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Page 12 of 17 Plast Aesthet Res 2018;5:6 I http://dx.doi.org/10.20517/2347-9264.2018.08

complete muscular coverage of the dural repair. The bilateral composite latissimus dorsi muscleocutanous
and gluteus maximus fasciocutanous flaps are medialized and closed over the paraspinous muscle flap repair.
Demographic and outcomes data of 7 patients from June 2014 to present were retrospectively reviewed.

Results: Of the 7 patients that underwent the above technique for closure of myelomeningocele defects,
there have been no episodes of dehiscence with a median follow-up of 51 weeks (7-161 weeks). One patient
experienced an area of small, superficial skin necrosis requiring surgical excision and reclosure.

Conclusion: Use of bilateral paraspinous muscle flaps and bilateral composite latissimus dorsi and gluteus
maximus flaps provides robust coverage of lumbosacral defects following myelomeningocele repair in
infants.

19. Outpatient bilateral mastectomies with immediate pre-pectoral breast reconstruction

Sara L. Struve, Barbara A. Pockaj, Raman C. Mahabir

Mayo Clinic Phoenix, Arizona

In the setting of breast cancer, ductal carcinoma in-situ, and other high risk patients, breast reconstruction
can be offered in the immediate stage, at the same time as mastectomy. Immediate breast reconstruction has
historically been done as an inpatient surgery, with at least one overnight stay in the hospital. Recently, we
switched to performing these procedures in the outpatient setting. This case series documents ten bilateral
mastectomies with immediate pre-pectoral direct-to-implant breast reconstruction patients, who were
discharged home on post-operative day zero. To be able to achieve this outcome in an outpatient setting,
there were several aspects we implemented prior to the transition. These included: pre-operative education
and counseling, intra-operative measures, post-operative measures, and a discussion of the expected post-
operative outcomes with patients and their families. Patient education and counseling was most important
for setting expectations during and after surgery. Intra-operative measures included: IV Tylenol, Toradol,
and steroids, as well as Exparel rib blocks, field blocks, and pectoralis major muscle blocks. Post-operatively,
the patients were given scheduled analgesics for the first two post-operative days, then switching to prn
medications thereafter. These factors all contributed to patients and families feeling comfortable enough for
the patient to be discharged home the same day as their procedure.

20. Use of social media in plastic surgery resident recruitment. A perspective from the
applicants

Lacey Pflibsen, Nicole Kurnik, Ashley Howarth, Anthony Smith, Shelley Noland

Mayo Clinic - AZ

Aim: There has been plenty of publications looking at how residency programs use social media websites
of applicants to help with ranking; however, no such study has looked at the reverse, how social media
websites of residency programs recruit applicants. This study aimed to investigate if plastic surgery residency
programs are using social media platforms in resident recruitment.