Peripheral nerve injuries requiring surgical repair affect over 100,000 individuals in the US annually. Three accepted methods of peripheral repair include end-to-end, end-to-side, and side-to-side neurorrhaphy, each with its own set of indications. While it remains important to understand the specific circumstances in which each method is employed, a deeper understanding of the molecular mechanisms underlying the repair can add to the surgeon’s decision-making algorithm when considering each technique, as well as help decide nuances in technique such as the need for making epineurial versus perineurial windows, length and dept of the nerve window, and distance from target muscle. In addition, a thorough knowledge of individual factors that are active in a particular repair can help guide research into adjunct therapies. This paper serves to summarize the similarities and divergences of the three commonly used nerve repair strategies and the scope of molecular mechanisms and signal transduction pathways in nerve regeneration as well as to identify the gaps in knowledge that should be addressed if we are to improve clinical outcomes in our patients.

BACKGROUND: As the US demographic evolves, surgical fields must adapt to ensure equitable healthcare. Healthcare disparities notably affect minority populations, with communities of color often facing physician shortages and higher rates of diseases such as coronary disease, stroke, and cancer. Research shows that minority physicians significantly improve patient satisfaction and outcomes in underserved communities, highlighting the need for increased physician diversity to enhance cultural competency and patient centered care. Data from the Association of American Medical Colleges (AAMC) reveals minimal increases in underrepresented minorities (URM) in surgical residency and academic careers over the past thirty-six years, with little change URM applicants and matriculants in the nine surgical specialties recognized by the American College of Surgeons from 2010 to 2018. OBJECTIVE: This review aims to critically evaluate the current landscape of racial and gender diversity in six out of the nine defined surgical specialties (general surgery, plastic surgery, neurosurgery, orthopedic surgery, cardiothoracic surgery, and vascular surgery) in the US. DESIGN: We conducted a comprehensive literature review to assess of the state of diversity within surgical specialties in the United States. By analyzing the benefits of diversity in surgical fields, evaluating the effectiveness of various diversity programs and initiatives, examining the comparative diversity between surgical subspecialties, and assessing the impact of diversity on patient outcomes, our aim is to highlight the critical importance of enhancing diversity in surgical fields. RESULTS: While nuances in representation and diversity vary across surgical specialties, all fields persistently exhibit underrepresentation of certain racial/ethnic groups and persistent gender disparities. These disparities manifest throughout various phases, including in residency, and in the recruitment and retention of URM individuals in surgery and surgical subspecialties. While interventions over the past decade have contributed to improving diversity in surgical fields, significant disparities persist. Limitations include the time required for recent interventions to show significant impacts and the inability of established interventions to eliminate disparities. CONCLUSIONS: Despite the clear benefits, diversity within surgical specialties remains an uphill battle. Addressing the diversity gap in surgical fields is crucial for improving patient outcomes, healthcare access, and workplace environments, requiring strategies such as targeted recruitment, mentorship programs, and addressing systemic biases. This review highlights the undeniable imperative for change and serve a call to action.

Introduction: The Defense Health Agency aims to ensure that military surgical residents have the expeditionary general surgical skills necessary to deploy to a combat environment and maintains the Clinical Investigation Programs (CIPs) that foster research during graduate medical education. This project evaluates the potential to achieve both aims simultaneously through a large animal Combat Casualty Care Research Program (CCCRP). Materials and Methods: Large animal experimental protocols within a single CIP’s CCCRP were collected from July 1, 2017, to June 30, 2022. Operations performed were tabulated and categorized by Emergency General Surgery procedure equivalent. In addition, procedures performed by a single resident from July 1, 2020, to June 30, 2022, were separately indexed for a more granular analysis. Results: The results are presented with total 5-year numbers listed first, followed by single resident 2-year numbers in parentheses. The residents at the CIP carried out 8676 (1,609) tabulated procedures. Major surgical procedures included 573 (154) laparotomies, 364 (129) thoracotomies, 279 (125) splenectomies, 219 (108) craniotomies, 206 (81) hepatorrhaphies, 363 (62) nephrectomies, 383 (48) bowel resections, 215 (48) spine exposures with laminectomies, and 173 (9) sternotomies. Additional procedures included 1028 (127) central venous lines, 878 (127) arterial lines, 90 (67) tube thoracostomies, 199 (37) carotid artery exposures, 394 (29) suprapubic urostomies, and placement of 278 (10) aortic occlusion catheters. At this time, the residents had 17 (10) presentations at national meetings, 8 (7) research awards, and published 20 peer-reviewed manuscripts. Additionally, the residents involved in the CCCRP gained valuable experience in critical care, including management of 110 traumatic brain injuries, 121 Intercranial Pressure catheters, 316 cases of hemorrhagic shock, and 211 massive transfusion protocols, among a variety of other vital critical care skills. Conclusions: This large animal CCCRP represents a unique training model that not only achieves its primary goal of fostering graduate medical education research but also bolsters Emergency General Surgery readiness for military surgical residents.

Introduction: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive method to control noncompressible torso hemorrhage, now integral to military damage control resuscitation. Modern combat conditions may create mixed inventories of REBOA catheters that differ in balloon compliance, flow modulation, and monitoring capability. Understanding device-specific performance is essential for safe use and informed procurement. Materials and Methods: We conducted a head-to-head evaluation of 3 FDA-cleared, combat-deployable REBOA catheters: ER REBOA PLUS, pREBOA PRO, and COBRA OS. Testing used a custom pulsatile flow loop that simulated physiologic pressures, flows, and vessel dynamics. Devices were assessed for their ability to achieve complete Zone 1 occlusion, provide accurate pressure readings, correlate distal pulsatility and mean arterial pressure with true flow, and maintain controlled partial occlusion during simulated vasomotor and heart rate changes. Each system’s logistical footprint, including mass and cube, was measured in field and packaged configurations. Results: ER REBOA PLUS and pREBOA PRO achieved complete Zone 1 occlusion across aortic diameters up to 26 mm, while COBRA OS did not occlude above 22 mm. Only pREBOA PRO maintained stable partial flow with minimal drift during simulated vasoconstriction, vasodilation, and heart rate variation. The compliant balloons of ER REBOA PLUS and COBRA OS transmitted distal pulsatility despite negligible flow, indicating that pressure or waveform alone may misrepresent perfusion. pREBOA PRO demonstrated the most controllable flow response and strongest correlation between distal pressure and true flow. COBRA OS offered the lowest mass and volume but lacked integrated pressure monitoring and reliable partial REBOA function. Conclusions: pREBOA PRO provided the most controllable partial occlusion and stable pressure flow relationship, supporting its use when prolonged occlusion or partial REBOA is anticipated. ER REBOA PLUS and COBRA OS remain suitable for short-duration complete occlusion but not for pressure-guided partial REBOA.