Applications In Reconstructive Surgery Research Articles

Artificial Intelligence in plastic surgery: What is it? Where are we now? What is on the horizon?

An increasing quantity of data is required to guide precision medicine and advance future healthcare practices, but current analytical methods often become overwhelmed. Artificial intelligence (AI) provides a promising solution. Plastic surgery is an innovative surgical specialty expected to implement AI into current and future practices. It is important for all plastic surgeons to understand how AI may affect current and future practice, and to recognise its potential limitations. Peer-reviewed published literature and online content were comprehensively reviewed. We report current applications of AI in plastic surgery and possible future applications based on published literature and continuing scientific studies, and detail its potential limitations and ethical considerations. Current machine learning models using convolutional neural networks can evaluate breast mammography and differentiate benign and malignant tumours as accurately as specialist doctors, and motion sensor surgical instruments can collate real-time data to advise intraoperative technical adjustments. Centralised big data portals are expected to collate large datasets to accelerate understanding of disease pathogeneses and best practices. Information obtained using computer vision could guide intraoperative surgical decisions in unprecedented detail and semi-autonomous surgical systems guided by AI algorithms may enable improved surgical outcomes in low- and middle-income countries. Surgeons must collaborate with computer scientists to ensure that AI algorithms inform clinically relevant health objectives and are interpretable. Ethical concerns such as systematic biases causing non-representative conclusions for under-represented patient groups, patient confidentiality and the limitations of AI based on the quality of data input suggests that AI will accompany the plastic surgeon, rather than replace them.

Integrated Plastic Surgery Applicant Review: Important Factors and Selection Criteria

Summary:Matching into integrated plastic surgery residency is highly competitive. Applicants to these programs are among the most accomplished graduating medical students, consistently demonstrating some of the highest United States Medical Licensing Examination scores, mean numbers of research publications, and rates of Alpha Omega Alpha Honor Medical Society membership. The applicant review process requires programs to rely on a number of objective and subjective factors to determine which of these qualified applicants have the most potential for success. We outline these factors, discuss their correlation with resident performance, and provide our institution’s applicant review process both for applicants hoping to optimize their applications for success in the National Resident Matching Program and for program faculty hoping to optimize their resident selection process.

Relevance of Academic Productivity in the Assessment of Integrated Plastic Surgery Applicants

The academic productivity of an integrated plastic surgery applicant is strongly considered during the ranking process but is often difficult to assess. The h-index is a tool that provides an objective measure of both the quality and impact of an author's academic works. The goals of this study were to assess whether the h-index of recently matched plastic surgery interns correlates with their home and eventual residency program characteristics. A database of all 2018 interns in integrated plastic surgery programs was created. The SCOPUS database was queried for the h-indices for each individual. In 2018, 77 integrated plastic surgery programs offered a total of 168 PGY1 positions; data was able to be obtained for 131 individuals. The mean h-index was 1.26 (range 0-14), with a mean of 4.22 publications (range 0-58). The h-index increased in concordance with overall number of publications. The h-index of applicants matching at Top 50 NIH Funded institutions had a significantly higher h-index (1.57) compared to those that matched to all other institutions (0.76) (p<0.05). Applicants matching at a "top 20" program as determined by Doximity reputation rankings also had a significantly higher h-index (1.96) compared to those matching at all other programs (0.83) (p< 0.05). The h-index of recently matched integrated plastic surgery interns correlates with several factors including program reputation and level of NIH funding. As applicants become increasingly well-qualified and the number of the publications increases commensurately, programs that place an emphasis on academic productivity may consider incorporating the h-index into their evaluation.

Global Pandemics and the Aspiring Plastic Surgery Applicant: Challenges and Potential Solutions.

Global Pandemics and the Aspiring Plastic Surgery Applicant: Challenges and Potential Solutions.

Three-dimensional visualization of blood supply of the upper lip using micro-CT and implications for plastic surgery.

The anatomy of the arterial branches in the upper lip and their relationships to soft tissue are not well described in the literature. The purpose of this study was to explore a method for visualizing the microvessels and soft tissue three-dimensionally to gain better understanding of the upper lip blood supply. Seventeen stillborn fetuses were injected with lead oxide-gelatin and stained with iodine. Thirty-four half upper lip specimens were obtained and scanned by micro-computed tomography. The images were then examined and Inveon analysis software was used for three-dimensional reconstructions. The main supplies to the upper lip were from the superior labial and inferior alar arteries. In some cases, the infraorbital and lateral nasal arteries also branched off to the upper lip. The anatomical variations were classified into six types on the basis of the observed vascular composition patterns. The skin was supplied by the subcutaneous vascular network, formed by the superficial ascending branches of the superior labial and inferior alar arteries. The mucosa was supplied by the submucosal vascular network, formed by the deep ascending branches of the superior labial artery and the labial branches of the infraorbital artery. The muscles were supplied by small vertical branches from the subcutaneous and submucosal vascular networks. This study provides new anatomical insight into the upper lip by describing the microvessels and the relationship between the arteries and the soft tissue involved. This is important information for clinical applications in upper lip plastic surgery.

Mammalian Pericardium-Based Bioprosthetic Materials in Xenotransplantation and Tissue Engineering.

Bioprosthetic materials based on mammalian pericardium tissue are the gold standard in reconstructive surgery. Their application range covers repair of rectovaginal septum defects, abdominoplastics, urethroplasty, duraplastics, maxillofacial, ophthalmic, thoracic and cardiovascular reconstruction, etc. However, a number of factors contribute to the success of their integration into the host tissue including structural organization, mechanical strength, biocompatibility, immunogenicity, surface chemistry, and biodegradability. In order to improve the material's properties, various strategies are developed, such as decellularization, crosslinking, and detoxification. In this review, the existing issues and long-term achievements in the development of bioprosthetic materials based on the mammalian pericardium tissue, aimed at a wide-spectrum application in reconstructive surgery are analyzed. The basic technical approaches to preparation of biocompatible forms providing continuous functioning, optimization of biomechanical and functional properties, and clinical applicability are described.

Resident Behaviours to Prioritize According to Canadian Plastic Surgeons.

Many articles have been published outlining the resident selection process for plastic surgery training programs. However, which qualities Canadian plastic surgeons value most in their current residents remains unclear. A national survey study was conducted to identify which attributes surgeons associate with the highest resident performance and which behaviours trainees should prioritize during their training. A literature review was performed to identify studies that documented attributes valued in plastic surgery applicants and characteristics of high-performing surgical residents. These qualities were extracted to construct a survey consisting of both ranking and open-ended questions. After an iterative review process, the survey was disseminated nationally to consultants and trainees of Canadian plastic surgery training programs. Survey responses were obtained from 120 invitees and a weighted rank was calculated for each evaluated attribute. The terms integrity, professional, and work ethic were viewed as the most important attributes prized by surgeons. Dishonesty, lack of dependability, and unprofessionalism were viewed as the most concerning behaviours. Additionally, disinterest and arrogance were identified by the open-ended questions as behaviours surgeons would like to see less frequently in their trainees. When compared to surgeons, trainees undervalued the importance of knowledge and the impact of unprofessional behaviour. With the multiple roles that a resident must fulfill, understanding which attributes are of the most importance will help focus self-directed learning and development within residency programs. Ultimately, instilling the importance of integrity and professionalism is most highly valued by members of the Canadian plastic surgery community.

Autologous platelet concentrates in maxillofacial regenerative therapy.

Platelet concentrates have emerged as innovative autologous blood products that enhance tissue healing and regeneration in regenerative therapy. A common feature of these products is their higher than baseline platelet concentration, which improves wound healing and tissue repair. Four main categories of products can be easily defined, based on their leukocyte content and fibrin architecture: pure platelet-rich plasma, such as Cell Separator PRP or Anitua' PRGF; leukocyte- and platelet-rich plasma (L-PRP), such as PCCS or Ace PRP; pure platelet-rich fibrin (P-PRF), such as Fibrinet PRFM; and leukocyte- and platelet-rich fibrin (L-PRF), such as Choukroun's PRF. Two families contain significant concentrations of leukocytes: L-PRP and L-PRF. These four families of products have different biological signatures and mechanisms and obviously different clinical applications. An L-PRF membrane releases growth factors and matrix proteins over a period longer than 7 days, whereas a PRP gel matrix releases and disperses its growth factors in a relatively quick download. In the near future, simple and inexpensive products such as L-PRF are expected to have applications in oral-maxillofacial surgery, periodontal surgery, plastic surgery, orthopedic surgery, and sports medicine. Leukocytes substantially affect the intrinsic biology and properties of platelet concentrates, not only because they enhance immune function and antibacterial potential, but also because they have essential roles in the wound healing process. Unfortunately, their impact has been almost completely neglected in the literature. Improved understanding of the effects of leukocytes in wound healing is essential for development of new clinical applications of platelet concentrates.

