Innovations In Plastic Surgery Research Articles

Joseph Pancoast (1805-1882) and His Innovations in Plastic Surgery.

Background: Joseph Pancoast (1805-1882), a prominent figure in 19th-century surgery and medical education, introduced several innovative surgical techniques during his careerPurpose: While he made significant contributions to various areas of surgery, including plastic surgery and anatomy, his techniques were particularly notable for their precision and efficacy.Results: Some of his surgical innovations are the facial grafting especially in rhinoplasty either by using a forehead graft or by using a graft from the cheeks. He introduced his own operation for Staphyloplasty by dissecting two flaps of mucous membrane having a triangular shape and contributed also in taliacotian operation, blepharoplasty, otoplasty, cheiloplastic operation in case of lip cancer, amputations at the hip-joint, ocular deformities and tongue cancer restoration. In ocular surgery he had produced a fine needle turned into a hook in order to be inserted behind the cornea to cut deeply the soft parts of the lens and withdraw any hardened nucleus.

2021 Kazanjian Lecture: Caring for Children With Facial Anomalies—Inspiring the Next Generation

Varaztad Kazanjian stood for innovation in plastic surgery, serving as a founder of many of the craniomaxillofacial principles practiced today. However, we have seen attrition in career interest toward craniofacial and pediatric plastic surgery as trainees progress from medical school to early career. We explore several aspects of our specialty that could help reinvigorate enthusiasm for our specialty and the retention of young surgeons. We begin by judging career success and defining the patient population we wish to serve. We examine several areas by which our specialty can be perceived as more attractive to young surgeons, to include early mentorship and maintaining these mentoring relationships beyond the training period. We emphasize the need to diversify our trainees and include them in efforts to expand innovation in our specialty. We discuss the need to champion craniofacial and pediatric plastic surgery as mission-critical to our institutions, involve trainees and young surgeons in advocacy efforts on behalf of our patients, and involve trainees and young surgeons in global health efforts. We discuss how to structure our divisions to make craniofacial and pediatric plastic surgery an inviting environment that welcomes new participants, rather than making them feel they are working their way through an “old boys’ club.” Innovation alone will not sustain our specialty unless we mentor the next generation to want to continue in the line of innovation that drew us to this specialty.

Overcoming the Patent Gap: A Guide to Patenting for Plastic Surgeons.

Patenting protects innovation, fosters academic incentives, promotes competition, and generates new revenue for clinician-inventors and their institutions. Despite these benefits, and despite plastic surgery's history of innovation, plastic surgery-related patent applications are few. The goal of this article was to use unpublished data and formulate a robust discussion. The U.S. Patent and Trademark Office's boolean search was investigated between the timeline of 1975 and June 23, 2020, to identify patents related to the key phrases to contrast patent (both, issued and filed) tally in each specialty. Queries for two key phrases related to plastic surgery and a core plastic surgical activity, both with and without the added term "plastic surgery," were performed. Total patents with "cardiology" outnumber those with "plastic surgery" by 22,450 versus 7749 (i.e., almost 3:1). The overwhelming number of patents with "cosmetic" are non-plastic-surgery related: 87,910 total versus 2782 for those with plastic surgery. The corresponding numbers for "wound healing" are 36,359 versus 2703. Reasons for the patent gap between clinical innovations in plastic surgery and number of patents in our field are identified. Clear steps to bridge this gap are delineated that include a step-by-step process for patenting, from idea creation through commercialization. The authors propose "breakthrough to bank," a framework wherein academic medical centers can create an environment of innovative freedom, establish the infrastructure for technological transfer of intellectual property, and generate a pipeline toward commercial applications. Innovation and inventions are important hallmarks for the progress of plastic surgery. Using a stepwise process, it may be possible to convert ideas into patents.

Perception of Risk Among Aesthetic Plastic Surgeons.

With continuous innovation in plastic surgery, new procedures are constantly being introduced. A number of these procedures are generally safe but have the potential for rare yet serious complications. Many surgeons steer clear of these procedures due to safety concerns. The aim of this paper was to survey the membership of The Aesthetic Society to elicit perception of risk of several novel or less mainstream procedures. A 24-item survey was sent out to members of The Aesthetic Society. The survey focused on surgeon experience and attitude towards 3 procedures: filler rhinoplasty, gluteal augmentation with fat grafting, and submandibular gland excision. In total, 189 completed surveys were returned. Of the responders, 50%, 49%, and 89% of surgeons said they do not perform filler rhinoplasty, gluteal augmentation with fat grafting, or submandibular gland excision in their practices, respectively. The majority of those who do not perform the procedures selected "danger to the patient" as the primary concern for each of the 3 procedures. Surgeons overwhelmingly reported not learning these procedures in training. Additionally, surgeons perceive the risks of more common procedures such as abdominoplasty and breast augmentation-mastopexy to be significantly lower and more acceptable than those of the studied procedures. When comparing the perceived complication rates with data published in the literature, particularly when looking at rates of serious or life-threatening complications, plastic surgeons overestimate the risks of procedures with which they are less familiar. This perception of risk, accompanied by the lack of exposure to novel techniques in training, may contribute to surgeons avoiding these procedures.

Plastic Surgery Innovation Through War, Disaster and Pandemic

Introduction and Objectives: Mass casualties from modern warfare in World War I and advancements in medicine resulted in survivors with deformities. The field of Plastic Surgery developed from a need to reconstruct soft tissue injuries in these soldiers. Wars and disasters provide unique situations which push the development of new techniques that impact the field. The objective of this work was to identify innovations in plastic surgery that emerged from disasters. 
 
 Project Methods: The PubMed and Ovid databases were searched for articles documenting origination of plastic surgery ideas during a disaster with the terms “disaster”, “war”, “plastic”, “burn”, “terror”, and/or “novel”. Types of disasters considered include: war, terrorism, accident and natural disaster. Articles were included if they discussed novel therapies published emerging from a disaster. 
 
 Results: Twenty-one articles meeting inclusion criteria. Eleven papers described innovations during war including use of k-wires in hand fractures, gender affirmation surgery, delayed wound closure, cleft lip repair, vascular repair of acute trauma, sulfamylon antibiotics, and portable vacuum-assisted-closure (VAC) devices. Two articles resulted in surgical staff collaboration modeling and rapid recruitment from terrorist attacks. Five manuscripts defined accidents that brought about ideas of cultured epithelial autografts, VAC for burns, and targeted muscle reinnervation to decrease chronic pain in amputees. Natural disasters that caused change were depicted in three articles discussing adequate burn treatments for resource poor areas and using telemedicine for outpatient care and academic meetings. 
 
 Conclusions and Potential Impact: The field of Plastic Surgery continues to advance from innovations developed during disasters. Our study found war resulted in the greatest novel advancements. Terrorism and natural disasters have emerged as sparking innovation during the last few decades. Physicians should be encouraged to look for opportunities of innovation using their ingenuity when faced with disaster. What progress will COVID-19 bring?

Innovation in Plastic Surgery: A Call for Re-Emergence of the Surgeon-Scientist.

Innovation in Plastic Surgery: A Call for Re-Emergence of the Surgeon-Scientist.

The Relevant Roles of Plastic and Orthopedic Surgery in Hand Salvage

Over the recent past few years, there is a huge innovation in plastic surgery and orthopedic surgery through implantation of new techniques, which enabled a great level of success in hand salvage. Conditions such as trauma, tumor, sepsis, or vascular disease, may necessitate hand salvage. The most frequent argument among surgeon from different subspecialties (orthopedics, plastics, trauma, and vascular surgery) are characterized by in what way each one can do his own part of the salvage operation, be it bony fixation, revascularization, or soft-tissue coverage, but none of them is sure whether it should be endeavored. What is necessary in such clinical situations is an interdisciplinary team attitude led by individual or groups of clinicians who are conversant not only with their identifiable subspecialized skills but also with those of their coworkers and the consequences accompanying the joined efforts at hand salvage. The perception of orthoplastic surgery is based on such an indication, where the integrated skills and techniques of the orthopedic surgeon and reconstructive microsurgeon are performed in recital to direct efforts concerning hand salvage or choose against it when it is not designated. The current article reviews the roles of orthopedic and plastic surgery and how this team can deal with the existing techniques to improve outcomes in hand salvage surgery.

Commentary on: Autologous Fat Grafting in Cosmetic Breast Augmentation: A Systematic Review on Radiological Safety, Complications, Volume Retention, and Patient/Surgeon Satisfaction

In their article, Groen et al conduct a systematic review of autologous fat grafting (AFG) for cosmetic breast augmentation.1 They focus on radiological safety, complications, volume retention, and patient/surgeon satisfaction. The science and practice of AFG is generating a lot of interest. It is a highly active research front with significant discussion occurring at most international plastic surgical meetings. Rohrich et al have classed it as number three in the list of top innovations in plastic surgery.2 Our own group recently published a systematic review and meta-analysis of this topic with respect to breast reconstruction.3 Groen et al focus on cosmetic breast augmentation and define two broad research questions: (1) to determine the safety and efficacy of AFG either alone or in combination; and (2) to identify knowledge gaps in the current literature. They searched four databases (PubMed, Embase, Cochrane Library, and …

Fifty Years of Innovation in Plastic Surgery.

