Plastic Surgery Research Research Articles

Going Viral: A Systematic Review of Google Trends in Plastic Surgery and a Recommended Framework for Its Use.

As the leading global search engine with billions of daily queries, Google and its open-source Google Trends (Google, Mountain View, CA) represent an emerging and powerful tool for epidemiological and medical research. Within the field of plastic surgery, Google Trends has yielded insights into online interest for facial feminization surgery, gender-affirmation surgery, cosmetic body procedures, and breast reconstruction, among other common procedures. The existing literature of Google Trends in plastic surgery was systematically reviewed following established Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Google Trends' 4 input variables-keyword, region, period, and category-were assessed. Seventeen plastic surgery studies employing Google Trends were reviewed. There was strong inter-rater reliability (Cohen's kappa = 0.68). Analyzing keyword syntax, only 3 of 17 studies (17.6%) used the "+" function to combine terms, which can significantly improve sensitivity. For the region variable, 12 of 16 studies (75%) conducted worldwide searches; yet, none of the studies used any non-English keywords, introducing significant bias. For the period, 88.2% of studies utilized a timespan of greater than 5 years, resulting in monthly intervals between data points in Google Trends. For the "category" variable, none of the studies appear to have employed the "surgery," "cosmetic surgery" or "health" categories to improve specificity. Google Trends is presented as an emerging methodology in plastic surgery research. The strengths and limitations of Google Trends as a resource for plastic surgeons and medical professionals are discussed, and a recommended step-by-step guide for conducting and interpreting Google Trends research is outlined.

Quality of Patient-Reported Outcome Studies Utilizing the BREAST-Q: A Systematic Review.

Patient-reported outcome (PRO) studies are essential in the assessment of surgical procedures in plastic surgery. One accepted and validated questionnaire is the BREAST-Q. The aim of this study was to assess the quality of PRO studies in plastic surgery utilizing the BREAST-Q questionnaire. This study involved 2 steps: (1) a systematic review of 23 key criteria assessing the quality of survey research in studies utilizing the BREAST-Q that were published between 2015 and 2018; (2) a review of current guidance for survey research in journals related to plastic surgery and breast surgery which were included in the systematic review. Seventy-nine studies were included in the systematic review. Many key criteria were poorly reported: 51.9% of the studies did not provide a defined response rate and almost 90% did not provide a method for analysis of nonresponse error; 67.1% lacked a description of the sample's representativeness of the population of interest, and 82.3% did not present a sample size calculation. The methods used to analyze data were not described in 11.4% of the papers; in 27.8% the data analysis presented could not allow replication of the results. Of the 16 journals in the fields of plastic surgery and breast surgery for which the "instructions to authors" were reviewed, 15 (93.7%) did not provide any guidance for survey reporting. The majority of key criteria are underreported by authors publishing their survey research in peer-reviewed journals in the fields of plastic and breast surgery. There is an urgent need to construct well-developed reporting guidelines for survey research in plastic surgery, and particularly in breast surgery.

Comparing Surgical Site Occurrences in 1 versus 2-stage Breast Reconstruction via Federated EMR Network.

Background:TriNetX (TriNetX Inc., Cambridge, Mass.) is a federated electronic medical record network. The TriNetX system conducts customized search queries of over 36 million electronic medical records, and returns results in just minutes. To our group’s knowledge, TriNetX has not been previously used in plastic surgery research. This study aimed to utilize a continuously updated federated network of 36,000,000 electronic medical records (TriNetX) for comparing 90-day postoperative outcomes between prosthetic breast reconstruction techniques.Methods:Using TriNetX, we analyzed the records of approximately 36 million patients in 31 health care organizations. The de-identified records of 18,744,519 women (age 18–9) were retrospectively screened. A cohort of 4747 patients with a diagnosis of malignant neoplasm of the breast, any stage, having undergone mastectomy, and breast reconstruction with tissue expander was compared with a second cohort of 870 patients diagnosed with malignant neoplasm of the breast, any stage, mastectomy, and immediate insertion of breast implant following mastectomy. Surgical site occurrences occurring within 90 days postoperatively were compared using propensity score matching.Results:Propensity score matching resulted in 870 patients in both well-balanced cohorts. There were no statistically significant differences between the balanced cohorts with respect to 90-day surgical site occurrences.Conclusions:TriNetX enables data-driven clinical research such as retrospective cohort comparison. During the 90-day postoperative period, there were fewer complications noted in the single-stage cohort for all outcomes studied; although this comparison was not statistically significant, we believe it demonstrates a clinically significant finding that single-stage direct-to-implant is at least as safe as the more complicated 2-stage approach.

