Early detection and treatment can slow the progression of lymphedema. To diagnose lymphedema in the subclinical phase, a sensitive imaging modality is required. Radioisotope-based lymphoscintigraphy (LSG) has been the “gold standard” for a century. Indocyanine green lymphography (ICGL) is being used at our institute for diagnosing and grading all lymphedema patients. In this study, ICGL disease detection rate was compared to that of LSG. Chart review of all patients who presented for lymphedema consult between February 2020 and April 2022 was conducted. Patients who underwent both LSG and ICG for extremity edema in symptomatic/asymptomatic limbs were included. A total of 50 limbs in 23 patients met the inclusion criteria. Of those, 37 were symptomatic and 13 were asymptomatic. LSG detected lymphatic dysfunction in 26/37(70%) of the symptomatic limbs while ICG detected the same in 37/37(100%) limbs (p < 0.01). In the asymptomatic group, LSG detected the disease in 1/13(8%) limbs while ICG detected lymphatic dysfunction in 8/13 (62%) limbs (p < 0.01). LSG missed symptomatic limbs 30% of the time, whereas ICG did not miss any symptomatic limbs (p < 0.01). LSG missed asymptomatic disease 54% of the time (p < 0.01) compared to ICG. In conclusion, ICG lymphography was determined to have a higher lymphatic dysfunction detection rate compared to LSG.

Background: Surgical videos are reshaping the landscape for surgical education. As this form of education has rapidly grown and become a valuable resource for experienced surgeons, residents, and students, there is great variability in the presentation of what is offered. This study aimed to assess and compare the educational quality of free flap instructional videos on public and paid platforms.Methods: Free flap videos from public (YouTube) and paid (American Society of Plastic Surgeons Education Network and Plastic and Reconstructive Surgery Journal) sources were screened independently by three reviewers. Sample size was calculated to reach 80% power. The educational quality of the videos was determined using a modified version of Laparoscopic Surgery Video Educational Guidelines (0–6 low, 7–12 medium, 13–18 high). Professionally‐made videos were identified per lighting, positioning, and video/imaging quality. Interrater reliability between the three reviewers was calculated. The educational quality of the videos was compared between public and paid sources using Mood's median test. Pearson's correlation coefficient was utilized to assess the correlation between video length and educational quality.Results: Seventy‐six videos were included (40 public, 36 paid). The median video lengths for public and paid platforms were 9.43(IQR = 12.33) and 5.07(IQR = 6.4) min, respectively. There were 18 high, 16 medium, and 6 low‐quality public videos, versus 13 high, 21 medium, and 2 low‐quality paid videos. Four public and seven paid videos were identified as professionally made. Interrater reliability was high (α = .9). No differences in educational quality were identified between public and paid platforms. Video length was not correlated with quality (p = .15). A video library compiling public high‐quality videos was created (https://www.youtube.com/playlist?list=PL‐d5BBgQF75VWSkbvEq6mfYI‐‐9579oPK).Conclusions: Public and paid platforms may provide similar surgical education on free tissue transfer. Therefore, whether to subscribe to a paid video platform for supplemental free flap education should be determined on an individual basis.

Introduction: The aim of this study was to evaluate ex vivo perfusion (EVP) for vascularized composite tissue preservation. We hypothesized that EVP could maintain allografts in near‐physiologic conditions for ≥ 24 h. Methods: Twenty superior epigastric artery perforator‐based abdominal flaps were procured from 10 Yorkshire pigs. Flaps were preserved for 12 h ( n = 5) or 24 h ( n = 5) using EVP with an oxygenated colloid solution containing HBOC‐201 oxygen carrier (HbO ₂ Therapeutics, Souderton, PA). Contralateral flaps were cold storage controls (4°C) ( n = 10). Hemodynamics, temperature, gases, metabolites, electrolytes, indocyanine green (ICG) angiography, and weight were analyzed. Biopsies were taken every 6 h for histology. Results: Ischemia time was 16 ± 6 min. There were no significant differences between the 12 h EVP and 24 h EVP groups at perfusion end for the following parameters: MAP ( p = 0.63), pH ( p = 0.77), pO2 ( p = 0.20), venous pCO ₂ ( p = 0.22), lactate ( p = 0.28), creatine kinase ( p = 0.89), or myoglobin ( p = 0.95). Electrolytes were also comparable at perfusion termination: sodium ( p = 0.31), potassium ( p = 0.61), and calcium ( p = 0.29). After 12 h, flaps in the 24 h EVP group demonstrated a significant weight decrease (−4.5% [−4.6%, −4.1%] weight change), compared to the 12 h EVP group (1.2% [−1.1%, 1.6%] weight change) ( p = 0.03). At perfusion end, weight did not differ from baseline between the 24 h EVP (2.3% [0%, 3%]) and 12 h EVP groups ( p = 0.37). SCS flap weight was unchanged from baseline at 12 h ( p = 0.954) and 24 h ( p = 0.616). ICG revealed well‐perfused flaps. H&E staining revealed preserved skin architecture without histopathological changes. Conclusion: EVP preserved flaps for 24 h within physiologic parameters and without development of edema. EVP may extend preservation time for VCAs.