BackgroundInnovation has molded the current landscape of plastic surgery. However, documentation of this process only exists scattered throughout the literature as individual articles. The few attempts made to profile innovation in plastic surgery have been narrative, and therefore qualitative and inherently biased. Through the implementation of a novel innovation metric, this work aims to identify and characterise the most prevalent innovations in plastic surgery over the last 50 years.MethodsPatents and publications related to plastic surgery (1960 to 2010) were retrieved from patent and MEDLINE databases, respectively. The most active patent codes were identified and grouped into technology areas, which were subsequently plotted graphically against publication data. Expert-derived technologies outside of the top performing patents areas were additionally explored.ResultsBetween 1960 and 2010, 4,651 patents and 43,118 publications related to plastic surgery were identified. The most active patent codes were grouped under reconstructive prostheses, implants, instruments, non-invasive techniques, and tissue engineering. Of these areas and other expert-derived technologies, those currently undergoing growth include surgical instruments, implants, non-invasive practices, transplantation and breast surgery. Innovations related to microvascular surgery, liposuction, tissue engineering, lasers and prostheses have all plateaued.ConclusionsThe application of a novel metric for evaluating innovation quantitatively outlines the natural history of technologies fundamental to the evolution of plastic surgery. Analysis of current innovation trends provides some insight into which technology domains are the most active.

The ACAPS and SESPRS surveys to identify the most influential innovators and innovations in plastic surgery: no line on the horizon.

Who and what have been the most influential innovators and innovations in plastic surgery? This historical paper attempts to determine our most important contributors and contributions. We conducted an anonymous, 7-question, web-based survey of all members of the American Council of Academic Plastic Surgeons (ACAPS) and the Southeastern Society of Plastic and Reconstructive Surgeons (SESPRS). We asked respondents to list their top 5 most influential surgeons, the most important publications or bodies of work, and the most important innovations in plastic surgery, past and present. Of the 86 nominees from ACAPS, the 15 most influential surgeons of the past century were Tessier, Buncke, Murray, Millard, Gillies, Mathes, Jurkiewicz, Taylor, Converse, Blair, Kleinert, Edgerton, McCraw, Peacock, and Brown, in that order. The most 10 influential surgeons of the current era are Rohrich, McCarthy, Wei, Lee, Siemionow, Allen, Coleman, Guyuron, Serletti, and Nahai. Of the 112 nominees from SESPRS, the 15 most influential surgeons of the past century were Gillies, Millard, Tessier, Buncke, Murray, Jurkiewicz, Hartrampf, Mathes, Taylor, Bostwick, McCraw, Furlow, Converse, Peacock, and Blair, in that order. The 10 most influential surgeons of the current era are Rohrich, Nahai, Wei, McCarthy, Coleman, MacKinnon, McGrath, Rubin, Guyuron, and Hammond. Pooled from both lists, the 10 most influential publications or bodies of work were Hartrampf's TRAM flap, Millard's cleft lip repair, McCraw/Mathes/Nahai's myocutaneous flaps, Furlow's cleft palate repair, Tessier's cleft classification and craniofacial repairs, Ramirez's components separation, Buncke's replantation/toe-to-thumb transfer, McCarthy's mandibular distraction osteogenesis, Taylor's free flap and angiosome concepts, and Murray's kidney transplant. The top 10 innovations of the 20th century were myocutaneous flaps, microsurgery, craniofacial surgery, skin grafts, transplantation, liposuction, bioimplants, distraction osteogenesis, angiosome anatomy, and rigid fixation. The 10 most important, current innovations are hand/face transplantation, fat grafting, stem cells, neurotoxins and soft-tissue fillers, biologic scaffolds, information technology, tissue engineering and regenerative medicine, negative pressure wound therapy, perforator flaps, and noninvasive imaging. Plastic surgery includes a rich history of both incremental and disruptive innovation, which has endowed our discipline with a competitive advantage over other medical and surgical subspecialties. Based upon our past success in managing change, there may be no limit, or no line on the horizon, as to what is possible, provided that we pursue innovation in a systematic way that combines creativity and discipline.

Applying the Concepts of Innovation Strategies to Plastic Surgery

Plastic surgery has a well-known history of innovative procedures and products. However, with the rise in competition, such as aesthetic procedures being performed by other medical specialties, there is a need for continued innovation in plastic surgery to create novel treatments to advance this specialty. Although many articles introduce innovative technologies and procedures, there is a paucity of publications to highlight the application of principles of innovation in plastic surgery. The authors review the literature regarding business strategies for innovation. The authors evaluate concepts of innovation, process of innovation (i.e., idea generation, idea evaluation, idea conversion, idea diffusion, and adoption), ethical issues, and application to plastic surgery. Adopting a business model of innovation is helpful for promoting a new paradigm of progress to propel plastic surgery to new avenues of creativity.

Creativity in Plastic Surgery as a Major Contribution to Medicine, Surgery, and Patient Care

All human beings are provided by nature with the ability not only to survive but also to improve the quality of life. A sort of brain plasticity allows us to adapt to new information and circumstances. This also accounts for what is called creativity. Due to its etymological roots in Latin, the word suggests that by means of imagination either a new idea of significant value may be ``created'' or an already existing and valid one may be improved, transformed, and applied so as to serve more purposes. As the German poet Goethe aptly observed, the ``birth'' of something new often requires the ``death,'' or the letting go, of old ideas. In the course of history, creativity has brought about changes, innovations and advances in all aspects of human life. Creativity, accompanied by talent, motivation and interest, patience and perseverance, self-confidence and courage, as well as the determination to overcome obstacles, is highly significant also in the field of medicine, in surgery, and, of course, in Plastic Surgery. Specific techniques and methods, invented by creative individuals and/or the research community, have contributed to a history of great innovations in Plastic Surgery and have also proved useful in other surgical institutions. Cooperation beyond the scope of 1 discipline has always been highly important, as it is the patient who is meant to profit from the products of creative minds in these fields. Two examples from my own experience shall serve to illustrate the vast scope of possibilities in the field of Plastic Surgery: cross-face nerve grafting and total reconstruction of a trachea.

The life and career of a great surgeon: Sir Archibald McIndoe CBE, MD, MSc, FRCS, FRCSI (Hon), FACS (Hon)1900-1960

Sir Archibald McIndoe is undoubtedly one of the greatest surgeons of the twentieth century. He is widely regarded as being one of the founding fathers of plastic surgery. Throughout his early career McIndoe had shown signs of his potential by winning numerous prizes and being awarded various scholarships. During the Second World War McIndoe was appointed civilian consultant plastic surgeon to the Royal Air Force, at the East Grinstead hospital. Here he worked with RAF servicemen who had suffered horrific burns. McIndoe not only pioneered new techniques for treating and reconstructing these servicemen’s injuries, he also developed new methods for reducing the risk and preventing them from happening to other servicemen. McIndoe was renowned not only for his technical brilliance and innovations in plastic surgery but also for the huge dedication he made towards his patient’s rehabilitation and return to society. McIndoe was able to inspire the staff at the East Grinstead hospital to help him achieve this goal by emphasising the importance of teamwork and total patient care. For his outstanding work McIndoe received numerous accolades at home and abroad and was knighted in 1947.

So You Want to Be an Innovator?

So You Want to Be an Innovator?

From Bedside to Bench and Back Again: Technology Innovation in Plastic Surgery

From Bedside to Bench and Back Again: Technology Innovation in Plastic Surgery

Reconstruction modality based on the spare part concept for massive soft tissue defects following oncological hemipelvectomy

Background.Hemipelvectomy for massive malignancy can result in large soft tissue defects that cannot be reconstructed using conventional posterior flaps. For such cases, reconstruction methods, including a latissimus dorsi flap or a rectus abdominis myocutaneous flap, may be applied, resulting in donor site morbidity. Recent innovations in plastic surgery have resulted in the development of novel reconstruction modalities based on “the spare part concept,” applying tissues from amputated limbs. Methods.Five subjects with pelvic malignant tumors underwent hemipelvectomy with reconstruction using the spare part concept. Femoral artery-based myocutaneous flap and free fillet lower leg flap were used for three and two cases, respectively. The clinical results, including postoperative complications and oncological outcomes, were assessed. Results.The mean follow-up period was 43.2 months (range 12-94 months). No local recurrence was encountered in any cases throughout follow-up. As of the final follow-up, three patients remained alive and two patients were dead due to distant metastasis. Minor postoperative infection was observed in two cases. Conclusions.The femoral artery-based myocutaneous flap and the free fillet lower leg flap are both useful, safe options for reconstruction of the large defect following extensive hemipelvectomy for malignant bone and soft tissue tumors. The present data support the continued application of these flap reconstruction techniques based on the spare part concept.

Innovation: A Sustainable Competitive Advantage for Plastic and Reconstructive Surgery

Innovation: A Sustainable Competitive Advantage for Plastic and Reconstructive Surgery

Morphometric evaluation of collagen fibril dimensions in expanded human breast skin

A great innovation in plastic surgery in recent years has been skin expansion, which has provided the discipline with new possibilities for skin reconstruction. At present, little is known about the biology of skin expansion although it is clear that cell proliferation occurs both in the epidermis and the dermis. During previous morphological investigations of skin under expansion we recorded a number of signs comparable with those seen in wound healing. In the present study, the collagen fibril diameter of skin before and under expansion has been recorded using an IBAS computer-based morphometric system. Preferentially, we have studied the papillary dermis where the most conspicuous morphological events occur.