Majority of Most-Cited Articles in Top Plastic Surgery Journals Do Not Receive Funding.

Plastic surgery faculty, residencies, and institutions are frequently judged on the quantity and quality of their research output. Some of the most impressive individuals in the specialty receive financial support in the form of grants and payments to help with research ideas. The authors sought to discern if funding directly correlates to greater impact in the top plastic surgery journals as measured by citations. Using the Web of Science database, the authors identified the 50 most-cited articles in each of the top plastic surgery journals from January 1975 to August 2020. The articles were scanned for funding sources and categorized as industry, federal, foundational, and institutional, while stratifying by decade. Between 16 journals, 13.3% of the most-cited articles received funding, 2.6% of which came from industry, 5.4% from government, 4.4% from foundations, and 0.86% from institutions. The percentage of most-cited articles and the proportion that received funding were both correlated with decade (P = 0.0017 and P = 0.043, respectively). However, only the percentage of articles was found to significantly increase over time (P = 0.0068). Although funding leads to meaningful publications, this study showed that financial support is not required to have an influence in plastic surgery research.

Editorial introductions

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Didier A. MandelbrotDidier A. MandelbrotDr Mandelbrot is currently Medical Director of Kidney and Pancreas Transplantation at UW Health and Professor of Medicine at the University of Wisconsin School of Medicine. He was an undergraduate at Harvard College, medical student at the University of Pennsylvania, resident in Medicine at the Hospital of the University of Pennsylvania, and renal fellow at Brigham and Women's Hospital. He has a background in basic transplant immunology and a longstanding interest in the diagnosis and treatment of solid organ rejection. He has participated in numerous single and multi-center clinical trials in kidney transplantation, and has published almost 200 papers and chapters. He has made important contributions on the role of donor-specific antibodies in the context of kidney transplantation, pancreas transplantation and simultaneous liver-kidney transplantation. He also has a particular interest in living kidney donation, and has been active in describing and improving practices in the US. He was co-PI of the NIH-funded Kidney Donor Outcomes Cohort study and recently finished serving as Chair of the American Society of Transplantation's Living Donor Community of Practice. He is currently a member of the United Network of Organ Sharing Medical and Professional Standards Committee, the American Transplant Congress Program Planning Committee, and the Medical Board of the National Kidney Registry. He is an Associate Editor of Clinical Transplantation. Maria SiemionowMaria SiemionowDr Siemionow, a world-renowned scientist and microsurgeon, is Professor of Orthopedics and Director of Microsurgery Research at The University of Illinois at Chicago. She specializes in microsurgery, hand surgery, peripheral nerve surgery, transplantation, and microsurgery research. She is pioneering development of new technology for minimal immunosuppression in transplantation and enhancement of nerve and muscle regeneration. She served as a President of the American Society for Reconstructive Transplantation, President of the International Hand and Composite Tissue Allotransplantation Society and President of the American Society for Peripheral Nerve. She is a member of the academic-industry team, Warrior Restoration Consortium, focusing on development of clinical therapies and new technologies for wounded soldiers as part of the second phase of the Armed Forces Institute for Regenerative Medicine (AFIRM II). She has received numerous honors, including high praise as Principal Investigator for the world's first IRB approval for Facial Allograft Transplantation protocol; in 2008, she led the team that performed the first near-total face transplantation in the United States. Dr Siemionow has over 330 scientific publications. She has edited three plastic surgery textbooks, two popular science books, and has contributed to over 120 published book chapters. Dr Siemionow received numerous awards including the Polish Order of Merit (2009), the Commander's Cross Polonia Restituta Award from the President of Poland (2009), the Outstanding Achievement in Clinical Research Award from the Plastic Surgery Educational Foundation (2010); the 2011 American Society of Plastic Surgeons’ Board of Trustees Special Achievement Award and Casimir Funk National Science Award (2013). In 2014 she received the Great Immigrants Award from the Carnegie Foundation of New York. In 2016 Dr Siemionow was awarded the Heritage Award granted by the Polish American Congress. In 2019 she received Golden Otis Award. Prior to her UIC appointment, she was Director of Plastic Surgery Research and Head of Microsurgical Training for Cleveland Clinic's Department of Plastic Surgery. Jeffery A. KahnJeffery A. KahnDr Jeffrey A. Kahn completed his undergraduate training at the University at Albany, State University of New York, medical school training at the State University of New York, Upstate Medical University and internal medicine residency at Emory University. He then went on to fellowship training in gastroenterology at the University of Southern California and transplant hepatology training at Cedars Sinai-Sinai Medical Center. He has been the medical director of the Keck School of Medicine of USC Liver Transplant Program since 2011, with a special interest in living donor liver transplantation and transfusion-free liver transplantation. His research interests include liver transplant waitlist disparities, liver transplant outcomes and has ongoing translational research related to occult hepatitis C infection.