Applied Deep Learning in Plastic Surgery: Classifying Rhinoplasty With a Mobile App.

Advances in deep learning (DL) have been transformative in computer vision and natural language processing, as well as in healthcare. The authors present a novel application of DL to plastic surgery. Here, the authors describe and demonstrate the mobile deployment of a deep neural network that predicts rhinoplasty status, assess model accuracy compared to surgeons, and describe future directions for such applications in plastic surgery. A deep convolutional neural network ("RhinoNet") was developed to classify rhinoplasty images using only pixels and rhinoplasty status labels ("before"/"after") as inputs. RhinoNet was trained using a dataset of 22,686 before and after photos which were collected from publicly available sites. Network classification was compared to that of plastic surgery attendings and residents on 2269 previously-unseen test-set images. RhinoNet correctly predicted rhinoplasty status in 85% of the test-set images. Sensitivity and specificity of model predictions were 0.840 (0.79-0.89) and 0.826 (0.77-0.88), respectively; the corresponding values for expert consensus predictions were 0.814 (0.76-0.87) and 0.867 (0.82-0.91). RhinoNet and humans performed with effectively equivalent accuracy in this classification task. The authors describe the development of DL applications to identify the presence of superficial surgical procedures solely from images and labels. DL is especially well suited for unstructured, high-fidelity visual and auditory data that does not lend itself to classical statistical analysis, and may be deployed as mobile applications for potentially unbridled use, so the authors expect DL to play a key role in many areas of plastic surgery.

Trends in Academic "Ghost Publications" in Plastic Surgery Residency Applications: A 3-Year Study.

Background:Plastic surgery is an attractive specialty to medical students. Residency training programs have the luxury of selecting their trainees from the “cream of the crop” from United States medical schools. Because of the steep competition for PGY-1 integrated program positions, the temptation exists for applicants to falsify parts of their applications, particularly those parts that are difficult to verify.Methods:A retrospective analysis of the Integrated Plastic Surgery applications from the years (2010–2013) was done. Two reviewers manually and independently handsearched each of the articles in the databases (Medline, Scopus, Clinical trials, Google scholar) additionally, a specialized medical librarian corroborated. A ghost article was defined as the inability to find the listed applicant in the authorship list of the claimed article/abstract/chapter or the inability to find the submitted article. Misrepresentation was defined as a change in authorship order. Data were summarized and analyzed, generalized estimating equations model was used. SAS software, v9.4.Results:All 392 applicants were included, 159 (2010–2011), 120 (2011–2012), and 119 (2012–2013). The number of manually reviewed records was 2,124. “Ghost” authorship was found in 234 articles out of 2,124 (11.02%). The overall rate of “Ghost” authorship in applicants to our program was found to be 34.4%, 135 applicants and misrepresentation in 5 cases (1.28%).Conclusions:Ghost publications are present in Plastic Surgery applications, its trend is similar through the years, “protective” factors are: first authorship and published peer reviewed abstract/article.

Application of cone-beam computed tomography in ENT and reconstructive surgery of head and neck – literature review and own experience

Cone-beam computed tomography (CBCT) is a relatively new diagnostic imaging method. It was first used in 1982 at the Mayo Clinic Biodynamics Research Laboratory [1], and since 2001 is commercially used in dentistry. In differs from multidetector computed tomography in terms of implementation technique and some parameters. A low dose of radiation is its greatest advantage, thanks to which many specialists, including ENT doctors and reconstructive surgeons, are more willing to use it. In otorhinolaryngology, CBCT is applied in pre- and peri-operative diagnostics in both rhinology and otology. In reconstructive surgery, CBCT facilitates precise planning of the flap, and intraoperatively allows a perfect match of the reconstructed tissue elements. In the article, the authors present current information on CBCT in ENT obtained on the basis of a review of Polish and foreign literature and share their own experience in its application in reconstructive surgery within the craniofacial region.

