ImportanceThere has been an increase in health care–focused smartphone apps, including those for encouraging healthy behaviors and managing chronic conditions, but app-assisted postsurgical care has yet to be fully explored.ObjectiveTo compare quality of recovery and patient satisfaction between conventional in-person follow-up and smartphone app–assisted follow-up for patients following Enhanced Recovery After Surgery Society (ERAS) protocols.Design, Setting, and ParticipantsThis randomized clinical trial, conducted from June 2019 to April 2021, included women older than 18 years undergoing oncologic breast reconstruction or major gynecologic oncology surgery following ERAS protocols with the care of 2 surgeons at an academic tertiary care center.InterventionsPatients were randomized 1:1 to receive smartphone app–assisted follow-up or conventional in-person follow-up. The smartphone group used a surgeon-monitored app to record Quality of Recovery 15 (QoR15) scores, European Organisation for Research and Treatment of Cancer–selected adverse events, drain outputs, and surgical site photographs over 6 weeks. Patient satisfaction scores were assessed using validated Patient Satisfaction Questionnaire III (PSQ-III) subscales at 2 and 6 weeks postoperatively. The conventional follow-up group also completed the QoR15 and PSQ-III questionnaires at these intervals.Main Outcomes and MeasuresThe primary outcomes were quality of recovery and patient satisfaction, as measured by the QoR15 and PSQ-III, respectively. Secondary outcomes were costs of follow-up; the number of contacts with the medical system, complications, and surgeons’ contacts with patients; and surgeons’ perceptions of app-assisted care.ResultsOf 72 patients included in the trial, 36 underwent breast reconstruction (mean [SD] age, 45.30 [9.13] years) and 36 underwent gynecologic oncology surgery (mean [SD] age, 54.90 [11.18] years). Three patients dropped out (2 who underwent breast reconstruction [1 in the app group, 1 in the control group], 1 who underwent gynecologic oncology surgery [control group]). The app group had significantly higher mean (SD) QoR15 scores than the control group (2 weeks: 127.58 [22.03] vs 117.68 [17.52], P = .02; 6 weeks: 136.64 [17.53] vs 129.76 [16.42], P = .03). Patients were equally satisfied between groups in all subsets of the PSQ-III at these intervals. The mean (SD) number of complications was similar in both groups, and a similar number of surgeon contacts per patient occurred (1.6 [1.2] vs 2.1 [2.0], P = .16). Surgeons appreciated early identification of complications with the app.Conclusions and RelevanceIn this randomized clinical trial, postoperative follow-up for patients undergoing breast reconstruction and gynecologic oncology surgery using smartphone app–assisted monitoring led to improved quality of recovery and equal satisfaction with care compared with conventional in-person follow-up.Trial RegistrationClinicalTrials.gov Identifier: NCT03456167

Background: The purpose of this study was to review the rate and type of infectious complications after surgical fixation of hand fractures managed under wide-awake local anesthesia with no tourniquet (WALANT) in minor procedure rooms outside the main operating room. Methods: A two-surgeon retrospective chart review was performed of patients who received surgical fixation of hand fractures under WALANT in minor surgery from March of 2014 to March of 2019. Results: A total of 58 patients, with distal phalanx (n = 16), middle phalanx (n = 7), proximal phalanx (n = 11), or metacarpal (n = 26) fractures, were included in the study. The average patient age was 37 years, with a higher proportion of male patients (51:7). Two patients had two fractures each. Thirty of the 58 cases were already open fractures. Fixation was performed using either plates and screws (25 of 58) or nonburied Kirschner wires (31 of 58). Thirty-six percent of patients (21 of 58) were treated with prophylactic antibiotics. One patient developed postoperative cellulitis. The only case of osteomyelitis occurred in a patient with risk factors known to increase rates of infectious complications (open fracture, smoking history, and >24 hours from injury to treatment). No infectious complications occurred in those who sustained closed fractures. Conclusions: Although the minor surgery environment varies significantly from that of the main operating room, infection rates after surgical fixation of hand fractures using WALANT in this setting remain low (3.4 percent), with no documented infections in fractures that were referred closed and opened surgically for operative fixation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Methods A retrospective study including all cases of SH performed in a tertiary referral center in Israel during 2014-2021. We searched all surgeries performed by Senior gynecological surgeons in the Gynecologic department and extracted data of surgeries coded as SH in the surgical notes. Further, the rate of minimally invasive surgery (MIS) was evaluated across years of study Results Overall, we included 143 SH surgeries of women with a median age of 52 years. Symptomatic myoma was the indication in 75.5% of cases. MIS SH was completed in 33 (23.1%) of cases. The rate of MIS SH decreased from 46.7% in 2014 to 8.3% in 2021. Importantly, in 5 (3.5%) SH, malignancy was evident in the final pathological report. Reoperation was performed in 5 (3.5%) of cases in a median time of 71 months with 3 cases (2.1%) of malignancy as the indication.Conclusions Although performed, SH carries a non negligible risk of performing an incomplete surgery in gynecologic unsuspected malignancy and the necessity of future gynecological oncological surgery.

Paramedian forehead flaps (PMFFs) are commonly performed procedures for the reconstruction of complex nasal defects and require multiple stages predicated on when the interpolated pedicle is no longer required to provide perfusion to the neo-nose. As the presence of the pedicle is disfiguring, the flap is therefore divided ideally as soon as safely possible, but that determination is challenging. Recently, a novel device that uses near-infrared spectroscopy (NIRS) to measure tissue oxygen saturation has been developed and may provide an accurate and cost-effective tool to assess tissue perfusion. Here we present the use of this technology in the management of 2 patients who underwent successful oncologic nasal reconstructions using PMFFs. Using the device as a clinical adjunct, we measured tissue oxygen saturation values in the flaps before and after pedicle division, which assisted us in deciding when to safely divide the flaps, as well as with post-division management, particularly when a low tissue oxygen saturation reading ultimately necessitated the use of nitroglycerine past to improve flap perfusion in one of our patients. Interestingly, the values we recorded corresponded well to previously published cut-off values for adequate tissue perfusion, which have to date only been reported for free flaps. To our knowledge, this is the first description of the use of NIRS in the division of PMFFs, which we overall found to be a useful and reliable adjunct to a clinical examination in assessing flap neovascularization.