Globalization of Plastic and Reconstructive Surgery: A Continent, Country, and State-Level Analysis of Publications.

Background:Over the past decade, there has been a worldwide increase in plastic and reconstructive surgery research as well as increased interest in global collaboration. However, little is known about who is contributing to this global expansion or the trends of individual countries. The aim of our study was to analyze the output of Plastic and Reconstructive Surgery (PRS) over a decade to elucidate trends in the plastic surgery field.Methods:The country of origin for all first authors of articles published by PRS from 2010 to 2019 were determined and date extracted using PubMed2XL. The change in frequency of publications over the decade by country, continental contributions, as well as state-level analysis within the United States were analyzed.Results:From 2010 to 2019, there were a total number of 8680 publications with an increase in total articles from 747 to 1049 per year. 54 countries contributed over the decade, with the United States producing the most followed by Italy, China, Canada, and the UK. The top producing states were Texas, New York, California, Massachusetts, and Pennsylvania.Conclusions:The last decade (2010–2019) saw a large international increase in research, not only with the total number of publications, but also in the diversity of originating country. Our work shows a shift away from a US-focused journal to incorporate more work from our international colleagues, as research is conducted in centers across the globe.

Analysis of Alternative Metrics of Research Impact: A Correlation Comparison between Altmetric Attention Scores and Traditional Bibliometrics among Plastic Surgery Research.

Scholarly output has typically been measured by citation-based metrics such as the Hirsch index (h-index). The Altmetric Attention Score has emerged as a substitute to measure digital attention given to a project. This study aims to determine whether there is any correlation between h-index and the Altmetric score in the plastic surgery literature. Article metrics (full-text views, abstract views, PDF downloads, times e-mailed, Altmetric Attention Score, times tweeted, and number of citations by posts) were extracted from articles published in Plastic and Reconstructive Surgery over a 2-year period. Author metrics, including h5-index, were also collected. Pairwise correlations were performed using Spearman's rank correlation coefficient (r). A total of 1668 articles were published, with 971 included. Altmetric Attention Scores showed strong correlation with other article metrics (r = 0.48 to 0.97; p < 0.001) but weak correlation with h5-index (r = 0.14; p < 0.001) and sum of times cited without self-citation (r = 0.14; p < 0.001). It did not correlate with total publications, average citations per item, or sum of times cited. The h5-indexes showed strong positive correlation with other author bibliometrics (r = 0.66 to 0.97; p < 0.001); moderate correlation with times e-mailed (r = 0.41; p < 0.001); weak correlation with number of citations by posts (r = 0.10; p = 0.002); and no correlation with full-text views, abstract views, PDF downloads, and times tweeted. The Altmetric Attention Score and conventional senior author bibliometrics have weak positive correlation at best and appear to have distinct but complementary roles in measuring scholarly output.

Discussion: Analysis of Alternative Metrics of Research Impact: A Correlation Comparison between Altmetric Attention Scores and Traditional Bibliometrics among Plastic Surgery Research.

