routinely apply external nasal splints after closed nasal reduction or rhinoplasty and secure the splint by transnasal suturing. We seek to describe our technique and review our experience.

METHODS

A retrospective chart review was performed to review patients who had an external nasal splint secured by transnasal suturing. The technique consists of steristrips applied across the dorsum and nasal bones. The Aquaplast is molded to the nose and a 2-0 polypropylene suture on a straightened tapered needle or a Keith needle is passed through the splint, the nasal sidewalls and septum, through the splint on the contralateral side, and back again in a horizontal mattress fashion. The suture is tied down to maintain the desired shape of the splint. The splint is removed in the first postoperative followup (10-14 days).

RESULTS

Mean patient age was 31.5 years, 82 male and 18 female patients were reviewed, 67 % of splints were placed for closed reduction of acute nasal trauma, and 33 % placed after elective rhinoplasty for late correction of functional and cosmetic traumatic deformity. No splints were inadvertently removed by patients prior to followup. Splints were removed an average of 12 days postoperatively, and mean followup was 27 weeks. There were no complications related to transnasal suturing of the splint, such as skin ulceration, pressure necrosis, identifiable scarring related to the suture entry points or breathing difficulty attributable to internal nasal valve narrowing.

CONCLUSION

Transnasal suturing is a safe and reliable method for fixation of an external nasal splint.

Clinical and Radiological Safety of Retained Implantable Doppler Devices Used for Free Flap Monitoring

INTRODUCTION

Implantable Doppler devices are reliable adjuncts used for free flap monitoring. Occasionally, the probe/wire is not removed and remains in the soft tissues. The clinical safety of the retained probes and safety and compatibility with magnetic resonance imaging (MRI) have not been studied. We present a series of retained implantable Doppler probes examining clinic outcomes, safety and compatibility with MRI, and effect on MRI image quality.

METHODS

A retrospective review was conducted of patients who had an implantable Doppler device for free flap monitoring between July 2007 and August 2018. Routine post-operative imaging was reviewed for all patients to identify incidental findings of a retained probe. A subset of patients with retained implantable Doppler probes who underwent MRI was identified. Magnetic resonance images were reviewed to detect any degradation of image quality.

RESULTS

A total of 323 patients who had an implantable Doppler device placed were reviewed 18 (5.6%) patients were identified with a retained probe and were included in this study. Mean age was 49 years with mean follow-up of 34.4 months. One potential device-related complication occurred in 1 (5.6%) patient. A total of 32 MRI scans were performed in 8 patients with retained devices, including 6 patients who underwent a total of 21 MRIs of the surgical site. There were no complications related to the MRI scans, and we found no significant degradation of image quality.

CONCLUSION

Retained implantable Doppler probes were not associated with substantial adverse clinical outcomes nor affected MRI image quality of the surgical site.

Frequency, Pattern, and Treatment of Hand Fractures in Children and Adolescents: A 27-Year Review of 4356 Pediatric Hand Fractures

Background: The frequency, pattern, and treatment of pediatric hand fractures are rarely reported. We sought to review our institution's experience in the management of pediatric hand fractures. Methods: A retrospective review of children and adolescents (younger than 18 years) treated for hand fractures between January 1990 and June 2017 was preformed. Fractures were categorized into metacarpal, proximal/middle phalanx, distal phalanx, or intra-articular metacarpophalangeal (MCP)/proximal interphalangeal (PIP)/distal interphalangeal (DIP) fractures. Patients were categorized into 3 age groups (0-5, 6-11, and 12-17 years). Results: A total of 4356 patients were treated for hand fractures at a mean ± SD age of 12.2 ± 3.5 years. Most fractures occurred in patients aged 12 to 17 years (n = 2775, 64%), followed by patients aged 6 to 11 years (n = 1347, 31%). Only 234 (5%) fractures occurred in children younger than 5 years. Most fractures occurred in the proximal/middle phalanx (48%), followed by metacarpal (33%), distal phalangeal (12%), and intra-articular MCP/PIP/DIP joints (7%). Proximal/middle phalangeal fractures were the most common in all age groups. About 58% of intra-articular MCP/PIP/DIP fractures in patients aged between 0 and 5 years required open reduction ± fixation, and the remaining 42% fractures were amenable to closed reduction. In patients older than 5 years, about 70% of these fractures were amenable to closed reduction. All age groups included, most metacarpal (93%), proximal/middle phalangeal (92%), and distal phalangeal (86%) fractures were amenable to closed reduction alone. Conclusions: The frequency, pattern, and treatment of hand fractures vary among different age groups. Understanding the pattern of these fractures helps making the right diagnosis and guides choosing the appropriate treatment.