Biosynthesis of size-controlled gold nanoparticles using M. lucida leaf extract and their penetration studies on human skin for plastic surgery applications

Recently, majority of the studies were focusing on the nanoparticles (NPs) and their abilities of penetrating Stratum Corneum (SC), as they can be prominently utilized in the plastic surgeries. In the current work, we demonstrated the penetrating abilities of gold NPs (AuNPs) through anthropological skin with diameters of 10 and 15 nm, varying in sizes, with the help of Multiphoton Microscopy. In addition, we also demonstrated a rapid facile environment friendly process of synthesizing AuNPs of adjustable sizes with the help of aqueous M. lucida leaf extract. Surface plasmon resonance was performed to confirm the synthesis of AuNPs at 530 nm with the help of UV–vis spectrophotometer. By differentiating the quantities of M. lucida leaf aqueous extracts, we studied the reduction time, morphological differences and size of the AuNPs. By performing Fourier Transformation Infrared Spectroscopy (FTIR), UV–vis spectroscopy, Transmission Electron Microscopy (TEM), Powder X-ray Diffraction (XRD), Energy Dispersive X-ray Spectroscopy (EDAX) and Selected Area Electron Diffraction (SAED), we characterized the fabricated AuNPs. The further aggregation and growth of AuNPs was protected by the polyphenols in the oxidised form by having a coordination with the surface of AuNPs. Moreover, the experiments of skin penetration showed an effort to deeply examine the factors leading to the penetration of particles into the human skin. These responses indicate that NPs at the determined size ranges penetrate the SC in the same pattern of the drug molecules, mostly by the intercellular paths. These responses attained were essential for developing a unique transdermal transporter as well as for understanding the basic interaction of skin–NPs for the application of plastic surgeries.

The Independent Plastic Surgery Match (2010-2018): Applicant and Program Trends, Predictors of a Successful Match, and Future Directions

Changes were made to the independent plastic surgery residency in 2009 to 2010 that included full prerequisite training and increased from 2 to 3 years of independent residency. The authors sought to determine subsequent match trends and predictors of a successful match. With American Council of Academic Plastic Surgeons approval, the San Francisco Match provided data for the independent match (2010-2018). Trends in the independent plastic surgery were reviewed. Applicant variables were analyzed to determine correlation with a successful match and a match at top-ranked programs using Doximity Residency Navigator. Total independent applicants per cycle decreased 18% while foreign medical school applicants increased from 19.4% to 27%. Available positions decreased from 97 to 66 (32%) and match rate decreased from 82% to 78%. Applicants who matched were from US medical schools, had higher USMLE Step 1 scores, were from University and top General surgery residencies, and averaged more interviews (p < 0.05). By multivariate regression, number of interviews completed (odds ratio [OR] 15.35 95% confidence interval [CI] 7.7-30.6, p < 0.001) and having completed prerequisite training at a university based program in addition to having graduated from an allopathic medical school (OR 1.78 95% CI 1.1-2.97, p = 0.027) were predictive of a successful match. Step 1 score ≥ 240 (OR 3.2, 95% CI 1.0-10.2, p = 0.046), Alpha Omega Alpha membership (OR 2.2, 95% CI 1.1-4.9, p = 0.048), and having completed prerequisite training at the same institution (7.6, 95% CI 2.2-25.7, p < 0.001) were predictive of matching at top-ranked programs. Since 2010, independent plastic surgery applicant and program participation have decreased. Greater number of interviews, university-based prerequisite training, and allopathic medical school background are variables that correlate with a successful match. Factors predictive of a match at top-ranked Doximity Residency Navigator plastic surgery programs include high Step 1 scores, Alpha Omega Alpha membership, and prerequisite training at the same institution.