Fan, Kenneth L. M.D.; Dekker, Paige B.A.; Song, David H. M.D., M.B.A. Author Information

From presentation to publication: an 11-year comparison of aesthetic and reconstructive surgery research among Chilean plastic surgeons

The transition from a presentation in a scientific conference to publication in an academic journal should be the ideal journey for a research project. This phenomenon is summarized in a conversion rate, which has been previously reported in the literature. The aim of this study was to determine the characteristics and conversion rate of Chilean authors’ aesthetic and reconstructive research projects in a nationwide study. Conference abstracts from the two official Chilean plastic surgery meetings released between 2008 and 2018 were analyzed. A bibliographic search of all published articles involving each Chilean plastic surgeon followed. This information was cross-referenced to obtain the conversion rates and time to publication for transferred studies. Fisher's exact test and Mann-Whitney test were used to establish statistical associations. Four hundred sixty-eight abstracts were included, and 227 articles were found in our bibliographic search. Of these, 82 were considered to qualify as transferred studies. Aesthetic surgery publications had a higher proportion of prospective design than reconstructive articles (34.6% vs 20.1% (p = 0.02)). Median time to publication was 15 months, with a longer delay for reconstructive articles (19.5 vs 13 (p = 0.035)). The 2008–2016 conversion rate index was 19.2%, which was significantly higher for aesthetic surgery studies (36.4% vs 11.9% (p < 0.001)). Despite a smaller proportion of plastic surgery research being focused on aesthetic topics in our sample, they accounted for higher quality study design, shorter time to publication, and higher overall chances of publication following presentations in local meetings. Level of evidence: Not ratable.

Underrepresentation of Racial Minorities in Breast Surgery Literature: A Call for Increased Diversity and Inclusion.

In this study, the extent of racial diversity in images of breast-related plastic surgery published literature was investigated to better understand disparities that exist in breast surgery. The lack of racial diversity in images of skin color in surgery literature can perpetuate implicit bias and stereotypes. Implicit bias can affect the way patients are evaluated, diagnosed, and treated. The visual aspects of plastic surgery make a lack of diversity in imagery especially impactful on patient care and outcomes. Published medical images and graphics depicting human skin were analyzed across 4 major plastic surgery journals. Up to 4 years were chosen a priori to evaluate from each journal and represented the initial year of color image publication, the year of study initiation (2016), and representative years for a given decade (2000 and 2010). Images and graphics were tabulated, rated by Fitzpatrick scale and categorized into "White" or "non-White." Data were evaluated with pair-wise and linear regression statistics. Of the 2774 images and 353 graphics that met inclusion criteria, only 184 (8.18%) images and 9 graphics (6.34%) depicted non-White skin. Temporal analysis showed that there is an increased diversity of images published since 2010 with 0% of images being non-White before and 7.3% to 10.3% after 2010. International and multi-national authors tended to publish more non-White images. There is insufficient racial diversity visually represented in the breast-related plastic surgery literature with a small degree of progress made towards more equitable imagery over time. Increasing awareness of image content, and the need for equitable visual representation may allow for improved racial diversity in surgical literature.

Impact Factor, h-Index, and Alternative Metrics: How Should We Measure the Impact of Publications in Plastic Surgery?

