Background Applying into plastic surgery (PS) is competitive. Lacking a home residency program (HRP) is another barrier. Our goal is to characterize challenges faced by PS applicants without HRPs and identify solutions. Methods Surveys were designed for current integrated PS residents and applicants in the 2022 Match without HRPs. Surveys were distributed electronically. Only U.S. allopathic graduate responses were included. Results Of 182 individuals surveyed, 74 responded (39%, 33 residents, 41 applicants). Sixty-six percent reported feeling disadvantaged due to lack of an HRP. Seventy-six percent of applicants successfully matched. Of these, 48% felt they required academic time off (research year) versus 10% of unmatched applicants. Ninety-seven percent of matched applicants identified a mentor versus 40% of unmatched applicants (p < 0.05). Matched applicants identified mentors through research (29%) and cold calling/emailing (25%). Matched versus unmatched applicants utilized the following resources: senior students (74 vs. 10%, p < 0.05) and social media (52 vs. 10%, p < 0.05). Among residents, 16 had PS divisions (48%). Thirty-six percent with divisions felt they had opportunities to explore PS, compared with 12% without divisions. Residents without divisions felt disadvantaged in finding research (94 vs. 65%, p < 0.05), delayed in deciding on PS (50 vs. 28%), and obtaining mentors (44 vs. 35%) and letters of recommendation (31 vs. 24%). Conclusion PS residents and applicants without HRPs reported feeling disadvantaged when matching. The data suggest that access to departments or divisions assists in matching. We identified that external outreach and research were successful strategies to obtain mentorship. To increase awareness for unaffiliated applicants, we should increase networking opportunities during local, regional, and national meetings.

ChatGPT and similar generative AI have immense potential to revolutionize health care and the field of microsurgery. We found that when it comes to microsurgical procedures, ChatGPT-generated FAQ sheets tend to be highly accurate but somewhat non-specific. At this stage, microsurgeons should read over any ChatGPT-generated patient materials and briefly addend in more specific information while verifying for general accuracy. Overall, it remains to be seen how microsurgeons respond to this exciting new development, to best incorporate ChatGPT in an advantageous yet ethical manner. Received: 04 April 2023 Accepted after revision: 03 May 2023 Accepted Manuscript online: 24 May 2023 © . Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background/Objectives: Patients with postural orthostatic tachycardia syndrome (POTS) or neurogenic orthostatic hypotension (nOH) experience vertigo, confusion, and syncope. Compression garments help reduce venous pooling in these patients, thereby increasing cardiac output. We aimed to determine end-user opinions of compression products intended to alleviate symptoms for POTS and nOH. Methods: This was a survey study sampling participants diagnosed with POTS or nOH. The data collected included demographics, medical history, and compression garments previously used. The participants rated their most frequently used garment across comfort, aesthetic appeal, ease of use, durability, cost-effectiveness, efficacy, and consistency on the Likert scale (1–5). One-way ANOVA was used to compare the design criteria ratings across garments. For all tests α = 0.05. Results: Of the 330 POTS and 28 nOH participants surveyed (mean age 37.9, mean BMI 27.5, 95.0% women, 90.5% White), 354 (98.9%) reported trying at least one compression garment since their diagnosis. The majority of participants reported using leg compression most frequently rather than shapewear or abdominal compression (65.4% vs. 20.1% vs. 13.4%, respectively). Approximately 67.0% of participants tried multiple product types. Shapewear was reported to have greater concealability compared to abdominal or leg compression garments (mean 3.43 vs. 2.90 vs. 2.91, respectively; p < 0.01). Shapewear and abdominal compression were rated to be less comfortable compared to leg compression (2.67 vs. 2.94 vs. 3.05, respectively; p = 0.03). Conclusions: The existing compression products do not fully meet needs of individuals with POTS or nOH, as evidenced by participant ratings on multiple domains. There is potential consumer demand for novel adjustable abdominal compression garments that are low-profile and comfortable when disengaged.

Background: Distal radius fractures (DRFs) are common upper extremity fractures and often require surgical fixation when they are intraarticular. Preoperative computed tomography (CT) has emerged as a surgical planning tool to evaluate intraarticular DRFs. Although CT affords additional details, patients receive higher radiation doses than standard radiographs. We aim to develop a low-dose CT (LDCT) protocol, relative to the institutional standard-dose CT wrist for intraarticular DRFs although providing adequate detail for surgical decision-making. Methods: A single-institution prospective study was conducted on patients with intraarticular DRFs who underwent closed reduction and below-elbow splinting who otherwise would undergo wrist CT. Observations were defined as total measurements taken, with each view undergoing 44 measurements. Patients underwent 2 scans with a standard dose and a 10× dose reduction. Articular step and gap measurements were recorded in the sagittal and coronal images. Results: A total of 11 patients were enrolled (7 women and 4 men). The mean age was 55 years (SD = 20.1). There were a total of 4 reviewers: 1 attending surgeon, 2 resident physicians, and 1 student. When comparing LDCT and conventional-dose CT (CDCT), there were no significant differences in step and gap measurements across all reviewers. Conclusion: This study demonstrated that LDCT provides comparable imaging quality for surgical planning as a CDCT without significant diagnostic decay in the setting of DRFs. This comes with the added benefit of a 10-fold reduction in radiation exposure. These results suggest that LDCT is an opportunity to reduce effective radiation in patients although providing beneficial preoperative imaging.

Background Surgical drains are a key component for recovery in breast reconstruction procedures. However, they are often cumbersome and carry a risk of infection with prolonged use. We aimed to develop a more thorough understanding of patient and health care provider perspectives on surgical drains, to inform future efforts in improving the breast reconstruction patient experience. Methods Twenty-nine breast reconstruction patients and eight plastic surgery providers were recruited to complete surveys focused on surgical drains. Likert scales ranging from 1 to 5 were developed to gauge how bothersome drains felt, as well as concern for infection. Ordinal variable and categorical multiple-choice analyses were applied as appropriate. Results Fifteen (51.7%) patients underwent implant-based breast reconstruction, and 14 (48.3%) patients underwent autologous breast reconstruction. The most common duration of drain placement was 2 weeks (N = 13). The surgical site infection (SSI) rate requiring antibiotics was 28% (N = 8). On a scale of 1 to 5, both patients (median = 3) and providers (median = 2.5) viewed drains as bothersome. Patients were “frequently” concerned about infection risk (median = 3). Other high-frequency patient concerns included general pain and discomfort. Conclusion Surgical drains are a common component of breast reconstruction procedures and are viewed as cumbersome by both patients and providers. Patients expressed concerns about drain site pain, discomfort, and tugging on clothing. Patients and providers both believed that drains could contribute to SSI. Overall, these data provide insight to drive future improvements in the patient drain experience.