Introduction Microsurgical replantation following digital amputation has variable success rates. Sociodemographic factors and surgery-related variables have been shown to influence survival rates; however, few studies have evaluated these data systematically across a combined dataset. Therefore, the objective of this study was to analyze the current literature to identify the predictors of replant survival. Materials and Methods A literature review was performed using the PubMed/Medline database focused on complete digit amputation/replantation studies. Studies were evaluated for patient and surgery-related variables and their respective effects on survival. Statistical analysis was conducted to identify predictors of survival and derive pooled estimates from the combined dataset. Results Thirty-two studies representing more than 6,000 digit amputation/replantation cases met inclusion/exclusion criteria. Statistical analysis revealed the number of venous anastomosis (0 vs. 1 vs. 2), the number of arterial anastomosis (0 vs. 1 vs. 2), and the mechanism of injury (sharp cut versus blunt cut versus avulsion versus crush) to influence replant survival (p < 0.05). The authors failed to find a significant association between survival and the following variables: age, sex, zone of injury, digit number, tobacco use, ischemia time, method of preservation, and use of vein graft. Conclusion Patient- and surgery-related variables affect digit survival following replantation. The etiology of injury can help risk-stratify patients and assist in an informed decision making process, whereas surgery-related factors can guide surgeon practice to improve clinical outcomes following replantation.

We assess Google Glass ("Glass") in improving postoperative review ("debriefing") and augmenting education in Neurological Surgery at a tertiary academic medical center. This was a prospective study. Participants were patients of Neurological Surgery physicians at a Tertiary Care Level 1 Academic Trauma Center. Resident physicians received a pre-questionnaire immediately following surgery. Next, the resident and attending physicians debriefed by reviewing the Glass operative recording. Then, residents completed a 4-part post-questionnaire. Questions 1-3 assessed: (1) the residents' comfort level with the procedure, (2) the quality of education provided by their superiors, and (3) their comfort level in repeating the operation. Question 4 assessed: (4) the perceived benefit of debriefing using Glass. Twelve surveys were collected. Scores were based on a 5-point Likert scale, with a higher score corresponding to a more positive response. For Questions 1-3, the average pre- and post-questionnaire scores were 3.75 and 4.42, respectively (P <.05). For Question 4, the average post-questionnaire score was 4.63, suggesting that postoperative Glass review improved their technical understanding of the procedure. Glass significantly improved neurosurgery residents' comfort level and quality of training, and provided a high fidelity, reliable, and modifiable tool that enhanced residents' understanding, expertise, and educational experience. Of note, certain limitations such as variable battery life, variable image quality, and subpar compatibility with surgeon loupes must still be overcome for Glass to become a realistic addition to neurosurgical education.

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Educational interventions may alleviate the burden of TBI for patients and their families. Interactive modalities that involve engagement with the educational material may enhance patient knowledge acquisition when compared to static text-based educational material. OBJECTIVE: To determine the effects of educational interventions in the outpatient setting on self-reported patient knowledge, with a focus on iPad-based (Apple, Cupertino, California) interactive modules. METHODS: Patients and family members presenting to a NeuroTrauma clinic at a tertiary care academic medical center completed a presurvey assessing baseline knowledge of TBI or concussion, depending on the diagnosis. Subjects then received either an interactive iBook (Apple) on TBI or concussion, or an informative pamphlet with identical information in text format. Subjects then completed a postsurvey prior to seeing the neurosurgeon. RESULTS: All subjects (n = 152) significantly improved on self-reported knowledge measures following administration of either an iBook (Apple) or pamphlet (P < .01, 95% confidence interval [CI]). Subjects receiving the iBook (n = 122) performed significantly better on the postsurvey (P < .01, 95% CI), despite equivalent presurvey scores, when compared to those receiving pamphlets (n = 30). Lastly, patients preferred the iBook to pamphlets (P < .01, 95% CI). CONCLUSION: Educational interventions in the outpatient NeuroTrauma setting led to significant improvement in self-reported measures of patient and family knowledge. This improved understanding may increase compliance with the neurosurgeon's recommendations and may help reduce the potential anxiety and complications that arise following a TBI.

CellScope®, an iPhone-enabled otoscope, was introduced into the neurotrauma clinic at an American College of Surgeons certified Level I trauma center. CellScope is an innovative tool that digitally improves optical clarity of the tympanic membrane, providing the acquisition of HIPPA compliant images. We compared the CellScope to the traditional otoscope in teaching medical students, neurosurgery physician assistants, and neurosurgery residents. In addition, the utility of this device in a neurotrauma clinic was specifically examined because of the high frequency of otologic symptoms after head trauma.

Background/Objectives: Despite the popularity of vascularized lymph node transfers (VLNTs) for treatment of breast cancer-related lymphedema (BCRL), the comparative effectiveness of VLNT placement locations is unknown. In this meta-analysis, we examined the impact of VLNT recipient site (proximal vs. distal vs. dual) and adjunct surgical techniques, including scar release, supercharging, and intervention timing on patient outcomes. Methods: PRISMA-guided search of PubMed, MEDLINE, and Embase (January 2015–March 2025). Patient outcomes including limb circumference/volume reduction, cellulitis frequency, compression garment discontinuation, and patient satisfaction were analyzed. Subgroup analyses assessed node placement, scar release, supercharging, and timing. Results: A total of 1440 patients were analyzed (proximal 63.8%; distal 29.2%; dual 7.0%). No significant differences in mean volume/circumference reductions, patient satisfaction rates, and compression garment discontinuation were observed amongst placement strategies (p > 0.30). Adjunct scar release (65%) was associated with significantly greater patient satisfaction (p = 0.04) and showed trends toward improved volume reduction and compression discontinuation. Earlier intervention (<5 years from diagnosis) showed improved volume reduction, patient satisfaction, and compression discontinuation. Longitudinal analysis revealed dual placement maintained superiority throughout a 12-month follow-up. Conclusions: VLNT is an effective treatment for BCRL regardless of placement location, with all strategies demonstrating substantial clinical improvements. While dual placement showed numerically superior outcomes across all measures, differences did not reach statistical significance due to limited number of studies. Adjunct scar release significantly improves patient satisfaction, and earlier intervention may optimize outcomes. These findings suggest that recipient site selection may be guided by technical factors, vessel availability, and patient preference rather than efficacy differences.