Pubectomy and urinary reconstruction provides definitive treatment of urosymphyseal fistula following prostate cancer treatment

OBJECTIVE

To describe the natural history, reconstructive solutions, and functional outcomes of those men undergoing pubectomy and urinary reconstruction after prostate cancer treatment.

PATIENTS AND METHODS

This study retrospectively identified 25 patients with a diagnosis of urosymphyseal fistula (UF) following prostate cancer therapy who were treated with urinary reconstruction with pubectomy. This study describes the natural history, reconstructive solutions, and functional outcomes of this cohort.

RESULTS

All 25 patients had a history of pelvic radiotherapy for prostate cancer. The median (interquartile range [IQR]) time from prostate cancer treatment to diagnosis of UF was 11 (6, 16.5) years. The vast majority of men (24/25; 96%) presented with debilitating groin pain during ambulation. Posterior urethral stenosis was common (20/25; 80%), with 60% having repetitive endoscopic treatments. Culture of pubic bone specimens demonstrated active infection in 80%. Discordance between preoperative urine and intraoperative bone cultures was common, 21/22 (95.5%). After surgery, major 90-day complications (Clavien-Dindo Grade III and IV) occurred in eight (32%) patients. Pain was significantly improved, with resolution of pain (24/25; 96%) and restoration of function, the median (IQR) preoperative Eastern Cooperative Oncology Group Performance Status (ECOG PS) was 3 (2, 3) vs median postoperative ECOG PS score of 0 (0, 1).

CONCLUSION

Endoscopic urethral manipulation after radiation for prostate cancer is a risk factor for UF. Conservative management will not provide symptom resolution. Fistula decompression, bone resection, and urinary reconstruction effectively treats chronic infection, improves pain and ECOG PS scores.

Landmarks in Facial Rejuvenation Surgery: The Top 50 Most Cited Articles

BACKGROUND

Facial rejuvenation procedures are common in plastic surgery.

OBJECTIVES

The aim of this study was to report the 50 most cited articles in the field of aesthetic facial rejuvenation surgery and provide a simple educational resource for plastic surgeons.

METHODS

The authors utilized the Web of Science Citation Index to identify the 50 most cited articles related to surgery for facial rejuvenation published from 1950 to 2019. Articles were classified according to their level of evidence, type of study, country of publication, and topic of interest: facelift, blepharoplasty, brow lift, neck lift, or combined areas.

RESULTS

The mean number of citations per article was 137, and the majority of articles (n = 19) were published between 1990 and 1999. The most prevalent topic was facelift surgery (n = 24), followed by articles discussing combined procedures (n = 13), blepharoplasty (n = 6), brow lift (n = 4), and neck lift (n = 3). Most of the articles were classified as clinical (n = 26), followed by basic science studies (n = 12) and review articles (n = 12). Among the articles amenable to grading level of evidence (n = 26), most (n = 24) presented their findings utilizing level IV evidence. The nation of origin for most of the articles (n = 41) was the United States.

CONCLUSIONS

Articles addressing facelift surgery represented the largest proportion of peer-reviewed landmark publications in aesthetic facial surgery research. A simple educational resource is presented to encourage the appreciation of the research in this field.

