Applications In Reconstructive Surgery Research Articles

What COVID Restrictions Have Taught Us About Visiting Subinternships.

Integrated plastic surgery applicants complete among the highest number of visiting audition rotations of any specialty. In the 2021 match, we observed that the elimination of audition rotations and in-person interviews drastically increased the number of applicants who matched at their home program. We sought to evaluate the effect of applicants participating in one selective visiting subinternship rotation on home program match rates. Top 50 plastic surgery residency programs were identified by 2021 Doximity rankings. Publicly available, online plastic surgery match spreadsheets were used to collect available information including matched applicants' medical school, the institution at which they matched, whether they matched at their home institution, and whether they had previous communication with their matched program including research year or visiting subinternship completed. Fourteen percent of applicants matched at their home institution in 2022, comparable with recent prepandemic rates of 14.1% and 16.7%, versus 24.1% in 2021. The largest effect was observed among the top 25 programs. Separately, approximately 70% of applicants provided self-reported information on whether they completed a subinternship. Among the top 50 programs, 39.0% of applicants completed an audition rotation at the institution at which they eventually matched. The allowance of medical students to perform only one visiting subinternship in the 2022 match cycle normalized home match rates to the prepandemic baseline, possibly driven by a large proportion of students matching at their visiting rotation institution. Perhaps from both a program and applicant standpoint, 1 away rotation may provide sufficient exposure for eventual match success.

D69. Racial/Ethnic and Gender Representation Trends of Applicants and Matriculants to Plastic Surgery Residency Programs from 2010-2018

PURPOSE: To evaluate representation trends of races and genders applying to plastic surgery using novel methodology. METHODS: Reports on race and gender of medical school graduates, plastic surgery applicants, and matriculants between 2010-2018 were obtained. The proportion of each racial and gender identity among applicants and matriculants were divided by a denominator of their proportion among medical school graduates to produce representation quotients: RQapp, RQmat. Linear regression was performed to assess yearly representation changes. Non-parametric testing was used to assess differences in average representation within identities. P<0.05 was deemed significant. RESULTS: There were 4,251 applicants and 1,197 matriculants. Among matriculants, Asian men declined in representation (RQmat slope: -6.0x10-2); Asian women had increased representation (RQmat slope: +9.7x10-2). On average, all men applicants were overrepresented (RQmat=1.29). Hispanics were the most represented among women applicants (RQapp=0.87); all others had RQapp<1. For matriculants, Hispanic men (RQmat=1.41) were most represented; Black women (RQmat=0.38) were the least. Black men experienced the largest decrease in representation (RQapp=1.60 vs. RQmat=0.76; p=0.002). CONCLUSION: Black men were overrepresented among plastic surgery applicants but underrepresented as matriculants. Women remained underrepresented in both cohorts. Greater support for these groups may help reduce the apparent representation gaps.

D129. A Novel Screening Method for Plastic Surgery Applications: Towards Increased Equity In the Application Process

D129. A Novel Screening Method for Plastic Surgery Applications: Towards Increased Equity In the Application Process

Montelukast Attenuates Retraction of Expanded Flap by Inhibiting Capsule Formation around Silicone Expander through TGF-β1 Signaling.

Tissue expansion has tremendous applications in plastic surgery, but flap retraction provides insufficient tissue for use. Inspired by the use of montelukast to suppress capsular contracture, the authors investigated the effects of montelukast on capsule formation around the expander and retraction of the expanded scalp of the rat. Thirty-six male Sprague-Dawley rats were randomly divided into control and montelukast groups. In each group, 12 expanded flaps with or without capsules were harvested for histologic and molecular analysis; the six remaining expanded flaps were transferred to repair defects. Myofibroblast and transforming growth factor-β1 expression in the capsule was determined using immunofluorescence. Capsule ultrastructure was observed using transmission electron microscopy. Related protein expression in the capsules was detected using Western blot analysis. A comparison of control and montelukast groups revealed that areas of the harvested expanded flaps with capsules were greater (2.04 ± 0.11 cm 2 versus 2.42 ± 0.12 cm 2 , respectively; P = 0.04); the retraction rate decreased (41.3% ± 2.16% versus 28.13% ± 2.17%, respectively; P < 0.01). However, the increased areas and decreased retraction disappeared after capsule removal. The number of myofibroblasts declined. Thin, sparse collagen fibers were observed in the capsules. The expression of COL1, COL3, TGF-β1, EGR1, and phosphorylated ERK1/2 in the capsules decreased. Furthermore, the recipient area repaired by the transferred expanded flap was increased from 4.25 ± 0.39 cm 2 to 6.58 ± 0.31 cm 2 ( P < 0.01). Montelukast attenuates retraction of the expanded flap by inhibiting capsule formation through suppressing transforming growth factor-β1 signaling. This study provides novel insights into a method for increasing the area of the expanded flap.

