Scientific Abstract Presentations: Research & Technology Session 1 Thursday, October 9 Thu, Oct 9 3:30-4:30 p.m. CDT

Purpose: Academic influence is often equated with research volume, yet per-publication impact varies widely across institutions. The Departmental Scholarly Index (DSI) was developed to standardize institutional comparisons by integrating publication volume and journal impact factor, offering a balanced assessment of scholarly output. Unlike cumulative metrics, DSI generates scores for individual calendar years, offering a temporal snapshot of research productivity and quality.

Methods: A systematic PubMed search identified all plastic surgery publications from the 22 Southeastern institutions from 2019–2023. Journal impact factors were obtained from Clarivate's Journal Citation Reports. The DSI was calculated by dividing each institution's total impact score (TIS) per year by its annual publication count, yielding an average per-publication impact.

Results: A total of 1,731 plastic surgery publications were identified across the 22 institutions over the five-year period. Vanderbilt University led in publication volume (258 articles) and Total Impact Score (634.1), followed by Duke University (202 articles, TIS: 483.1) and Mayo Florida (231 articles, TIS: 313.6). Despite lower publication volumes, the University of North Carolina achieved the highest average DSI (3.24), followed by Virginia Tech Carilion (3.06) and University of Kentucky (2.97). The five-year mean DSI across all institutions was 1.93 ± 0.76.

Institutional research strategies varied markedly. Virginia Tech Carilion (DSI rank: 2nd; TIS rank: 20th) prioritized low-volume, high-impact publications, achieving substantial influence per article despite limited output. In contrast, Mayo Florida (DSI rank: 19th; TIS rank: 3rd) employed a volume-focused strategy, yielding high productivity but lower per-publication impact. Balanced institutions such as Vanderbilt (DSI rank: 4th; TIS rank: 1st) and Duke (DSI rank: 5th; TIS rank: 2nd) maintained high DSI and TIS through sustained productivity, illustrating an equilibrium between quantity and per-publication impact.

Regression analysis revealed a strong correlation between publication volume and TIS (R² = 0.876), confirming that high productivity drives cumulative impact. Conversely, the weak correlation between DSI and TIS (R² = 0.22) highlights a disconnect between publication quality and volume. These findings suggest that institutions with higher research outputs may not always produce the most impactful works on a per-publication basis.

Conclusion: By distinguishing between research volume and per-publication quality, the DSI offers a refined framework for assessing institutional productivity and promoting meaningful comparisons across academic programs. This preliminary analysis validates the utility of DSI in academic plastic surgery programs and suggests its potential for broader application across diverse research fields.

Background

Early detection of compromised tissue perfusion and timely intervention are critical to prevent irreversible damage following ischemia.1 Ischemia to tissues can lead to cellular dysfunction, necrosis, and significant morbidity if not identified and managed promptly.2,3 Traditional methods for assessing tissue perfusion, such as clinical observation and invasive diagnostics, can be time-consuming, inefficient, subjective, or limited in scope. Consequently, there is a growing need for noninvasive, objective, and timely techniques to identify ischemic regions and monitor therapeutic effectiveness in resolving ischemia. This case series evaluates the utility of Forward-Looking Infrared (FLIR) thermographic imaging, using a handheld portable plug-in device to detect ischemic regions and monitoring responses to hyperbaric oxygen therapy (HBOT) for ischemia management across diverse clinical scenarios.

Methods

FLIR thermographic imaging was performed before and after HBOT to detect temperature gradients associated with impaired perfusion in various cases of post-surgical flap ischemia recovery. Darker colors represent lower temperatures suggesting limited blood flow; brighter colors representing warmer temperatures suggest more robust perfusion to an area. Patients received standard HBOT sessions for their indications. Pre- and post-HBOT thermograms were obtained to assess changes in tissue temperature and perfusion within sessions and over the patients' clinical course. Outcomes including tissue viability, resolution of ischemia, and functional improvements were analyzed.

Results

Ten (n=10) patients presented with post-surgical ischemic complications. Indications for HBOT included tissue necrosis after oncologic mastectomy, penile implant surgery, soft tissue filler injection forehead vein removal, gender-affirming mastectomy, and rhytidectomy. Additionally, HBOT was used to treat digit ischemia resulting from heparin-induced thrombocytopenia (HIT),

FLIR monitoring demonstrated that FLIR imaging identified localized areas of reduced blood flow in all patients, correlating with clinical diagnoses of ischemia. Following HBOT, thermograms showed increased tissue temperature in the previously ischemic zones, suggesting improved oxygenation and perfusion. These findings were associated with appropriate wound healing, and with serial FLIR imaging, we successfully tracked healing trajectory and documented progressive improvements in blood flow over time.

Conclusion

This case series highlights the potential use of FLIR thermographic imaging for assessment of post-operative tissue recovery. It is a rapid, efficient, and low-cost noninvasive tool for both detecting ischemia and evaluating therapeutic response to HBOT and other therapies. Broader adoption of this technology may assist in clinical decision-making, leading to earlier interventions and more favorable outcomes in patients with compromised tissue perfusion.

References:

Razavi, S.A., A.L. Hart, and G.W. Carlson, Ischemic Complications After Bilateral Nipple-sparing Mastectomy and Implant-based Reconstruction: A Critical Analysis. Ann Plast Surg, 2021. 86(6S Suppl 5): p. S526-s531.

Javed, H., et al., Challenges and Solutions in Postoperative Complications: A Narrative Review in General Surgery. Cureus, 2023. 15(12): p. e50942.

Nasr, Hani Y. MD; Rifkin, William J. MD; Muller, John N. MD; Chiu, Ernest S. MD. Hyperbaric Oxygen Therapy for Threatened Nipple-Sparing Mastectomy Flaps: An Adjunct for Flap Salvage. Annals of Plastic Surgery 90(5S):p S125-S129, May 2023. | DOI: 10.1097/SAP.0000000000003441

Purpose: Minority patients have historically been underrepresented in medical research, including in plastic surgery. Previous studies have highlighted that 80% of images on plastic surgery websites and social media depict white individuals, and 30% of surgeons' social media accounts lack images of non-white patients. (1,2) Few studies have assessed visual representation in plastic surgery literature, but all demonstrate inequitable representation. (3,4) This study evaluates the equity of skin tone representation in visual materials published in plastic surgery journals.

Methods: Four independent reviewers completed an inter-rater reliability test, which was assessed using Cohen's Kappa. A comprehensive review of four plastic surgery journals, Aesthetic Surgery Journal, Plastic and Reconstructive Surgery, Annals of Plastic Surgery, and Journal of Plastic Reconstructive and Aesthetic Surgery, was conducted for articles published from September 2019 to September 2024. Articles were categorized by subspecialty and evaluated for images, graphics, or videos depicting human skin. Skin tones were rated using the Massey-Martin Skin of Color Scale, where scores of 1–3 indicated light skin tones, 4–6 medium skin tones, and 7–10 dark skin tones.

Results: A total of 5,349 articles were analyzed, of which 2,461 contained visual representations of skin, with an average of 2.2 images per article. The overall average Massey-Martin Score (MMS) was 1.8. Within subtopics, cosmetic surgery and breast surgery had an average MMS of 1.7. Head and neck reconstruction and trunk reconstruction had an average MMS of 1.8, followed by hand/peripheral nerve with an average of 1.9. Craniofacial and lower extremity reconstruction both had an average MMS of 2.0. Finally, burn related articles had an average of 2.3. There was a statistically significant difference in the average MMS across subspecialties (p < 0.001). Breast had a significantly lighter average MMS compared to craniofacial, burn, and lower limb reconstruction (p < 0.01, p < 0.001, p = 0.01, respectively). Cosmetic had a significantly lighter average MMS compared to craniofacial, lower limb reconstruction, and burn (p < 0.001, p = 0.03, p < 0.001, respectively). Hand/peripheral nerve, head and neck reconstruction, and trunk reconstruction also had significantly lighter MMS than burn (p = 0.043, p = 0.02, p = 0.04, respectively).

Conclusions: Plastic surgery literature predominantly features lighter skin tones, with breast and cosmetic surgery articles showing significantly lighter skin tones compared to other subspecialties. These findings highlight the need for more equitable visual representation to better reflect the diversity of patient populations and improve educational and clinical relevance in plastic surgery. Promoting diverse representation can enhance inclusivity and accuracy, ultimately benefitting both education and patient care.

1. Ali MM, Chatterjee A, Khoo LS, Sinno S, Rizk E. Patient Representation and Diversity in Plastic Surgery Social Media. Plast Reconstr Surg. 2021;147(1):128-134. doi:10.1097/PRS.0000000000007481

2. Cavazos-Rehg PA, Krauss MJ, Costello SJ, Kaiser N, Cahn ES, Fitzsimmons-Craft EE, Wilfley DE. Patient Representation and Diversity in Plastic Surgery Social Media. Plast Reconstr Surg. 2021;147(1):128-134. doi:10.1097/PRS.0000000000007481

3. Cho DY, Kneib CJ, Massie JP, et al. "Visual Representation of Racial Diversity in Aesthetic Surgery Literature." J Plast Reconstr Aesthet Surg. 2021;74(1):223-243. doi:10.1016/j.bjps.2020.05.048

4. Cho DY, Kneib CJ, Massie JP, et al. "Underrepresentation of Racial Minorities in Breast Surgery Literature: A Call for Increased Diversity and Inclusion." Annals of Surgery. 2021;273(2):202-207. doi:10.1097/SLA.0000000000004481.

PURPOSE Autologous tissue grafts are used by reconstructive surgeons for defect restoration but are limited by their diffusion dependence for nourishment. Engineering flaps by promoting angiogenesis within transferred tissue might potentially overcome this diffusion barrier and promote early revascularization. A novel cell line, reset vascular endothelial cells (R-VECs), consists of human umbilical vein endothelial cells transduced to express ETV2, an embryonic transcription factor that regulates early angiogenesis and is not normally expressed after 20 weeks in gestation. R-VECs have been shown to form microvascular networks in fibrin matrices within microfluidic systems. However, fibrin is not a component of human extracellular matrix and therefore limits the translatability of this network. Collagen is a more biocompatible substrate for R-VECs and ribosylated collagen, which is plain collagen incubated with ribose to cause non-enzymatic glycosylation and stiffening, has enhanced structural integrity. This study aims to demonstrate that R-VECs are capable of forming stable microvascular networks in matrices of increasing collagen compositions.

METHODS A total of 300,000 GFP-tagged R-VECs were suspended in 30ul of extracellular matrix composed of 0, 25, 50, and 100% 3 mg/mL ribosylated collagen. The remaining percentage for each was composed of fibrin. Suspensions were plated in a microfluidic chip via an inlet well, which flowed across a channel to an outlet well. The chips with collagen were incubated until the matrix polymerized and 1cc cylinders were attached to each well and filled with media at the inlet side. The microfluidic chip systems were then placed in an incubator at an angle to encourage flow through the channel via gravity. After 48 hours, they were transferred to a rocking machine in an incubator, applying shear force and continuous perfusion for the microvascular structures. Media was changed every 1 to 2 days and day 6 immunofluorescent VE-Cadherin staining of constructs was performed to characterize the formed endothelial network. Immunofluorescent beads and heparinized murine blood were flowed through the microfluidic chip to confirm perfusability of the network.

RESULTS Light microscopy confirmed the presence of vessel-like structures of differing morphology in each extracellular matrix. R-VECs in pure fibrin and 25% ribosylated collagen formed capillary-like microvascular networks that demonstrated capacity for fluorescent bead and heparinized murine blood flow, whereas the 50% group formed vessel-like structures, but did not survive until day 6 due to contraction. R-VECs in 100% ribosylated collagen formed vessel-like structures that were longer and wider than those observed in fibrin and partial collagen, resembling individual vessels more than capillary networks. These vessels appeared to have a lumen, sprouts, and branches. Fluorescent imaging identified GFP tagged R-VECs comprising the vessel-like structures.

