Further studies yielding level I data in this field are warranted. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.Despite recent advances in surgical, anesthetic, and safety protocols in the management of nonsyndromic craniosynostosis (NSC), significant rates of intraoperative blood loss continue to be reported by multiple centers. The purpose of the current study was to examine our center's experience with the surgical correction of NSC in an effort to determine independent risk factors of transfusion requirements. Methods A retrospective cohort study of patients with NSC undergoing surgical correction at the Montreal Children's Hospital was carried out. Baseline characteristics and perioperative complications were compared between patients receiving and not receiving transfusions and between those receiving a transfusion in excess or 25 cc/kg) intraoperative (P = 0.004; odds ratio, 1.95; 95% CI, 1.23-3.07) transfusions.  https://www.selleckchem.com/products/slf1081851-hydrochloride.html  Conclusions Our findings suggest increasing operative time as the predominant risk factor for intraoperative transfusion requirements. We encourage craniofacial surgeons to consider techniques to streamline the delivery of their selected procedure, in an effort to reduce operative time while minimizing the need for transfusion. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.The free flap failure rate is 5% in head and neck microsurgical reconstruction, and ischemia-reperfusion injury is an important mechanism behind this failure rate. Remote ischemic preconditioning (RIPC) is a recent intervention targeting ischemia-reperfusion injury. The aim of the present study was to investigate if RIPC improved clinical outcomes in microsurgical reconstruction. Methods Head and neck cancer patients undergoing tumor resection and microsurgical reconstruction were included in a randomized controlled trial. Patients were randomized (11) to RIPC or sham intervention administered intraoperatively just before transfer of the free flap. RIPC was administered by four 5-minute periods of upper extremity occlusion and reperfusion. Clinical data were prospectively collected in the perioperative period and at follow-up on postoperative days 30 and 90. Intention-to-treat analysis was performed. Results Sixty patients were randomized to RIPC (n = 30) or sham intervention (n = 30). All patients received allocated intervention. No patients were lost to follow up. At 30-day follow-up, flap failure occurred in 7% of RIPC patients (n = 2) and 3% of sham patients (n = 1) with the relative risk and 95% confidence interval 2.0 [0.2;20.9], P = 1.0. The rate of pedicle thrombosis was 10% (n = 3) in both groups with relative risk 1.0 [0.2;4.6], P = 1.0. The flap failure rate did not change at 90-day follow-up. Conclusions RIPC is safe and feasible but does not affect clinical outcomes in head and neck cancer patients undergoing microsurgical reconstruction. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.The use of systemic prophylactic antibiotics to reduce surgical-site infection in esthetic breast surgery remains controversial, although the majority of surgeons prefer to utilize antibiotics to prevent infection. Nonetheless, postoperative acute and subclinical infection and capsular fibrosis are among the most common complications following implant-based breast reconstruction. After esthetic breast augmentation, up to 2.9% of women develop infection, with an incidence rate of 1.7% for acute infections and 0.8% for late infections. After postmastectomy reconstruction (secondary reconstruction), the rates are even higher. The microorganisms seen in acute infections are Gram-positive, whereas subclinical late infections involving microorganisms are typically Gram-negative and from normal skin flora with low virulence. In primary implantation, a weight-based dosing of cefazolin is adequate, an extra duration of antibiotic cover does not provide further reduction in superficial or periprosthetic infections. Clindamycin and vancomycin are recommended alternative for patients with β-lactam allergies. The spectrum of microorganism found in late infections varies (Gram-positive and Gram-negative), and the antibiotic prophylaxis (fluoroquinolones) should be extended by vancomycin and according to the antibiogram when replacing implants and in secondary breast reconstruction, to target microorganisms associated with capsular contracture. All preoperative antibiotics should be administered less then 60 minutes before incision to guarantee high serum levels during surgical procedure. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.Left hand dominance is a minority trait historically regarded as disadvantageous for surgeons. Contemporary scientific literature and folklore have shed new light on left handedness as a "boutique trait" and possible marker of gifted and exceptional individuals. Our subjective impression that left handedness is prevalent in the unique field of plastic surgery raised questions regarding the scope and possible causality of this phenomenon. Methods One hundred eleven medical doctors in our medical center filled out a 13-item questionnaire regarding hand dominance, medical speciality, and various creative outlets or hobbies. Results Sixty-four percent of the participating plastic surgeons were left handed (significantly higher than the approximate 12% of the general population; P = 0.007). Many of the left-handed doctors admitted to practicing musical instruments and various arts, crafts, and other hobbies. Conclusions Plastic surgery is a unique profession requiring astute minds capable of creative and "outside-the-box" thinking; traits we have learned in recent decades may be particularly keen in left-handed individuals, perhaps suggest a causal relationship to the conglomeration of a majority of left-handed plastic surgeons. Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.