The prestige of academic journals is largely determined based on impact factor, and the prestige of authors is based on h-indices.1,2 Despite their widespread acceptance, these citation-based metrics have inherent drawbacks, resulting in increasing interest in alternative metrics (altmetrics). Impact factors originated from researchers’ desire to gauge the “scientific prestige” of academic journals.1,3 A measure of the relative frequency with which an “average” article in a journal has been cited, impact factor is calculated by dividing the number of article citations from a particular journal by the number of publications in that journal over a 2-year period (Fig. 1). By design, this formula overvalues large-readership, far-reaching journals and undervalues niche, specialty journals with lower readership—a concern for plastic surgery journals.1,3Fig. 1.: The impact factor equation.The h-index is used to evaluate an individual researcher’s scientific output. It attempts to correlate the quantity of articles an author has published with the number of times those articles have been cited. Drawbacks include the lag of citation of publications of influential work and the limited size of the field in which an author publishes.4 Despite these shortcomings, impact factor and h-index are both heavily used within plastic surgery. A side effect of the “publish or perish” mentality, many authors are willing to pay high prices to have their research published in journals with high impact factors.1 This financial outflux is not unwarranted—having high–impact factor journal publications has been shown to help secure tenure positions, promotions, and committee appointments.3 In addition, h-indices have been cited as crucial to faculty promotion decisions.5 With the questionable relevance of these traditional measures of academic success and their continued emphasis, altmetrics have emerged. Although traditional metrics only account for research shared within the academic community, altmetrics generally account for the fact that—especially within plastic surgery—dissemination of information on the Internet and through social media platforms has risen to prominence, and scientific research is reaching a larger audience than ever before.2 The Altmetric Attention Score tracks mentions of research on platforms such as blogs, news channels, and social media, and then weights each mention to account for each platform’s degree of influence on readers.2 With the increasing popularity of online citation management programs, another altmetric is the Mendeley readership score, which is based on the frequency with which an article is “collected” in users’ personal Mendeley libraries and also accounts for the academic ranks of the researchers “collecting” an article.2 Although critics of altmetrics argue that these measures gauge the impact of research on the general public, not the scientific community, social media directly impact traditional, citation-based metrics. One article found that coverage of medical research in popular media amplifies the number of scientific citations that research receives for at least 10 years thereafter.3 With clear overlap existing between the relevance of both traditional and altmetrics of academic research in plastic surgery (Table 1), it is our view that altmetrics should not replace citation-based metrics, but should be incorporated into the evaluation of journals and of many plastic surgeons’ research prowess. Table 1. - Summary of the Meanings of Impact Factor, h-Index, and Altmetrics Term Definition Impact factor Scientific prestige of a journal, based on relative number of academic citations h-index Scientific prestige of an author, based on relative importance of an author’s publications Altmetrics Alternative citation-based metrics of a journal’s or an author’s scientific prestige; dissemination of scientific articles in nonacademic areas; influence “at large” DISCLOSURE The authors have no financial interests in this document and have received no external support related to this article.

Outcomes Research in Facial Plastic Surgery: A Review and New Directions.

Outcomes research is a fast-growing field of study that focuses on patient-related aspects of medical or surgical outcomes such as satisfaction and quality of life. In the realm of facial plastic surgery, many outcomes are subjective evaluations based on the patient and physician's judgment as to the surgical result, but little has been done to quantify these qualitative results in an objective manner. This paper discusses the basis for outcomes research and suggests its application to the field of facial plastic surgery. Four new facial plastic outcomes instruments have been developed and are provided for the potential use in measuring the quality of life results of rhytidectomy, rhinoplasty, blepharoplasty, and skin rejuvenation procedures.

The New 2019 Institutional Review Board Common Rule Update: Implications for Plastic Surgery Research.

Clinical research remains at the forefront of academic practice and evidence-based medicine. Unfortunately, history has shown that human subjects are vulnerable to experimentation without regard for their own dignity and informed decision-making. Subsequently, it is vital for research institutes to uphold safeguards and ethical conscientiousness toward human subjects. The establishment of federal regulations and the development of institutional review boards have set guidance on these processes. On January 21, 2019, final revisions to the Federal Policy for the Protection of Human Subjects (the "Common Rule") went into effect. The purpose of this article is to review changes to the Common Rule and discuss their impact on plastic surgery research.

Level of Evidence in Facial Plastic Surgery Research: A Procedure-Level Analysis.

As evidence-based medicine has taken hold across medical specialties, the level of evidence within the facial plastic surgery literature has risen, but remains weak in comparison. There has not yet been a systematic, critical appraisal of the relative strength of evidence among subsets of the practice of facial plastic surgery. The current study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature. Five journals were queried using facial plastic surgery terms for four selected years over a 10-year period. Following screening, articles were assigned to a category regarding subject matter, assessed for the presence of various methodological traits, and evaluated for overall level of evidence. Comparisons were made in regard to level of evidence across the breadth of facial plastic surgery subject matter. A total of 826 articles were included for final review. Studies on operative facial rejuvenation and rhinoplasty had significantly fewer authors on average than studies on cancer reconstruction or craniofacial topics. Craniofacial studies demonstrated higher levels of evidence relative to all other categories, with the exception of facial paralysis and facial trauma studies, from which there was no significant difference. In general, reconstructive studies had significantly more authors and higher levels of evidence than did articles with an aesthetic focus. Level of evidence in facial plastic surgery remains relatively weak overall. Reconstructive and particularly craniofacial studies demonstrate higher mean level of evidence, relative to other subsets of facial plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Abstract 64: Chartsweep: A Hipaa-compliant Tool To Automate Chart Review For Plastic Surgery Research

