Global Plastic Surgery Research Articles

Ethics in Global Plastic Surgery Missions.

Delivering ethical care in global plastic surgery is challenging due to the unique complexities of resource-limited settings. Additionally, the rise of medical tourism has highlighted the importance of informed consent and awareness of the potential risks that are associated with seeking medical care in foreign countries. This article aims to consider core medical ethics principles and apply them in the context of delivering global plastic surgery. This article examines the application of the four core medical ethics principles in a framework set forth by Beauchamp and Childress, namely autonomy, beneficence, nonmaleficence, and justice, in the context of delivering plastic surgery in international settings. A literature review was performed, where all potential global plastic surgery articles were reviewed to better understand the application of the four core medical ethics framework in this context. Increased communication between visiting surgeons and local healthcare providers; heightened education of surgeons traveling to low-to-middle-income countries regarding local medical practices, resource availability, and cultural norms before providing surgical education; and a greater emphasis on collecting and publishing data analyzing short- and long-term outcomes in low-to-middle-income countries are all likely to improve the success of international medical missions, ensuring that all patients receive medical treatment in a manner that upholds Beauchamp and Childress' four core medical ethics principles. Providing plastic and reconstructive surgery abroad can be done ethically if the four main principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice) are used.

Global Surgery Speaker Series: An Education and Advocacy Resource for the Advancement of Global Plastic Surgery.

Global Surgery Speaker Series: An Education and Advocacy Resource for the Advancement of Global Plastic Surgery.

Livestreaming Microsurgery Education: An Avenue to Expand Global Plastic Surgery.

Microsurgery is a complex subspecialty requiring fine manual dexterity and a thorough understanding of microsurgical techniques, requiring years of training to reach proficiency. On a global scale, trainees may not have access to a longitudinal microsurgery curriculum and instead attend brief courses to learn microsurgical techniques, limiting their ability to practice the nuances of microsurgery. There remains a gap in global microsurgical education for trainees to have consistent educational exposure. This article presents a novel and easy to use software-based microsurgical system for virtual microsurgical teaching. In doing so, this system provides a free-of-cost and highly accessible avenue to deliver consistent microsurgical education worldwide.

Safety and Sustainability: Optimizing Outcomes and Changing Paradigms in Global Health Endeavors.

The need to address inequities in global surgical care has garnered increased attention since 2015, after the Lancet Commission on Global Surgery underscored the importance of ensuring safe, accessible, affordable, and timely surgical and anesthetic care. The vast unmet global plastic surgery needs make plastic surgery care essential in reducing the global burden of disease. In the past, many nonprofit organizations undertook humanitarian activities within low- and middle-income countries that were primarily service-provision oriented. The Lancet Commission on Global Surgery report prompted a shift in focus from direct patient care models to sustainable global surgical models. The realization that 33% of deaths worldwide were due to unmet surgical needs led to a global shift of strategy toward the development of local systems, surgical capacity, and a focus on patient safety and quality of care within international global surgery partnerships. In this report, the authors explore some of the primary components of sustainable international global surgical partnerships discussed in a recent panel at the American Society of Plastic Surgeons Plastic Surgery The Meeting 2022, titled "Safety and Sustainability Overseas: Optimizing Outcomes and Changing Paradigms in Global Health Endeavors." A literature review elaborating the topics discussed was performed. This report focuses on cultural competence and humility, international collaboration, and the use of technology and innovation, all of which are needed to promote sustainability and patient safety, within global surgery efforts. The adoption of these components into international surgical collaborations will lead to greatly enhancing the development and sustainability of mutually beneficial relationships.

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P8. The Development of a Smart Phone Application for Global Plastic Surgery Education and Mobile Electronic Medical Records

Background: Access to safe and timely surgical care is marked by inequities across the globe. This is particularly true in the specialized field of plastic and reconstructive surgery. Barriers to care include lack of human resource and limited surgical education. Covid-19 has alienated remote medical systems even further by reducing international missions. The Ohana One phone application is an innovative technology developed by plastic surgeons which aims to circumvent these barriers, all via a user-friendly smartphone interface Methods: Ohana One International Surgical Aid is a California-based global surgery non-profit organization. The Ohana One smartphone application (app) was designed and developed by the organization’s surgeon leaders, who recognized an opportunity to improve international collaboration and plastic surgery education. The free, HIPAA-compliant app provides a central location for surgeons to share challenging patient cases, network with international physicians and upload user-created surgical videos. Integration with VUZIX smart glasses also allows mentee surgeons to share surgeries and patient evaluations while receiving audiovisual feedback from remote mentor surgeons in real-time. Mentors can assess mentees using a surgical benchmark system developed for the app. Additional features include dictation and case logs for physicians without access to an electronic medical record Results: Beta-testing demonstrated a seamless design compatible with smartphone operating systems. The app has been disseminated across Ohana One’s global network comprised of 88 surgeons representing over 40 countries and now five additional surgical sub-specialties. Collaborations with other organizations like ReSurge International have expanded our reach in global plastic surgery. The app will be a valuable adjunct to international missions when they resume. Frequent needs assessments will be essential for maintaining success Conclusion: The Lancet Commission on Global Surgery recognizes the importance of novel technologies in the creation of sustainable global interventions. The Ohana One phone app exemplifies this concept by providing an accessible interface for surgeons to gain real-time training and professional support pre-operatively, intra-operatively, and post-operatively. It is also a remote electronic medical record. Providing surgeons with these tools all via their smartphones optimizes physician training in plastic surgery and, in turn, improves patient access to complex reconstruction around the world.

Ethical Dilemmas in Global Plastic Surgery: Divergent Perspectives of Local and Visiting Surgeons.

As more of the world's resources are directed toward improving patient access to safe surgical and anesthesia care, there is a growing concern that volunteer surgeons' "desire to help" has numerous unintended consequences. The purpose of this study was to ask in-country, local surgeons and visiting volunteer plastic surgeons about the frequency of ethical dilemmas for different types of global surgery collaborations and to assess their perception of compliance with the concepts of autonomy, beneficence, nonmaleficence, and justice. A cross-sectional email survey tool was sent to a representative sample of domestic American Society of Plastic Surgeons members, all international members of the American Society of Plastic Surgeons, and international partners of the Volunteers in Plastic Surgery committee of the Plastic Surgery Foundation. The survey response rate was 7.7 percent, with 356 respondents from 65 countries. This survey data showed a statistically significant divergence of perspectives between local and visiting surgeons in regard to scope of practice, quality of patient care, impact on local health care systems, perception of the quality of care by local providers, the integrity of the informed consent process, and photography in global plastic surgery collaborations. Though the short-term mission trip model was particularly polarizing when comparing the responses of local and visiting surgeons, educational and research exchanges may also significantly interrupt local health care and incite ethical lapses. This survey provides quantitative insight into the impact of current global plastic surgery collaborations and highlights ethical areas of disagreement between local and visiting surgeons.

Discussion: Ethical Dilemmas in Global Plastic Surgery: Divergent Perspectives of Local and Visiting Surgeons.

Discussion: Ethical Dilemmas in Global Plastic Surgery: Divergent Perspectives of Local and Visiting Surgeons.

Cleft Lip and Palate Research in Low- and Middle-income Countries: A Scientometric Analysis.

Background:Cleft lip and palate (CLP) comprise over 90% of the world’s congenital anomalies and cause significant disability worldwide, while disproportionally burdening low- and middle-income countries (LMICs). Research can help inform strategies that reduce disparities in accessing CLP care. We performed a scientometric analysis of CLP research in LMICs to identify influential contributors and themes.Methods:The authors searched seven citation databases accessed via Web of Science, from inception to March 2, 2021. Social network analysis was done using VOSviewer. The Kruskal-Wallis test and linear regression were used.Results:In total, 1561 articles authored by 6414 researchers affiliated with 2113 organizations in 119 countries were included. Most authors (n = 6387, 99.6%) had published two or more articles. The USA (454 articles), Brazil (211 articles), China (175 articles), and India (127 articles) published the most. The most prolific institutions were the University of Sao Paulo (94 articles), the University of Pittsburgh (57 articles), and the University of Iowa (55 articles). Marazita ML (33 articles), Shi B (27 articles), and Murray JC (22 articles) had the highest number of publications. An estimated 510 articles (32.7%) were focused on epidemiology, 240 (15.4%) on management, and 54 (3.5%) on global plastic surgery for CLP.Conclusions:LMICs are disproportionally burdened by CLP, but research is limited and often produced by high-income countries. This study elucidates partnership and health system strengthening opportunities to improve LMIC research capacity and ultimately informs the management and outcomes for patients with CLP.

Global Plastic Surgery: A Review of the Field and a Call for Virtual Training in Low- and Middle-Income Countries.

Lack of surgical access severely harms countless populations in many low- and middle-income countries (LMICs). Many types of surgery could be fulfilled by the plastic surgeon, as populations in these areas often experience trauma, burns, cleft lip and palate, and other relevant medical issues. Plastic surgeons continue to contribute significant time and energy to global health, primarily by participating in short mission trips intended to provide many surgeries in a short time frame. These trips, while cost-effective for lack of long-term commitments, are not sustainable as they require high initial costs, often neglect to educate local physicians, and can interfere with regional systems. Education of local plastic surgeons is a key step toward creating sustainable plastic surgery interventions worldwide. Virtual platforms have grown popular and effective-particularly due to the coronavirus disease 2019 pandemic-and have shown to be beneficial in the field of plastic surgery for both diagnosis and teaching. However, there remains a large potential to create more extensive and effective virtual platforms in high-income nations geared to educate plastic surgeons in LMICs to lower costs and more sustainably provide capacity to physicians in low access areas of the world.

Rebuilding Global Plastic Surgery Services and Safeguarding Workforce Density after COVID-19.

A recent report has found that approximately 150,000 health care workers have been infected with the SARS-CoV-2 virus, resulting in more than 1400 deaths.1 Of the 32 reported deaths of doctors in the United Kingdom due to coronavirus disease of 2019 (COVID-19), one was a plastic surgeon.2 Although the loss of any colleague is tragic, this pandemic will have an unprecedented and disproportional effect on low-income and middle-income countries and our collective global surgery aspirations. Recently, an extensive scoping review of health care workers’ COVID-19–related infections and deaths worldwide was published.1 Interestingly, the majority of documented health care worker deaths were seen in specialties not routinely associated with exposure to oronasal secretions, thereby highlighting the risk to all surgeons, including our plastic surgery community.1 While in the United Kingdom there are approximately 900 plastic surgeons, with over one surgeon per 100,000 people, the majority of countries worldwide are not as well equipped. For example, in Malawi, there are only three qualified plastic surgeons, representing 0.01 surgeons per 100,000 people.3 These figures are consistent across the multitude of low- and middle-income countries. The implications, therefore, of COVID-19 on the plastic surgery workforce in such countries are striking, with one death in Malawi representing a loss of 33 percent of the qualified plastic surgeons. The Lancet Commission on Global Surgery revealed the importance of an adequate surgical, obstetric, and anesthesia workforce density, due to a clear positive association between surgical, obstetric, and anesthesia workforce density and reduced morbidity and mortality rates and increased life expectancy.4The Lancet commission’s target of at least 20 surgical workers per 100,000 aimed to provide equality in health system staffing and patient outcomes.4 However, as many of our plastic surgery colleagues around the world (and particularly in low- and middle-income countries) are working exclusively as COVID-19 doctors, plastic surgery units are being converted to COVID units (e.g., the biggest plastic surgery specialist hospital in the world, with 500 beds and based in Dhaka, Bangladesh, is currently used solely for COVID-19), and personal protective equipment remains sparse and supply chains broken, we must act swiftly and in unison to safeguard global plastic surgery.5 The current global consequences of COVID-19 and restrictions in travel have strained traditional means of workforce training and attempts to improve surgical, obstetric, and anesthesia workforce density. However, biopsychosocial, economic, and ethical arguments should continue to compel us to overcome these challenges. Moving forward, we must focus on promoting safe working practices and preventative measures (such as advocating for safe and resilient personal protective equipment supply chains) and supporting our plastic surgery colleagues in low- and middle-income countries. Plastic surgery training in low- and middle-income countries must continue, and may require further development of our virtual teaching, e-learning, webinar, and simulation resources. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Abstract 16: Characterizing the Global Need for Plastic Surgery Service

Background: Nearly 5 billion people worldwide do not have access to surgical care. Access to plastic surgery for trauma-related injuries, congenital anomalies, and malignancies is equally limited. The current global surgery model relies heavily on short-term international surgical mission trips, yet little information is available to guide their development. Methods: To assess global plastic surgery service needs, a 16-item survey was designed and electronically distributed to 4550 members of the International Society for Aesthetic Plastic Surgeons (ISAPS). Members are required to maintain active membership in their respective national society of plastic surgery. Three rounds of surveys were distributed. Countries with fewer than 3 responses were excluded from individual analysis. Results: A total of 906 responses (20%) were obtained. 91% of respondents practice in an urban setting, and the majority are in private practice. More than 80% of respondents from Bangladesh (n=12), China (n=3), Colombia (n=20), Ecuador (n=10), Iraq (n=5), Panama (n=10), Philippines (n=11), Saudi Arabia (n=7) and Vietnam (n=5) indicated a need for volunteer plastic surgeons. 80% of respondents in Southeast Asia (n=40) and 79% of respondents in Central America (n=29) indicated a need for volunteers. Respondents from India (n=26) and Bangladesh (n=12) indicated a particular need for burn and trauma reconstruction, while craniofacial anomaly repair is needed globally. “Operating together with local surgeons” and “offering educational opportunities to local surgeons” were rated as the “most helpful” service modalities overall. A majority of respondents in each country indicated that plastic surgeons, operating room staff, anesthesia, physical therapists, and speech therapists are at least “somewhat accessible” in their local community. Conclusion: To maximize the impact of global plastic surgery outreach, organizers should know which service modalities are most needed and where. Our study suggests partnering with local surgeons may provide the greatest local impact, and that much of the global need for plastic surgeons is concentrated in Southeast Asia and Central America.

Abstract 11: The Gender Disparity in Global Plastic Surgery Mission Participation

Background: Plastic surgery is integral to global surgery; however, not all plastic surgeons are equally represented in this effort, with women only representing 18.7% of plastic surgeons who participate in international mission trips.1 The present study aims to identify gender barriers to participating on surgical mission trips by surveying members of the American Cleft Palate Association. Methods: A validated survey methodology with neutral, fact-based questions was implemented through Google Forms. The google form link was distributed by an administrator in the American Cleft-Palate Association (ACPA). Questions included demographics, non-identifying surgeon-specific information, and potential barriers in participation. Responses were analyzed using GraphPad Prism 8.1.2. Results: One hundred-fifty-one plastic surgeons responded to the distributed survey, resulting in a 27.45% response rate. Respondents consisted of 118 (78%) males and 33 (22%) females, with 77 (51%) under the age of 55 years old. One hundred twenty-one (80.13%) were married, and 129 (85.4%) had children, with an average number of 2.5 children. All respondents were plastic surgery trained, with 6 (3.92%) having additional training in otolaryngology and 2 (1.3%) having additional training in oral surgery. One-hundred-seventeen (77.5%) of respondents were fellowship trained. One hundred-thirty-four (88.74%) respondents reported previously having been on mission trips, with 77 (51.0%) having previously been on more than 5 mission trips and 107 (70.4%) having been on a mission trip less than 5 years ago. More men reported prior experience on mission trips as compared to women (92.2% vs. 78.8%, p<0.05), with no significant difference in men vs. women reporting mission trip experience in the last 5 years (72.0% vs. 66.7%, p>0.05). Forty-three percent of respondents with prior mission experience reported no institutional support, and of those who did not receive institutional support, there were significantly more men than women with children (p<0.05). Eight women (24.24%) reported barriers surrounding pregnancy and lactation, with 4 of those participants reporting significant barriers due to Zika. Conclusion: The present study should provoke future initiatives to encourage female plastic surgeon participation through initiatives that aid female participation during reproductive years and initiatives that enhance institutional support.

Proposed A New Multidimensional Face Recognition For Surgically Altered Faces In Security Surveillance

From previously carried out review results, authors have proposed a new multidimensional face recognition approach and applied on the sample database of sensitive medical images. The basic idea is to differentiate an individual’s identity with its own core features extracted from local or global plastic surgery. Features are being highlighted to match pre-to-post or post-to-pre surgery face images. The procedure may affect different face recognition algorithms working on linear or non-liner variations approach and that’s what multidimensional approach is meant. Hence it proves that the performance of verified rank accuracy ratio has increased in face recognition for security surveillance.

Bending Reality: Adventures in Global Plastic Surgery

Schultz RC. Morgan Hill, California: Bookstand Publishing. ISBN: 1618635549. Pp. 243. 87 illustrations. Softcover. 2013. $15.95.

Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery.

Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. The setting for this study was a district hospital located in Latacunga, Ecuador. Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P < .01). There was an 82.6% agreement between observers for cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P = .74). Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

PRS Global Open's Evolution: Logo, Growth, and Mission.

PRS Global Open's Evolution: Logo, Growth, and Mission.

The Amazing World of Global Plastic Surgery and Global Medicine.

The Amazing World of Global Plastic Surgery and Global Medicine.

Book Review: Bending Reality: Adventures in Global Plastic Surgery

Book Review: Bending Reality: Adventures in Global Plastic Surgery

Multiple Projective Dictionary Learning to Detect Plastic Surgery for Face Verification

Researchers have shown that the changes in face features due to plastic surgery can be modeled as a covariate that reduces the ability of algorithms to recognize a person's identity. Traditional dictionary learning methods learn a sparse representation using I <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0</sub> and I <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</sub> norms that are computationally expensive. This paper presents a multiple projective dictionary learning (MPDL) framework that does not require the computation of I <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">0</sub> and I <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</sub> norms. We propose a novel solution to discriminate plastic surgery faces from regular faces by learning representations of local and global plastic surgery faces using multiple projective dictionaries and by using compact binary face descriptors. Experimental results on the plastic surgery database show that the proposed MPDL framework is able to detect plastic surgery faces with a high accuracy of 97.96%. To verify the identity of a person, the detected plastic surgery faces are divided into local regions of interest (ROIs) that are likely to be altered by a particular plastic surgery. The cosine distance between the compact binary face descriptors is computed for each ROI in the detected plastic surgery faces. In addition, we compute the human visual system feature similarity score based on phase congruency and gradient magnitude between the same ROIs. The cosine distance scores and the feature similarity scores are combined to learn a support vector machine model to verify if the faces belong to the same person. We integrate our proposed MPDL framework for face verification with two commercial systems to demonstrate an improvement in verification performance on a combined database of plastic surgery and regular face images.