Acellular Dermal Matrices: Applications in Plastic Surgery.

Modern advances in tissue engineering have transformed the plastic surgeon's management strategies across a wide variety of applications. Comprehension of the fundamentals of biologic constructs is critical to navigating the available armamentarium. It is essential that plastic surgeons become familiar with some of the existing methods for utilizing biologics as well as the advantages and limitations to their use. In this article, the authors describe the basic science of biologics with a focus on acellular dermal matrices (ADMs), and review the recent evidence behind their use for a variety of reconstructive and aesthetic purposes. The review is organized by system and examines the common indications, techniques, and outcomes pertaining to the application of ADMs in select anatomic areas. The final section briefly considers possible future directions for using biologics in plastic and reconstructive surgery.

Bone Grafts, Bone Substitutes, and Orthobiologics: Applications in Plastic Surgery.

As reconstructive needs often extend past the soft tissue alone, a plastic surgeon must also be well versed in the methods of bony reconstruction. Understanding of the basic science of fracture healing and the biochemical mechanisms of the different bone grafts, bone substitutes, and orthobiologics is essential to selecting among the many different options available to the modern plastic surgeon. This review provides a broad overview of these different options and the specific applications for plastic surgeons based on anatomic location.

The evolving roles of computer-based technology and smartphone applications in facial plastic surgery

This article aims to provide a comprehensive review of the established and emerging applications of various computer-based technologies and smartphone applications in the field of facial plastic surgery. Computer-based technologies and smartphone applications have widespread utility across various domains of facial plastic surgery; these include preoperative consultation, surgical planning, intraoperative navigation, custom implant creation, postoperative assessment, physician productivity, communication, and education. Smartphone applications are being utilized for assessment of patients such as those with facial paralysis. Three-dimensional (3D) imaging and 3D printing has influenced preoperative counseling, surgical planning, and execution. The incorporation of intraoperative navigation has the potential to improve the accuracy and precision of facial reconstruction. Current advances in computer-based technology have made a significant impact on the practice of facial plastic and reconstructive surgery. These technological advances have influenced how we counsel patients, perform procedures, assess outcomes, and learn new techniques.

Safety and Efficacy of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) in Craniofacial Surgery.

Introduction:Recombinant human bone morphogenetic protein-2 (rhBMP-2) is one of the most commonly used osteogenic agents in the craniofacial skeleton. This study reviews the safety and efficacy of rhBMP-2 as applied to craniofacial reconstruction and assesses the level of scientific evidence currently available.Methods:An extensive literature search was conducted. Randomized controlled trials (RCTs), case series and reports in the English language as well as Food and Drug Administration reports were reviewed. Studies were graded using the Oxford Center for Evidence-Based Medicine Levels of Evidence Scale. Data heterogeneity precluded quantitative analysis.Results:Seventeen RCTs (Levels of evidence: Ib-IIb) were identified evaluating the use of rhBMP-2 in maxillary sinus, alveolar ridge, alveolar cleft, or cranial defect reconstruction (sample size: 7–160; age: 8–75 years). Study designs varied in rigor, with follow-up ranging 3–36 months, and outcome assessment relying on clinical exam, radiology, and/or histology. There was wide variation in rhBMP-2 concentrations, carriers, and controls. Most studies evaluating rhBMP-2 for cranial defect closure, mandibular reconstruction, or distraction osteogenesis consisted of retrospective cohorts and case reports. The evidence fails to support RhBMP-2 use in maxillary sinus wall augmentation, calvarial reconstruction, mandibular reconstruction, or distraction osteogenesis. RhBMP-2 may be effective in alveolar reconstruction in adults, but is associated with increased postoperative edema.Conclusions:A risk–benefit ratio favoring rhBMP-2 over alternative substitutes remains to be demonstrated for most applications in plastic and reconstructive surgery. Long-term data on craniofacial growth is lacking, and using rhBMP-2 in patients younger than 18 years remains off-label.

