Plastic And Reconstructive Surgery Research Articles

The Need for Higher Levels of Evidence in Plastic Surgery.

Evidence-based medicine in plastic surgery is essential to provide optimal care to individual patients. Level of evidence (LOE) and number of citations are metrics used to gauge quality of research and impact within a field, respectively. The objective of this study was to determine an association between LOE and number of citations within recently published articles in Plastic and Reconstructive Surgery (PRS). A review of original research articles published in PRS from January 2018 to June 2022 was performed. LOE was identified through the PRS website, and the number of citations identified via PubMed. Articles were further divided into sections of their corresponding topic. A total of 965 articles were reviewed, of which 21 (2.2%) were articles assigned level I evidence. There were 147 (15.2%) level II articles, 360 (37.3%) level III articles, 377 (39.1%) level IV articles, and 60 (6.2%) level V articles. The average number of citations per article was 2.72, and the average LOE of all included articles was 3.31. Level I articles had an average of 4.95 citations, whereas level II, III, IV, and V articles had averages of 2.95, 2.54, 2.64, and 2.71, respectively. Breast articles were cited on average 3.85 times each, more than any other type of article. Our data show that articles assigned level I evidence in PRS trend toward higher numbers of citations compared with articles assigned lower LOEs. These findings should encourage investigators to publish high-quality research to advance the field of plastic surgery.

Exploring the 6-year Trend in Dedicated Research Years among Integrated Plastic and Reconstructive Surgery Residents.

The plastic and reconstructive surgery (PRS) match has become more competitive with an emphasis on research productivity. With the transition of the US Medical Licensing Examination step 1 examination to pass-fail grading, alternative evaluation metrics for residency applications are needed. Our study provides a landscape of the incidence of research years amongst integrated PRS residents and the potential impacts of gender and race. A retrospective study was conducted for all integrated PRS residents who matched between 2017 and 2022, using publicly available sources including residency websites, PubMed, Doximity, and social media. Demographics, educational background, and participation in a dedicated PRS research year were recorded. Among 993 residents across 85 accredited integrated PRS programs, 15.7% (156 of 993) took a research year, with a significant increase over 6 years (R 2 = 0.73, P = 0.019). The majority were men at 51.9%, and White at 53.5%, with underrepresented in medicine residents comprising 13.5%. A total of 73.1% came from a medical school with a home program, and 52.6% matched into a top 20 residency program. No significant difference was seen in the racial/ethnic or gender representation of residents who took a research year compared with all PRS applicants and active PRS residents. Research years before applying to residency are becoming more common among integrated PRS residents. Research years are especially common with students who do not have a home program and may help them gain skills and access to mentorship that improves the likelihood of matching.

ChatGPT Virtual Assistant for Breast Reconstruction: Assessing Preferences for a Traditional Chatbot versus a Human AI VideoBot.

Recent advancements in artificial intelligence (AI) have reshaped telehealth, with AI chatbots like Chat Generative Pretrained Transformer (ChatGPT) showing promise in various medical applications. ChatGPT is capable of offering basic patient education on procedures in plastic and reconstructive surgery (PRS), yet the preference between human AI VideoBots and traditional chatbots in plastic and reconstructive surgery remains unexplored. We developed a VideoBot by integrating ChatGPT with Synthesia, a human AI avatar video platform. The VideoBot was then integrated into Tolstoy to create an interactive experience that answered four of the most asked questions related to breast reconstruction. We used Zapier to develop a ChatGPT-integrated chatbot. A 16-item survey adapted from the 2005 validated measurement of online trust by Corritore et al was distributed online to female participants via Amazon Mechanical Turk. A total of 396 responses were gathered. Participants were 18 to 64 years old. Perceptions of truthfulness, believability, content expertise, ease of use, and safety were similar between the VideoBot and chatbot. Most participants preferred the VideoBot compared with the traditional chatbot (63.5% versus 28.1%), as they found it more captivating than the text-based chatbot. Of the participants, 77% would have preferred to see someone who they identified with in terms of gender and race. Both the VideoBot and text-based chatbot show comparable effectiveness, usability, and trust. Nonetheless, the VideoBot's human-like qualities enhance interactivity. Future research should explore the impact of race and gender concordance in telehealth to provide a more personalized experience for patients.

In the Era of pass/fail: Medical student perceptions on optimizing their surgical residency applications

BackgroundIt is unclear how changes to the 2023–2024 Electronic Residency Application Service (ERAS) application will impact future applicants. We investigate students’ perceptions about applying to residency during this transition period. MethodsAn anonymous electronic survey was sent to medical students through social media of a women's surgical society. Questions reflected aspects of the ERAS application. ResultsThere were 415 responses, with 68 ​% planning to apply into surgical specialties (SS) and 17 ​% into non-surgical specialties (NSS). Compared with the NSS group, SS students reported decreased confidence in successfully matching, less attainable applicant expectations, and increased personal sacrifices to pursue their residency of interest. Students interested in Plastic and Reconstructive Surgery (PRS) placed 3-times more importance on the number of publications than General Surgery students. Away rotations were rated significantly more important for Otolaryngology, Orthopaedic, and PRS students. ConclusionStudents applying into surgical residencies experience unique stressors. Values among SS students differed across surgical subspecialties in preparation for the match. Further investigation characterizing the relationship between these values and characteristics of successful resident applicants is warranted.

Representation of Racial Diversity on US Plastic Surgery Websites: A Cross-sectional Study: Racial Diversity on Plastic Surgery Websites.

The racial diversity portrayed in plastic and reconstructive surgery (PRS) media is an important indicator of an inclusive environment for potential patients. To evaluate the degree to which PRS websites demonstrate inclusivity, we assessed the racial composition of both patients and plastic surgeons depicted on the most visited academic and private PRS websites to determine the extent to which racial diversity is represented. A cross-sectional study was conducted in September 2023. The 10 most visited websites in each state were identified. Sociodemographic characteristics including race and sex of patients and plastic surgeons, as well as the type of practice, were collected. Race was classified according to individuals' Fitzpatrick Phototypes into White and non-White. Differences in patient and surgeon representation were compared to the 2020 US Census and the 2020 ASPS demographics using χ2 tests. Subgroup analyses were conducted to identify differences by type of practice and region. We analyzed a total of 2,752 patients from 462 websites belonging to 930 plastic surgeons. PRS websites were predominantly from private practices (93%). Regarding patient representation, 92.6% were female, 7.4% were male, 87.6% were White, and 12.4% were non-White. The surgeon population on the studied webpages was 75.1% male, 92.1% White, and 7.8% non-White. Statistically significant differences were found in the patient population when compared to the 2020 national (P < 0.001) and regional (P < 0.001) US Census demographics and the 2020 ASPS Statistics Report (P < 0.001). Although minority representation was significantly higher on academic websites compared to private practice (22.9% vs. 12.1%; P = 0.007), both were significantly lower than the percentage of minority patients undergoing PRS. This study illuminates racial disparities in the representation of racial groups among patients and plastic surgeons in the most frequented plastic surgery websites. Moreover, it underscores the imperative to bolster racial diversity within the digital content of both private and academic PRS websites. Greater racial representation can foster a more inclusive perception of the plastic surgery field, which may potentially broaden access to care and enrich the professional landscape.

Assessing the Knowledge and Insight of Medical Students into the Field of Plastic Surgery: A Step Toward Creating Well-Rounded Healthcare Professionals.

