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BackgroundThe importance of aesthetic surgery exposure for plastic and reconstructive trainees has been recently validated by the expansion of case requirements for aesthetic procedures from 50 to 150, as well as resident-driven desire for increased cosmetic exposure throughout training. We aim to systematically review the literature at a national level to report on overall trends in aesthetic surgery training within PRS residencies.MethodsA literature search of PubMed, Embase, and Scopus identified all English articles published in the USA between 2000 and 2020, using a combination of “aesthetic surgery”, “cosmetic surgery”, “plastic surgery”, “residency and internship”, “education”, and “training.”ResultsOur initial search resulted in 415 articles. After review of inclusion and exclusion criteria, in addition to cross-referencing, 41 studies remained, including 15 studies discussing resident and/or program director surveys, eight studies discussing teaching methods, sixteen studies discussing dedicated resident clinics, four studies discussing cosmetic/aesthetic fellowships, three studies discussing cosmetic practice patterns, and eleven studies discussing patient outcomes.ConclusionCurrent literature demonstrates that there are gaps in aesthetic surgery training for PRS residents in the USA, including facial and neck surgeries and non-surgical interventions. Resident clinics have clear benefits for resident education, without sacrificing patient outcomes. Residency programs should consider the development of a resident cosmetic clinic and/or dedicated cosmetic center to increase surgical exposure and increase trainee comfort in providing this subset of procedures. Published literature is limited in consistency of methods of evaluation, and further in-depth analysis of case volume and diversity at training programs within the USA and internationally is indicated.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background Medical tourism has grown increasingly popular in the past few decades. Cosmetic surgery centers have developed in vacation locales, offering procedures at lower prices. However, surgeons and patients alike are often unprepared for management of complications after patients return to the USA. The aim of this study is to provide an overview of US cosmetic surgery tourism patients and the complications faced by US healthcare providers. Methods A systematic review was performed using the Web of Science, Cochrane, Embase, Scopus, and PubMed databases up to February 2022; included articles were full-text, English language, and reported complications of patients receiving postoperative care in the USA after cosmetic surgery abroad. Two independent reviewers performed screening for article eligibility with a 3rd for conflict resolution. Patient demographics, procedure characteristics, and outcomes were extracted and aggregated. Results Twenty studies were included, describing 214 patients. Most patients were female (98.1%, n = 210), middle-aged, and Hispanic. The most common destination country was the Dominican Republic (82.7%, n = 177) and the most common surgical procedure was abdominoplasty (35.7%, n = 114). Complications were mainly infectious (50.9%, n = 112) and required prolonged treatment periods often greater than two months, with high rates of hospitalization (36.8%) and surgical management (51.8%). Conclusions Cosmetic surgery tourism is a growing industry with adverse implications for the US healthcare system and patients themselves. This review aims to serve as a reference to prepare plastic surgeons for the scope of complications associated with cosmetic tourism and improve counseling to better prepare patients for the financial and health risks. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This systematic review aims to identify genetic and biologic markers associated with abdominal hernia formation. Following PRIMSA-guidelines, we searched PubMed, MEDLINE, Embase, Scopus, and COCHRANE databases. Of 5946 studies, 65 were selected, excluding parastomal hernias due to insufficient data. For inguinal hernias, five studies unveiled 92 susceptible loci across 66 genes, predominantly linked to immune responses. Eleven studies observed elevated MMP-2 levels, with seven highlighting greater MMP-2 in direct compared to indirect inguinal hernias. One incisional hernia study identified unique gene-expression profiles in 174 genes associated with inflammation and cell-adhesion. In hiatal hernias, several genetic risk loci were identified. For all hernia categories, type I/III collagen ratios diminished. Biological markers in inguinal hernias appears consistent. Yet, the genetic predisposition in incisional hernias remains elusive. Further research to elucidate these genetic and biological intricacies can pave the way for more individualized patient care. •Elevated MMP-2 linked to inguinal hernia pathogenesis nuances.•Collagen type I/III ratio decrease suggests remodeling roles.•Genetic studies reveal multiple loci, potential immune system link.•Gene regulation's influence on inguinal hernias highlighted.•Incisional hernia studies suggest genetic predisposition, intervention targets.

