Background: The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown. Objective: The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters. Methods: A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage “top box” scores (ie, the percentage of respondents who selected the most positive response category on the survey, “very good”), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05. Results: Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3%), White (n=1059, 92.7%), and not Hispanic or Latino (n=985, 92.4%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Conclusions: Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine.

We report a case of severe hypertriglyceridemia (HTG) complicated by hyperviscosity syndrome as a possible adverse reaction to risankizumab-rzaa in a 49-year-old male with a history of longstanding uncontrolled type 2 diabetes, obesity, and coronary artery disease with prior ST-elevation myocardial infarction. On admission, the patient presented with xanthomatous plaques, chest and epigastric discomfort, and headache. Subsequent blood testing revealed severely elevated triglyceride (TG) levels at 7670 mg/dL (86.59 mmol/L) [reference range: <150 mg/dL; 1.69 mmol/L] and total cholesterol at 934 mg/dL (24.14 mmol/L) [reference range: <200 mg/dL; 5.17 mmol/L]. Triglyceride levels decreased and symptoms resolved with dietary restrictions and plasmapheresis. At follow-up, his TG remained elevated but improved, and he was advised to continue lipid-lowering medications as well as cessation of risankizumab. While the patient presented with high risk factors, we posit that the subacute presentation of severe HTG is a possible result of his recent course of risankizumab-rzaa therapy for management of psoriasis. This is noteworthy as pharmaceutical surveys and clinical trials do not list severe HTG as an adverse effect. Postmarketing surveillance studies are essential to confirm this potential association and monitor drug safety. In summary, this case highlights a possible link between risankizumab and severe HTG, emphasizing the importance of ongoing pharmacovigilance to identify and manage unexpected adverse effects associated with new medications.

Background: Lasers and energy-based devices are commonly employed in aesthetic medicine. In the United States, the FDA regulates lasers as medical devices, restricting marketing to approved indications and making off-label claims illegal. Despite this, no comprehensive analysis of off-label marketing prevalence exists. Objectives: The authors of this study aim to compare the FDA-approved indications for 2 popular aesthetic lasers to their online advertising claims. Additionally, they seek to educate aesthetic providers on the current regulatory restrictions surrounding off-label advertising. Methods: FDA-approved indications for 2 lasers—helium plasma dermal resurfacing and 2940 nm fractional erbium-doped yttrium aluminum garnet—were obtained from the publicly available Establishment Registration & Device Listings Database. Online advertisements regarding the capabilities of each laser were collected from practice websites in the United States. Results: Our analysis of 100 online claims for each laser revealed that more than half of the websites advertising helium plasma (n = 59) and 44 websites advertising fractional lasers made at least 1 off-label claim. Both plastic surgeons and nonplastic surgeons made at least 1 off-label claim, with no statistically significant difference between the groups. Conclusions: Despite FDA regulation of medical devices, online advertising regarding the indications and capabilities of popular medical lasers varies widely. Patients who seek information regarding aesthetic laser treatments may encounter inaccurate and differing claims for these treatments, potentially leading to false expectations and poor patient outcomes. Level of Evidence: 4 (Risk):

Summary: Sacral reconstruction post tumor resection has historically been executed with the placement of hardware or free tissue transfer. Reconstruction using a vascularized bone graft is an alternative that avoids the complications associated with hardware placement or free tissue transfer. This article describes the first documented case of spinoplastic reconstruction using an iliac crest vascularized bone graft (IC-VBG) after the resection of a sacral ependymoma. This is a case of a 17-year-old boy with a history of a sacral myxopapillary ependymoma. He presented to a local emergency department complaining of 6 months of urinary incontinence and progressive paresthesias affecting the left lower extremity. Magnetic resonance imaging was significant for a lesion located in the extradural spinal canal. Biopsy confirmed a myxopapillary ependymoma, World Health Organization grade II. The initial intervention involved tumor resection with titanium hardware placement. He subsequently required replacement of the titanium hardware with carbon fiber, secondary to the need for surveillance imaging. He underwent harvesting and inset of the IC-VBG at the time of hardware replacement. IC-VBG is a safe and effective modality for spinoplastic reconstruction. It enhances the potential for solid bony union and offers a practical alternative to free bone transfer. This approach provides an asset to add to a reconstructive surgeon’s armamentarium, making it an essential tool for reconstructive surgeons working in conjunction with spinal surgery colleagues.

Background: The contribution of the lateral chest wall to overall aesthetic outcome following breast augmentation, breast reduction, or breast reconstruction has been understudied. The authors of this study aim to determine whether a patient-perceived “ideal” lateral extension of the chest wall exists and whether it is influenced by respondents' demographic factors or body perceptions. Objectives: The authors seek to provide plastic surgeons with valuable insights to optimize aesthetic results in breast procedures and better manage patient expectations. Methods: Realistic female figures were modeled to represent different body types. For each body type, 3 torsos were created with increasing lateral chest wall fullness (concave, neutral, and full). An anonymous online survey was sent to subscribers of a beauty magazine to determine their aesthetic preference toward lateral chest wall contours related to their perceived body type. Results: A total of 1131 individuals responded to the survey, with 894 meeting the inclusion criteria: 48.7% selected the neutral lateral chest wall as the most aesthetically appealing, 46.0% the concave contour, and 5.3% the full contour. First-choice preferences varied significantly by self-selected body type (P < .001) and cosmetic procedure history (P = .01). With increasing BMI, respondents ranked the concave contour less favorably (P < .001), whereas the neutral (P = .007) and full (P = .01) contours received higher rankings. Conclusions: The aesthetics of the lateral chest wall are highly dependent on individual anatomy as well as patient perception of their body morphology. A contour ranging from slightly concave to neutral is generally preferred, with preferences correlating directly with body composition. These insights suggest that plastic surgeons should discuss the lateral chest wall with patients in consultation for breast procedures. Additionally, surgeons should adopt personalized surgical plans that consider the breast–chest wall relationship and integrate ancillary procedures to optimize patient satisfaction. Level of Evidence: 4 (Therapeutic):

Background/Objectives: Spino-plastic surgery describes a specialized, multidisciplinary approach to addressing various spinal pathologies. The field is the innovative product of a multidisciplinary collaboration between plastic and reconstructive, orthopedic, and neurosurgery. Over the last few decades, this collaboration has borne promising surgical techniques and treatment plans geared toward restoring form, function, and aesthetics in patients with a variety of spinal conditions, including failed fusions, pseudoarthrosis, and the need for oncologic reconstruction. This paper explores the application of spino-plastic surgery in the context of post-sarcoma resection reconstructions, focusing on the efficacy in addressing the unique challenges posed by extensive tissue loss and structural deformities. Methods: Our study reviews a series of cases wherein spino-plastic techniques were utilized in patients with sarcomas of the spine and adjacent structures. We also discuss the technical considerations, including preoperative planning, intraoperative challenges, and overall patient care, that are crucial for the success of spino-plastic procedures. Results: The outcomes demonstrate significant improvements in patient mobility, pain reduction, and overall quality of life. Most notably, spino-plastic surgical techniques help facilitate the restoration of functional anatomy by leveraging vascularized bone grafts and muscle flaps, thereby enhancing long-term stability and reducing the risk of complications such as nonunion or infection. Conclusions: Spino-plastic collaboration represents a pivotal advancement in oncologic treatment, spinal care, and reconstructive surgery, offering new hope for patients undergoing post-sarcoma reconstruction. Further research and refinement of the techniques will only expand their application and improve outcomes for a broader range of patients in the future.