IUSM Plastic Surgery Research Day 2026

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Craniofacial Keloid Management Using Post-Excisional Adjuvant Brachytherapy: A Case Report
(2026-02) Massoud, Louis; Fell, Claire; Zellars, Richard; Ingersol , Chris; Hadad, Ivan
Introduction: Keloids are fibroproliferative scars that that can range from mildly abnormal wound healing to significant and excessive outgrowth of skin beyond the area of the wound. They may be associated with microtrauma, and surgery is a well-recognized risk factor in patients with predisposition keloid scars formation. Treatment options can range from minimally invasive medical therapy to surgical excision of the keloid. Methods: In this paper, we present an interesting case of craniofacial keloid likely secondary to microtrauma, treated with surgical excision, split thickness skin graft, and adjuvant brachytherapy. Given that keloid secondary to surgical wounds tend to most commonly occur at the skin edges, brachytherapy was applied at the wound margins in addition to the wound bed to reduce the risk of keloids recurrence. Results: Post-operative results at 2 years demonstrated no recurrence in the treated area, thus decreasing the overall keloid burden in the patient. In addition, patient reported high overall satisfaction with the outcomes. Conclusion: This paper demonstrated that brachytherapy can be an effective adjunct treatment following excision of keloid scars, with no evidence of long-term recurrence.
Preoperative GLP-1 Receptor Agonist Use and Postoperative Opioid Outcomes in Elective Surgery
(2026-02-04) Hanna, Ellias; Priest , Caitlin; Gunaseelan , Vidhya; Howard, Ryan; Adkinson, Joshua; Waljee, Jennifer
Preoperative GLP-1 Receptor Agonist Use and Postoperative Opioid Outcomes in Elective Surgery Ellias Hanna, BS1, Caitlin R. Priest, MD2,3, Vidhya Gunaseelan, MBA, MS, MHA3,4, Ryan Howard, MD2,3, Joshua Adkinson, MD5, Jennifer F. Waljee, MD, MPH, MS2,3,4,5 1Indiana University School of Medicine, South Bend, IN 2Department of Surgery, University of Michigan, Ann Arbor, MI 3Center for Healthcare Outcomes and Policy, Ann Arbor, MI 4Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI 5Department of Surgery, Indiana University School of Medicine, Indianapolis, IN Objective To examine the association between preoperative glucagon-like peptide-1 receptor agonist (GLP-1 RA) use and postoperative opioid outcomes among opioid-naïve adults undergoing elective surgery. Background GLP-1 receptor agonists modulate central reward pathways and have been associated with reduced substance use and opioid-related outcomes in preclinical and observational studies. However, whether preoperative GLP-1 RA use is associated with reduced postoperative opioid prescribing or persistent opioid use in surgical populations remains unclear. Methods We conducted a retrospective cohort study using the Merative MarketScan Commercial Database, including opioid-naïve adults aged 18–64 years undergoing one of the 20 most common elective surgical procedures between January 1, 2018, and June 30, 2023. The primary exposure was any GLP-1 RA prescription fill within 365 days prior to surgery. Secondary analyses evaluated patterns of preoperative GLP-1 RA exposure using K-means clustering based on prescription duration, continuity, and recency. Outcomes included perioperative opioid prescription fill, opioid refill, new persistent opioid use, and total opioid prescribing volume measured as morphine milligram equivalents (MMEs) within 30 and 90 days after discharge. Multivariable regression models adjusted for demographics, comorbidity burden, mental health and substance use disorders, chronic pain conditions, and surgical procedure type. Results Among 914,550 opioid-naïve surgical patients, 20,482 (2.2%) had preoperative GLP-1 RA exposure. In adjusted analyses, GLP-1 RA use was associated with higher odds of perioperative opioid prescription fill (adjusted odds ratio [aOR], 1.18; 95% CI, 1.13–1.22), opioid refill (aOR, 1.05; 95% CI, 1.01–1.10), and new persistent opioid use (aOR, 1.17; 95% CI, 1.05–1.30). Absolute differences in outcome rates were small, and adjusted mean MMEs at 30 and 90 days were nearly identical between GLP-1 RA users and non-users. Cluster-based analyses did not demonstrate a protective association for longer, more continuous, or more recent GLP-1 RA exposure. Conclusions Preoperative GLP-1 receptor agonist use was not associated with clinically meaningful reductions in postoperative opioid prescribing or opioid exposure among opioid-naïve surgical patients, suggesting limited utility of GLP-1 RAs as opioid-sparing agents in the perioperative setting.
2026 IUSM Plastic Surgery Research Day Program
(Indiana University School of Medicine Department of Surgery Division of Plastic and Reconstructive Surgery, 2026-02-04)
Official programs for the third annual Indiana University School of Medicine Plastic Surgery Research Day held at Sidney & Lois Eskenazi Hospital on February 4, 2026.
Alpha Testing of a Patient-Centered Decision Aid for Cleft Revision Procedures
(2026-02-04) Baker, Elizabeth; Hendricks, Brody; Makar, Katelyn
Introduction Cleft lip and palate are the most common craniofacial anomaly. Primary repair occurs in the first year of life, with elective revision procedures becoming available in later childhood and adolescence. The choice to undergo a cleft-related revision procedure is preference sensitive, meaning that more than one reasonable treatment option exists. Shared decision-making is standard of care for preference-sensitive decisions, and decision aids facilitate the shared decision-making process. Methods After IRB approval, surgeons, parents of children with cleft lip, and children with isolated cleft palate, none of whom were currently facing the decision to undergo a cleft-related revision procedure, were recruited for alpha testing. Think aloud interviews were conducted and their content transcribed for qualitative analysis and theme development. All participants completed a single item literacy screener, a decision aid acceptability scale, and a system usability scale. Results Participants reported an excellent level of usability and acceptability. Scores indicated that all participants found the decision aid useful in decision making. Most participants answered that the length and amount of information in the decision aid were appropriate. In analysis of qualitative data, three themes emerged: use affirming and neutral language, improve visual appeal and usability, and clarify realistic expectations. Conclusions To our knowledge this is the first decision aid to be developed and tested with the goal of helping children make informed choices about cleft-related revision surgery. Participants overwhelmingly found the tool helpful and serviceable. Participant feedback will guide revisions that ensure the final iteration meets the needs of patients and families. These results support the readiness of the decision aid for beta testing and eventual integration into clinical practice as a resource that enhances shared decision-making.
Effect of Prophylactic Mesh and Placement Plane on Abdominal Wall Outcomes Following DIEP Flap Reconstruction
(2026-02-04) Borders, Kathryn; Towfighi, Parhom; Danforth, Rachel; VonDerHaar, Jason; Lester, Mary; Hassanein, Aladdin H.; Bamba, Ravi
Background/Objective: The deep inferior epigastric perforator (DIEP) flap is the most widely used autologous option for breast reconstruction. Donor-site morbidity, particularly abdominal wall weakness or bulge, remains a recognized complication. Prophylactic mesh has been proposed to reduce these risks, but the optimal plane of mesh placement has not been established. This study examines abdominal wall outcomes in patients undergoing DIEP flap reconstruction with and without prophylactic mesh, as well as across different planes of mesh placement. Methods: A retrospective review of patients who underwent DIEP flap reconstruction (2021–2025) at a single institution was performed. Patients were grouped by mesh type and location. Demographic data and postoperative outcomes were collected. Significance was set at p<0.05. Results: A total of 250 patients underwent DIEP flap reconstruction, including 150 with prophylactic mesh (retrorectus, n=81; overlay, n=69) and 100 without mesh. When analyzed by mesh use overall, patients with mesh had a significantly lower rate of abdominal bulge compared with those without mesh (2.7% vs. 9%, p=0.027). Subgroup analysis by plane of mesh trended towards significance demonstrating lowest rate of bulge in the retrorectus group (1.2%) compared with overlay mesh (4.3%) (p=0.06). Rates of infection and hernia were similar among groups. (p=0.6) Conclusion: Prophylactic mesh placement during DIEP flap reconstruction is associated with a significantly lower risk of abdominal bulge compared with no mesh. Retrorectus placement demonstrated the lowest rates of donor-site complications.
From Pixels to Prediction: AI-Driven Detection of Free-Flap Compromise Using Clinical and Imaging Data
(2026-02-04) Shah, Sara; Borschel, Gregory
Introduction Free-flap reconstruction remains a cornerstone of microsurgical reconstruction, yet flap failure and vascular compromise continue to impose a consequential clinical burden. Although preoperative imaging modalities such as Computed Tomographic Angiography (CTA) and fluorescent Indocyanine Green (ICG) imaging are commonly used to evaluate vascular anatomy, the decision-making largely relies on surgical experience. Emerging studies propose that applying artificial intelligence (AI) to imaging and clinical data may improve prediction of potential postoperative complications and guide flap selection. Methods A literature search was performed in PubMed and Embase to identify human studies applying neural network or machine-learning techniques to predict vascular complications, flap failure, or perfusion abnormalities using preoperative or perioperative data. The included studies reported imaging or clinical inputs, model architecture, validation methods, and predictive performance metrics such as sensitivity, specificity, and the area under the curve (AUC). Relevant data were reviewed and synthesized to assess model performance, trends, and limitations in current applications. Results Key findings include a study by Shi et al., who developed a random forest classifier to predict flap failure using data from 946 patients undergoing microvascular reconstruction, achieving an AUC of 0.770. Yang et al. retrospectively modeled vascular complications in 570 free-flap patients, with the neural network model performing the highest (AUC 0.828). Imaging-based investigations using hyperspectral imaging (HIS) paired with convolutional neural networks reported AUCs around 0.82 for detecting postoperative perfusion deficits. Prior HIS feasibility work demonstrated that tissue oxygenation correlates with flap compromise and may provide earlier warning than clinical assessment. Collectively, these studies show promising potential but remain limited by retrospective design, modest sample sizes, and restricted generalizability. Conclusion AI-enhanced imaging and machine learning-based algorithms represent a compelling frontier for improving free-flap outcomes and guiding flap choice. Translation into clinical practice will require prospective, multicenter validation and integration into preoperative planning workflows.
Prophylactic Muscle Flap Coverage in Frail Patients Undergoing Spinal Surgery
(Elsevier, 2026-02-04) Hajj, John; Towfighi, Parhom; Cahya, Cynthia; Chen, Larry; Sidhu, Angad; Danforth, Rachel; Hassanein, Aladdin; Anthony, Archual
Background: Postoperative wound complications remain a significant challenge in complex spinal fusion, particularly in patients with multiple comorbidities. Prophylactic muscle flap coverage can reduce these complications, but the specific patient populations most likely to benefit have not been consistently defined. This study evaluated the utility of the five-item modified frailty index (mFI-5) scores in identifying high-risk patients who may benefit from prophylactic muscle flap closure. Methods: The American College of Surgeons National Surgical Quality Improvement Program database (2005-2020) was queried for patients ≥50 years old undergoing posterior-approach spinal surgery with and without prophylactic muscle flap closure. Patients with mFI-5 scores ≥2 were included, while revision and non-spine procedures were excluded. A 4:1 propensity score match was performed, comparing nonflap to flap patients. Postoperative complications were assessed with chi-square and Fisher's exact tests, and outcomes were further analyzed using multivariate logistic regression. Results: A total of 680 patients who underwent nonflap reconstruction were matched to 170 patients who underwent flap reconstruction. On univariate analysis, flap coverage was associated with reduced superficial surgical site infection (SSI) (0.6% vs 3.4%, p = 0.049) and increased bleeding requiring transfusion (35.3% vs 5.1%, p < 0.0001). On multivariate analysis, flap reconstruction was independently associated with a 94% reduction in odds of superficial SSI (odds ratio [OR], 0.062; 95% confidence interval [CI], 0.008-0.498; p = 0.022), while higher body mass index (kg/m2) independently predicted SSI risk (OR, 1.09 per unit; 95% CI, 1.03-1.16; p = 0.003). Bleeding requiring transfusion was no longer significant. Conclusion: Prophylactic muscle flap coverage significantly reduces superficial infection in frail patients (mFI-5 scores ≥2) undergoing spinal surgery. This provides a standardized framework to identify high-risk patients most likely to benefit from this approach.
