Workers of many occupations bear a health burden associated with disabling musculoskeletal pain and injuries of a work-related etiology, collectively called work-related musculoskeletal disorders (MSDs). These are a group of preventable disorders affecting muscles, tendons, and nerves. Examples include carpal tunnel syndrome, tendinitis, degenerative spine disease, thoracic outlet syndrome, and tension neck syndrome.¹ These diagnoses share common risk factors, such as sustained nonneutral postures and forceful repetitive tasks, often resulting from poor instrumentation design; they manifest with insidious pain that can result in temporary or permanent work disability, if not addressed.

Despite a growing literature on patient satisfaction in breast reconstruction, few studies have compared perforator flaps with the more commonly practiced methods. The authors compared four reconstructive techniques and identified factors influencing patient satisfaction. All patients undergoing postmastectomy breast reconstruction between 1999 and 2006 at a single academic institution were included in our study. A total of 583 patients with tissue expander/implant, latissimus, pedicle transverse rectus abdominis muscle (TRAM), and deep inferior epigastric perforator (DIEP) flap reconstructions received a validated questionnaire on satisfaction, health-related quality of life, and sociodemographic data. Patient response was 75 percent, with 439 completed questionnaires including 87 tissue expander/implant, 116 latissimus, and 119 pedicle TRAM and 117 DIEP flap patients. DIEP patients had the highest level of general satisfaction at 80 percent, and pedicle TRAM patients had the highest level of aesthetic satisfaction at 77 percent (p < 0.001 and p < 0.001, respectively). Health-related quality of life and length of time since surgery were identified as significant covariates influencing patient satisfaction. After logistic regression analysis, autologous reconstruction had significantly higher general and aesthetic satisfaction than implant-based reconstruction (p = 0.017 and p < 0.001). Among the autologous reconstructions, abdominal-based flaps had significantly higher general and aesthetic satisfaction than latissimus flaps (p = 0.011 and p = 0.016). When comparing the abdominal-based reconstructions, general and aesthetic satisfaction were no longer statistically significant between pedicle TRAM and DIEP flaps (p = 0.659 and p = 0.198). Autologous, abdominal-based reconstructions had the highest satisfaction rates across all four groups. After logistic regression analysis, differences in patient satisfaction between pedicle TRAM and DIEP flap reconstruction were no longer observed. Discussing satisfaction outcomes with patients will help them make educated decisions about breast reconstruction.

Many incisional techniques have been described for access to the craniofacial skeleton for traumatic fracture repair, including subciliary, subtarsal, and transconjunctival approaches. Each is associated with a distinct set of complications. The goal of the authors' study was to examine lower lid malposition associated with these incisional approaches at the authors' institution and in the literature. A retrospective chart review of all operative orbital and/or zygomatic fractures at the Beth Israel Deaconess Medical Center from 1998 to 2008 was performed. The surgical approach and postoperative lower eyelid complications were noted. A literature review was performed of all peer-reviewed studies in the English language examining the incidence of complications of lower eyelid incisions in operative facial trauma. A total of 180 cases were treated with a lower eyelid incision; these were identified as subtarsal (41 percent), subciliary (31 percent), and transconjunctival (25 percent). The risk of ectropion was highest in subciliary incisions (12.5 percent, p = 0.018); however, only two cases required operative management. Entropion was found in two cases after transconjunctival incisions; both required operative management. Seventeen studies were included in the meta-analysis, representing 2086 patients. The risk of ectropion was highest in subciliary incisions (14 percent), the risk of entropion was highest in transconjunctival incisions (1.5 percent), and the risk of hypertrophic scarring was highest in subtarsal incisions (3.4 percent). A majority of these complications resolved with conservative management. Lower eyelid complications can be seen with all three incisional approaches to facial fracture repair. Based on their findings, the authors favor the subtarsal approach for zygomaticomaxillary fractures and the transconjunctival incision for isolated orbital floor fractures.

The introduction of pulse oximetry in the 1970s provided a new vital sign to physicians for monitoring patient care.^{1, 2, 3} While easy to use and relatively inexpensive, pulse oximetry only monitors arterial oxygenation. More recent advances in modeling and instrumentation have led to the development of quantitative spectroscopic probes capable of measuring total tissue oxygenation (arterial & venous).^{4, 5, 6, 7, 8, 9} However, these devices typically provide local measurements and require a priori knowledge of the location of a potential oxygenation defect. Thus, an imaging system that offers truly passive monitoring by measuring large areas of tissue oxygenation without a priori knowledge would aid patient management in many surgical and critical care applications.

Background: The development of a complication after surgery can be difficult for both patient and surgeon. With a growing body of literature evaluating patient satisfaction after breast reconstruction, few studies directly focus on the impact of surgical complications on satisfaction. This study analyzed the effect of complications on general and aesthetic satisfaction after breast reconstruction. Methods: All women at an academic institution undergoing breast reconstruction between 1999 and 2006 were identified. Patient demographics and history of complications were collected. A questionnaire adapted from the Michigan Breast Reconstruction Outcomes Survey was administered examining general and aesthetic satisfaction. Patients with complications were compared with patients with no complications. Results: Overall, 716 women underwent 932 reconstructions; 233 patients had a complication. Patient demographics and response rate were similar between the two groups (overall response rate 75.4 percent). Development of a complication correlated with increased odds of aesthetic dissatisfaction (odds ratio = 1.61, p = 0.047). Other predictors of dissatisfaction were older age, reconstruction with an implant, and a longer time interval between reconstruction and survey, while autologous reconstruction was a predictor of satisfaction. Among patients with a complication, implant reconstruction and mastectomy for prophylaxis were significant predictors of dissatisfaction. Conclusions: Aesthetic satisfaction after breast reconstruction is lower in patients developing a complication, older patients, and those receiving an implant reconstruction. Furthermore, patients with a prophylactic mastectomy are more likely than those with a therapeutic mastectomy to be dissatisfied when complications arise. These relationships are important, as measures to improve quality and decrease complications can directly improve patient satisfaction.