Our study results show a discrepancy between the availability of surgeons for elective procedures and on-call emergency care for facial and hand/wrist condition.

Background: Cellulite is a common aesthetic condition that affects the majority of women. It is characterized by the inhomogeneous appearance of the skin overlying the gluteal and the posterior thigh region. Despite a wide array of treatment options, little has been done to evaluate the anatomical basis of cellulite formation. This study used ultrasound to visualize subcutaneous changes of cellulite to aid with treatment guidance and complication avoidance. Methods: Cellulite dimples were examined on the bilateral thigh and buttock regions of 50 consecutive women and each dimple was scored with the Hexsel Cellulite Scoring System based on severity. Cellulite dimples were then analyzed by ultrasound to identify the presence, orientation, and origination of subcutaneous fibrous bands and the presence of associated vascular structures. Results: Two hundred total sites were examined, with 173 dimples identified. Of these, 169 demonstrated the presence of fibrous bands (97.6 percent). The majority of bands demonstrated an oblique (versus perpendicular) orientation to the skin (84.4 percent), with the majority (90.2 percent) taking origin from the superficial fascia (versus the deep fascia). Overall, 11 percent of bands had an associated vascular structure. When stratified by body mass index, overweight and obese patients had a higher likelihood of having an associated blood vessel visualized (p = 0.01). Results were similar for dimples in the thigh compared to those located in the buttock region. Conclusions: Ultrasound appears to be a valid technique to image the subcutaneous architecture of cellulite. This technology can help guide surgeons in real time to improve outcomes and minimize complications while performing cellulite treatments.

In recent years, internet search engines such as Google (Alphabet Inc) have put the power of healthcare knowledge in the hands of the general population. Google Trends is a tool which tracks activity of various search topics over time, offering valuable insights into the interests and expectations of the general public. Nearly two thirds of cancer patients research their cancer and its treatments online. 1 The ability to track online search data allows healthcare researchers to gauge patient interest in a multitude of medical topics. Google Trends has previously been used to evaluate "hot topics" in esthetic surgery, with studies by Tijerina and Motosko demonstrating positive correlations between Google Trends search terms and the number of corresponding cosmetic procedures performed. 2,3 The goal of this study was to use Google Trends to analyze search interest in breast reconstruction procedures involving implants and autologous flaps over the last 10 years and correlate these findings with the trends in surgery volume as reported by the American Society of Plastic Surgeons (ASPS). 4 American Society of Plastic Surgeons statistical reports were analyzed from 2008 to 2017 to determine the annual case volume for the following types of breast reconstructive surgeries: reconstruction with tissue expander and implant, reconstruction with saline or silicone implant, deep inferior epigastric artery perforator (DIEP) flap, transverse rectus abdominis musculocutaneous (TRAM) flap, and latissimus dorsi flap. Each topic was then individually entered in Google Trends, and relative search interest was generated over the corresponding 10year period. Annual search interest was calculated as a mean of the monthly search interest. (Google Trends expresses search interest over a given month as a percentage of searches in relation to the month with the highest number of searches). Graphs were generated with Microsoft Excel (Version 16.21; Microsoft Corp), and Spearman correlation coefficients (Rs) were determined for search terms with corresponding procedures reported by ASPS. Analyses were performed using Statistical Package for Social Sciences (SPSS version 23; IBM Statistics), with statistical significance defined as α < .05.We began by examining trends related to implant-based reconstruction. An increasing frequency of searches for "tissue expander + breast implant" was observed, which correlated positively with the number of two-stage alloplastic breast reconstructions reported by the ASPS over the 10-year period. This relationship did not achieve significance (Rs = 0.612, P = .060, Figure 1A,B).Search frequency for "breast reconstruction + saline implants" has consistently decreased over time, as has the number of reported surgeries by ASPS using saline implants. This correlation was not significant (Rs = 0.714, P = .71, Figure 1C,D). The frequency of searches for "breast reconstruction + silicone implants" also decreased; however, the number of procedures reported by the ASPS has increased. This relationship was not signif...

Although uncommon, bulge formation after abdominal free flap reconstruction can create significant morbidity to patients. Laproscopic hernia repair using composite mesh underlay offers an alternative to traditional open hernia repair and can be successfully used to minimize scarring, infection, and pain to free flap patients who have already undergone significant reconstructive procedures. © 2016 Wiley Periodicals, Inc. Microsurgery 36:367-371, 2016.