To the Editor: In “Surgical Pearl: Artificial skin model for simulation of flap mechanics,” Garcia et al1Garcia C. Haque R. Poletti E. Surgical pearl: artificial skin model for simulation of flap mechanics.J Am Acad Dermatol. 2005; 53: 143-144Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar demonstrate a way to simulate flap movement. Although clever, this is not novel; in fact, a very similar approach has been both published2Lewis L.A. Nusbaum B.P. VaraDerm: a skin substitute for surgical workshops.J Dermatol Surg Oncol. 1987; 13: 473-474Crossref PubMed Scopus (5) Google Scholar and patented.3Lewis LA, Nusbaum BP, Leeds HR. US Patent 4,596,528. June 24, 1986. Simulated skin and method. Available at: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=/netahtml/srchnum.htm&r=1&f=G&l=50&s1=4,596,528.WKU.&OS=PN/4,596,528&RS=PN/4,596,528. Accessed November 28, 2005.Google Scholar In essence, the publication makes an indirect false priority claim by failing to cite directly pertinent prior work. In recent issues of this journal, there have been a number of letters discussing firstness, firstedness, and false firstedness with examples of erroneous claims and scenarios of unintentional false claims.4Summers J.B. Journalology and citation etiquette: firstedness might matter, but only if you're really first!.J Am Acad Dermatol. 2003; 48 (author reply 310): 309-310Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 5Summers J.B. Kaminski J.M. False firstedness: the dilemma of priority claims in biomedical publications.J Am Acad Dermatol. 2005; 52: 735-736Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 6Barankin B. False firstedness.J Am Acad Dermatol. 2005; 53: 367-368Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 7Cropley T.G. Bernhard J.D. Another first.J Am Acad Dermatol. 2005; 53: 368Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar As the number of global medical journals, online journals, Internet chat rooms, and listservs increase, it becomes more difficult for an author to make priority or firstness claims. It all depends on sleuthing skills and thoroughness to identify previously published work and inventions online and offline. The Internet is an invaluable resource for the savvy user to dig out both old and new information about almost any product, technique, or invention. We believe that in contrast to medical or research articles, authors of Surgical Pearls who think they have invented a technique do not realize they need to search for precedents, do not know how, or do not realize how simple it is to do. A simple search via PUBMED using the search terms “skin substitute” or “skin surgery teaching” would have identified preceding descriptions of the approach. There are many different methods of searching, using multiple search engines, and using Boolean logic to narrow the search and locate information. Sites such as www.searchbug.com allow users to link to many other focused search engines; www.archive.org allows users to find World Wide Web sites that are no longer in existence. Meta-search engines such as www.dogpile.com and www.mamma.com allow users to search many search engines simultaneously. The World Wide Web site www.soople.com, which simplifies advanced searches, is the “Google for Dummies,” as it allows Boolean searches without the need for understanding Boolean principles. Perhaps we are the first to suspect that authors who report on what they believe are new surgical techniques may not realize that a search for prior work can and should be achieved through a variety of search techniques, and that this is important whether a claim of firstness is being made or not. Even when no such direct claim is made, failure to identify earlier work may lead to an indirect first priority claim, perhaps a new concept, but we are cautious and scared enough not to commit the false firstedness fallacy here.4Summers J.B. Journalology and citation etiquette: firstedness might matter, but only if you're really first!.J Am Acad Dermatol. 2003; 48 (author reply 310): 309-310Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar