Tissue expansion is an integral procedure of the vast majority of breast reconstruction and has a significant impact on the final clinical outcomes. Therefore, technological advances leading to a fewer number of unfavorable outcomes and a decrease in complication rates are imperative. In this study, using a porcine model, we investigated an effect of acellular dermal matrix (ADM) used as a tissue expander cover on the dermal changes induced by mechanical forces during tissue expansion. After 14 days of expansion, skin samples were collected from one animal, while the second animal underwent radiation, and tissue was collected 8 weeks later. Tissue expanded without the use of ADM and unexpanded skin served as the controls. Collected skin biopsies were used for histological and immunohistochemical evaluation, and for gene expression analysis. We revealed that the biological cover incorporation into host tissue is facilitated by macrophages without inducing a broad inflammatory response. The utilization of ADM mitigated disruption in the dermal structure, excessive collagen deposition, and capsule formation in non-irradiated expanded skin. The protective effect was not fully maintained in irradiated skin. These results demonstrate that tissue expansion might be improved by using the tissue expander cover.

Varaztad Kazanjian stood for innovation in plastic surgery, serving as a founder of many of the craniomaxillofacial principles practiced today. However, we have seen attrition in career interest toward craniofacial and pediatric plastic surgery as trainees progress from medical school to early career. We explore several aspects of our specialty that could help reinvigorate enthusiasm for our specialty and the retention of young surgeons. We begin by judging career success and defining the patient population we wish to serve. We examine several areas by which our specialty can be perceived as more attractive to young surgeons, to include early mentorship and maintaining these mentoring relationships beyond the training period. We emphasize the need to diversify our trainees and include them in efforts to expand innovation in our specialty. We discuss the need to champion craniofacial and pediatric plastic surgery as mission-critical to our institutions, involve trainees and young surgeons in advocacy efforts on behalf of our patients, and involve trainees and young surgeons in global health efforts. We discuss how to structure our divisions to make craniofacial and pediatric plastic surgery an inviting environment that welcomes new participants, rather than making them feel they are working their way through an “old boys’ club.” Innovation alone will not sustain our specialty unless we mentor the next generation to want to continue in the line of innovation that drew us to this specialty.

Objective Families increasingly use online resources to acquire medical information about their child's condition with little understanding of the legitimacy of the source of information or of the information itself. We evaluate the quality and readability of online information related to positional head shape conditions and identify unmet needs for healthcare providers to improve online patient education. Design The search terms “flat head baby,” “brachycephaly,” and “plagiocephaly” were queried on the Google search engine and the first 20 websites for each were reviewed. Included websites were evaluated for quality using the DISCERN Instrument and readability using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Websites were categorized by upload source and results were compared using one-way ANOVA. Results 38 websites met inclusion criteria. There was no significant correlation between DISCERN score and Google search rank between the three search terms. Professional organizations provided websites with the highest mean DISCERN score (56.3) and commercial websites with the lowest score (36.6, P = .003), indicating “good” and “poor” quality content, respectively. Readability assessments showed an overall average FKGL of 9.9 and FRES of 54.4, suggesting “fairly difficult”. Hospitals provided the most website results and tended to publish lower quality information, yet are the most readable. Conclusions High quality websites written at an appropriate reading level for the general public are lacking. A review of online resources for positional head shape conditions can be used to derive recommendations to improve the content of online patient education for pediatric healthcare.

fficient skin growth during tissue expansion is critical for obtaining satisfactory outcomes from reconstructive operations. Despite many years of practice, tissue expansion still relies mostly on the surgeon's skills and expertise, and on the innate ability of the skin to grow in response to mechanical forces. 1 According to the American Society of Plastic Surgeons in 2018, 61% of two-stage breast reconstruction cases involving a tissue expander performed in the United States used a biologically derived acellular dermal matrix (ADM), 2 even though use of ADM or any other biological cover for the tissue expander has yet to be approved by the U.S. Food and Drug Administration for this specific purpose. Lack of requisite animal studies demonstratingBackground: Biological cover over tissue expander prostheses has been introduced to provide soft-tissue support for tissue expanders during breast reconstruction. However, its impact on mechanically induced skin growth remains unknown. This study investigates the hypothesis that covering the tissue expander with acellular dermal matrix (ADM) affects mechanotransduction without compromising the efficacy of tissue expansion. Methods: Tissue expansion, with and without use of ADM, was performed on a porcine model. The tissue expanders were inflated twice with 45 mL of saline, and the full-thickness skin biopsy specimens were harvested from expanded and control unexpanded skin 1 week and 8 weeks after the final inflation. Histologic evaluation, immunohistochemistry staining, and gene expression analysis were performed. Skin growth and total deformation were evaluated using isogeometric analysis. Results: The authors' results demonstrate that use of ADM as a biological cover during tissue expansion does not impede mechanotransduction that leads to skin growth and blood vessel formation. Isogeometric analysis revealed similar total deformation and growth of expanded skin with and without a biological cover, confirming that its use does not inhibit mechanically induced skin growth. In addition, the authors found that use of an ADM cover results in more uniform distribution of mechanical forces applied by the tissue expander. Conclusions: These results suggest that ADM improves mechanically induced skin growth during tissue expansion by facilitating a more uniform distribution of mechanical forces applied by the tissue expander. Therefore, the use of a biological cover has potential to improve outcomes in tissue expansion-based reconstruction.