Introduction Plastic and reconstructive surgery (PRS) is unique in its versatility; however, there seems to be a lack of familiarity with the breadth of the discipline among healthcare workers and medical students. Methods This is a questionnaire-based, cross-sectional study conducted between June and July 2021, targeting medical students at Kuwait University. The questionnaire examined three domains: demographics, perception, and knowledge of the scope of PRS. Results A total of 465 medical students completed the survey, with most (N=106, 22.8%) being in their final year (seventhyear). The majority(N=414, 89%) of students had no previous clinical exposure to PRS. Amongthe several PRS disciplines, knowledge was highest in the aesthetic discipline (4.1/5). Awareness in the hand (0.82/5) and craniofacial (0.8/5) disciplines were the lowest. Students in their clinical years had a higher overall PRS score when compared to those in their pre-clinical years (10.9 versus 9.1, p<0.0001). Participants who believed that PRS is a rewarding specialty had higher overall scores compared with those who disagreed (10.3 versus 9.5, p=0.055). Participants who believed that PRS is synonymous with cosmetic surgery had a lower overall score (9.3 versus 10.4, p=0.008). Furthermore, participants who would consider a career in PRS had a better understanding of all aspects of the specialty as evidenced by higher overall scores. Conclusion Exposure to the field of PRS improves medical students' insight into the various disciplines of PRS and ultimately influences how the field is perceived.Efforts should be made toward promoting the exposure of medical students to PRS through clinical placements and/or didactic lectures.

Unmatched. What's Next? Is a Preliminary Year of Residency or Research Fellowship Better for Reapplicants to Plastic Surgery?

Plastic and reconstructive surgery is one of the most competitive residency programs, and given the increased number of applicants for a relatively fixed number of positions, successfully matching is a challenge. Match rates have declined since 2018, with a match rate of ~55% in 2022. Two common options before reapplying are a preliminary year of residency (preliminary year) or a research fellowship. This study investigated which option is more beneficial for reapplicants seeking a successful match. This retrospective study included all applicants to an integrated plastic and reconstructive surgery residency from 2015 to 2023. Two cohorts based on reapplication strategy (research fellowship or preliminary year) were created. Demographic, applicant, and match data were collected. Pearson chi-squared, Fisher exact, and Wilcoxon rank sum testing were performed. In total, 125 reapplicants were included. Seventy-one (56.8%) reapplicants pursued a preliminary year, and 29 (23.2%) completed a research fellowship. Research fellowship reapplicants had a greater mean number of first author publications (8.8 versus 3.2, P < 0.001), non-first author publications (11.3 versus 5.9, P = 0.021), poster presentations (9.7 versus 6.0, P = 0.028), and oral presentations (11.8 versus 6.4, P < 0.001). Research fellowship reapplicants were more likely to match into plastic and reconstructive surgery (PRS) than preliminary year reapplicants, with 72.4% (n = 21) of research fellowship reapplicants matching into PRS compared with 39.4% (n = 28) of preliminary year reapplicants (P = 0.003). Research fellowship reapplicants demonstrated greater research productivity and were almost twice as likely to match into PRS compared with preliminary reapplicants.

Maximizing surgical outcomes with gender affirming hormone therapy in gender affirmation surgery

Gender Affirmation Surgery (GAS) is a super specialized subset within the field of plastic and reconstructive surgery (PRS) that is ever evolving and of increasing interest to the PRS community. It is a multifaceted process which, in addition to surgical therapy, involves mental health therapy and hormonal therapy. One rapidly emerging interest within GAS is the role that gender affirming hormone therapy (GAHT) plays in enhancing surgical outcomes. GAHT has been used adjunctively with GAS as a comprehensive therapy to ameliorate gender dysphoria. This literature review will examine the positive effects of GAHT on the surgical outcomes on GAS, as well as other important considerations prior to surgery. As such, the primary objective of this literature review is to evaluate and assess the current evidence concerning the efficacy and safety of GAHT, as it relates to Gender Affirmation Surgery procedures.

Barriers of Three-Dimensional Printing in Craniofacial Plastic Surgery Practice: A Pilot Study and Literature Review.