Substrate mechanics controls adipogenesis through YAP phosphorylation by dictating cell spreading

The mechanoregulated proteins YAP/TAZ are involved in the adipogenic/osteogenic switch of mesenchymal stem cells (MSCs).MSC fate decision can be unbalanced by controlling substrate mechanics, in turn altering the transmission of tension through cell cytoskeleton. MSCs have been proposed for orthopedic and reconstructive surgery applications. Thus, a tight control of their adipogenic potential is required in order to avoid their drifting towards fat tissue. Substrate mechanics has been shown to drive MSC commitment and to regulate YAP/TAZ protein shuttling and turnover. The mechanism by which YAP/TAZ co-transcriptional activity is mechanically regulated during MSC fate acquisition is still debated.Here, we design few bioengineering tools suited to disentangle the contribution of mechanical from biological stimuli to MSC adipogenesis. We demonstrate that the mechanical repression of YAP happens through its phosphorylation, is purely mediated by cell spreading downstream of substrate mechanics as dictated by dimensionality. YAP repression is sufficient to prompt MSC adipogenesis, regardless of a permissive biological environment, TEAD nuclear presence or focal adhesion stabilization.Finally, by harnessing the potential of YAP mechanical regulation, we propose a practical example of the exploitation of adipogenic transdifferentiation in tumors.

Smartphone Applications in Plastic Surgery: A Cross-Sectional Survey of 577 Plastic Surgeons, Fellows, Residents, and Medical Students.

There are now over 2.2 million mobile applications (apps) in existence, with more than 250 identifiable by searching "plastic surgery." Unfortunately, only 30% of these are academically relevant, which makes finding useful plastic surgery apps both challenging and inefficient. The authors sought to evaluate the use of digital resources and awareness of available apps within plastic surgery to improve their clinical/educational utilization. An extensive search of the Apple and Android databases was performed to identify all relevant plastic surgery apps. An American Society of Plastic Surgeons-sponsored survey was distributed to a random cohort of American Society of Plastic Surgeons members (practicing surgeons, fellows, and residents) and students applying to an integrated plastic surgery residency. The survey queried utilization of resources to access medical information and awareness of apps relevant to clinical/educational plastic surgery. A total 153 relevant applications were identified between the Apple iTunes and Google Play stores. Of the 577 respondents (273 practicing surgeons, 117 residents, 11 fellows, and 177 medical students), 99.31% own a smartphone/tablet. Furthermore, medical students and residents/fellows utilized both smartphones and computers more frequently than practicing physicians (P < 0.0001 and P = 0.0022, respectively). Digital resources were also utilized more frequently than printed material (P < 0.00001). For app awareness, 82.1% of respondents reported knowing of fewer than 10 apps relevant to plastic surgery, and only 8.41% were aware of more than 20. Smartphone usage is nearly ubiquitous among plastic surgeons, and most utilize these devices daily to access medical information. However, awareness of the many available and relevant plastic surgery apps is extremely limited.

Matching into Integrated Plastic Surgery: The Value of Research Fellowships.

Integrated plastic surgery residency applicants sometimes complete research fellowships before residency. The average productivity and the impact of these fellowships on subsequent application to residency are unknown. The purpose of this study was to provide objective data to better understand the utility and productivity of a research fellowship. A national survey was conducted in which integrated plastic surgery residency applicants from 2013 to 2016 were surveyed regarding their experiences with research fellowships. American Council of Academic Plastic Surgeons members were also surveyed to elicit their perspectives on the value of these fellowships. Six hundred twenty-one integrated plastic surgery applicants from 2013 to 2016 were included in the study. Twenty-five percent of applicants participated in a research fellowship. Applicants who completed research fellowships were more likely to match into plastic surgery compared to those who did not (97 percent versus 81 percent, respectively; p < 0.05). Fellows were highly satisfied with their fellowship experience and produced an average of five publications and presentations per fellowship year. Sixty-three percent of research fellowships were performed to strengthen applications to categorical integrated plastic surgery residency. American Council of Academic Plastic Surgeons members considered three or four publications/presentations productive. Most do not recommend research fellowships to all medical students. Research fellowships can effectively prepare for categorical plastic surgery by improving publication and presentation experience. This is the first study to show that applicants who completed research fellowships were highly satisfied with their experience, accomplished higher than expected levels of productivity, and statistically significantly matched into an integrated plastic surgery residency more often than applicants without research fellowships.