Blockchain, Information Security, Control, and Integrity: Who Is in Charge?

Blockchain technology has attracted substantial interest in recent years, most notably for its effect on global economics through the advent of cryptocurrency. Within the health care domain, blockchain technology has been actively explored as a tool for improving personal health data management, medical device security, and clinical trial management. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, integration of blockchain technologies within plastic surgery is in its infancy. Recent advances and mainstream adoption of blockchain are gaining momentum and have shown significant promise for improving patient care and information management. In this article, the authors explain what defines a blockchain and discuss its history and potential applications in plastic surgery. Existing evidence suggests that blockchain can enable patient-centered data management, improve privacy, and provide additional safeguards against human error. Integration of blockchain technology into clinical practice requires further research and development to demonstrate its safety and efficacy for patients and providers.

Comparative Evaluation of the Electronic Residency Application Service Versus the Plastic Surgery Common Application to a Single Institution in the 2022 Integrated Plastic Surgery Match.

The Plastic Surgery Common Application (PSCA) has emerged as a low-cost alternative application portal to the Electronic Residency Application Service (ERAS) for integrated plastic surgery applicants. During the 2021 to 2022 application cycle, our plastic surgery residency program accepted both the PSCA and ERAS applications to help recruit candidates otherwise deterred by prohibitively high application costs. We sought to determine how the PSCA compared with the ERAS application in a standardized review of applications scores. The PSCA and ERAS applications from 28 candidates who received interviews from the Keck School of Medicine were analyzed. These 56 applications were randomly assigned across 22 independent reviewers. Each reviewer scored applications on a scale of 1 to 5 with regard to communication skills, leadership, intellectual curiosity, compatibility with the program, service, and perseverance. Mean scores between the applications were compared using 2-tailed z tests, with statistical significance set at P < 0.05. The 56 residency applications had a combined mean score of 4.21 (95% confidence interval [CI], 4.13-4.29). The mean score of PSCA applications (4.19; 95% CI, 4.08-4.31) did not significantly differ from the mean score of ERAS applications (4.24; 95% CI, 4.12-4.35; P = 0.57). The PSCA and ERAS applications did not have a significant difference in the mean scores for any review category. There was no difference between the overall scores and the scores of each review category between the PSCA and ERAS applications, suggesting that the PSCA may be a reasonable alternative to ERAS for medical students applying to plastic surgery residency.

Evaluating Language Characteristics and Related Gender Bias in Letters of Recommendation for Hand Surgery Fellowship

Letters of recommendation (LORs) function as an indicator of competence and future potential for a trainee. Our purpose was to evaluate gender bias in hand surgery fellowship applicant LORs. This was a retrospective study of all LORs submitted to a hand surgery fellowship program between 2015 and 2020. Demographic data about applicants and letter writers were collected. Linguistic analysis was performed using a text analysis software, and results were evaluated with nonparametric tests, multiple linear regression models, and a mixed effects regression model. Letters of recommendation were analyzed; 720 letters for 188 (23.4%) female applicants and 2,337 letters for 616 (76.6%) male applicants. Compared with LORs written for men, those written for women had more references to categories of anxiety (eg, worried and fearful) and affiliation (eg, ally and friend). Letters for women had more "clout." In subgroup analysis, letters for female plastic surgery applicants had more words signaling power, whereas recommendations for female applicants from orthopedic residencies had more words related to anxiety, achievement, work, and leisure. Letters of recommendation written for female residents applying to hand fellowship had more references to anxiety but were written with higher clout and more words of affiliation. Subgroup analysis looking at orthopedic and plastic surgery applicants separately found a mixed picture. Overall, these LORs written for applicants to hand fellowship had no notable specific patterns of gender bias in our analyses. Because programs look to train the next generation of hand surgeons, alerting letter readers to trends in implicit bias may help in the selection of qualified applicants. Bringing topics of implicit bias forward may help writers think more critically about word choice and topics.