Triceps Neurectomy for Management of Elbow Extension Spasticity
(2026-02-04) Stuart, Sam; Towfighi, Parhom; Adkinson, Joshua
Introduction: Neurectomy for elbow flexion spasticity has been described, but its role in elbow extension spasticity is not well defined. Triceps spasticity can affect arm posture, function, and ease of care and transfers from a wheelchair. Tendon lengthening of the triceps in combination with hyperselective neurectomy (HSN) has previously been reported, with favorable outcomes. The role of neurectomy alone for triceps spasticity, however, is not well described. Methods: We performed a single-center, retrospective review of patients who underwent triceps selective neurectomy (TSN) between April 2022 and August 2025. Through a posterior approach, radial nerve motor branches to the triceps were identified and stimulated, with 60-70% of the cross-sectional innervation to the triceps muscles transected, and a 1-2 cm segment of motor nerve excised. Demographics, spasticity etiology, and concurrent procedures were recorded. Outcomes included spasticity (Modified Ashworth Scale [MAS], Tardieu Scale), passive range of motion (ROM), and resting elbow position. Results: Five patients underwent six procedures (one bilateral). Mean follow-up was 14 (range: 2-36) months. Etiologies of extension spasticity included cerebral palsy (n=4) and stroke (n=1). Three extremities presented with primary triceps spasticity, two developed spasticity following flexor release, and one underwent concomitant flexor and extensor neurectomies. Concurrent procedures included tendon transfer (superficialis to profundus transfer and FCU to ECRB; n=3) and pectoralis lengthening (n=2). Spasticity was markedly improved post-procedure, as MAS decreased from 3 to 0.7 and Tardieu from 3.5 to 1. Complete resolution of spasticity was achieved in 2 extremities. Resting elbow posture improved from full or near-full extension to a mean 38° of flexion. Passive ROM increased from 20° to 93°. One patient developed mild recurrence at 36 months. Conclusion: TSN alone safely reduces spasticity, improves passive mobility, and restores functional posture without the need for concomitant triceps lengthening. These findings support TSN as a viable option for elbow extension spasticity.
Not Just for Kids: A Systematic Review of Outcomes of the Thenar Flap
(2026-02-04) Toole, Camren; Martinez, Carlos; Adkinson, Joshua
Introduction: Fingertip injuries are common and the thenar flap is a well-described technique used to maintain digital length. However, its use in patients over 30 years of age is generally discouraged due to concerns regarding postoperative joint contracture. The purpose of this review was to evaluate whether these concerns are substantiated. Methods: A search of PubMed, Embase, and SCOPUS (1947–2025) identified 15 studies involving 519 flaps. Case reports and studies lacking functional outcome data were excluded. Bias was assessed using the MINORS instrument, and results were synthesized using Microsoft Excel. Results: Joint contracture occurred in 32.4% of cases, all of which involved only the distal interphalangeal (DIP) joint. Active range of motion (AROM) at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints remained near normal and comparable to contralateral finger values. DIP joint AROM was reduced by 14.1° compared to contralateral fingers. Patients over 30 demonstrated a 3° greater PIP joint AROM than younger patients (p=0.02). Conclusion: Our analysis of the literature shows that there is an elevated risk of DIP joint contracture after thenar flap reconstruction of a fingertip injury, but this risk was not significantly different in patients over age 30. Further investigation with larger studies and standardized outcomes assessment is recommended.

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