Scientific Abstract Presentations: Resident Only Hand & Research & Technology Abstracts Session 4 Friday, October 10 Fri, Oct 10 8:00 a.m.-1:55 p.m. CDT

Purpose:
To understand the long-term aesthetic and functional outcomes of pediatric patients who have previously undergone nailbed repair following nailbed injury.

Methods:
A survey was sent to a cohort identified from a previously conducted retrospective chart review of simple pediatric finger nailbed injuries seen at a single pediatric Level 1 Trauma Center from 2017-2024. Nailbed injuries were excluded if they had no follow up, no X-Ray, Seymour or Salter-Harris fractures, or amputation type injuries. 239 patients were identified to meet inclusion criteria, and 163 had available contact information. The survey included 19 questions seeking to evaluate sensation, appearances, and opinions of the repair. Participants were also asked to upload several current photos of the previously injured nail which were reviewed by the research team to determine the presence or absence of aesthetic deficits (nail pits, hook nails, discoloration, etc.). Data was analyzed with descriptive statistics and Student's T test for comparisons.

Results:
Forty-three parents of eligible patients responded to the survey. 20 patients were female (47.6%) and 23 were male (52.4%). Average age at the time of injury was 4.99 years. Initial injuries were treated in 38 patients (90.4%) with nail plate removal and nail bed repair; the remaining 4 (9.6%) were treated conservatively without intervention. Average time of survey completion from initial injury was 3.73 years (range: 1.36-7.27 years). The dominant hand was injured 32.5% of the time. On a five-point scale of overall satisfaction from 1 (very unsatisfied) to 5 (very satisfied), parents reported overall average of 4.65 (range=1-5). When estimating sensation compared to the contralateral finger on a five-point scale from 1 (no sensation compared to contralateral) to 5 (same sensation compared to contralateral), parents reported an overall average of 4.475 (range=2-5). Patients or parents rarely reported complaints related to function, sensation, avoidance of use, or hypersensitivity. Evaluation of the patient-submitted photos of the affected nail showed that deformity of the proximal nail fold was the most common long-term abnormality. There were no differences in number of aesthetic deformities in those treated conservatively vs with nailbed repair (p=0.11).

Conclusions:
Pediatric patients and parents are overall satisfied with the long-term appearance, sensation, and function of a digit following nailbed injury repair. Deformity of the proximal nail fold is a common long-term aesthetic complication following nail bed injury.

1.Capstick R, Giele H. Interventions for treating fingertip entrapment injuries in children. Cochrane Database Syst Rev. Apr 30 2014;2014(4):CD009808. doi:10.1002/14651858.CD009808.pub2

2. James V, Heng TYJ, Yap QV, Ganapathy S. Epidemiology and Outcome of Nailbed Injuries Managed in Children's Emergency Department: A 10-Year Single-Center Experience. Pediatr Emerg Care. Feb 01 2022;38(2):e776-e783. doi:10.1097/PEC.0000000000002400

3. Al-Qadhi S, Chan KJ, Fong G, Al-Shanteer S, Ratnapalan S. Management of uncomplicated nail bed lacerations presenting to a children's emergency department. Pediatr Emerg Care. May 2011;27(5):379-83. doi:10.1097/PEC.0b013e318216b22d

4. Pearce S, Colville RJ. Nailbed repair and patient satisfaction in children. Ann R Coll Surg Engl. Sep 2010;92(6):483-5. doi:10.1308/003588410X12664192075891

5. Miranda BH, Vokshi I, Milroy CJ. Pediatric nailbed repair study: nail replacement increases morbidity. Plast Reconstr Surg. Feb 2012;129(2):394e-396e. doi:10.1097/PRS.0b013e31823af1bb

The objective of this study was to analyze the efficacy of musculoskeletal ultrasound for diagnosing carpal tunnel syndrome (CTS) in correlation with electromyography, using it as the reference standard.

BACKGROUND Carpal tunnel syndrome is the most common peripheral entrapment neuropathy of the upper extremity. 1 Its diagnosis requires the presence of clinical signs and symptoms, along with electromyographic and/or magnetic resonance imaging (MRI) findings. 2 In recent years, novel ultrasonographic techniques have demonstrated high utility in diagnosing CTS, with reported sensitivities and specificities exceeding 80%. 3 However, the literature remains inconsistent, and its diagnostic utility and accuracy are not yet fully established. 4

OBJECTIVE To determine the sensitivity and specificity of ultrasonographic (high frequency ultrasound) measurements in diagnosing carpal tunnel syndrome in comparison with electrodiagnostic studies.

MATERIALS AND METHODS This was a prospective, analytical, observational study conducted in patients presenting with signs and/or symptoms of carpal tunnel syndrome at the Physical Medicine and Rehabilitation Department and the Reconstructive Surgery Department at the Hospital Regional Manuel Cárdenas de la Vega, ISSSTE, Culiacán, Sinaloa, Mexico. A cross-sectional, diagnostic test study was carried out, including a total of 60 cases and 30 controls. All participants underwent clinical evaluation, electromyography, and ultrasound assessment of the median nerve were performed and compared. Statistical analyses included the chi-square test, relative risk, area under the curve, sensitivity, and specificity, with a confidence level of 95% and a 5% margin of error.

RESULTS A total of 90 patients were included, two groups: n=30 control individuals and n=60 patients with CTS. Abnormal values (>8.15 mm) were found in 52.25% (n=58) of the measurements. The cutoff point of 8.15 mm2 for the CSA-1 measurement yielded a diagnostic (AUC) of 0.87 (p=0.039), a sensitivity 91.75%, and a specificity 84%. Having a CSA1 measurement above 8.15 mm2 increased the risk of electromyographically confirmed CTS by 4.1 times (OR 4.1, 95% CI: 2.39–7.02, p=<0.005).

CONCLUSION Our findings indicate that ultrasound is an effective and valuable tool in supporting the diagnosis of CTS. The transverse cross-sectional area 1 measurement of the median nerve was the most sensitive parameter for this diagnosis, with sensitivity exceeding 85% and specificity reaching 95%.

1. Rayegani SM, Malekmahmoodi R, Aalipour K, Nouri F. The relationship between ultrasound and electrodiagnostic findings in relation of the severity of carpal tunnel syndrome. BMC Musculoskelet Disord. 2024;25(1):864. doi:10.1186/s12891-024-07987-w
2. Luo YT, Huang YT, Chiu V, Chang YW, Horng YS. Diagnostic meta-analysis of the efficacy of ultrasonography for diagnosing carpal tunnel syndrome: A comparison between Asian and non-Asian populations. J Formos Med Assoc. 2024;(289). doi:10.1016/j.jfma.2024.06.026
3. Okura T, Tajima T, Fukuda H, Matsuoka T, Chosa E. Diagnostic utility of anteroposterior measurements of the median nerve on sagittal ultrasonographic images and their correlation with clinical findings in carpal tunnel syndrome. J Clin Ultrasound. 2023;51(9):1522-1528. doi:10.1002/jcu.23584
4. Kanagasabai K. Ultrasound of Median Nerve in the Diagnosis of Carpal Tunnel Syndrome-Correlation with Electrophysiological Studies. Indian J Radiol Imaging. 2022;32(1):16-29. doi:10.1055/s-0041-1741088

Background: The ultimate role of the thumb metacarpophalangeal joint (MCPJ) is grip stabilization and instability can be debilitating (1). Arthrodesis is a well-established surgical technique sacrificing motion for return of stability (2). Multiple arthrodesis techniques are described, however, no consensus among hand surgeons exists for which technique is best (3). This study aims to examine available literature from the most recent two decades to summarize the documented efficacy and safety of thumb MCPJ arthrodesis methods.

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Databases searched include Pubmed, Google Scholar, and Cochrane Library using Boolean expression: ("thumb MCPJ" OR "thumb metacarpophalangeal joint") AND (arthrodesis OR fusion) AND (technique* OR method) AND (outcome OR compar*), retrieving studies documenting thumb MCPJ arthrodesis technique outcomes. Studies examining outcomes between at least two techniques in adults published from January 2005 to January 2025 were included. Excluded studies did not meet these criteria. Primary outcomes (fusion rates), and secondary outcomes (patient-reported and/or functional outcomes), were extracted by two independent reviewers. Articles were evaluated for risk of bias (ROB) using design-appropriate assessment tools; those demonstrating high ROB were excluded.