Three-dimensional printing (3Dp) and modeling have demonstrated increasing utility within plastic and reconstructive surgery (PRS). This study aims to understand the prevalence of how this technology is utilized in craniofacial surgery, as well as identify barriers that may limit its integration into practice. A survey was developed to assess participant demographics, characteristics of 3Dp use, and barriers to utilizing three-dimensional technologies in practice. The survey was distributed to practicing craniofacial surgeons. A secondary literature review was conducted to identify solutions for barriers and potential areas for innovation. Fifteen complete responses (9.7% response rate) were analyzed. The majority (73%) reported using three-dimensional modeling and printing in their practice, primarily for surgical planning. The majority (64%) relied exclusively on outside facilities to print the models, selecting resources required to train self and staff (55%), followed by the cost of staff to run the printer (36%), as the most common barriers affecting 3Dp use in their practice. Of those that did not use 3Dp, the most common barrier was lack of exposure (75%). The literature review revealed cost-lowering techniques with materials, comparability of desktop commercial printers to industrial printers, and incorporation of open-source software. The main barrier to integrating 3Dp in craniofacial plastic and reconstructive surgery practice is the perceived cost associated with utilizing the technology. Ongoing literature highlights the cost-utility of in-house 3Dp technologies and practical cost-saving methods. The authors' results underscore the need for broad exposure for currently practicing attendings and trainees in 3Dp practices and other evolving technologies.

Plastic Surgery Involvement With Surgical Management of Infected Ventricular Assist Devices Decreased Lifetime Return to Operating Room and 90-Day Infectious Complications.

The use of left ventricular assist devices (LVADs) for patients with end-stage cardiac failure awaiting heart transplantation has become increasingly common. However, ventricular assist device-related infections remain a major problem complicating their long-term use. Retrospective review has previously shown a decrease in lifetime return to operating room (RTOR) with no change in 90-day complications when a muscle or omental flap is used for coverage after washout for infection. We wished to determine if early plastic surgery intervention led to a decreased length of stay for these patients. Patients with LVAD readmitted for LVAD infection at a single institution from 2008 to 2021 were identified using a preexisting database. Patients were followed retrospectively for an average of 3.2 years. Patient demographics, preoperative diagnosis/disease state, type of ventricular assist device inserted, postoperative day of ventricular assist device infection onset, definitive device coverage, timing of coverage procedure after the initial washout for infection, type of flap used for coverage, 90-day complications after definitive coverage, and lifetime return to operating room for infection were reviewed. Comparison analysis with χ2 and analysis of variance testing was used to analyze outcomes. Of 568 patients admitted with an LVAD infection, 104 underwent operative debridement and closure by plastic and reconstructive surgery (PRS) or cardiothoracic surgery (CTS). Fifty-three underwent PRS closure, and 51 underwent CTS closure. There was an increased incidence of diabetes among the PRS group (P < 0.001); otherwise, there was no difference in baseline characteristics. There was increased RTOR over a lifetime with CTS closure compared with PRS (P = 0.03) and increased 90-day risk of infection (P = 0.007). Patients with PRS closure had an increased risk of postoperative hematoma (P = 046). Plastic and reconstructive surgery was typically consulted on hospital day 10. Both PRS and CTS closure patients were discharged on postoperative day 7, on average (P = 0.542). Plastic surgery involvement with surgical decision making and closure of infected LVAD devices has a decrease in lifetime RTOR and decreased 90-day complications related to infections. There may be a benefit to earlier PRS consultation for coverage assessment.

A 10-year analysis of the racial distribution of authors in plastic surgery research and the impact of minority mentorship

BackgroundThis study evaluates the racial distribution in Plastic and Reconstructive Surgery (PRS) publication authorship and illustrates the impact underrepresented in medicine (URiM) mentorship has on increasing diverse trainee contributions to the PRS peer-reviewed literature. MethodsArticles published in the seven highest-impact PRS peer-reviewed journals within the last 10 years (2012–2022) were reviewed and analyzed for first and senior authors’ race and ethnicity, publication year, and citation count. ResultsA total of 23,549 publications were identified of which 8250 were from the US-based institutions. A random sampling of 778 publications (∼10 ​%) were scrutinized for first and senior author race and ethnicity. Across all journals, 64.5 ​% of senior authors were White, 29.9 ​% Asian, 4.6 ​% Hispanic, and 1.0 ​% Black. First authors were 59.5 ​% White, 32.8 ​% Asian, 5.2 ​% Hispanic, and 2.6 ​% Black (p=<0.0001). The presence of a URiM senior author increased the likelihood of a URiM first author 7-fold (p=<0.0001); 95 ​% CI [3.5–14.0]). There was no statistically significant difference in the total citation count relative to author race or ethnicity. The Aesthetic Surgery Journal had the greatest proportion of White senior authors (73.6 ​%), while Microsurgery had the highest percentage of URiM senior authors (8.7 ​%). ConclusionsURiM authorship of PRS publications is limited and mentorship is essential to improve underrepresented perspectives in the PRS peer-reviewed literature.

