Background/Objectives: The evolving capabilities of large language models, such as generative pre-trained transformers (ChatGPT), offer new avenues for disseminating health information online. These models, trained on extensive datasets, are designed to deliver customized responses to user queries. However, as these outputs are unsupervised, understanding their quality and accuracy is essential to gauge their reliability for potential applications in healthcare. This study evaluates responses generated by ChatGPT addressing common patient concerns and questions about cleft lip repair. Methods: Ten commonly asked questions about cleft lip repair procedures were selected from the American Society of Plastic Surgeons’ patient information resources. These questions were input as ChatGPT prompts and five board-certified plastic surgeons assessed the generated responses on quality of content, clarity, relevance, and trustworthiness, using a 4-point Likert scale. Readability was evaluated using the Flesch reading ease score (FRES) and the Flesch–Kincaid grade level (FKGL). Results: ChatGPT responses scored an aggregated mean rating of 2.9 out of 4 across all evaluation criteria. Clarity and content quality received the highest ratings (3.1 ± 0.6), while trustworthiness had the lowest rating (2.7 ± 0.6). Readability metrics revealed a mean FRES of 44.35 and a FKGL of 10.87, corresponding to approximately a 10th-grade literacy standard. None of the responses contained grossly inaccurate or potentially harmful medical information but lacked citations. Conclusions: ChatGPT demonstrates potential as a supplementary tool for patient education in cleft lip management by delivering generally accurate, relevant, and understandable information. Despite the value that AI-powered tools can provide to clinicians and patients, the lack of human oversight underscores the importance of user awareness regarding its limitations.

A total of 71,364 breast reductions were performed in 2022, which demonstrates a 54% increase from 2019. Women most often seek breast reduction surgery for pain, but psychological symptoms may be equally distressing, particularly those who are younger. These women may also suffer low self-esteem, inhibitions in intimacy, and reluctance to exercise, which may contribute to depressive symptoms. A systematic review was conducted using PRISMA guidelines and registered on PROSPERO (CRD42023456884). Cochrane Library, Embase, and Pubmed were searched for RCTs in English irrespective of timeframe. The studies were screened using the RoB2 tool, and data was extracted using standardized tables. The search strategy yielded 84 references, and only three were eligible for inclusion. The sample size collectively amounted to 193. The tools used to assess depressive symptoms were the Beck Depression Inventory, a modification of this tool, and the Hospital Anxiety Depression Score. All three studies showed a significant reduction in depression scores. Breast hypertrophy may cause impairment in several key psychological domains including depression, which may be relieved with surgery. Standardized assessment tools and scoring systems may enable more comprehensive evaluation and potentially lead to guidelines defining broader criteria as indications for surgery. Further investigation into the differences between women who seek breast reduction surgery versus those who do not may provide insights into other contributing factors that may be at play. Further trials should be designed with longer durations of follow-up to investigate the long-term effects of breast reduction surgery.

Background: Diverting loop ileostomies (DLI) are commonly used to protect high-risk anastomoses. While a higher body mass index (BMI) is known to increase postoperative morbidity, its specific effect on DLI-related complications is less well understood. Methods: This systematic review and meta-analysis followed PRISMA guidelines, and Cochrane Library, Embase, PubMed, and Google Scholar were searched for English publications without time restrictions. Statistical analysis was performed using Meta-Mar v3.5.1. Results: Out of 586 studies yielded and 6 manually retrieved, 26 were included, totaling 5,141 patients (53.5% male). The mean ages were 35.0–65.3 years, and the mean BMI was 19.8–27.1 kg/m². Higher BMI increased stoma-site incisional hernia in 100% (n = 7) with a standardized mean difference of 0.88 (95% CI, 0.34–1.42). Two studies (40%) reported increased peristomal skin complications. One study each (100%) found increased risk for delayed reversal, stoma outlet obstruction, stoma-specific morbidity score, and longer operative time. Elevated BMI increased anastomotic leakage in 2 studies (50%), surgical site infection in 1 (33%), permanent stoma in 1 (20%), and overall complications in 2 (67%). However, no significant BMI differences were seen for high-output ileostomies, stoma retraction, parastomal hernia, complications after reversal, length of hospital stay, or mortality. BMI > 30 was associated with higher complication risks overall (OR [95% CI], 2.01 [1.11–3.64]), but BMI > 25 showed no significant difference except for stoma-site incisional hernia (OR [95% CI], 4.66 [3.54–6.14]) and parastomal hernia (OR [95% CI], 2.41 [1.70–3.40]). Conclusion: Increased BMI is a risk factor for certain DLI-related complications, particularly stoma-site incisional hernia. If feasible, mesh placement at the ileostomy site should be strongly considered for patients with a BMI > 25 to reduce the risk of stoma-site incisional hernia. Weight loss prior to DLI and reversal should be encouraged.

Background. Although phenytoin's potential benefits in wound healing, pain relief, and infection control across various wound types have been previously reported, its use in wound care remains limited. Objective. To conduct a comprehensive review to assess the efficacy of topical phenytoin compared with standard and alternative treatments for different wound types. Materials and Methods. The authors last searched Cochrane Library, PubMed, PubMed Central, and MEDLINE in June 2023. All English-language human RCTs and NRCTs from any time were included. The RoB 2 was used to assess quality of randomized trials, and the ROBINS-I was used to assess the quality of nonrandomized trials. Studies with a low risk of bias or some concerns in no more than 1 domain were included. Data collected and analyzed included wound type, interventions, sample size, outcome measures, and adverse effects. Results. The search yielded 101 studies, of which 17 RCTs and 8 NRCTs were eligible for inclusion. Of the included studies, 56% had a low risk of bias in all domains. The sample sizes varied between 20 and 130 (median, 60), with a total sample size of 1653 patients. Phenytoin improved wound healing in 17 of the 24 studies that evaluated it (71%), increased granulation tissue in 9 of the 10 studies that evaluated it (90%), provided analgesic effects in 7 of the 13 studies that evaluated it (54%), and inhibited bacterial contaminants in 6 of the 8 studies that evaluated it (75%). Adverse effects were rare (29%), minimal, and transient. Conclusion. Phenytoin enhances wound healing and offers analgesic and antibacterial properties with minimal adverse effects. Further research is needed on optimal dosage of phenytoin, as well as frequency, delivery vehicles, and effects on other postoperative wounds. Background. Although phenytoin’s potential benefits in wound healing, pain relief, and infection control across various wound types have been previously reported, its use in wound care remains limited. Objective. To conduct a comprehensive review to assess the efficacy of topical phenytoin compared with standard and alternative treatments for different wound types. Materials and Methods. The authors last searched Cochrane Library, PubMed, PubMed Central, and MEDLINE in June 2023. All English-language human RCTs and NRCTs from any time were included. The RoB 2 was used to assess quality of randomized trials, and the ROBINS-I was used to assess the quality of nonrandomized trials. Studies with a low risk of bias or some concerns in no more than 1 domain were included. Data collected and analyzed included wound type, interventions, sample size, outcome measures, and adverse effects. Results. The search yielded 101 studies, of which 17 RCTs and 8 NRCTs were eligible for inclusion. Of the included studies, 56% had a low risk of bias in all domains. The sample sizes varied between 20 and 130 (median, 60), with a total sample size of 1653 patients. Phenytoin improved wound healing in 17 of the 24 studies that evaluated it (71%), increased granulation tissue in 9 of the 10 studies that evaluated it (90%), provided analgesic effects in 7 of the 13 studies that evaluated it (54%), and inhibited bacterial contaminants in 6 of the 8 studies that evaluated it (75%). Adverse effects were rare (29%), minimal, and transient. Conclusion. Phenytoin enhances wound healing and offers analgesic and antibacterial properties with minimal adverse effects. Further research is needed on optimal dosage of phenytoin, as well as frequency, delivery vehicles, and effects on other postoperative wounds.

Introduction: Hemorrhagic transformation is a major complication of large vessel occlusion (LVO) recanalization after mechanical thrombectomy in acute ischemic stroke. The hypoperfusion index ratio (HIR) quantifies the severity of cerebral hypoperfusion in the setting of an acute ischemic stroke using CT perfusion (CTP) to compare the volume of severely hypoperfused tissue (time-to-maximum [Tmax] > 10 s) to total hypoperfused tissue (Tmax >6 s), and has emerged as a potential predictor of ischemic core growth and poor outcomes. We investigated whether computed tomography perfusion (CTP) derived hypoperfusion index ratio correlates with the rate of hemorrhagic transformation. Methods: We conducted a retrospective cohort analysis of a prospectively maintained patient database. Included patients underwent mechanical thrombectomy for large vessel ischemic stroke from January 2019 to December 2022 at a single comprehensive stroke center. Patients were separated into 2 groups depending on whether hemorrhagic transformation developed. Hemorrhagic transformation included any hemorrhage that could be classified according to the ECASS criteria as hemorrhagic infarction (HI)1, HI2, parenchymal hematoma (PH)1 and PH2. Hypoperfusion index ratio on admission CTP was determined using VizAI software. Data were analyzed using Chi-square and Mann-Whitney U tests. Results: Among the 289 patients included (median age, 72.5; 41.5% female), 55 (19%) had hemorrhagic transformation. Patients with hemorrhagic transformation had a significantly higher hypoperfusion index ratio (median, 0 vs 0.2; P = 0.004) compared with those with no hemorrhagic transformation. Multivariable analysis showed that for every 0.1 increase in the hypoperfusion index ratio, there was a significant 4.64-fold increase in hemorrhagic transformation (OR 4.64; 95% CI 1.40 to 15.18; p = 0.011). Conclusion: In patients with LVO who underwent mechanical thrombectomy, a higher hypoperfusion index ratio on admission CTP was associated with an increased rate of hemorrhagic transformation. This suggests that the hypoperfusion index ratio could be used as a predictor for hemorrhagic transformation after mechanical thrombectomy.