Field Of Plastic Surgery Research Articles

Diversity in the Plastic Surgery Match: The Effect of Program Chair, Program Director, and Faculties' Race and Sex on Matched Applicants.

Prior studies have identified the lack of diversity within the field of plastic surgery (PS) and associated residency matches. In this study, the authors aimed to examine the effect of PS program chairs (PCs), program directors (PD), and faculty members' race and sex on PS applicants and matriculants within the same program. Deidentified applicant data from 2017 to 2021 submitted to the University of Wisconsin-Madison's integrated PS program were analyzed. Applicants' self-reported sex and race were collected. Integrated PS program websites were assessed to determine whether applicants matched the program. Race and sex of PCs, PDs, and faculty members were collected from each program's website. Overall, 79 integrated PS programs' websites and 1470 applicants were reviewed. The majority of PCs, PDs, and faculty members were male (87.3%, 81.0%, and 69.6%, respectively) and white (74.7%, 70.9%, and 68.8%, respectively). Most applicants were male (54.0%) and white (60.8%). For a given program, white PCs and PDs have 5 and 6 times the odds of matching an applicant of the same race ( P <0.001 for both). Having male PCs and PDs did not significantly increase the odds of matching an applicant of the same sex ( P =0.198 and 0.905, respectively). Although the field of PS has made great strides to close the sex gap within the residency match process, this study highlights ongoing racial disparities among nonwhite applicants.

Introducing the bungee-IVaS technique: A modification for safer and simpler intravascular stenting in supermicrosurgery

Supermicrosurgery has revolutionized the field of reconstructive surgery by enabling surgeons to perform challenging procedures that were previously unattainable. Lymphaticovenous anastomosis (LVA) for the treatment of lymphedema is a commonly performed procedure using this technique. However, the small diameter and thin-walled nature of lymphatic vessels limit the use of microsurgical forceps instrumentation into the lumen to prevent trauma, increasing the risk of inadvertent catching of the vessel backwall during anastomosis.

Cellular activation pathways and interaction networks in vascularized composite allotransplantation.

Vascularized composite allotransplantation (VCA) is an evolving field of reconstructive surgery that has revolutionized the treatment of patients with devastating injuries, including those with limb losses or facial disfigurement. The transplanted units are typically comprised of different tissue types, including skin, mucosa, blood and lymphatic vasculature, muscle, and bone. It is widely accepted that the antigenicity of some VCA components, such as skin, is particularly potent in eliciting a strong recipient rejection response following transplantation. The fine line between tolerance and rejection of the graft is orchestrated by different cell types, including both donor and recipient-derived lymphocytes, macrophages, and other immune and donor-derived tissue cells (e.g., endothelium). Here, we delineate the role of different cell and tissue types during VCA rejection. Rejection of VCA grafts and the necessity of life-long multidrug immunosuppression remains one of the major challenges in this field. This review sheds light on recent developments in decoding the cellular signature of graft rejection in VCA and how these may, ultimately, influence the clinical management of VCA patients by way of novel therapies that target specific cellular processes.

Unleashing the Power of ChatGPT: Revolutionizing Plastic Surgery and Beyond.

Artificial Intelligence (AI) technology has become increasingly popular in the last few months. AI software has limitless applications in various industries, including plastic surgery. While AI technology is promising, there are some drawbacks. In the field of plastic surgery, AI tools can be used to streamline research projects, patient education materials and instructions, social media and marketing and more. Conversely, AI tools can also be abused, and can infringe on copyrights, lead to plagiarism, disseminate misinformation, threaten job security in various fields and limit original creativity. In conclusion, ChatGPT (OpenAI, San Francisco, CA) can be used responsibly to rapidly disseminate information and communications while improving overall efficiency in practice; however, if misused or abused, ChatGPT can lead to ethical issues, unknown and unintended consequences.

Risk of Complications in Combined Plastic Surgery Procedures Using the Tracking Operations and Outcomes for Plastic Surgeons Database.