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case-Control Study.

The wide-awake local anesthesia no tourniquet (WALANT) technique is commonly used in elective hand surgery, whereas its application in plastic surgery is still limited. The aim of the study is to evaluate the feasibility and efficacy of WALANT in common plastic surgery operations performed on the upper limbs. Patients who underwent those operations under WALANT were matched and compared with patients who had general or regional anesthesia without infiltration of a local anesthetic solution. All operations were performed by the same surgeon. Data from 98 operations were collected and analyzed for the total operation time, operation theatre time and complication and patient satisfaction rates. All operations under WALANT, mainly skin tumor excision and flap repair or skin grafting and burn escharectomy with or without skin grafting, were completed successfully. No statistical difference in total operation time and complication rates was revealed. Statistical significance favoring WALANT was identified regarding the mean operation theatre time and patient satisfaction. WALANT is an effective method for common plastic surgery operations performed on the upper limbs that is associated with better operation theatre occupancy and high patient satisfaction rates.

Platelet-Rich Plasma Applications in Plastic Surgery.

Platelet-Rich Plasma Applications in Plastic Surgery.

40. An Update on the Independent Plastic Surgery Match: Recent Trends and Predictors of Successful Match (2019-2022)

Background: The number of independent plastic surgery residency programs and applicants have consistently declined over the past decade. A prior study by the authors demonstrated trends and predictors associated with increased match success up until 2018. The purpose of this study was to analyze recent match trends and predictors to aid prospective applicants. Methods: After approval from the American Council of Academic Plastic Surgeons, the San Francisco Match provided data for the independent match (2019-2022). Applicant variables were analyzed to determine correlation with a successful match. Outcomes were compared between candidates utilizing chi square tests, t-tests, univariate and multivariate logistic regressions. Results: 428 applicants participated in the independent plastic surgery match from 2019 to 2022, of whom 243 matched. In this period, the number of independent plastic surgery residency programs and positions decreased from 40 to 36 (10%), and 63 to 57 (9.5%), respectively. The number of applicants increased from 90 in 2019 to 124 in 2022 (37.8%), and match rate decreased from 82% to 56%. Osteopathic and international medical graduates increased from 9 to 21 (133%), and 20 to 28 (40%) respectively. A successful match was associated with US medical school graduates, prerequisite training at a university-affiliated general surgery program, greater number of interviews (13 ± 6 vs. 3 ± 3), higher USMLE step 1/2 scores, and AOA status (p<0.05). By multivariate regression, number of interviews completed (odd ratio [OR] 1.40 95% confidence interval [CI] 1.23-1.59 p <0.001) and allopathic medical school background (OR 3.65 95% CI 1.1 – 12 p = 0.003) were predictive of a successful match. Conclusion: Despite residency review committee’s ongoing support of the independent plastic surgery track, program participation during the period examined has decreased while applicant interest increased, likely contributing to a decreased match rate. Although more interviews and allopathic medical school background correlate with a successful match, continued support for the independent plastic surgery track is encouraged.

27. A Novel Screening Method for Plastic Surgery Applications: Towards Increased Equity in the Application Process

27. A Novel Screening Method for Plastic Surgery Applications: Towards Increased Equity in the Application Process

34. Matching into Plastic Surgery Residency in the Virtual Era: Program Perspectives

Background: Plastic surgery residency program perspectives are often overlooked in post-match surveys. This study aims to describe program experiences with the common interview release policy, virtual interviews, and the Plastic Surgery Common Application (PSCA) to better inform future interview policy modifications. Methods & Results: An anonymous survey was sent to all 2021 (group 1) and 2022 (group 2) integrated plastic surgery program directors regarding experience with the residency application and virtual interview process. Response rate was 30.9% for group 1 and 64.4% for group 2. There was no significant difference in average number of integrated positions offered per year (2.1 vs. 2.2, p=0.779), interview slots available (33.3 vs. 36.4, p=0.286), or invitations sent (36.5 vs. 40.3, p=0.228). There was a significant difference in utilization of the PSCA (34.6% vs. 61.8% PSCA and ERAS, 3.8% vs. 10.9% PSCA only), with a p-value of 0.012. However, most respondents in group 1 and group 2 agreed that PSCA should be continued, either as PSCA alone (47.8% vs. 39.0%) or PSCA with ERAS (26.1% vs. 29.3%). In both groups, program-sponsored meet-and-greets, sub-internships, and social media were identified as the three most effective outreach platforms. In group 2, programs ranked letter of recommendation content, letter of recommendation author, and completion of an away rotation as highest in terms of importance for evaluation of applicants. In group 2, programs were very satisfied with the common interview release policy (65.1% “strongly agree”) and time allotted to review applications prior to release of interviews (44.2% “strongly agree”). However, programs were ambivalent regarding likelihood of using virtual interviews or PSCA in future cycles. Conclusion: Understanding program perceptions following recent modifications to the plastic surgery application process is important to guide future policymaking. Programs report a positive experience with the common interview release policy and PSCA, yet virtual interviews remain controversial. Outside the formal interview, both virtual (social media and meet-and-greets) and in-person (sub-internships) outreach efforts are important to increase applicant engagement.

Trends in Integrated Plastic Surgery Applicant, Resident, and Junior Attending Research Productivity

IntroductionResearch productivity is critical for matching into integrated plastic surgery residency. This study will identify how pre and intraresidency research productivity correlate with resident/junior attending productivity. Materials and methodsRetrospective review from 2006 to 2015 issues of the American Board of Plastic Surgery's Annual Newsletter to Diplomates was performed to identify newly board certified plastic surgeons. Only surgeons from US medical schools matching directly into integrated programs were included. Residency type/length, graduation year from medical school, and publication counts were recorded for each surgeon. Publications were categorized as preresidency, intraresidency, and junior attending (6 y post residency/fellowship training). ResultsSix hundred fifty-five integrated plastic surgery graduates were analyzed. The median number of total publications (preresidency, intraresidency, and junior attending) was 4 (interquartile range [IQR], 1 to 10). Linear regression revealed negligible correlation between preresidency and junior attending publications (r = 0.019, P = 0.002). Total publications and increasing graduation y had a significant correlation of 0.89 (P < 0.001). Graduates of fellowships had significantly increased median total publications compared to those without fellowships (7 IQR, 3 to 18 versus 3 IQR, 1 to 7, respectively, P < 0.001). Dedicated research years during residency were associated with significant (P < 0.001) increases in median total and junior attending publications. Total publications ranged from 3 (IQR, 1 to 6) to 8 (IQR, 7 to 18) for those who completed 5- and 8-y residencies, respectively. ConclusionsIncreased preresidency research productivity is not strongly associated with increased junior attending productivity in integrated plastic surgery. Better markers are completing dedicated research years in residency or fellowship after residency.

Perspectives on the Plastic Surgery Common Application (PSCA): A Survey of 2021-2022 Integrated Plastic Surgery Applicants.

An anonymous survey was distributed to integrated plastic surgery residency applicants from the 2021-2022 application cycle. Participants were asked to provide basic demographic information, their perspectives of the PSCA, and overall application preference. One hundred forty (43.1%) applicants completed the survey. Nearly, 63% of applicants responded "slightly well" or "not well at all" regarding their ability to highlight at least one aspect of their application. Forty-one percent of applicants believed ERAS best highlighted the strengths of their application compared with 27% who believed their strengths were better highlighted by the PSCA. Seventy-nine percent reported the cost savings associated with the PSCA were "very" or "extremely important." Overall, 63% of respondents reported a preference to apply with the PSCA alone. This is the first study to provide insight on applicants' perspectives of the PSCA. Although the majority preferred applying with the PSCA, there may be challenges with transitioning to this application solely. Future iterations of the PSCA may aim to ameliorate functionality concerns, optimize application content, and incorporate plastic surgery-specific information that may be important to selection committees.

Flap Application in Reconstructive Surgery to Manage Severe Radiation-induced Ulcers: A Case Series

Introduction. Radiation-induced ulceration is a late-stage skin reaction after RT for cancer treatment. Objective. The present study examined the use of a single-stage reconstructive procedure to manage radiation-related wounds. Materials and Methods. Nine patients with radiation-induced chronic ulcer with accompanying severe complications were admitted to the Plastic, Reconstructive, and Regenerative Center of Viet Nam National Burn Hospital between October 2015 and September 2019. The patients ranged in age from 49 to 77 years. Complications included exposed cheekbone (n = 1), exposed trachea (n = 1), exposed carotid artery (n = 2), exposed axillary artery (n = 2), exposed pleura (n = 1), and exposed pericardium (n = 2). Flap type used to achieve defect coverage after debridement was individualized to each patient and included ALT, LD, SCA, and DIEP flaps. Additionally, a high-density polyethylene was used to reconstruct the trachea to recover breathing function in the patient with exposed trachea. Results. Complete survival of all flaps was achieved. Most vital organs (the trachea, axillary artery, and carotid artery) were covered. Hospital length of stay ranged from 15 to 120 days. Conclusions. The successful management of patients with severe complications suggests that immediate single-stage reconstruction may be a valuable option for managing radiation-induced ulcers.

Artificial intelligence for objectively measuring years regained after facial rejuvenation surgery

BackgroundFew objective measures are available for assessing the success of facial rejuvenation after face lift surgery. Convolutional neural networks (CNNs) may be used for this type of measurement. The purpose of this investigation is to use artificial intelligence (AI) via CNNs to objectively classify patient photos by age before and after aesthetic surgery. Uniquely, men and patients undergoing deep plane face lifts were included. MethodsA CNN (FaceX) was used for facial age recognition and age estimation. Patient photos were analyzed preoperatively, and at three (PO1) and 12 months (PO2) postoperatively. The study population included male and female patients who underwent facial rejuvenation at our institution from 2017 to 2021. Patient photos were collected with the same camera, distance, and lighting. Results226 patients were analyzed with a mean true age of 62.2 (SD 6.7) years. The AI estimated the mean preoperative age to be 64.7 (SD 10.4) years. The AI was 96.0 % accurate. Across all subjects, a 3.5-year, 5 % reduction in age (p ≤ 0.001) was attributed at PO1, and a 1.7 year, 3 % age reduction (p = 0.034) at PO2. No single ancillary procedure or technique conferred more benefit than others. The 15 males had a 2.0 year, 4 % age reduction (p = 0.06) at PO1. ConclusionAI can be used to objectively measure the success of facelift surgery and compare outcomes among rhytidectomy techniques. Additionally, multiple, different approaches were effective with no single approach being superior. As AI continues to rapidly advance, more accurate models may be developed for multiple applications in facial plastic surgery.

Impact of ACAPS Coordinated Interview Release Policy: Applicant and Program Attitudes, Adherence, and Interview Trends.

The authors studied the impact of a new, coordinated interview release date for integrated plastic surgery residencies. A cross-sectional study of all 2020 integrated plastic surgery residencies and applicants was performed. Voluntary, anonymous surveys were administered following implementation of the interview policy. Program response rates were 55.6% for the initial survey and 57.1% for the follow-up survey. Programs released an average of 2.1 (95% CI, 1.8 to 2.4) rounds of interview invitations and invited 39.0 (95% CI, 35.3 to 42.6) applicants to interview. Policy adherence was high (91.1%). Most programs believed the interview policy was an improvement for applicants (46.5% yes; 9.1% no) and programs (41.9% yes; 27.0% no). Median rank of matched candidates was 13, and 55.1% of programs matched candidates within the top quartile of their rank list. The average candidate applied to 72 programs, attended 11 interviews, and ranked 12 programs. Interview distribution was bimodal, with peaks at six and 15 total interview invitations. Applicants within the top fifth, tenth, and fifteenth percentile for total interview invites disproportionately accounted for 15.3%, 26.6%, and 36.5%, respectively, of all invitations received. Survey data suggested applicant satisfaction with travel planning, improved scheduling, and cost savings following implementation of the interview policy. Applicants were somewhat dissatisfied with interview distribution. A coordinated interview release date is facile to adopt and does not adversely impact program interview trends or match rates. Applicants benefit from improved scheduling, travel planning, and cost savings; however, interview distribution continues to favor top-tier candidates.