Reported Variability in General Surgery Training Across Integrated Plastic Surgery Residency Programs.

Since their development, integrated plastic and reconstructive surgery (PRS) residency training programs have established diverse methods of incorporating general surgery training into graduate medical education. Programs have questioned the necessary duration and timing of such training. The aim of this study is to assess the landscape of general surgery exposure in integrated PRS residency programs. Thirty-six integrated PRS residency programs were included based on the availability of postgraduate year (PGY)-level rotation data. Rotations were measured in units of weeks with descriptive titles maintained as advertised by the program. Individual general surgery rotations were also categorized as being either PRS-aligned, American Board of Plastic Surgery (ABPS) Required Clinical (RC) or ABPS Strongly Suggested (SS). Statistical analyses were carried out on the relative proportions of each subcategory in the 2 parent groups. All 36 programs evaluated required general surgery rotations in years PGY- 1 to -2. By PGY-3, 69% of programs required general surgery, and by PGY-6, 25%, and these were limited to 4- to 6-week rotations in burn, breast, or trauma. Looking across all 6 years, with 312 weeks of training total, the minimum number of weeks spent in general surgery rotations was 32, and the maximum number was 119, with an average of 61 weeks (±21).Programs were subcategorized into 2 groups based on whether they spent more (n = 16) or less (n = 20) than the net average number of weeks in ABPS RC + SS rotations. No significant difference was found in the relative proportion of PRS-aligned general surgery across groups. Programs with <60 weeks of general surgery had a relatively greater proportion of ABPS RC and SS rotations. These data demonstrate that there exists significant variability in overall duration of general surgery training across integrated PRS training programs. When controlling overall general surgery exposure for variables of interest like PRS-aligned exposure or compatibility with ABPS requirements, we found no discernable educational model or patterns to explain the observed range in exposure. These results warrant reexamination of an ideal general surgery track within the integrated plastic surgery training model that optimizes training for the PRS resident.

Machine learning review of hand surgery literature

Background: Latent Dirichlet Allocation is an artificial intelligence model which processes text into topics, and has had broad application in medicine, political science, and engineering. As the orthopedic hand literature continues to grow, such technology may have value in efficiently conducting identifying trends and conducting systematic reviews. The purpose of this study is to demonstrate the use of Latent Dirichlet Allocation and machine learning to review literature and summarize the past 21 yr of hand surgery research. Methods: All original research articles published in the Journal of Hand Surgery (American), Journal of Hand Surgery (European), Hand, Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Journal of the American Academy of Orthopaedic Surgeons (JAAOS) and Plastic and Reconstructive Surgery (PRS) from 2000-2021 were analyzed using Latent Dirichlet Allocation, generating 50 topics which were then ranked by popularity and trended over the previous 21 yr. Results: Research article abstracts totaling 11,501 from 2000-2020 were extracted and analyzed to create 50 topics. Conclusion: This is the first study of its kind to utilize machine learning models for reviewing the hand surgery literature. Machine learning possesses the ability to rapidly process a large body of test and assess the current state of research and trends or research topics, which can aid clinicians and researchers in time-intensive tasks to provide clues that will promote areas of further study.

Revisiting Level of Evidence Ratings in Plastic Surgery: A Call to Action.

Evidence-based medicine underpins medical and surgical practice, with level of evidence (LOE) being a key aspect that allows clinicians and researchers to better discriminate the methodological context by which studies are conducted and appropriately interpret their conclusions, and more specifically the strength of their recommendations. The aim of this study was to reassess the LOE of articles published in plastic surgery journals. To assess the overall LOE of publications from January 1 to December 31, 2021, a review of the following plastic surgery journals was performed: Aesthetic Surgery Journal (ASJ), Annals of Plastic Surgery (Annals), Journal of Plastic Reconstructive and Aesthetic Surgery (JRPAS), Plastic and Reconstructive Surgery (PRS), and Plastic and Reconstructive Surgery Global Open (PRS GO). Of 3698 PUBMED articles, 1649 original articles and systematic reviews were analyzed. The average LOE for each journal was: ASJ 3.02 ± 0.94, Annals 3.49 ± 0.62, JPRAS 3.33 ± 0.77, PRS 2.91 ± 0.77, and PRS GO 3.45 ± 0.70. The collective average LOE was 3.28 ± 0.78. Only 4.4% were LOE 1 and 7.3% were LOE 2. Compared to past studies, PRS showed a significant LOE improvement (P = .0254), while ASJ and JPRAS saw nonsignificant changes; Annals experienced a significant decrease (P = .0092). ASJ and PRS showed the highest LOE among the journals analyzed. Despite this, low LOE studies remain prevalent in plastic surgery. This paper serves as a call to action for both researchers and academic journals to elevate the standard, offering several strategies to help improve the LOE in plastic surgery.

Update on the Selection Criteria of Plastic Surgery Residents: A Survey of Program Directors and Associate Program Directors.

Plastic and reconstructive surgery (PRS) is recognized as a highly competitive specialty. Since the first assessment of resident selection criteria in 2007, PRS residency programs have adopted holistic review processes and adapted to changes such as a decline in medical schools participating in the Alpha Omega Alpha Honor Medical Society as well as the recent transition to pass/fail grading for the United States Medical Licensing Examination (USMLE) step 1 examination (Schultz et al. Plast Reconstr Surg Glob Open . 2020;8:e2892; Tadisina et al. Plast Reconstr Surg . 2017;139:330e-331e). This study was devised to evaluate current PRS residency criteria in light of these changes. An anonymous, 12-item, electronic survey was generated and distributed using Alchemer. An email was sent to 171 program directors (PDs) and associate program directors (APDs) of PRS residency programs. Survey questions were developed to collect data regarding respondent demographics and their desired criteria when assessing residency applicants. Complete responses were collected and analyzed with summary statistics and multivariate logistic regression using RStudio (version 1.3.109). In total, 44 (25.7% response rate) of the 171 PDs and APDs completed the survey. Of the 16 programs (36.4%) with a USMLE cutoff score, 7 (43.8%) reported a range of 230 to 239 and 6 (37.5%) reported a range of 240 to 249. Without a score for step 1, the majority (48.8%) of respondents believe that step 2 scores will replace step 1 scores in terms of assessment criteria, and the content of recommendation letters was selected as the criterion with the greatest increase in weight (66.7%). In addition, 27.3% of programs require a step 2 score at the time of interview. The top 3 academic criteria in order of decreasing importance were the content of recommendation letters, clinical grades, and letter writers, whereas the top 3 nonacademic criteria were subinternship performance, maturity, and interview performance. Plastic and reconstructive surgery remains a highly competitive specialty for residency applicants. Our findings suggest that Alpha Omega Alpha membership remains diminished in importance, whereas USMLE cutoff scores have increased. With recent changes in the step 1 grading system, PDs and APDs will rely more heavily on step 2 scores and the content of recommendation letters.