Combining multiple surgical procedures into one operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood. This study compared 30-day complication rates associated with combined plastic surgery procedures compared to index procedures. This retrospective cohort analysis utilized the Tracking Operations and Outcomes for Plastic Surgeons database from 2016-2020 to identify the three most frequent combinations with augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty. The 30-day overall complication rate was 5.0% (1,400 of 26,771 patients), with a higher complication rate for combined procedures compared to index (7.6% vs 4.2%, aOR 1.91 (95% CI 1.61-2.27), p<0.001). There were no significant differences in complication rates for abdominoplasty or mastopexy combinations compared to index. Complication rates for reduction mammaplasty combinations compared to index were not statistically different after controlling for demographics (aOR 1.02 (95% CI 0.61, 1.64) p=0.93). Higher rates of minor and major complications were observed for combinations of trunk liposuction (aOR 4.84, (95% CI 3.31, 7.21), p<0.001) and augmentation mammaplasty (aOR 1.60, (95% CI 1.13, 2.22), p=0.007) compared to index. TOPS data suggests that combinations with trunk liposuction or augmentation mammaplasty present with increased risk of complications compared to index, controlling for demographics. Abdominoplasty and mastopexy may be combined with other plastic surgery procedures without increased risk to patients. The complication risk of reduction mammaplasty combinations is mediated by other variables, suggesting the need for shared surgical decision making when recommending these combinations to patients.

Performance of ChatGPT on the Plastic Surgery Inservice Training Examination.

Developed originally as a tool for resident self-evaluation, the Plastic Surgery Inservice Training Examination (PSITE) has become a standardized tool adopted by Plastic Surgery residency programs. The introduction of large language models (LLMs), such as ChatGPT (OpenAI, San Francisco, CA), has demonstrated the potential to help propel the field of Plastic Surgery. The authors of this study wanted to assess whether or not ChatGPT could be utilized as a tool in resident education by assessing its accuracy on the PSITE. Questions were obtained from the 2022 PSITE, which was present on the American Council of Academic Plastic Surgeons (ACAPS) website. Questions containing images or tables were carefully inspected and flagged before being inputted into ChatGPT. All responses by ChatGPT were qualified utilizing the properties of natural coherence. Responses that were found to be incorrect were divided into the following categories: logical, informational, or explicit fallacy. ChatGPT answered a total of 242 questions with an accuracy of 54.96%. The software incorporated logical reasoning in 88.8% of questions, internal information in 95.5% of questions, and external information in 92.1% of questions. When stratified by correct and incorrect responses, we determined that there was a statistically significant difference in ChatGPT's use of external information (P < .05). ChatGPT is a versatile tool that has the potential to impact resident education by providing general knowledge, clarifying information, providing case-based learning, and promoting evidence-based medicine. With advancements in LLM and artificial intelligence (AI), it is possible that ChatGPT may be an impactful tool for resident education within Plastic Surgery.

Hyperbaric oxygen therapy: Therapeutic role in various cases – A case series

Hyperbaric oxygen therapy (HBOT) is an adjuvant novel non-invasive treatment technique in the field of plastic surgery for treating different wounds. This technique utilizes 100% oxygen at pressures above the atmospheric pressure. In our study, we are discussing about eight different cases in the field of plastic surgery. HBOT plays an important role in the treatment for different pathological conditions. It involves a hundred percent breathing of oxygen in a closed chamber for a certain period of time. HBOT main mechanism of action is hyper oxygenation but also enhances the immunity by antimicrobial properties and improves stem cell production.

Use and Influence of Social Media on the Private Practice of Plastic Surgeons in Saudi Arabia.

The study was based on a self-administered questionnaire that was built on previous literature and distributed to practicing Saudi plastic surgeons. A survey consisting of 12 items was conducted to assess patterns of social media use and its impact on plastic surgery practice. This study included 61 participants. Thirty-four surgeons (55.7%) were using social media platforms in their practice. The use of social media was significantly different among surgeons with different levels of practice in cosmetic surgery (P = 0.004) and reconstructive surgery (P = 0.049). Social media presence was significantly more prevalent among surgeons in private practice (70.6%, P = 0.034). The use of social media in plastic surgery is overall positive for the field (60.7%). Despite plastic surgeons' differing views on social media, its role within the field of plastic surgery is evidently on the rise. The use of social media is not equal across all practice types. Surgeons practicing in private hospitals and specializing in aesthetic surgery are more likely to view social media favorably and use it in their practice.

The effect of Ranolazine on random pattern skin flap survival in rats

Objective: Flap surgery is widely used in the field of plastic surgery for defect reconstruction. The most important problem of this surgery is ischemic necrosis which may occur in the distal of the flap. For this reason, studies have been conducted to develop many treatment methods to solve this problem. Our study aimed to investigate the effects of different doses of ranolazine, a selective late sodium current blocker, on the viability of skin flaps prepared from the back of the rat. Material and Methods: A total of 32 rats, including 8 rats in each group, were included in the study. A random patterned caudal base 3x9 cm width : length modified McFarlane skin flap was elevated from the backs of all rats and adapted back to its place For 7 days postoperatively, 1 cc of saline was added to the control group (Group A), and 45 mg/kg, 90 mg/kg, and 180 mg/kg of ranolazine were added to the study groups (Group B, C, D), respectively, and administered daily with gastric lavage On the 7th postoperative day, photographs were taken to evaluate the viability of the flaps and scintigraphic evaluations were made. After the rats were sacrificed, the flaps were separated from their bases and evaluated histopathologically. Results: As a result of the evaluations, the viable flap area was calculated as 12.7548 cm2 for Group A, 14.9533 cm2, 16.494 cm2 and 16.7599 cm2 for Groups B, C and D, respectively, and a statistically significant difference was found between the groups (P = 0.00 &lt;0.05 ). The viable flap area percentages were calculated as 57.486% for Group A, 68.908% for Group B, 70.174% for Group C and 74.603% for Group D, and a statistically significant difference was found between the groups (P = 0.00 &lt;0.05). As a result of scintigraphic evaluation, the viable flap area was found to be 61.57% for Group A, 71.04% for Group B, 70.21% for Group C and 73.85% for Group D, and a statistically significant difference was found between the groups (P = 0.03 &lt;0.05). Histopathological evaluation revealed a decrease in the flaps' inflammation, edema and necrosis scores with the increasing drug dose. Conclusion: As a result, although flap viability increased with increasing doses in the group given ranolazine, more detailed studies are needed before it can be used clinically.

PC27. Understanding Factors Associated with Paid Malpractice Claims in Plastic Surgery

PURPOSE: Few studies have investigated malpractice broadly in the field of plastic surgery. The purpose of this analysis was to characterize plastic surgery malpractice cases and examine factors influencing malpractice case outcomes, thereby identifying areas of patient safety concern. METHODS: The Candello database, which catalogs approximately 30% of all paid and unpaid malpractice claims in the United States, was utilized to obtain cases involving plastic surgery closed between 2009 and 2018. A total of 2674 cases were identified. A multivariable regression model was developed to analyze factors associated with a malpractice case closing with indemnity payment. RESULTS: A total of 716 (26.8%) of claims resulted in an indemnity payment. The clinical severity was determined to be high in 229 cases (8.6%). Emotional trauma (n=558, 20.9%) was the most frequently cited injury category. Major differences between procedure groups were not observed, with consistent severity of injury across categories. Poor surgical technique, problems with communication among providers, inadequate informed consent, and deficient documentation were significant factors predictive of malpractice cases closing with payment. Issues with technical performance resulting in a known complication and patient factors were protective against paid claims. CONCLUSION: Overall, both the financial and clinical severity of malpractice claims in plastic surgery were relatively low. Multiple factors were found to be associated with a case closing with an indemnity payment. Taken together, these data highlight the importance of the informed consent process and managing expectations in the clinical care of surgical patients.

Identification of Key Breast Features Using a Neural Network: Applications of Machine Learning in the Clinical Setting of Plastic Surgery.

In plastic surgery, evaluation of breast symmetry is an important aspect of clinical practice. Computer programs have been developed for this purpose, but most of them require operator input. Artificial intelligence has been introduced into many aspects of medicine. In plastic surgery, automated neural networks for breast evaluation could improve quality of care. In this work, the authors evaluate the identification of breast features with an ad hoc trained neural network. An ad hoc convolutional neural network was developed on the YOLOV3 platform to detect key features of the breast that are commonly used in plastic surgery for symmetry evaluation. The program was trained with 200 frontal photographs of patients who underwent breast surgery and was tested on 47 frontal images of patients who underwent breast reconstruction after breast cancer surgery. The program was able to detect key features in 97.74% of cases (boundaries of the breast in 94 of 94 cases, the nipple-areola complex in 94 of 94 cases, and the suprasternal notch in 41 of 47 cases). Mean time of detection was 0.52 seconds. The ad hoc neural network was successful in localizing key breast features, with a total detection rate of 97.74%. Neural networks and machine learning have the potential to improve the evaluation of breast symmetry in plastic surgery by automated and quick detection of features used by surgeons in practice. More studies and development are needed to further knowledge in this area.

The notch of the mandible: what do different fields call it?

The bony notch on the inferior border of the mandible, anterior to the attachment of the masseter muscle, where the facial vessels commonly pass, has been called different names in the literature, e.g., premasseteric notch, antegonial notch, and notch for the facial vessels. Interestingly, various disciplines have leaned toward different names for this notch. Therefore, to aid in consistent communication among professionals, the present study aimed to analyze usage of these varied terms and make recommendations for the best terminology. Based on the adjacent anatomical structures used to name this notch, three groups were analyzed in this study, a group using masseter in the term, a group using gonion in the term, and a group using facial vessels in the term. A literature search found that the group using gonion in the term was found most in the literature. The orthodontics field used gonion in the term the most (29.0%: 31/107) followed by the oral and maxillofacial surgery field (14.0%: 15/107), the plastic surgery field (4.7%: 5/107), and the anatomy field (3.7%: 4/107). The dental field used gonion in this term the most (43.9%: 47/107) and the medical field used facial vessels in the term the most (33.3%: 6/18). Based on these results, the use of gonial terms for this notch seems to be preferred.

Understanding Factors Associated with Paid Malpractice Claims in Plastic Surgery.

Few studies have investigated malpractice broadly in the field of plastic surgery. The purpose of this analysis was to characterize plastic surgery malpractice cases and examine factors influencing malpractice case outcomes, thereby identifying areas of patient safety concern. The Candello database, which catalogs approximately 30% of all paid and unpaid malpractice claims in the United States, was used to obtain cases involving plastic surgery closed between 2009 and 2018. A total of 2674 cases were identified. A multivariable regression model was developed to analyze factors associated with a malpractice case closing with indemnity payment. A total of 716 claims (26.8%) resulted in an indemnity payment. The clinical severity was determined to be high in 229 cases (8.6%). Emotional trauma [ n = 558 (20.9%)] was the most frequently cited injury category. Major differences between procedure groups were not observed, with consistent severity of injury across categories. Poor surgical technique, problems with communication among providers, inadequate informed consent, and deficient documentation were significant factors predictive of malpractice cases closing with payment. Issues with technical performance resulting in a known complication and patient factors were protective against paid claims. The financial and clinical severity of malpractice claims in plastic surgery were relatively low overall. Multiple factors were found to be associated with a case closing with an indemnity payment. These data highlight the importance of the informed consent process and managing expectations in the clinical care of surgical patients.

Breast Reconstruction with DIEP Flap: The Learning Curve at a Breast Reconstruction Center and a Single-Surgeon Study.

Although microsurgical breast reconstruction represents a very interesting and rewarding field of plastic surgery, appropriate microsurgical training is not possible in every plastic surgery department. In this retrospective study, we present the learning curve of our plastic surgery department as a whole and of a single microsurgeon assessing breast reconstruction procedures with a deep inferior epigastric artery perforator (DIEP) flap between July 2018 and June 2021. The present study included 115 patients and 161 flaps. Cases were stratified into single DIEP/double DIEP groups and into early and late groups based on the flap order. Surgery times and postoperative complications were analyzed. Regarding the institution, the length of hospital stay was lower in the late group than in the early group (single 7.1 ± 1.8 vs. 6.3 ± 1.5 days, p = 0.019; double 8.5 ± 3.8 vs. 6.6 ± 1.4 days, p = 0.043). Apart from that, no statistically significant differences were found between the start and end of our study. In terms of the single surgeon, there was a significant improvement in the total surgery time (single 296.0 ± 78.7 vs. 227.5 ± 54.7 min, p = 0.018; double 448.0 ± 85.6 vs. 341.2 ± 43.1 min, p = 0.008), flap ischemia time (53.6 ± 15.1 vs. 40.9 ± 9.5 min, p = 0.007) and length of stay among the compared groups. There was no significant difference in flap loss rate or other complications between the early and late groups. Further performance of surgeries seemed to improve the surgeon's skills as well as the overall experience of the medical institution.

The Status of the Plastic Surgery Workforce for Women and Recommendations on How to Be Successful

Abstract Goals/Purpose The status of women in medicine has been rapidly evolving. Recent data shows that women now make up the majority of current medical students in the United States. Women now constitute 40.5% of integrated plastic surgery residents and make up 20% of the current plastic surgery workforce. The evolving face of the plastic surgery workforce warrants a deeper look at where we stand today. There has been literature published in recent years looking at women plastic surgeons in academia but little attention has been paid to the greater female plastic surgery workforce to include those in other practice settings. The purpose of this study is to look at current practices for female plastic surgeons, paths taken to get there, and advice for young female surgeons and surgical trainees. We aim to characterize and project future trends of the status of women in plastic surgery. We further outline recommendations on how to be successful as a female entering the field. Methods/Technique A survey was created using Survey Monkey with a series of 37 questions. These questions focused on demographics, what practices currently look like, paths taken to get there, individual desires for practice changes, and advice for female plastic surgeons early in their career. Email addresses were obtained through a web-based search using both the American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons listed board-certified female plastic surgeon members in the United States. A total of 748 surveys were emailed and survey responses were collected. Results/Complications There was a total response rate of 33%. Most respondents trained in an integrated pathway program (54%) and did not complete a fellowship (37.7%). The majority practice in a large city (44.6%), work 40-60 hours per week (63.4%) and perform 20-30 cases per month (34.05%). Most respondents work in a solo practice (32.05%). For those that previously worked in a different practice setting, the most common prior settings were small group practice (36.89%) and academia (32.04%). Fifty six percent of women did not have a female mentor. The majority of respondents are very satisfied in their current career (54.63%). The factors that ranked highest for helping women achieve success were persistence (81.14%), patient care (76.75%), patient rapport/communication (77.19%) and grit (74.89%). The highest ranked barrier to success included discrimination as a female (17.18%), lack of mentorship (16.81%), and personal/family demands (16.74%). Recommendations for women pursuing a career in private practice included starting to learn to run a business in residency/fellowship and get additional business education, finding a mentor, and to start growing your social media platform during training. Conclusion The plastic surgery workforce for women continues to evolve. Most practicing female plastic surgeons recommend for trainees to start learning how to run a business during their training and acquire additional business education. In addition, they stress the importance of mentorship throughout this process. As more women continue to enter the field of plastic surgery, mentorship and support for childcare to help with family demands will be paramount to their success. Residency programs should consider incorporating more business training into their curriculum given the majority of trainees will go on to work in a private practice setting.

Evidenzbasierte Forschung in der Plastischen und Ästhetischen Chirurgie: Querschnittsanalyse von Forschungsarbeiten im Zeitraum 2019–2021

In the field of plastic and aesthetic surgery, continuous international publication is seen annually. However, the publication output is not regularly assessed for its level of evidence. In view of the strong publication activity, a regular assessment of the evidence level of the current publication years is reasonable and was the objective of this work. We evaluated the Journal of Hand Surgery/JHS (European Volume Journal), the journal Plastic and Reconstructive Surgery/PRS and the journal Handchirurgie, Mikrochirurgie und Plastische Chirurige/HaMiPla from January 2019 to December 2021. The authors' affiliation, the type of publication, the number of patients examined and the level of evidence with existing conflicts of interest were considered. A total of 1341 publications were evaluated. Of these, 334 original papers were published in JHS, 896 in PRS, and 111 in HaMiPla. The largest share were retrospective papers (53.5%, n=718). The further distribution was as follows: 18% (n=237) clinical prospective papers, 3.4% (n=47) randomised clinical trials (RCT), 12.5% (n=168) experimental papers and 6.5% (n=88) anatomic studies. The distribution of evidence levels of all studies was as follows: Level I: 1.6% (n=21), Level II: 8.7% (n=116), Level III: 20.3% (n=272), Level IV: 25.2% (n=338), Level V: 2.3% (n=31). In 42% (n=563) of the papers, there was no indication of the level of evidence. Most level I evidence was from university hospitals (n=16) in 76.2% (χ²-test 0.619, >0.05, 95% confidence interval). Although RCTs are inappropriate for many surgical questions, well-designed and conducted cohort or case-control studies could improve the evidence base. Many of the current studies tend to be retrospective and do not have a control group. Researchers in the field of plastic surgery should consider using a cohort or case-control design when an RCT is not feasible.

Large Language Models in Academic Plastic Surgery: The Way Forward

Large Language Models in Academic Plastic Surgery: The Way Forward

Establishment of Saudi Arabia’s Plastic Surgery Interest Club: First-year Outcomes and Future Directions

This cross-sectional study utilized a self-developed questionnaire that experts in the field revised. The authors recruited active PSIC members during the year 2021-2022 to assess the overall impact of the club in their various interests of the field as well as to have an overview of their opinions of this newly done initiative in Saudi Arabia. The data collection spanned from October 2021 to September 2022. The authors analyzed the responses from 66 active members with a response rate of 78%. We found various significant positive impacts of the PSIC in the community of plastic surgery in Saudi Arabia. There was a significant difference in the interest in pursuing a career in plastic surgery before and after being a member of PSIC, with a P value of 0.0001. The members became noticeably more interested in pursuing an academic career and publishing field data after enrolling in PSIC research activities. The authors provided an analysis of 1-year outcomes of the PSIC in Saudi Arabia; there were many positive impacts of such an initiative in enhancing the local community of plastic and reconstructive surgery. The authors strongly encourage the adaption of such initiatives in various parts of the globe to develop the field of plastic surgery further.

The Lasting Impact of Generational Mentors: Drs. Joseph G. McCarthy and Henry K. Kawamoto

Background: Within the field of plastic and craniofacial surgery, Joseph G. McCarthy, M.D. and Henry K. Kawamoto Jr., M.D., D.D.S. have both dedicated a significant portion of their career, time, and effort to mentoring the next generation of surgeons. Our study reflects the impact of these generational mentors by analyzing the career paths and academic contributions of their graduate plastic and craniofacial surgeon mentees. It also highlights the unique mentorship styles of Drs. McCarthy and Kawamoto. Methods: Academic productivity of trainees under Drs. Kawamoto and McCarthy who completed a craniofacial fellowship (n = 81) or plastic surgery residency (n = 270) from 1984 to 2016 were assessed using institutional records. Curriculum vitae, practice websites, and personal correspondence were used to record practice type, geographic location, academic titles, societal leadership roles, mission trip involvement, and bibliometric data (publications, citations, h-index, grants). Results: The craniofacial fellows studied had a mean time since completion of fellowship training of 21 ± 11 years. Three-fourths had active craniofacial practices (75.3%) and over half of the fellows continued to practice in an academic setting (56.8%). The majority continued their surgical practice in the United States with a distribution of 24.7% in the Northeast, 29.6% in the South, 11.1% in the Midwest, and 25.9% in the West. Many became Division/Department Chiefs (42.0%), Craniofacial Directors (45.7%) and professional societal leaders (49.4%). Many sustained research productivity with an average of 77 ± 136 publications; 2070 ± 5459 citations; and h-index of 17 ± 16. An additional analysis of plastic surgery residents showed almost as robust of an academic interest: 34.5% were appointed Chief; 52 ± 95 mean publications; 1808 ± 4517 citations; and h-index of 15 ± 15. These numbers superseded other plastic surgery graduates. Conclusions: The McCarthy and Kawamoto craniofacial fellows and plastic surgery residents were noted to have impressive academic records. Mentorship relationships should be envisioned as a 2-way “Give-Get” relationship that will improve clinical skills, research productivity, and patient care.

Creating and Implementing a Novel Wellness-Inspired Resident Educational (WIRE) Curriculum

The Wellness-Inspired Resident Education (WIRE) curriculum is a resident-driven educational program consisting of six formal panels or lectures that are fully incorporated into the yearly resident didactic schedule, in addition to informal events and a resident wellness retreat. The curriculum promotes personal and professional wellness, enhances resident and department camaraderie, and provides opportunities to network with leaders in the field of plastic surgery. This paper provides the context which inspired the development of this curriculum, as well as key steps for successful implementation of wellness educational programming at any institution.