Objective: To identify factors associated with late cleft repair at a US tertiary children’s hospital. Design: Retrospective study of children with CL/P using Children’s Hospital Los Angeles (CHLA) records. Setting: US tertiary children’s hospital. Patients/Participants: Patients undergoing primary CL or CP repair at CHLA from 2009 to 2018. Main Outcome Measures: Proportion of children who had delayed primary CL repair or CP repair using CHLA and American Cleft Palate-Craniofacial Association (ACPA) guidelines and factors associated with late surgery. Results: In total, 805 patients—503 (62.5%) who had CL repair, 302 (37.5%) CP repair—were included. Using CHLA protocol, 14.3% of patients seeking CL repair had delayed surgery. Delay was significantly associated with female gender, non-Hispanic ethnicity, Spanish primary language, government insurance, bilateral cleft, cleft lip and palate (CLP), and syndromic diagnosis. Using ACPA guidelines, 5.4% had delayed surgery. Female gender and syndromic diagnosis were significantly associated with delay and remained significant after adjustment for confounders in multivariate models. For CP repair, 60.3% of patients had delayed surgery using CHLA protocol. Cleft lip and palate diagnosis, complete cleft, syndromic diagnosis, and longer travel distance were significantly associated with delay. Using ACPA guidelines, 28.5% had delayed surgery; however, significant association with patient variables was not consistently observed. Conclusions: Delay in cleft surgery occurs most often for patients seeking CP repair and is associated with female gender, non-Hispanic ethnicity, Spanish language, government insurance, and bilateral CL, CLP, or syndromic diagnoses. Initiatives should aim to optimize cleft surgery delivery for these subpopulations.

Precise, effective delivery of laser energy to the dermal-adipose tissue, as well as the deep adipose lipodystrophy is feasible as a safe modality for the simultaneous treatment of cellulite and lipodystrophy in the buttocks and thighs, as a single stage procedure.

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Background and ObjectivesLiposuction has become increasingly popular in the past decade due to advances in technique and technology. Despite the demand, there exists a significant population of patients who have contour deformities post‐liposuction. The 1,060 nm diode laser has been Food and Drug Administration cleared for the removal of unwanted fat, so it was theorized that this noninvasive laser system could be efficacious to smooth these areas of post‐liposuction contour deformities. This study was designed to retrospectively study the clinical changes induced by a 1,060 nm diode laser system to treat contour deformities in tissue post‐liposuction.Study Design/Materials and MethodsFifteen patients with contour deformities post‐liposuction (minimally six months post‐surgery) were treated in the area of the deformity with the noninvasive hyperthermic 1,060 nm diode laser system. Each patient received two treatments at a 6‐week interval in the anatomical area of their contour deformity.ResultsFifteen subjects had completed two treatments and the necessary follow‐up needs to be included in these results. Two blinded evaluators could correctly identify the pre‐treatment image compared to the post‐treatment image in an average of 85% of subjects. So, 100% of the patients were graded to be at least “Improved” with an average of 40% of subjects being “Very Much Improved”. Patient satisfaction was “High” in all subjects who have completed the treatment protocol. The physician satisfaction was rated as “Much Improved” in 33% of the patient results and “Improved” in 66% of the patient results.ConclusionsThe noninvasive hyperthermic 1,060 nm diode system is highly effective and safe for the treatment of contour deformities post‐liposuction. Lasers Surg. Med. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Aim: To review the choices of soft tissue coverage in distraction osteogenesis of the extremity. Methods: A PubMed literature search yielded 14 articles included for systematic review. Data were extracted from each article if available (sample size, patient age, surgical indications, type of flap, use of additional modalities, method of bone osteogenesis, postoperative events, follow-up, satisfaction, weight-bearing status, and success rate). Unpaired t-tests were performed to compare complication rates. A retrospective review of three cases was also conducted. Results: Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average. Indications included chronic osteomyelitis or nonunion (58.2%) and acute trauma (41.8%). Average time from injury was 1.1 years. Ilizarov frame was used in 12 articles. Free flaps (88.0%) or rotational flaps (12.0%) were used, with muscle flaps (96.7%) being most common. Most extremities received free latissimus dorsi or rectus abdominis flaps. Bone grafts and antibiotic beads were often used in conjunction. Although complications and reoperations were not uncommon (up to 30%), 98.8% of patients on average were ultimately weight bearing and all articles reported > 91% success rate. Additionally, the rates of any complication were not statistically different between "fix and flap" protocol and flap or frame first. Lastly, a three-patient case series is presented. Conclusion: Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting. Not one surgical approach to limb salvage is superior, and decision should be made on a case by case basis between the surgeon and the patient.