A Systematic Review of Artificial Intelligence Applications in Plastic Surgery: Looking to the Future.

A comprehensive literature search of the Medline, EMBASE, Cochrane, and PubMed databases was conducted for AI studies with multiple search terms. Articles that progressed beyond the title and abstract screening were then subcategorized based on the plastic surgery subspecialty and AI application. The systematic search yielded a total of 1820 articles. Forty-four studies met inclusion criteria warranting further analysis. Subcategorization of articles by plastic surgery subspecialties revealed that most studies fell into aesthetic and breast surgery (27%), craniofacial surgery (23%), or microsurgery (14%). Analysis of the research study phase of included articles indicated that the current research is primarily in phase 0 (discovery and invention; 43.2%), phase 1 (technical performance and safety; 27.3%), or phase 2 (efficacy, quality improvement, and algorithm performance in a medical setting; 27.3%). Only one study demonstrated translation to clinical practice. The potential of AI to optimize clinical efficiency is being investigated in every subfield of plastic surgery, but much of the research to date remains in the preclinical status. Future implementation of AI into everyday clinical practice will require collaborative efforts.

USMLE Step 1 Pass/Fail is Here: Are Plastic Surgery Applicants Really Better Off?

As of January 26, 2022, the United States Medical Licensing Examination(USMLE) Step 1 score reporting will be changed from a numeric scoring system to pass/fail. Although the new scoring policy is expected to benefit medical students, there is concern that it will also amplify preexisting disadvantages and worsen disparities for students applying in the already-competitive plastic surgery match. Whether the reporting change will tangibly benefit applicants to plastic surgery has yet to be elucidated. A cross-sectional survey was distributed to medical students and graduates via social media platforms. Data were analyzed using Student t test and Chi-squared statistic, with an alpha level set at 0.05. Data collection and analysis was performed at Johns Hopkins University School of Medicine. This study included a sample of 120 American Medical Trainees (AMTs) and International Medical Trainees (IMTs) who are interested in plastic surgery. The plurality of respondents were against the new Step 1 score reporting (AMT: 40.7%; IMT: 44.3%), but differences existed between AMTs when compared to IMTs, especially regarding opinions about the reporting change on stress levels and competitiveness of highly competitive specialties. Regardless of training status, respondents felt that the pass/fail scoring system would increase their likelihood to engage with more research, dual apply, prioritize studying for Step 2 CK, and consider a dedicated research year. While a pass/fail reporting system for Step 1 may alleviate some stress for medical trainees, other issues arise that may perpetuate disparities and bias against students with little resources in the field of plastic surgery. Residency programs should offer anticipatory guidance regarding prioritization of aspects of application to ease this psychosocial and financial pressure, as well as help students reorganize their constrained time.

Cyanoacrylate and hyaluronic acid combination on palatal donor site management after de-epithelialized graft harvesting.

Although soft tissue substitutes showed promising improvement in the past decade, epithelialized gingival graft (EGG) is still widely used in periodontal plastic surgery applications. Donor site management after EGG harvesting has been challenging for clinicians. This study aimed to compare the effectiveness of cyanoacrylate, hyaluronic acid, and their combination in palatal donor site management after EGG harvesting. Data from 89 patients were included and categorized as gelatin sponge (GS), gelatin sponge with either cyanoacrylate (GS+CY), hyaluronic acid (GS+HA), or both (GS+CY+HA). The data of pain perception (PP), quantity of analgesics (QA), secondary bleeding (SB), epithelization level (EL), and color match (CM) were assessed retrospectively. The GS+CY and GS+HA+CY groups showed lower PP scores compared to the GS and GS+HA groups (p<0.05). The QA was higher in the GS group compared to the GS+CY and GS+HA+CY groups (p<0.001). All study groups showed greater EL than GS group on day 7 (p<0.001). On day 14, full EL was present in 81% of the patients in the GS+HA+CY group, which was higher than the other groups (p<0.001). All study groups reported lower SB in the first 3 days, which was lower compared to the GS group (p<0.001) and showed higher CM scores than the GS group on days 7 and 14 (p<0.001). CY application reduces pain and analgesic intake and HA may support the wound healing with increased EL. Using the CY-HA combination provides additional benefits for donor site management.