Results: The primary search yielded 15 studies. After exclusion criteria and ROB assessment, 9 were included in the final synthesis of results. Of these, 2 studies were retrospective cohort studies, 2 were retrospective case series, and 5 were retrospective chart reviews. Most were conducted in the United States [n=5, 55.5%], followed by France [n=3, 33.3%] and Canada [n=1, 11.1%]. The average sample size consisted of 54.6 patients, with average follow-up duration of 45.3 days. The typical patient was 55.1 years of age. Heterogeneity in outcome measures precluded meta-analysis. However, 3 studies found K-wire arthrodesis consistently safe and effective. Tension band wiring had greater numbers of hardware complications in 2 articles with one article citing higher union rates compared to screw fixation. Open arthrodesis techniques remain more reliable than minimally invasive in one study, and union rates may benefit from autologous bone grafting in another. Plate and screw technique may provide excellent alignment but less consistent union rates. All techniques alleviated patient pain.

Conclusion: K-wire methods for thumb MCPJ arthrodesis are widely efficacious and low risk across patient populations and indications. Other techniques lack consistency in terms of union and hardware complications. Further research is needed to directly assess each technique and compare outcomes across arthrodesis methods.

References: 1. Mesplié Gg. Hand and Wrist Rehabilitation : Theoretical Aspects and Practical Consequences. 1st ed. Springer International Publishing : Imprint: Springer,; 2015:1 online resource (XV, 485 pages 456 illustrations, 415 illustrations in color.

2. Berger AJ, Meals RA. Management of Osteoarthrosis of the Thumb Joints. J Hand Surg Am. Apr 2015;40(4):843-50. doi:10.1016/j.jhsa.2014.11.026

3. Finger LE, Hamaker MC, Singh-Varma A, Goitz RJ, Kaufmann RA, Fowler JR. Comparison of Fusion Rates/Complications Between Different Types of Thumb Metacarpophalangeal Fusion Techniques. Hand (N Y). Mar 22 2024:15589447241235343. doi:10.1177/15589447241235343

Purpose: Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is a common procedure for severe thumb carpometacarpal arthritis. Hand physiotherapy is a critical aspect of postoperative care and functional recovery. Prior to COVID-19, all patients received in-person hand physiotherapy as per our institution's protocol. The adoption of virtual care in hand surgery was a necessity during the pandemic, which has since realized an efficient and cost-effective solution to meet the needs of rural and underserved communities. This study investigates surgical outcomes following trapeziectomy with LRTI is those who received in-person physiotherapy versus mixed virtual and in-person physiotherapy.

Methods: A retrospective chart review of two surgeon's patients that underwent elective trapeziectomy with LRTI over a two year period was conducted. Patients were grouped into those who received mixed virtual and in-person physiotherapy, and those who received in-person therapy only. All patients had previously been referred to hand physiotherapy as per our institution's protocol. Measured outcomes included number and delivery method of physiotherapy appointments and postoperative complications. Patients were then contacted by telephone to complete the QuickDASH-9 questionnaire to measure hand functional outcomes.

Results: Seventeen hands were included in the mixed virtual and in-person group, and 21 hands in the in-person only group. There was an average of 5 physiotherapy visits per person in both groups. Of those with mixed therapy, 46% of the visits were virtual. Four patients experienced postoperative complications in the mixed group, including decreased grip strength, decreased range of motion, stiffness and edema. Five patients experienced postoperative complications in the in-person group, including postoperative pain, decreased grip strength and edema. There were no revision surgeries in either group. Ten patients from the mixed group and 11 patients from the in-person group completed the QuickDASH-9 questionnaire via telephone. There was no statistically significant difference in QuickDASH-9 scores between groups (p=0.363).

Conclusions: In patients undergoing elective trapeziectomy with LRTI, those who received virtual physiotherapy maintained the same average number of visits as compared to in-person therapy. Those who received virtual therapy sessions did not experience an increase in postoperative complications. In addition, patients reported similar hand functional outcomes regardless of therapy delivery method. This study supports providing virtual therapy to patients who do not have access to in-person care.