Purpose: Retrospective chart review (RCR) is the process of manual patient data review to answer research questions. Large study populations and heterogeneous data make this a tedious, biased and error-prone process1. The authors therefore designed and developed ChartSweep, a HIPAA-compliant Windows (Microsoft, WA, USA) application leveraging the Python coding language to streamline and expedite the RCR process while remaining faithful to its methodological rigor as outlined by Matt and Matthew. ChartSweep is open-source and can be customized for use with any electronic medical record system as part of any study requiring retrospective chart review. Methods: ChartSweep is a tool developed at the Massachusetts General Hospital. It uses the Selenium Python library to pull information from electronic medical records and securely store it in.csv,.txt,.pdf or.jpeg format. As a proof-of-concept, a retrospective review of 172 patient records stored in Epic (electronic medical record storage) was performed to identify subjects who had undergone radiofrequency ablation (RFA) of the greater or lesser occipital nerves (for treatment of migraine headache). The first search was conducted manually according to standard RCR methodology, the second automatically using ChartSweep. Automated ChartSweep output was then reviewed and patient charts describing RFA in other contexts (lumbar ablation, endometrial ablation) were manually excluded. Total time required for each review and discrepancies between data output were evaluated. Results: Overall manual review time was 1,371 minutes (23 hours) with a mean evaluation time per medical record of 8 minutes. Automated ChartSweep review was significantly faster requiring 56 minutes overall, and 0.3 minutes per patient record (P< 0.0001). Time saved was 7.6 minutes per chart and 1,315 minutes (21.9 hours) total. Both reviews identified 16 patients who had undergone RFA out of 172 total patients. Conclusion: Open-source Python libraries as leveraged by ChartSweep significantly accelerate the retrospective chart review process in plastic surgery research. Quality of data review is not compromised. Further analyses with larger study populations are required to validate ChartSweep as a reliable research tool. 1Matt, V., Matthew, H. J. J. o. e. e. f. h. p. The retrospective chart review: important methodological considerations. 2013;10.

Plastic Surgery Research: A Means to an End?

Plastic Surgery Research: A Means to an End?

Abstract 81: The Role Of Topical Tranexamic Acid (TXA) In Autologous Fat Transfer: A Single Institutional Outcomes Analysis And Considerations For Minimizing Postoperative Donor Site Ecchymosis

Purpose: Autologous fat grafting is an invaluable tool which has revolutionized breast reconstruction. However, there has been limited data on the use of pharmacologic agents to mitigate donor site ecchymosis. Antifibrinolytic medications, such as tranexamic acid (TXA) have been demonstrated to safely mitigate ecchymosis, edema, and intraoperative blood loss in plastic surgery procedures. As such, the authors investigate whether topical TXA safely reduces the degree of ecchymosis at liposuction donor sites following autologous fat grafting in the setting of breast reconstruction. Methods: A single-center, single-surgeon retrospective cohort study was performed to analyze all consecutive patients undergoing autologous fat transfer as part of second-stage breast reconstruction between 2016-2019. In all patients, the donor site was infiltrated with Klein’s tumescent solution. Once lipoaspiration was complete, patients in the intervention group received a total of 75mL of topical TXA (3g in NaCl 0.9%) into the harvest donor sites delivered via a spray applicator, whereas the patients in the historical control group did not receive TXA. The primary endpoint was degree of ecchymosis, which was graded on an ordinal assessment tool previously published by Hunstad et al. (1= no bruising” through 10= extremely bruised”). Secondary outcome measures included hematoma, seroma, and thromboembolic events. A double-blinded randomized assessment of postoperative photographs of the donor sites was performed by senior plastic surgery residents and research fellows. Comparative analysis of continuous variables and categorical variables were performed using the Mann-Whitney-Wilcoxon and Fisher’s exact tests, respectively. A value of p<0.05 was considered significant. Results: A total of 120 consecutive autologous fat grafting procedures for breast reconstruction were reviewed. Overall, 60 patients received TXA, whereas 60 patients did not. Patient demographics and comorbidities were similar amongst the groups. There was no difference between groups with regards to donor site locations. There was no difference in volume of tumescent injected amongst the groups. The median tumescent volume infiltrated in the TXA group was 1600mL (range: 1200-2400mL), and 1750mL (range: 800-2500mL) in the non-intervention group (p=0.86). Median volume of lipoaspirate amongst the TXA and control groups was similar: 317.5mL (range: 45-750) vs. 267.5mL (range: 55-905), p=0.44. A total of 10 blinded evaluators completed the assessment (7 senior plastic surgery residents and 3 research fellows). Average time to postoperative photograph for the TXA group was 14±13 days vs. 10.3±6.2 days for the non-intervention group (p=0.11). The median bruising score of patients who received TXA was significantly lower than the patients who did not (1.6/10 vs. 2.3/10, p=0.01). Postoperative complications, including hematoma, seroma, and thromboembolic events were similar amongst the groups. Adverse effects of TXA were not observed. Conclusion: As the role of TXA in plastic surgery increases, there remains a recognizable gap in the literature with regards to its use in autologous fat transfer procedures. Although, further prospective randomized studies are warranted, the authors demonstrate that patients who received topical TXA into the liposuction donor sites were found to have less donor site ecchymosis compared to patients who did not receive TXA.