Transversus Abdominis Release (TAR) during ventral hernia repair (VHR) allows for further lateral dissection by dividing the transversus abdominis muscles (TAM). The implications of division of the TAM on clinical and patient-reported outcomes has not be extensively studied. Adult patients undergoing retrorectus (RR) VHR with biosynthetic mesh with or without bilateral TAR were retrospectively identified. Post-operative and patient-reported outcomes (PROs) were collected. Of 50 patients, 24 underwent TAR and 26 had RR repair alone. Median defect sizes were 449 cm2 and 208 cm2, respectively (p < 0.001). Rates of SSO and SSI were similar (p > 0.05). One TAR patient (4.2%) and four RR patients (15.4%) recurred (p = 0.26), with median follow up of 24 and 38 months. PROs improved significantly in both groups (p < 0.05). Despite more complex abdominal wall reconstruction on larger defects, TAR has minimal major adverse events, low recurrence rates, and does not negatively affect PROs. •Improved quality of life after transversus abdominis release.•Low recurrence after abdominal wall reconstruction with transversus abdominis release.•Transversus abdominis release has comparable outcomes to retrorectus repair alone.

Purpose Incisional hernias are a significant source of morbidity in the United States that impact quality of life and can cause life-threatening complications. Complex patient factors, collected as structured and unstructured data, contribute to the risk of developing an incisional hernia following abdominal surgery. It is unknown how risk prediction models derived from imaging data, or radiomic features, can enhance pre-operative surgical planning. This study investigates surgeons’ perspectives regarding risk prediction models derived from radiomic features and assesses the model’s impact on surgeon behavior. Methods An online cross-sectional survey assessing perceptions of a pre-operative risk prediction model was administered to surgeons across the US from April 23, 2024– May 30, 2024. Surgeons’ beliefs of the risk model’s impact on surgeon behavior and its applicability in the clinical setting were assessed. Results A total of 166 completed surveys were analyzed. Mean age was 52.3 (SD 10.1), 71.1% were male, 78.9% were White, and 90.4% were not Hispanic or Latino. The majority of the respondents were general surgeons (58%), colorectal surgeons (14%), thoracic surgeons (12%), and urologists (7%). The mean level of accuracy predicted from radiomic features needed to prompt a change in management was 74.5% (SD 15.1%). The mean at which FPR and FNR were unacceptable was 25.9% (SD 16.9%) and 26.1% (SD 21.7%), respectively. Most believed a risk prediction model tool would improve their peri-operative management. Conclusion A majority of surgeons were positively supportive of incorporating a hernia risk-prediction clinical decision tool incorporating radiomic features in their clinical practice.

PurposeVentral hernia repair (VHR) can be augmented with biosynthetic poly-4-hydroxybutryate mesh (P4HB). Long-term outcomes, including quality of life outcomes, after VHR with P4HB mesh are not well established. Our study sought to assess these outcomes 5 years after repair.MethodsPatients who received VHR using P4HB by the senior author between 01/2015 and 09/2017 were retrospectively identified. Patients were prospectively interviewed for quality of life assessment using the Hernia-Related Quality-of-Life Survey (HerQLes) and Abdominal Hernia-Q (AHQ) and screened for recurrence. Those who screened positive were asked to follow up in clinic to confirm recurrence. Both 5-year quality of life and recurrence were univariately assessed with patient and operative factors.Results51 patients met inclusion criteria. 43 patients completed 5-year quality of life assessment (84.3% response rate). Quality of life scores at all postoperative time periods were greater than preoperative scores. Further, quality of life at 5 years is greater than that assessed 0–2 years following VHR. Most patients achieve their best quality of life in the 5-year time period. Thirty-five patients had clinical follow-up in the 5-year time period, 7 experienced recurrences (20% recurrence rate). There was no difference in 5-year quality of life assessment between those who had a recurrence and those who did not.ConclusionPatient quality of life following VHR with P4HB improves immediately and continues to improve 5 years following repair. There are no differences in quality of life with onset of recurrence. Quality of life should be the primary outcome of success in VHR.