Augmentation Phalloplasty for Acquired Penile Shortening: A Systematic Review of Techniques, Outcomes, Patient Satisfaction, and Limitations

INTRODUCTION

Although an infrequent cause of small penile size in adult men, acquired penile shortening represents a particular reconstructive challenge due to preexisting penile anatomic deformities.

AIM

With numerous techniques being performed, the purpose of our study is to assess available literature on length enhancement procedures used for acquired penile shortening deformities.

METHODS

A systematic review was performed using the guidelines outlined in the Preferred Reporting Items for Systematic reviews and Meta-analyses. Medline/PubMed, Scopus, and Cochrane Databases were used to identify papers on augmentation Phalloplasty in non-transgender males with acquired penile shortening from 1990 to 2018.

MAIN OUTCOME MEASURE

Outcomes, complications, and patient-reported satisfaction were analyzed.

RESULTS

12 articles, involving 931 patients and 8 primary procedures, met our inclusion criteria. The majority of articles had level of evidence of 4 (83%) and Newcastle Ottawa Scale score of 6 (92%, moderate risk of bias). All studies reported mean penile length gain; however, inconsistent methodology was used when measuring penile dimensions. Mean length gain ranged from 0.6 to 6.4 cm. Overall, the mean complication rate for all techniques ranged from 0% to 50%. Post-operative satisfaction was reported in 10 (83%) studies, 7 of which used a validated scale. Patients were generally satisfied, with reported satisfaction rates ranging from 77% to 100%.

CLINICAL IMPLICATIONS

While numerous procedures have been described, the significant limitations in the available data preclude identifying a single superior procedure.

STRENGTHS & LIMITATIONS

The significant heterogeneity in the reported literature is a limitation of this study and highlights the need for standardized reporting. However, this study is the first to analyze augmentation phalloplasty literature in the setting of acquired penile shortening.

CONCLUSION

Augmentation phalloplasty techniques for acquired penile shortening are evolving and are continuously being modified; best-practice guidelines are crucial to achieve safe and satisfactory outcomes in this population. Abu-Ghname A, Banuelos J, Davis MJ, et al. Augmentation Phalloplasty for Acquired Penile Shortening: A Systematic Review of Techniques, Outcomes, Patient Satisfaction, and Limitations. J Sex Med 2020;17:331-341.

Reconstruction of complex hemipelvectomy defects: A 17-year single-institutional experience with lower extremity free and pedicled fillet flaps

INTRODUCTION

Hemipelvectomy procedures result in massive soft tissue defects. The standard approach is to reconstruct the defect with anterior or posterior hemipelvectomy flaps. Certain situations preclude the use of local tissue flaps, and an alternative is the use of leg fillet flaps, circumferential pedicled or free flaps harvested from the amputated part. The purpose of this study is to present our institution's experience with using pedicled and free fillet flaps to reconstruct hemipelvectomy soft tissue defects.

METHODS

We performed a retrospective chart review of patients who underwent hemipelvectomy and fillet flap reconstruction from 2001 to 2018. Demographics, clinical and surgical characteristics, postoperative outcomes, and complications of patients were reviewed.

RESULTS

Ten patients were identified and included. Their mean age was 51 ± SD 12.4 years. Six patients underwent standard external hemipelvectomy and 4 patients underwent extended external hemipelvectomy. Seven lower extremity fillet flaps were performed as free tissue transfers, and 3 were pedicled flaps. The mean flap size was 1,153 ± SD 1137 cm². The mean follow-up was 5 months (range: 1-24 months). Five patients developed postoperative complications; none of them required operative intervention. There were no partial or total flap losses postoperatively.

CONCLUSION

Reconstruction with pedicled or free lower extremity fillet flaps is a valuable reconstructive approach, for managing large soft tissue defects following hemipelvectomy when the standard anterior and posterior thigh flaps are unavailable or inadequate for complete soft tissue coverage. This useful technique mitigates donor site morbidity, while simultaneously achieving massive soft tissue coverage with an acceptable complication profile.