An Update on Level of Evidence Trends in Facial Plastic Surgery Research

Background: Knowledge of the quality of evidence in facial plastic surgery research is essential for the implementation of evidence-based practices. The purpose of this study is to provide an update over the past decade as to whether the level of evidence in leading journals featuring topics in facial plastic surgery has changed in comparison with prior reports. Materials and Methods: This study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature over time. Five journals were queried using facial plastic surgery keywords for four selected years for a 10-year period. After screening, articles were assessed for the presence of various methodological traits and were evaluated for overall level of evidence. These variables were compared across the years studied to evaluate trends in level of evidence. Results: A total of 826 articles were included for final review. For all selected years, level IV or level V evidence was the most prevalent level of evidence. Over time, significantly less level IV (p = 0.009) and significantly more level II (p = 0.007) evidence was published. The proportion of studies reporting confidence intervals (p < 0.001) and p-values (p = 0.02) were significantly greater in later years. Conclusions: The level of evidence of facial plastic surgery literature has increased over time, as demonstrated by an increased proportion of level II evidence, decreased proportion of level IV evidence, and increased use of p-values and confidence intervals. The absolute number of randomized controlled trials continues to remain low.

Do We Publish What We Present? A Critical Analysis of Abstracts Presented At Three Plastic Surgery Meetings.

Presentation of research at scientific conferences provides an opportunity for researchers to disseminate their work and gain peer-feedback. However, much of the presented work is never published in peer-reviewed journals. We aimed to analyze the conversion rate of abstracts presented at three national plastic surgery meetings. Abstracts presented at the American Association of Plastic Surgeons(AAPS), American Society of Plastic Surgeons(ASPS), and Plastic Surgery Research Council(PSRC) annual meetings in 2014 and 2015 were identified to analyze the rates of successful conversion into full-text publications. Meeting administrators were contacted to obtain the respective acceptance rates of submitted abstracts. A total of 1174 abstracts were analyzed. The overall conversion rate was 65%. AAPS was the meeting with the highest conversion rate(73%) followed by PSRC(66%) and ASPS(61%). Conversely, AAPS had a lower acceptance rate(28%) compared to ASPS(42%) and PSRC(49%). The conversion rate was significantly higher for abstracts from native English-speaking countries while no significant differences were noted between oral and poster presentations. Plastic and Reconstructive Surgery(PRS) was the journal with the highest percentage of published manuscripts(34%). Abstracts presented at PSRC had the highest mean impact factor for the journal of publication. First authors changed in 31% and last authors in 18% of publications. The overall median time to publication from the date of presentation was 13 months. Almost two-thirds of abstracts presented at AAPS, ASPS, and PSRC successfully converted into full-text publications. Plastic surgery departments/divisions should follow unpublished work in their institutions to benefit both patients and the scientific community.

Artificial Intelligence in Plastic Surgery: Applications and Challenges

New developments in artificial intelligence (AI) offer opportunities to enhance plastic surgery practice, research, and education. In this article, we review relevant AI tools and applications, including machine learning, reinforcement learning, and natural language processing. Our own Markov decision process for keloid treatment illustrates how these models are developed and can be used to enhance decision-making in clinical practice. Finally, we discuss challenges of implementing AI and knowledge gaps that must be addressed to successfully apply AI in plastic surgery. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .