Plastic & Reconstructive Surgery

Reddy, Rajgopal R.; Gosla Reddy, Srinivas; Chilakalapudi, Anusha; Kokali, Swapnika; Bronkhorst, Ewald M.; Kummer, Ann W.; Bergé, Stefaan J.; Kuijpers-Jagtman, Anne Marie

doi: 10.1097/PRS.0000000000004486pmid: 29652768

Background: Is one-stage or two-stage palatoplasty more effective for preventing fistula formation and hypernasality in patients with complete unilateral cleft lip and palate? Methods: This parallel blocked randomized controlled trial included 100 patients with nonsyndromic complete unilateral cleft lip and palate with a repaired cleft lip, divided into two equal groups. Group A had one-stage palatoplasty patients at age 12 to 13 months while group B had two-stage palatoplasty patients with soft palatoplasty at age 12 to 13 months and hard palatoplasty at age 24 to 25 months. Presence of a fistula was tested clinically at 3 years and speech was tested using nasometry and perceptual analyses at 6 years. Group C consisted of noncleft controls (n = 20, age 6 years) for speech using nasometry. Fistula rates, hypernasality ratings, and nasalance scores were compared between groups A and B. Nasometry recordings of groups A and B were compared with control group C. Results: There was no difference in fistula rates between groups A and B (p = 0.409; 95 percent CI, 0.365 to 11.9). Mean nasalance scores of group A showed higher nasalance than group B (p = 0.006; 95 percent CI, 1.16 to 6.53). Perceptual analysis showed no difference between groups A and B (p = 0.837 and p = 1.000). Group A showed higher mean nasalance than group C (p = 0.837 and p = 1.000), whereas group B showed no difference (p = 0.088; 95 percent CI, −0.14 to 2.02). Conclusions: There was no difference in fistula rates between groups. Nasalance was slightly higher in patients in the one-stage palatoplasty group than two-stage palatoplasty group, but the difference was not clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Bonomi, Stefano; Sala, Laura; Cortinovis, Umberto

doi: 10.1097/PRS.0000000000004521pmid: 29683936

Barone, Mauro; Cogliandro, Annalisa; Grasso, Antonella; Altomare, Vittorio; Persichetti, Paolo

doi: 10.1097/PRS.0000000000004520pmid: 29952915

Xu, Fawei; Li, Hua; Cai, Jiaqin; Gu, Zichun; Cheng, Hao

doi: 10.1097/PRS.0000000000004524pmid: 29683938

Luck, J. D.; Lopez, Joseph; Faateh, Muhammad; Macmillan, Alexandra; Yang, Robin; Davidson, Edward H.; Nam, Arthur J.; Grant, Michael P.; Tufaro, Anthony P.; Redett, Richard J.; Manson, Paul N.; Dorafshar, Amir H.

Bhatt, Reena A.; Iyengar, Rajiv J.; Karacaoglu, Ercan; Zienowicz, Richard J.

doi: 10.1097/PRS.0000000000004542pmid: 29683933

Supplemental Digital Content is available in the text.

Tian, Naiyuan; Luan, Jie

doi: 10.1097/PRS.0000000000004479pmid: 29683942

Nagarkar, Purushottam A.; Janis, Jeffrey E.

doi: 10.1097/PRS.0000000000004485pmid: 29649057

Background: Previous studies have demonstrated that programs emphasize United States Medical Licensing Examination scores, publications, and geography in creating rank lists. The authors aimed to quantify the importance of geography and to determine how eliminating geographic preferences would affect Match outcomes. Methods: The Match algorithm was implemented and validated on 6 years of deidentified data from the San Francisco Match (2009 to 2014). A “consensus” ranking was generated for each year—all applicants were ordered into a single list using Markov chain rank aggregation. Each program’s rank list was reordered using the consensus list, and a new Match result was simulated. Statistical analysis was carried out with Microsoft Excel. Results: Variation of program rank lists from the consensus rank list was driven by geography (training in the same medical center or state as the ranking program), “pedigree” (top 25 ranking of applicants’ prior training), and foreign medical graduation status. Step 1 scores, publications, and medical school or residency region were not factors. The simulated Match resulted in a slight increase in the match rate. The median normalized number needed to match decreased from 6.7 to 6.5, and 80 percent of applicants had an unchanged or better result compared to the actual Match. Conclusions: Geography is the primary driver of variation between program rank lists. Removing this variation would result in fewer unfilled positions, no significant change in the average number needed to match, and improved Match outcomes for most applicants. Programs should critically evaluate whether their geographic biases reflect underlying information about applicant quality.

DiGiorgi, Mary; Carangelo, Matthew; Scranton, Richard

doi: 10.1097/PRS.0000000000004480pmid: 29742651

Demir, Canser Yilmaz; Yuzkat, Nureddin; Ozsular, Yavuz; Kocak, Omer Faruk; Soyalp, Celaleddin; Demirkiran, Hilmi

doi: 10.1097/PRS.0000000000004516pmid: 29952902

Background: The authors studied the alterations in mean platelet volume, neutrophil-to-lymphocyte ratio, and red blood cell distribution width values together with the platelet count in hospitalized patients diagnosed with Fournier gangrene to determine their association with disease prognosis. Methods: Records of patients diagnosed with Fournier gangrene were analyzed retrospectively. Results: Seventy-four patients (49 men and 25 women) with a mean age of 57.60 ± 15.34 years (range, 20 to 95 years) were included. Sixty-eight participants were discharged and six died during follow-up. In the discharged group, during hospitalization, there was a trend downward in neutrophil-to-lymphocyte ratio and mean platelet volume values, whereas platelet count increased significantly. In the nonsurvivor group, the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement and at the end of hospitalization were significantly higher; platelet counts at admission, after the first débridement, and at the end of hospitalization were significantly lower compared with the survivor group (p < 0.05). In correlation analysis, mortality rate was negatively correlated with platelet count at admission and after first débridement and positively correlated with the neutrophil-to-lymphocyte ratio and mean platelet volume after first débridement. Regarding the receiver operating characteristic curve analyses, a platelet count of 188,500/µl at admission and 196,000/µl after the first débridement, a neutrophil-to-lymphocyte ratio of 13.71, and a mean platelet volume of 9.25 fl after the first débridement were defined as the cutoff levels having the best sensitivities and specificities. Conclusions: This study suggests that platelet count at admission and platelet count, mean platelet volume, and neutrophil-to-lymphocyte ratio after first débridement and during discharge may be included among the prognostic scores of Fournier gangrene. The authors defined some threshold values that can be used during patient follow-up. Larger prospective studies are warranted to determine the exact role of those parameters in the prognosis of Fournier gangrene. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.