Statistical fragility of outcomes in acellular dermal matrix literature: A systematic review of randomized controlled trials

BackgroundAcellular dermal matrix (ADM) is commonly utilized in plastic and reconstructive surgery (PRS). With the abundance of randomized controlled trials (RCTs) reporting P-values for ADM outcomes, this study uses the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to evaluate the statistical stability of outcomes in ADM RCTs. MethodsPubMed, Embase, SCOPUS, Medline, and Cochrane databases were reviewed for ADM RCTs (2003-present) reporting a dichotomous, categorical outcome. FI and rFI (event reversals influencing outcome significance) and FQ (standardized fragility) were calculated and reported as median (IQR). Subgroup analysis was performed based on intervention types. ResultsOut of 127 studies screened, 56 RCTs with 579 outcomes were included. The median FI stood at 4 (3 - 5) and FQ was 0.04 (0.03 - 0.07). Only 101 outcomes were statistically significant with a median FI of 3 (1 - 6) and FQ of 0.04 (0.02 - 0.08). The nonsignificant outcomes had a median FI of 4 (3 - 5) and FQ of 0.04 (0.03 - 0.07). Notably, 26% of outcomes had a number of patients lost to follow up equal to or surpassing the FI. By intervention type, the median FIs showed minor fluctuations but remained low. ConclusionsOutcomes from ADM-related RCTs are statistically fragile. Slight outcome reversals or maintaining patient follow-up can alter the significance of results. Therefore, future researchers are recommended to jointly report FI, FQ, and P-values to offer a comprehensive view of the robustness in ADM literature.

Assessing the Readability of Online English and Spanish Language Patient Education Resources Provided by the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgeons, and American Society of Reconstructive Microsurgeons.

The National Institutes of Health recommends that patient education materials (PEMs) be written at the sixth grade level. However, PEMs online are still generally difficult to read. The usefulness of online PEMs depends on their comprehensibility. This study assessed the readability of PEMs from national Plastic and Reconstructive Surgery (PRS) organization websites. Patient education materials were collected from 3 prominent PRS organizations-the American Society of Plastic Surgeons (ASPS), American Society of Aesthetic Plastic Surgeons (ASAPS), and the American Society of Reconstructive Microsurgeons (ASRM). ASPS PEMs were organized into reconstructive and cosmetic groups, and then further subdivided into English and Spanish subgroups. ASAPS and ASRM PEMs provided cosmetic and reconstructive comparison groups to ASPS, respectively. Readability scores were generated using the Simple Measure of Gobbledygook (SMOG) and the Spanish SMOG scales. Overall, all PEMs failed to meet readability guidelines. Within ASPS, Spanish PEMs were easier to read than English PEMs ( P < 0.001), and cosmetic PEMs were easier to read than reconstructive PEMs ( P < 0.05). There was no significant difference between ASPS cosmetic and ASAPS PEMs ( P = 0.36), nor between ASPS reconstructive and ASRM PEMs ( P = 0.65). ASAPS and ASRM did not have any Spanish PEMs, and 92% of all ASPS PEMs were in English. Although PRS societies strive to better educate the public on the scope of PRS, PRS ranks lowly in public understanding of its role in patient care. In addition, Spanish language PEMs from the 3 PRS organizations are severely lacking. Addressing these concerns will make online patient resources more equitable for various patient populations.

Examining Racial and Gender Diversity in the Plastic Surgery Pipeline: Where is the Leak?

There is limited information about minority representation throughout the plastic and reconstructive surgery (PRS) pipeline. The aim of this study was to examine trends in representation among minorities at different stages of the PRS training pathway, starting with potential candidates in high school through practicing physicians. The PRS pipeline was defined as high school; college; medical school applicants, matriculants, and graduates; PRS residency applicants, matriculants, and active residents; and PRS practicing physicians. Racial data for each stage were obtained from the US Census and Association of American Medical Colleges. The proportion of races at each stage were divided by their US population counterpart proportions to produce representation quotients (RQs). Medians and interquartile ranges (IQRs) are reported. Mann-Whitney U tests compared RQ values within identities between successive stages. Black students had high representation in high school (RQ = 1.26 [IQR: 1.21-1.29]) but had significant, stepwise decreases in representation in subsequent stages. A similar trend was observed for Hispanic individuals, who had their highest representation in high school (1.43 [1.37-1.50]), followed by significant decreases in RQ at nearly every subsequent stage up to and including practicing physicians (0.30 [0.28-0.31). Asian individuals were overrepresented at every stage (high school RQ: 1.01 [1.00-1.03]; practicing physician RQ: 2.30 [2.27-2.32]). White individuals were underrepresented before residency but had an RQ that approximated 1 in subsequent stages. Racial minorities experienced decreases in representation at each successive stage in the PRS pipeline following high school. Ongoing diversity efforts should focus on premedical recruitment and professional support for minority students.

Plastic Surgery Clinical Trials: A Systematic Review of Characteristics, Research Themes, and Predictors of Publication and Discontinuation

Summary: Clinical trials (CTs) are crucial for evidence-based surgical care. Despite growing interest in plastic and reconstructive surgery (PRS) research, the status of PRS CTs remains unknown. We obtained PRS CTs from ClinicalTrials.gov and WHO’s International Clinical Trials Registry Platform (November 2022). Topic modeling identified research themes and machine learning models generated CT-publication pairs. Kaplan-Meier curves visualized CT discontinuation and nonpublication. Of the 4685 PRS CTs identified, 79% were interventional and 81% recruited adults. Most were single-center-led (67%) and academic-funded (77%). Male investigators led 77% of CTs. Female-only patient CTs outnumbered male-only (31% versus 1%). The United States led with 41% of CTs, followed by France, Canada, and China. Industry-funded CTs were higher in the USA, Germany, and Belgium, and academic-funded in France, Canada, and China. PRS CTs clustered into aesthetics (43%), reconstructive (20%), wound healing (8%), peripheral nerve (6%), tumor excision (5%), craniofacial (5%), perioperative pain (5%), and burns (4%). Industry preferred funding aesthetics, whereas academia and industry co-funded wound healing. Publication rates of completed (24%) and terminated (10%) CTs varied by cluster, with perioperative pain CTs exhibiting higher rates. Industry-funded CTs had lower publication rates (hazard ratio: 0.64, 95% confidence interval: 0.5–0.81) and higher discontinuation (hazard ratio: 1.34, confidence interval: 1.06–1.68) driven by sponsors’ decision to terminate prematurely. Global growth in PRS trialome reflects rising interest in evidence-based plastic surgery. Yet, imbalances in participant age, geography, funding source, and trial design influence likelihood of CT discontinuation and publication. Key research gaps include pediatric CTs, accountability in industry-funded research, and multicenter collaborations with underrepresented regions.

Having Social Media among Integrated Plastic Surgery Applicants: Is It Needed to Match?

Little information exists on the perceptions of integrated plastic and reconstructive surgery (PRS) residency applicants on the need for having social media (SoMe) during the application process. A cross-sectional survey study was conducted during the 2022 match cycle to assess integrated PRS residency applicants' perceptions on the role of SoMe during the match. Univariate and multivariate analyses were performed on variables of interest. Qualitative analysis was conducted on free-form responses. Seventy-nine surveys were completed (response rate: 24%). The majority of respondents were educated in the United States (92%). Instagram was the most commonly used SoMe platform (92%). Of those surveyed, 18% thought that SoMe was beneficial to the application process. Twenty-nine percent of respondents agreed that a SoMe presence increases one's chances of matching into PRS residency (41% disagreed and 30% responded neutrally). Forty-four percent endorsed stress about maintaining a SoMe presence in PRS. Having mentors who recommended maintaining a SoMe presence was associated with the belief that SoMe increases one's chances of matching [odds ratio (OR) 8.1, 95% confidence interval (CI) 1.1-40.4, P = 0.011] and stress about maintaining a SoMe presence (OR 6.3, 95% CI 1.2-33.3, P = 0.030). Applicants who did research years had lower odds of experiencing stress (OR 0.16, 95% CI 0.04-0.70, P = 0.015). The growing role of SoMe in the residency selection process may be exacerbating applicants' stress and anxiety. PRS programs may consider establishing clear policies for how SoMe will be used in evaluating candidates.