CONCLUSIONS This study demonstrates the formation of microvascular networks by R-VECs in vitro in matrices of different collagen compositions. This supports their potential as a bioengineered solution to diffusion dependent tissue flap barriers. Additionally, the differing caliber of these vascular structures may be promising for the generation of hierarchical blood vessels for tissue engineering and microsurgical settings. Ongoing work is focusing on characterizing morphological differences between vessels formed in different matrices.

Purpose: Although academic plastic and reconstructive surgery has trended toward dismantling gender disparities over the last decade, gaps remain within program leadership. This study mapped gender distributions of plastic surgery chiefs and program directors (PDs) in context of faculty and trainees to understand whether the field is advancing toward gender parity, and specifically to characterize how current program leadership reflects and shapes the broader gender landscape.

Methods: In a national cross-sectional study of the 89 accredited integrated plastic surgery residency programs (including independent tracks) in the 2024-2025 academic year, data on academic plastic surgery leaders, faculty, and trainees were extracted from program websites and/or social/professional media, determining gender using documented pronouns. Career metrics were collected for all leaders. Differences by gender were evaluated using Chi-square/Fisher's exact tests, independent-samples t-tests, and analyses of covariance. Associations among female representation in program leadership, faculty, and trainees were examined.

Results: Compared to prior reports, developments occurred in gender representation at all levels and in parity regarding career advancement opportunities. As of 2025, women comprise 26.4% of faculty and 50.9% of residents; 0.1% identify as nonbinary. In comparison, 13.5% of department/division chiefs, 22.5% of primary PDs, and 43.1% of associate PDs are female. Associate PDs are significantly more likely than chiefs or primary PDs to be female (P < .001), indicating expansion of women entering leadership positions. Analyses of career metrics supported gender parity in selection and advancement of program leaders. Qualification variables, including average post-residency years in practice, clinical fellowships completed, board certifications, additional graduate degrees, total publication count, or h-index, did not differ significantly by gender at any level of program leadership. Professional attainment variables, including professor rank and holding an endowed chair or journal editorship, likewise did not differ significantly by gender. Female vs male leaders at all levels were associated with significantly greater female faculty representation within their programs (approximately 150% relative magnitudes, P ≤ .005). Although chief and faculty gender were unrelated to female representation among trainees, PDs may shape trainee gender distributions. Significant associations suggested greater inclusion of female residents at programs with female primary and/or associate PDs (approximately 120% relative magnitudes, P ≤ .03).

Conclusions: Gender inclusion has progressed throughout academic plastic surgery. The gender composition of trainees has achieved an equal gender balance, forecasting further evolution of female representation in the field, as women currently comprise just over a quarter of faculty. Female representation among department/division chiefs is lower, though plausibly proportional to the cohort of surgeons who have accrued the longer career experience traditionally expected before heading a department/division. The gender distribution of PDs appropriately reflects the broader population of academic plastic surgeons and indicates a growth trend of female leadership. Associations between PD and resident gender may be attributable to the perceived importance of shared mentor-mentee gender and racial/ethnic identities for budding surgeons who are female and/or under-represented in medicine. We anticipate an ongoing forward trajectory of inclusiveness in plastic surgery as the contemporary gender balance of trainees remodels the field.

Background: Keloids are fibroproliferative skin disorders characterized by excessive extracellular matrix deposition, persistent growth, and high recurrence rates. While fibroblast hyperproliferation has been extensively studied, vascular dysregulation and endothelial dysfunction (ED) have received less attention. Emerging evidence suggests that keloid progression is driven by abnormal angiogenesis, increased vascular permeability, and endothelial injury. These vascular abnormalities contribute to a hypoxic microenvironment that promotes fibroblast activation, immune cell infiltration, and chronic inflammation. However, the precise role of ED in keloid formation remains unclear.

Methods: A comprehensive literature review was conducted across Medline, Embase, Web of Science, and the Cochrane Library to identify studies investigating vascular and endothelial mechanisms in keloid pathogenesis. Key search terms included "keloid," "vascular dysfunction," "angiogenesis," and "endothelial-to-mesenchymal transition (EndoMT)." The impact of ED on fibrosis was analyzed by reviewing studies on endothelial injury markers, vascular distribution patterns, and endothelial-fibroblast crosstalk. Additionally, current and emerging treatment strategies targeting vascular dysregulation were systematically reviewed.

Results: Keloids exhibit increased vascular density at the periphery, while the central regions experience vascular occlusion, ischemia, and fibrosis. This spatial heterogeneity suggests that hypervascularized edges support outward keloid expansion, whereas central hypoxia stabilizes excessive collagen deposition. Mechanistically, ED contributes to keloid formation through both direct and indirect pathways. Directly, EndoMT converts endothelial cells into fibroblast-like cells, driving fibrosis. Indirectly, ED enhances inflammation, immune cell recruitment, and hypoxia-driven metabolic reprogramming, which sustain a pro-fibrotic environment. Dysregulated signaling pathways, including VEGF, TGF-β, and nitric oxide, further reinforce this vascular dysfunction. Based on these findings, we propose that endothelial dysfunction plays a dual role in keloid persistence and recurrence. At the peripheral margin, an excessive, disorganized vascular network facilitates continuous fibroblast proliferation, collagen synthesis, and outward expansion, resembling tumor-like growth. In contrast, the central regions of keloids experience progressive vascular occlusion and ischemia, promoting collagen cross-linking and tissue stiffening, leading to a fibrotic core. This vascular paradox may explain why keloids resist treatment and frequently recur post-excision-surgical removal may leave behind an unstable vascular environment, predisposing residual endothelial cells to reinitiate fibroproliferative responses. Moreover, we hypothesize that dysregulated endothelial cells in keloids may remain in a "primed" but inactive state, poised to drive fibrosis when triggered by microenvironmental cues such as injury, inflammation, or mechanical stress. This could provide a mechanistic explanation for the high recurrence rates observed in keloids despite multimodal treatments.

Conclusion: Targeting endothelial dysfunction and vascular dysregulation presents a promising approach for improving keloid management. Therapeutic strategies such as anti-angiogenic drugs, radiotherapy, hyperbaric oxygen therapy, compression therapy, and laser treatments show potential in modulating vascular function. Future studies should focus on early vascular-targeted interventions to reduce recurrence rates and improve treatment outcomes. Understanding keloid pathogenesis from a vascular perspective offers novel insights that could lead to more effective and durable treatment strategies.

Purpose: The Indiana University Health Pre-Operative Wellness and Enhanced Rapid Recovery (POWERR) Program is a multifaceted surgical prehabilitation program implemented within a hospital system aimed at addressing the shortcomings of enhanced recovery after surgery (ERAS) protocols. This initiative includes immunonutritional supplementation, cleansing agents, MRSA decolonization, smoking cessation, pulmonary and physical preconditioning, preoperative hydration, carbohydrate loading, and nutritional assessment and counseling. Prior work from our group has demonstrated that this program has been associated with statistically significant reductions in hospital length of stay, harm events, surgical site infection rates, overall cost of care, and key complications. Patient messaging platforms have been shown to increase therapeutic adherence in various fields. Alongside its role in decreasing peri-operative complications, we sought to understand whether the use of a patient-specific targeted messaging platform 'TWISTLE' to promote patient engagement within the POWERR program might improve its conferred benefits to plastic surgery patients given that these procedures are often associated with high risks.

Methods: We identified 141 patients undergoing plastic surgery procedures at a large academic medical center from 2020-2024. Our primary exposure included TWISTLE scores, representing the number of messages patients had opened of reminders regarding their POWERR preoperative optimization pathway.This was used as a surrogate to measure patient engagement and compliance; a TWISTLE score of 0 was interpreted as no involvement with POWERR, these patients were not included in our study. Patients from this cohort were stratified by their TWISTLE scores into quartiles. Postoperative complications were referenced through the IU Health NSQIP database. Multivariable logistic regression was used to analyze the relationship between TWISTLE engagement and the presence of at least one postoperative complication within the first 30 days of surgery (Table 1).

Results: Rates of at least one postoperative complication within the first 30 days after surgery were not significant between TWISTLE score quartiles 1-3 (Table 1). The top quartile of TWISTLE scores, however, was associated with a significant odds ratio of 0.18 (p=0.0499; 95% CI 0.03-1.00) relative to quartile 1 regarding the presence of at least one postoperative complication (Table 1).

Conclusions: Our study is the first to characterize the added benefit of patient messaging platforms to improve engagement and compliance of surgical patients enrolled in a prehabilitation program. The implications of our data suggest that the messaging platform 'TWISTLE' in providing patients with time-sensitive reminders to complete each step of the POWERR pathway yields an added benefit in reducing postoperative complications among all plastic surgery patients enrolled in the POWERR plan. Our work contributes to the ongoing discussion on surgical optimization and its role in decreasing preventable adverse events within our specialty.

Introduction

As AI technology becomes increasingly prevalent, its role in medical education is expanding. Many educational startups now incorporate large language models (LLMs), such as ChatGPT APIs, into their platforms. However, since these models are trained on existing data, they may inadvertently perpetuate gender- and race-based inequities, reflecting broader historic societal biases. Prior research has demonstrated a decline in the percentage of underrepresented individuals in medicine (URiM) along the surgical career pipeline. However, it remains unclear whether AI-driven career guidance reinforces these disparities. This study aims to identify potential biases in AI-generated career advice by assessing the influence of sex and race on ChatGPT's 4o specialty recommendations.

Methods

A total of 200 unique applicant profiles were generated, systematically varying sex, race, and academic achievement. Each profile was queried for specialty recommendations using a standardized prompt that demonstrated an interest in a surgical residency, and ChatGPT 4o top three suggestions were recorded.

Specialties were ranked on a 4-point scale by competitiveness based on NRMP data. For each profile, a competitiveness score was calculated as the sum of assigned points for recommended specialties, and the number of surgical specialties suggested was recorded.

Multivariate linear regression assessed the effects of academic achievement, race, and sex on (1) the number of surgical specialties recommended and (2) the competitiveness score. Bonferroni correction was applied for multiple comparisons (p<0.05). Statistical analyses were conducted in RStudio 2023.

Results

Racial disparities were observed, with Black, Hispanic, and South Asian students receiving fewer surgical specialties and lower competitiveness scores compared to White students. Specifically, Black students were recommended significantly fewer surgical specialties (Coef = -0.48, p = 0.003) and had the largest decrease in competitiveness scores (Coef = -2.58, p < 0.0001). Hispanic students exhibited a similar pattern, with fewer surgical specialties recommended (Coef = -0.43, p = 0.008) and lower competitiveness scores (Coef = -2.23, p < 0.0001). Asian students showed lower competitiveness scores (Coef = -0.90, p = 0.03) but did not experience a significant difference in the number of surgical specialties recommended (Coef = -0.25, p = 0.115).

Higher Step 2 scores and publication counts were significantly correlated with higher competitiveness scores and number of surgical specialties recommended. Female students were significantly less likely to receive surgical specialty recommendations, though their competitiveness scores did not differ significantly from male students (Coef = -0.69, p < 0.0001; Coef = -0.23, p = 0.3773).

Conclusion

ChatGPT specialty recommendations exhibit algorithmic implicit biases related to sex and race, with female and URIM students receiving fewer surgical recommendations and lower competitiveness scores compared to white students with similar academic standing. These findings are particularly concerning given the rapid expansion of AI-driven startups utilizing these LLM in medical education. This underscores the urgent need for transparency and bias mitigation strategies to prevent the reinforcement of existing inequities.

BACKGROUND: Healthcare consulting is currently estimated to be a $9.1 billion dollar industry.(1) The majority of this revenue is focused on strategic and financial management of hospitals and pharmaceutical companies. However, there is a unique need for physician consultants in the product development sector. The purpose of this study is to investigate the frequency, size, and distribution of consultation fees made to plastic surgeons by leading companies in the plastic surgery instruments market. We hypothesize that payment allocations will be dependent on a surgeon's practice type, clinical experience, and research output.

METHODS: The top ten largest companies within the global plastic surgery instruments market were selected based on total revenue.(2) Companies subsidiaries with products related to plastic surgery were also identified. The Centers for Medicare & Medicaid Services' Open Payments database was used to find all financial payments made by each company to U.S. healthcare providers. Consulting payments made in 2023 to physicians who completed independent or integrated plastic surgery programs were included. Each plastic surgeon's practice type, years of clinical experience, and educational background was identified by reviewing a combination of LinkedIn profiles and institutional clinical profiles. Physician's H-Index was obtained from Scopus (missing rate was 10.1%).

RESULTS: A total of 702 consulting payments to 234 different plastic surgeons were evaluated. The median payment was $2,460 [IQR $529-$10,967]. The mean number of payments per plastic surgeon was 3.1 (SD 5.6) and the mean years of clinical experience was 18.07 (SD 10.3, ranging from 2 to 46). Clinical experience, fellowship type, and practice type all had no significant effect on consulting payment amounts (p=0.242, 0.540, 0.540 respectively). The only predictor that showed a significant effect on payment amounts was H-index (p=0.004). In a multivariable model, taking into account the above variables, H-Index remained significantly associated with payment amount in USD for plastic surgeons receiving payments from the top 10 medical device companies (p=0.0297).

CONCLUSION: Only about 3% of board-certified plastic surgeons received consulting payments from the top 10 medical device manufacturers in 2023. This analysis shows that years of clinical experience, fellowship training, and practice type had no significant effect on the payment amount. H-index, which was used to approximate each physician's research output, was the only factor shown to have a significant correlation between payment amount. These results provide insight into what these companies value when seeking advice on their new products. They can also be used as a frame of reference for any plastic surgeons interested in becoming a medical device consultant.

REFERENCES: 1. Fine, T. Healthcare Consultants in the US. OD5496. IBISWorld. June 2024. 2. Top 10 Companies in Plastic Surgery Instruments Market in 2023. ER_00458. Emergen Research. July 2023.

Background: Synthetic grafts, including ones made from expanded polytetrafluoroethylene (ePTFE), have traditionally performed well for high-flow, large diameter vessels. However, these grafts generally fail for smaller diameter vessels (<6mm). The poor performance of small diameter ePTFE vascular grafts is primarily due to early thrombotic occlusion. Prior clinical research has demonstrated that lining synthetic grafts with autologous endothelial cells prior to implantation improves the patency of ePTFE grafts. Our study investigated whether lining small diameter ePTFE grafts with arterial endothelial cells (AECs) derived from embryonic stem cells could decrease the rate of occlusion and therefore improve graft performance.

Methods: We developed a rhesus macaque model for lower extremity arterial bypass (femoral-femoral) grafts. Using this model, we assessed graft failure rates in naked (lacking an AEC lining) 3 mm ePTFE grafts to serve as a control as well as two experimental groups which were cellularized with wild-type AECs or engineered AECs. Interposition ePTFE grafts were placed in the superficial femoral artery of seven rhesus macaques in each group. Patency was visualized by ultrasound and grafts were explanted if they demonstrated occlusion or at the study endpoint, which was designated as 6 months post-implantation.

Results: The control group revealed 43% patency of naked ePTFE grafts at six months, with failure generally occurring by thrombosis within the first five weeks. The grafts that remained patent developed intimal hyperplasia by the study endpoint, with cells infiltrating only a few millimeters into the proximal and distal ends of the graft, while the middle portion remained free of infiltration. The patency rates of the wild-type AECs group and the engineered AECs group were 100% and 50%, respectively.

Conclusion: Over 50% of naked ePTFE interposition grafts failed within the first five weeks of implantation in this novel rhesus macaque model. By cellularizing these grafts with a scalable and defined source of embryonic stem cell-derived AECs, we aim to improve the performance of readily available small diameter arterial grafts with applications in cardiac and vascular surgery, as well as reconstructive microsurgery. In addition, assessment of the immunogenicity of grafts containing either wild-type AECs or AECs engineered to elicit a minimal immune response are forthcoming.