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The implementation of electronic health record (EHR) software at healthcare facilities in low- and middle-income countries (LMICs) is limited by financial and technological constraints. Smile Train, the world's largest cleft charity, developed a cleft treatment EHR system, Smile Train Express (STX), and distributed it to their partnered institutions. The purpose of this study was to investigate trends in medical documentation practices amongst Smile Train-partner institutions to characterize the impact that specialized EHR software has on medical documentation practices at healthcare facilities in LMICs.

Surveys were administered electronically to 843 Smile Train-partnered institutions across 68 LMICs. The survey inquired about institutions' internet connection, documentation methods used during patient encounters, rationale for using said methods, and documentation methods for cloud-based storage of healthcare data. Institutions were grouped by economic and geographic subgroups for analysis.

A total ofstudies are needed to characterize trends in medical documentation in LMICs at a more granular level.Shaft-only phalloplasty (SOP) has been described as an alternative option for phalloplasty. Although traditional phalloplasty represents the most complete form of genital gender-affirming surgery, this variation also carries the greatest surgical risk. Patients may opt for a lower risk SOP for reasons including gender identity, gender expression, sexual function, desire for future childbearing, or minimal gender dysphoria associated with sedentary urination. Further, some patients may, due to associated co-morbidities, not be a candidate for neourethral reconstruction. Forgoing urethral reconstruction also means forgoing the presence of a distal urethral meatus and thereby compromising on one of the basic tenets of phalloplasty surgery-the aesthetic appearance. In an SOP, the flap is usually a simple tube with a purse-string suture placed at the distal end. Another concern can be the insufficient bulk of the phallus due to the absence of the volume added by the inner tube. The purpose of this article is to review our technical modifications that allow for creation of a phallic meatus as well as increasing phallic girth when needed. The most frequently described technique to create a neo-urethra is the tube-within-tube concept. We expanded on this and apply it as a short segment for distal meatal creation in an SOP. Improved aesthetics are achieved by creating the appearance of a phallic meatus and when desired, utilizing a lateral de-epithelialized strip to increase phallic bulk and girth. We hope these technical refinements can assist the surgeon in better meeting the goal of creating an aesthetically pleasing phallus.

Although a boxy breast is a common aesthetic problem following breast reduction and mastopexy, literature regarding this deformity is scarce. It is vaguely described as a definitive postreduction deformity. To address this complication, it is important to fully analyze the problem, understand and predict its causes, and then try to prevent it.

This study included two groups. Group 1 included 14 patients presenting with boxy postoperative breasts. Revision surgeries were conducted for all patients, and the first algorithm was created for quantifying breast surgery in revision cases. Group 2 included 37 cases of primary mammaplasty reduction/mastopexy performed between 2016 and 2019. All the patients in this group were treated as per the study algorithm.

Patient satisfaction was measured on a scale of one to 10, with one being extremely dissatisfied and 10 being extremely satisfied. The results indicated overall satisfaction, with average scores of 9.5 and 9.1 in groups 1 and 2, respectively; the scores of surgeon satisfaction were 8.2 and 8.6, respectively.

The proposed algorithm, preoperative markings, intraoperative techniques, and postoperative orientation may help achieve optimal results and prevent undesired deformities or asymmetry. Applying a flexible and simplified algorithm provided a more objective plan, which enabled surgeons to attain more satisfactory results. Following a preset quantified plan supported and shortened learning curves and objectively addressed the common postoperative complication, breast boxing.

The proposed algorithm, preoperative markings, intraoperative techniques, and postoperative orientation may help achieve optimal results and prevent undesired deformities or asymmetry. Applying a flexible and simplified algorithm provided a more objective plan, which enabled surgeons to attain more satisfactory results. Following a preset quantified plan supported and shortened learning curves and objectively addressed the common postoperative complication, breast boxing.

Microsurgery is a highly specialized skill that requires advanced training. This is a recount of the 12-year development of Hanoi National Hospital of Odonto-Stomatology (NHOS) from a basic plastic surgery unit to a high-volume, subspecialized reconstructive center.

We present a 12-year retrospective account of the development of NHOS with a brief summary of microsurgical reconstructive outcomes.

From 2008 to 2020, NHOS has performed 665 microsurgical flaps for reconstruction of various maxillomandibular defects. In the pioneering stage (2008-2011), without surgical microscopes, all five free flaps failed. After acquiring a microscope and mentoring from Hanoi's 108 Military Hospital, mandibular bone defect reconstruction with free fibula flaps had 85% success rate. In the growth stage (2012-2015), reconstruction advanced toward more complex defects requiring soft tissue, with a 98.7% success rate. selleck inhibitor The maturation stage (2016-2020) focused on refinement of reconstructive service to provide subspecialized pact.Reconstruction of alveolar clefts includes fistula repair and bone grafting. However, bone is often harvested from the iliac crest or the skull, which can be associated with considerable donor site morbidity, and the failure rate may be as high as 20%. As such, some centers utilize bone morphogenetic protein (BMP)-2 to reconstruct the bony cleft. However, this remains an off-label use, and therefore we propose using BMP-2 only in patients with tenuous soft tissues, when the likelihood of graft failure is high. In four patients, we used BMP-2 with demineralized bone matrix (DBM) to reconstruct defects related to clefts-three patients had alveolar clefts, and the fourth patient was referred to us, with resorption of a necrotic premaxilla after premaxillary setback. In all cases, the decision was made to forego bone grafting intraoperatively given the poor quality of soft tissue and the increased risk of bone graft exposure. BMP-2 was infused onto a carrier and placed in the fistula, and Grafton DBM was then packed into the defect.