Purpose: Our objective was to identify flexor tendon injury patterns predictive of nerve injuries to aid in early diagnosis and management. Methods: A retrospective IRB-approved analysis was performed of patients who sustained flexor tendon injuries from a single institution from 2009-2023. Included patients all sustained acute traumatic flexor tendon injuries. Patients were stratified by those who sustained flexor tendon injuries with no nerve injuries and those who sustained flexor tendon injuries with nerve injuries. Univariate analysis, followed by stepwise multivariate logistic regression analysis using forward selection was used to identify predictors of nerve injuries. Median follow-up was 12.9 weeks (range:0- 534). Results: Of the 553 patients who sustained traumatic flexor tendon injuries, 251 had no nerve injuries and 302 had nerve injuries. Patients with flexor tendon injuries were more likely to sustain a nerve injury with index finger zone 2 injuries (OR: 2.9, 95%CI: 1.7-5.2; p<0.001), index finger zone 3 injuries (OR: 5.6, 95%CI: 1.7-18.3; p=0.004), long finger zone 1 (OR: 2.9, 95%CI: 1.1-7.9; p=0.038), long finger zone 2 (OR: 3.4, 95%CI: 2-6; p<0.001), long finger zone 3 (OR: 10.8, 95%CI: 1.3-91.3; p=0.028), long finger zone 5 (OR: 5.6, 95%CI: 3.1-9.9; p<0.001), and any arterial injury of the hand or forearm (OR: 5.6, 95%CI: 3.1-9.9; p<0.001). Conclusions: Nerve injuries should be suspected for patients with index finger zone 2 and 3 injuries, long finger zone 1, 2, 3, and 5 injures and any arterial injuries. Early suspicion and diagnosis may aid in early operative repair.

Background: Secondary lymphedema is limb swelling from lymphatic injury. It frequently occurs following lymph node dissection and radiation during the treatment of malignancies such as breast cancer or melanoma. The murine tail is the most commonly used model to study secondary lymphedema and involves full thickness tail skin excision and lymphatic vessel disruption. The murine hindlimb model, which has been less frequently used in the literature, offers a more clinically translatable method. However, there is inconsistency and variability, including the benefit of radiation, which have contributed to the model being less widely adapted than the tail model. The purpose of this study is to 1) optimize the murine hindlimb lymphedema to achieve consistent results and 2) assess the effect of radiation on outcome in the murine hindlimb model.

Methods: C57BL/6 mice either underwent 20 Gy irradiation of one hindlimb seven days prior to surgery (n=11) or no preoperative radiation (n=9). For all mice, a circumferential skin incision was created at the proximal hindlimb exposing the subcutaneous soft tissues. Lymphatics were identified with isosulfan blue dye injection into the paw and disrupted. Popliteal lymph nodes were excised. The skin was sutured leaving a 3 mm gap. The contralateral hindlimb served as the control. Paw thickness and calf thickness measurements were obtained at weekly intervals and indocyanine green (ICG) near-infrared laser lymphangiography was used to assess lymphatic function.

Results: For the irradiated mice, the average paw thickness of the operated hindlimb on postoperative day (POD) 14 was 3.50.3 cm compared to 2.10.05 cm on the contralateral limb (p=0.0001). At POD-90, the average paw thickness of the irradiated, operated hindlimb was 2.40.1 cm compared to 2.10.1 cm for the contralateral limb (p=0.01). ICG lymphangiography at 24-hours postinjection on POD-42 demonstrated an average signal intensity of 97.728.5 arbitrary fluorescent units (AFU) in the operated hindlimb compared to 33.66.2 AFU in the non-operated hindlimb (p=0.003). In the mice that did not undergo radiation, the average paw thickness was 2.50.2 cm on POD-42 was greater than the contralateral limb (2.10.1 cm) (p=0.0002) but smaller than hindlimbs that underwent radiation (3.20.1 cm) (p=0.0002). The nonradiated mice had greater paw thickness than the contralateral control until POD-56 whereas the radiated mice sustained significant paw thickness until Day 90.

Conclusion: Radiation of the murine hindlimb model results in sustained lymphedema compared to non-irradiated mice. The murine hindlimb lymphedema model is clinically more translatable than the murine tail model and includes limb lymphatic vessel disruption, and popliteal lymphadenectomy and ideally radiation for consistent results with lymphedema sustained for 90 days.

Abstract Background: Although it is the less common paradigm, the Independent program provides an indispensable pathway to becoming a plastic surgeon. We evaluated the difference in outcomes of Independent programs who's training exists alone (Independent Single = IS) compared to Independent programs who's training exists alongside an Integrated program (Independent Dual = ID). Methods: Each training pathway program was collected from 1942-2024 and classified into the one of the following groups: 1) IS, 2) ID, or 3) Integrated. Outcomes of the plastic training programs and trainees were compared including: 1) In-service examination (ISE) scores, 2) Written board (WB) and oral board (OB) exam results, and 3) Publications. Results: Most Independent programs now exist as dual programs (94% ID in 2024 vs. 55% ID in 2014). Among chief residents who graduated 2013-2017, the ISE raw percentage for ID trainees was significantly higher compared to IS trainees (69.2% correct vs. 68.2% respectively, p-value 0.03). First-time WB exam pass rate among ID trainees from 2013-2017 was 95% compared to 94% in IS trainees, while first-time OB exam pass rate among ID trainees from 2014-2018 was 93% compared to 92% in IS trainees. ID trainees were more likely to publish in greater quantity compared to IS trainees during residency (5 vs. 10 publications, p-value 0.01) and after residency (5 vs. 3, respectively). Conclusion: Although the Independent training program pathway is decreasing, outcomes of ID and IS program trainees are roughly similar. However ID program graduates may contribute more to academia.

Purpose: Surgery is a highly rewarding and challenging career; however, the rigorous demands of training and nature of the profession can have a debilitating impact on wellbeing. This can often take the form of burnout, which is multifactorial and impacts the health of surgeons in a variety of ways (1-3). The importance of wellness to combat burnout has been evident in the literature. A recent systematic review by West et al. (2016) (4), wellness interventions were found to help reduce overall burnout among physicians (54% to 44% [95% CI 5–14]; p<.0001; I2=15%; 14 studies), including a reduction in emotional exhaustion scores and depersonalization scores. However, while the literature is growing with studies on wellness interventions in surgery, currently there have been no published studies led by plastic surgery. Thus, the goal of this pilot study was to evaluate burnout scores within the plastic surgery residents at McMaster University and assess whether formalized wellness initiatives decrease burnout.

Methods: This is an ongoing prospective cohort study (June 2024 – 2025). A needs assessment was sent to all McMaster plastic surgery residents in June 2024. Monthly wellness initiatives were implemented based on the needs assessment. Pre- and post-intervention surveys and the Maslach Burnout Inventory (MBI) were sent out to all participating residents. Baseline and burnout scores at 6 months (T6) were analyzed.

Results: Fifteen of 18 plastic surgery residents (30% female, 80% Caucasian) completed the needs assessment. Fourteen residents felt formal wellness initiatives would add value. The most important issues were safety at work, sleep, and professional development. The highest rated wellness activities were exercise classes and social activities. Average working hours were 37-57 (SD 28.1) hours per week. Most residents (80%) slept 4-8 hours per night. Average raw group MBI scores at pre-intervention (T0; n=13) and 6 months post-intervention (T6; n=5) were 24 (moderate) and 35 (high) for emotional exhaustion (EE) p=.02, 10 (moderate) and 14 (high) for depersonalization (DP) p=.09, and 38 (moderate) and 29 (high) for personal accomplishment (PA) p=.01. Within-subjects (n=4) EE, DP, and PA scores from T0 to T6 were not statistically significant.

Conclusions: This is the first study evaluating burnout and wellness interventions in a Canadian plastic surgery residency program. Residents enjoyed wellness interventions and felt they improved burnout, however MBI scores showed worse EE, DP, and PA over 6 months, meeting criteria for burnout (EE>26 and DP>12). Preliminary results suggest that burnout is present within this cohort of plastic surgery residents, and wellness interventions may not target the core issues contributing to burnout.

Literature References 1. Acevedo JR, Schlacter JA, Chambers TN, et al. Targeted Wellness Initiatives Are Most Effective for Reducing Otolaryngology Resident Burnout. Ear Nose Throat J. 2021:1455613211009139. 2. Williams-Karnesky RL, Greenbaum A, Paul JS. Surgery resident wellness programs: the current state of the field and recommendations for creation and implementation. Advances in Surgery. 2020;54:149-171. 3. Dyrbye LN, West CP, Satele D, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-451. 4. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet. 2016;388(10057):2272-2281.

Background: Online resources have become essential training tools for plastic surgery residents. PRS Review, a newly developed question bank, was launched in December 2023 to provide a structured learning platform. This study analyzes usage trends and performance data across postgraduate years (PGY) to identify strengths and areas for improvement in plastic and reconstructive surgery education.

Methods: We analyzed data from the PRS Review Plastic Surgery Question Bank between December 2023 and December 2024. The dataset included all residents and fellows who utilized the platform, categorized by training level (integrated vs. independent pathways) and PGY year. Performance trends were assessed across different surgical topics and subspecialties. Pearson correlation analysis was used to evaluate trends, with statistical significance defined as R > 0.9.

Results: A total of 452 residents and fellows engaged with the question bank. The distribution by training level was as follows: Integrated PGY1 (19%), PGY2 (15%), PGY3 (16%), PGY4 (12%), PGY5 (8%), PGY6 (14%); Independent Year 1 (6%), Year 2 (4%), and Year 3 (5%). The highest overall performance was observed in Independent Year 3 trainees (61%), followed by Integrated PGY5 (59%) and PGY6 (58%). Other average scores included PGY4 (48%), PGY3 (53%), PGY2 (46%), PGY1 (37%), Independent Year 2 (50%), and Independent Year 1 (37%). Integrated PGY1 and Independent Year 1 trainees had identical overall performance (37%). A strong positive correlation (Pearson R > 0.9) was found between increasing PGY levels and improved scores, with scores rising from 37% in Integrated PGY1 to 58% in PGY6, and from 37% in Independent Year 1 to 61% in Independent Year 3. Performance varied across subject areas. Comprehensive Plastic Surgery had the highest overall scores, with PGY6 averaging 73% and Independent Year 3 averaging 75%. The greatest improvement was seen in Hand and Lower Extremity Surgery, where scores increased by 25% in PGY6 and 26% in Independent Year 3.

Conclusions: Our question bank data shows that Integrated PGY1 and Independent Year 1 trainees begin with similar scores. However, after six years in an integrated plastic surgery program and three years in an independent program, performance levels are nearly equivalent, suggesting that both training pathways lead to similar knowledge base by the end of training.

Background: Most physicians are in specialty training during the time of known fertility decline. In the general population, complications increase with greater numbers of hours spent standing while working while pregnant, as well as with physical effort and occupational fatigue. Female surgeons are known to have twice the number of miscarriages compared to the general population, and significantly more obstetric complications compared to female partners of male surgeons. The aim of this study is to describe differences between the experiences of physicians designated as proceduralists versus non-proceduralists.

Methods: An 11-item anonymous, pilot tested survey addressing experiences with pregnancy, obstetric outcomes and complications, and knowledge of and experiences around fertility and assisted reproductive technology (ART) was developed with IRB approval. The survey was distributed to male and female trainees and attendings (n= 2,098) at two separate institutions. Data was analyzed with the aid of a biostatistician.

Results: There was a 20% response rate. Of the respondents (293 women, 129 men), median age was 31 years and 69% were female. 66% were trainees and 36% were in procedural specialties. Of female respondents, 46.8% reported having ever been pregnant. Most respondents (44.6%) had their first child during training. The median age at birth of the first child was 32 years. Of women who have been pregnant, 40% reported pregnancy or obstetric complications. Pre-eclampsia, post-partum depression, and small gestational size were the most common complications among proceduralists. 80% of respondents reported working more than 40 hours per week during pregnancy with proceduralists significantly more likely to work more than 40 hours per week while pregnant (93% vs 74% p = 0.023). The overall birth rate was 2.57 live births per woman. Those in procedural specialties had a significantly lower mean number of total pregnancies (3.3 vs 3.7 p = 0.01) and live births (2.3 vs 2.7 p<0.014). Of the 53% who reported having tried to conceive, 28.5% reported difficulty; of those, 51% reported utilizing ART. 72% of respondents reported no prior knowledge of, or education about, fertility or ART.

Conclusions: Our findings demonstrate high prevalence of pregnancy and obstetric complications as well as pregnancy loss, with significantly fewer live births in those in procedural specialties versus non-procedural specialties. Future work should expand data collection to explore effects of geographic variation as well as evaluate any effects of research years and program culture on outcomes, as well as formal analysis of free responses around experiences with fertility and fertility education. As more women continue to apply to procedural residencies, and as the age of trainees continues to rise, it is imperative that we offer formal education around these topics early in training. This may lead to greater physical and mental health among physicians, and thus higher satisfaction in the workplace, and ultimately better patient care.

Access to healthy living tissue in the lab is an essential substrate for experimentation across the breadth of medical research. Historically limited to live animal studies using small mammals such as rats, and subsequently more anatomically and physiologically analogous animals such as pigs, recent developments in cellular technologies have allowed for the in-vitro production of human tissue, such as the development of spheroid and organoid technologies, which allow for the study of 3D cell structures in a microenvironment that mimics the in-vivo environment. However, they remain unable to completely recreate in-vivo conditions, including issues of scale and maintaining macroscopic tissue architecture.

The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous reconstruction of the breast following mastectomy. It recruits analogous, redundant and accessible adipocutaneous tissue from the abdomen based on a reliable and consistent blood supply, and necessarily requires the elevation of bilateral abdominal flaps, which offers the opportunity for the routine production of healthy and well-vascularised tissue that would otherwise represent medical waste.

This project aims to validate a reliable lab-based human model for normothermic perfusion of tissue by harvesting discarded abdominal tissue and perfusing it using human blood products. This would provide a higher fidelity substrate for research applications and incredible scope for the detailed study of novel flap techniques as well as broader potential applications in oncology, tissue therapeutics or tissue engineering and biofabrication.

Method We present a pilot case series of 5 consecutive patients undergoing unilateral autologous breast reconstruction using DIEP flap or cosmetic abdominoplasty, with the redundant abdominal flap placed on ex-vivo ECMO perfusion until tissue demise. Tissue viability was assessed using clinical, biochemical and histopathological parameters, alongside demographic and technical factors that influenced flap longevity. An additional 5 human and 10 porcine specimens are anticipated to be completed in the next 6 months.

Results Mean survival time was 3.8 days (max 8 days), with mechanical venous congestion the primary cause of demise in 80% of cases, and progressive venous congestion in 20%.

Conclusion The preliminary results in this study demonstrate that extracorporeal normothermic perfusion of human free tissue flaps is feasible, with current results in line or exceeding the currently reported survival data in the literature across all forms of ex-vivo tissue perfusion. Ongoing technical improvements of the experimental setup will undoubtedly improve these outcomes further.

Purpose: The purpose of this study is to describe and identify predictors of research productivity among current Canadian plastic surgery residents and to evaluate associations between research output and postgraduate academic career outcomes among graduates.

Methods: This national cross-sectional study included all current Canadian plastic surgery residents (2024–2025) and graduates from the preceding ten years for whom publicly available data could be identified. Resident names were identified via program websites and verified with administrators. Research metrics (e.g., total publications, citations, h-index, authorship position) were extracted from Scopus and PubMed. Productivity was defined as completed peer-reviewed publications per postgraduate year (PGY). Graduate outcomes included pursuit of fellowship training and academic appointment. Demographic, educational, and program characteristics were also collected, including enrollment in a Clinician Investigator Program (a structured, research-intensive pathway integrated into residency). Bivariate analyses used Fisher's exact and Wilcoxon rank-sum tests. Multivariable logistic regression identified predictors of high productivity (above-median publications per PGY). Negative binomial regression modeled publication rate as a continuous outcome. Separate logistic models assessed predictors of fellowship training and academic appointment.

Experience: 163 current residents and 146 residency graduates across all 13 Canadian training programs were included. All data reflect final, verified metrics as of February 2025. No imputation was performed in primary models for missing data.

Results: The median resident publication rate was 0.48 per PGY. In multivariable analysis, pre-residency publication count independently predicted high productivity (OR = 1.12; 95% CI: 1.04–1.22). When modeled continuously, pre-residency publications (IRR = 1.09; 95% CI: 1.06–1.13) and Clinician Investigator Program enrollment (IRR = 1.88; 95% CI: 0.99–3.35) were associated with increased publication rate, while male gender was associated with lower output (IRR = 0.58; 95% CI: 0.37–0.90). Graduate degree status and program director metrics (h-index, citations, publication count) were not associated with resident productivity.

Among graduates, 84% pursued fellowship training and 27% held faculty appointments. Research output during residency did not significantly correlate with pursuit of fellowship. However, academic appointment was consistently associated with higher total publications, first-author publications, citation counts, and h-index scores. In adjusted analyses, graduate degree attainment was the sole independent predictor of faculty appointment (OR = 3.41; 95% CI: 1.28–9.40), which remained true in sensitivity analyses using imputed data (OR = 3.94; 95% CI: 1.30–11.92).

Conclusions: Pre-residency publication experience and enrollment in a structured, research-intensive integrated residency pathway like CIP are independent predictors of research productivity during residency. Program director scholarly metrics appear to have no measurable influence. While stronger research output during residency is found to be associated with academic career achievement, only graduate degree attainment independently predicts faculty appointment. These findings underscore the critical role of early research involvement and structured training pathways in fostering academic productivity and advancing career development in plastic surgery. Moreover, they may inform residency selection committees in helping to identify applicants with greater academic potential and guide residents seeking academic careers in prioritizing early research engagement and formal scholarly training.

Purpose: Autologous breast reconstruction offers patients a durable and natural-appearing option after mastectomy. However, flap reconstruction carries risks including flap loss, infection, and delayed wound healing. This study developed both traditional statistical and machine learning (ML) models to predict individual risk of postoperative complications following autologous reconstruction. Materials and Methods: Patient characteristics and 90-day outcomes were retrospectively collected for all patients who underwent deep inferior epigastric perforator or muscle-sparing transverse rectus abdominis myocutaneous flap reconstruction from January 2015 to September 2024 at Memorial Sloan Kettering Cancer Center. Multivariable logistic regression and ML models were trained to predict five complications: infection, hematoma, seroma, delayed wound healing, and flap compromise. Results: In total, 2,128 patients who underwent 3,249 flap reconstructions were included (mean age 51 ± 8.8 years, mean BMI 26.9 ± 4.7). Overall, 90-day complications occurred in 475 (22.3%) patients, with infection in 10%, hematoma in 6%, delayed wound healing in 4.1%, seroma in 3.9%, and flap compromise in 2.8%. Logistic regression AUCs ranged from 0.6-0.66 and ML models AUCs ranged from 0.64-0.73. Factors associated with increased risk of complications included higher BMI for seroma (OR: 1.1, 95%CI:1.04-1.13) and neoadjuvant chemotherapy for infection (OR:1.72, 95%CI:1.17-2.51). Similarly, undergoing immediate reconstruction was significantly associated with increased risk of hematoma (OR 1.75, 95%CI:1.18-2.64). Key ML model predictors of 90-day complications included age, BMI, and radiation before flap reconstruction. Conclusions: Individualized risk prediction models for complications after autologous breast reconstruction were developed using traditional statistics and machine learning. These models may help personalize treatment options; however, further research is needed to enhance model predictive accuracy and clinical utility.

Purpose: Microvascular anastomoses are particularly sensitive to alterations in flow dynamics as evidenced by decreased flap success rates in end to side and disturbed vessel lumen architectures. Fluid flows are significantly affected by rapid changes in lumen diameter such as those seen with venous coupler applications in size mismatched vessels. The aim of this study is to identify the relationship between vessel size mismatch ratios and flow stagnation and propose alternative flow coupler designs for optimization of flows in scenarios of mismatch.

Methods: Computational fluid dynamic (Ansys, Fluent R1 2024) models were created to simulate sudden expansion of end to end microvascular anastomoses. Model assumptions included blood as a Carreau Newtonian fluid under laminar flow. Five models were created representative of anastomoses with the following vessel size mismatches (VSM): 1mm to 2mm, 1mm to 3mm, 1mm to 4mm, 2mm to 3mm, and 3mm to 4mm. An additional model was utilized to assess the effect of venous coupler modification. Post-processing analysis was completed using visualizations of fluid flows and line integral convolution plots.

Results: The cross sectional areas of blood stagnation increased with the ratio of sudden expansion in a logarithmic relationship (R^2 = 0.989). The area of stagnated flow for a VSM ratio of 4 was 81.84% compared to 26.59% for a VSM ratio of 1.33. Qualitative assessment of reversed flow shows significant increases with VSM ratio. Alteration of the anastomotic lumen for VSM ratio of 4 with a modified venous coupler device decreased stagnation from 81.84% to 56.21%.

Conclusion: Sudden expansion in microvascular anastomoses promotes blood stagnation and reversal. Strategies to mitigate this phenomenon, such as modifications to the venous coupler device, are an important area of future investigation.