Incisional hernia (IH) is a complex, costly and difficult to manage surgical complication. We aim to create an accurate and parsimonious model to assess IH risk, pared down for practicality and translation in the clinical environment. Institutional abdominal surgical patients from 2002 to 2019 were identified (N = 102,281); primary outcome of IH, demographic factors, and comorbidities were extracted. A 32-variable Cox proportional hazards model was generated. Reduced-variable models were created by systematic removal of variables 1–4 and 23–25 at a time. The c-statistic of the full 32-variable model was 0.7232. Four comorbidities decreased accuracy of the model: COPD, paralysis, cancer and combined autoimmune/hereditary collagenopathy or AAA diagnosis. The model with those 4 comorbidities removed had the highest c-statistic (0.7291). The most reduced model included 7 variables and had a c-statistic of 0.7127. Accuracy of an IH predictive model is only marginally affected by a vast reduction in end-user inputs. •Incisional hernia is a highly morbid surgical complication.•Predictive models aim to assess risk of incisional hernia after laparotomy.•Complex predictive models can involve a multitude of variables.•Variable-reduced predictive models are nearly as predictive as full-scale models.•Parsimonious models integrate into workflow to make a real-world impact.

BackgroundFemale genital mutilation/cutting (FGM/C) is the intentional alteration, removal, or injury of female genitalia for non-medical reasons. Approximately 200 million females have been victims of FGM/C, and genital reconstructive procedures are increasing in demand.ObjectivesThe objectives of this study were to assess clinical and patient-reported outcomes after FGM/C reconstruction to help guide treatment practices.MethodsAdult patients undergoing anatomic reconstruction after FGM/C were retrospectively identified. Outcomes included clitoral, labial, and donor site surgical site occurrences (SSO) and the need for revision operations. Patient-reported outcomes were assessed using an adapted version of the Female Sexual Function Index (FSFI), a validated outcomes instrument that assesses sexual function through 6 domains, with each domain having a maximum score of 6.ResultsNineteen patients were identified in our review. Patients presented for reconstruction due to dyspareunia, inability to orgasm, chronic infections, to normalize appearance, and/or to “feel normal.” There were no SSOs and two revision operations for adhesions. 74% of patients completed the FSFI postoperatively. Despite most patients seeking repair for inability to orgasm and/or dyspareunia, the median scores for these domains were 4.6 and 5.2. Patients’ desire to engage in sexual activity scored lowest (3.9), and patients reported concerns over the appearance of their genitalia (50%) that affected self-confidence (85.7%).ConclusionFGM/C reconstruction is safe and contributes to improvements in physical sexual health. Psychological trauma may contribute to lessened sexual desire and self-confidence even after reconstruction. Multidisciplinary treatment is important to address the long-term psychological effects of this practice.Level of evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background Fleur-de-lis panniculectomy (FDL), a contouring technique involving vertical and horizontal tissue resections, often involves longer operative times and potential complications. This study assessed operative time, postoperative outcomes, and patient-reported quality of life (PRO) with Insorb ® Absorbable Subcuticular Skin Stapler versus traditional sutures during FDL. Methods A retrospective review from 2015 to 2022 of FDL patients excluded those with complex concomitant procedures. Demographics, operative details, and surgical outcomes were compared between patients using the dermal stapler and those with suture-only closures. Results Forty subjects were identified, with 25 (62.5%) in the dermal stapler cohort. The dermal stapler significantly reduced total procedure time (66.76 vs. 125.33 min, p < 0.05). There were no significant differences in surgical site occurrences, aesthetic outcomes, readmissions, or reoperations. Multivariate regression analysis further highlighted the choice of closure technique as an independent predictor of operative time, with traditional sutures indicating a significantly increased operative time compared to using the dermal stapler (AOR 76.53, CI 38.11-114.95, p < 0.001). Regarding PROs, both groups saw improvements across multiple BODY-Q domains, but the dermal stapler group reported greater enhancements (six out of nine domains vs. three for sutures). Conclusion The absorbable dermal stapler significantly reduces FDL operative time without increasing wound healing or aesthetic dissatisfaction incidents and maintains comparable quality-of-life improvements to standard suture closure. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .