Reconstructive Surgery Research Research Articles

Developing a national trauma research action plan: Results from the Burn Research Gap Delphi Survey.

The 2016 National Academies of Science, Engineering and Medicine call for a national integrated, military-civilian trauma action plan to achieve zero preventable deaths and disability after injury included a proposal to establish a National Trauma Research Action Plan to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma/burn care from prehospital to rehabilitation. The Burn/Reconstructive Surgery group represents one focus area for this research agenda development. Experts in burn and reconstructive surgery research identified gaps in knowledge, generated research questions and prioritized questions using a consensus driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with military and civilian representatives. Literature reviews informed the panel. Panelists were encouraged to use a PICO format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome. Participants ranked the priority of each question on a nine-point Likert scale, which was categorized to represent low, medium, and high priority items. Consensus was defined based on ≥60% panelist agreement. Subject matter experts generated 949 research questions in 29 Burn & 26 Reconstruction topics. Five hundred ninety-seven questions reached consensus. Of these, 338 (57%) were high-priority, 180 (30%), medium-priority, and 78 (13%) low-priority questions. Many high-priority questions translate to complex wound management and outcomes. Panel recognition that significant gaps in knowledge exist in understanding functional outcomes after injury underscores the importance of long-term recovery metrics even when studying acute injury or interventions such as resuscitation or inhalation injury. Funding agencies and burn/reconstructive surgery researchers should consider these gaps when they prioritize future research. Expert consensus, Level IV.

Aesthetic Surgery Research Funding: Where Does It Come From and to Whom Does It Go?

Recent data show that aesthetic surgery research is lagging compared with reconstructive surgery: research funding and institutional disparities within aesthetic surgery are potential factors in this trend. The authors sought to determine if disparities exist in aesthetic surgery research based on funding sources or practice settings. The authors reviewed Aesthetic Surgery Journal articles from 2009 to 2019. Chi-square, t test, bivariate, and multivariate regression analyses were employed to evaluate research trends. A total of 2262 publications were identified, with 318 funded articles meeting inclusion criteria. The majority of studies (294, 92%) received external funding, with 281 (88%) being supported solely by external funds. Externally funded studies were financed by private industry (194, 66%), foundations/societies (53, 18%), government grants (23, 8%), or a combination of agencies (24, 8%). The majority of funded studies were at academic institutions (266, 84%), followed by private practice (46, 14%) and private industry (6, 2%). Analysis of annual publications revealed a rising percentage of academic-based research, which correlated with decreasing research from private practice (r = -0.95, r2 = 0.89, P < 0.001). Compared with academic institutions, private practice relied more heavily on industry funding (55% vs 87%, respectively, P = 0.001), exhibiting lower rates of foundational/societal (20% vs 2%), governmental (9% vs 0%), combined (8% vs 7%), and internal department funding (8% vs 4%). Article citations and level of evidence were unaffected by funding source, agency, or practice setting. Lack of diversity in research funding among private practice surgeons may explain the reported discrepancies that currently exist between aesthetic and reconstructive surgery research.

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.

Perforator Mapping of the Profunda Artery Perforator Flap: Anatomy and Clinical Experience.

Discovering alternatives to workhorse flaps that have more consistent anatomy and lower donor-site morbidity has become a focus of reconstructive surgery research. This study provides a simplified approach to profunda artery perforator flap design and harvest based on reliable anatomical landmarks. A retrospective review was conducted of 70 patients who underwent 83 profunda artery perforator flap reconstructions for postoncologic defects from 2016 to 2018. The authors recorded and analyzed the profunda artery perforator flap sizes and clinical applications, the numbers and locations of the perforators, and the patient outcomes. Most of the profunda artery perforator flaps were for head and neck [46 patients (65.7 percent)] and breast [21 patients (30 percent)] reconstructions. Flaps were most commonly based on perforator A (33.7 percent) and perforator B (33.7 percent), followed by perforators B and C combined (18.1 percent). Perforators were located a mean of 7.5 cm (perforator A), 12.7 cm (B), and 17.6 cm (C) distal to the pubic tubercle parallel to the axis between the pubic tubercle and the medial femoral condyle and 7.9 cm (A), 7.3 cm (B), and 6.1 cm (C) posterior from the axis. There was no flap loss. One patient underwent successful salvage surgery after arterial flap thrombosis. Eight patients (9.6 percent) developed superficial wound dehiscence that was managed conservatively. Perforator mapping demonstrated consistent anatomical locations of sizeable profunda artery perforators in the inner thigh. Along with its consistent and robust vascular anatomy and minimal donor-site morbidity, the profunda artery perforator flap's volume and pliability make it a reliable option for soft-tissue reconstruction. Therapeutic, IV.

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.

How do urogynecology and pelvic floor dysfunction terms used in female pelvic medicine and reconstructive surgery research relate to social media indicators?

The association between social media (SoMe) indicators and citation metrics is still controversial. we aimed to evaluate the frequency of urogynecology-related terms ("urogynecology" [UG] and "pelvic floor/dysfunction" [PF/PFD]) mentioned by traditional databases (Web of Science [WOS]) and journal ranking indicators (SCImago), as well as their association with SoMe (Altmetric database). In April 2019, two authors performed a search that was divided into three steps. The first one was to assess journals within the WOS Obstetrics/Gynecology and Urology categories updated to 2017 using UG and PF/PFD. The second step was to rank these studies in SCImago by the highest numbers of WOS and to correlate with journal h-index and SJR. The third step was to analyze SoMe indicators such as the Altmetric Attention Score (AAS) for each study and journal retrieved. The International Urogynecology Journal (IUJ) and Neurourology and Urodynamics (NAU) were the first (n = 1,394) and second (n = 974) most highly cited journals when using UG and PFD. IUJ also presented manuscripts with the highest AAS for UG and PF/PFD. Social media represented 74-93% of AAS calculated among the 20 top cited studies. For UG, SoMe presented 8,050 mentions, led by Twitter (n = 7,326). The same distribution was seen for PFD (8,493 mentions for SoMe, Twitter with 7,653). The higher the WOS citation, the higher the AAS (r = 0.483; p = 0.03). UG and PF/PFD terms are highly cited in databases and IUJ was the journal most frequently connected with them. Among SoMe tools, Twitter was the most frequently cited. WOS citations correlated with AAS.

Levels of Evidence in Plastic and Reconstructive Surgery Research: Have We Improved Over the Past 10 Years?

Summary:Levels of evidence (LOE) aid in the critical appraisal of evidence by ranking studies based on limitation of its design. Analyzing LOE provides insight into application of evidence-based medicine. The aim of this study is to determine if the quality of evidence in plastic surgery research has improved over the past 10 years. Systematic review of research published in Plastics and Reconstructive Surgery journal over the years, 10-year period (2008, 2013, 2018), was performed. LOE for each article was determined using the American Society of Plastic Surgeons (ASPS) guidelines. Each level was calculated as percentage of publications per year and compared yearly and between different topics. Eight hundred eighty-four studies were included in the final analysis. The LOE of the research improved over the study period. Level 4 evidence was the most frequent published (50.6%, 447/884), with a decline from 63.2% in 2008 to 41.3% in 2018. Level 1 evidence improved each year and accounted for 2.1% of all research in 2018. Aesthetic surgery was the most frequent published topic with upper limb research demonstrating an 18.5% increase in high-quality evidence over the study period. Increased awareness of evidence-based medicine has improved the quality of plastic surgery research over the past decade. It is vital this continues to provide gold standard patient care.

Is the adipofascial flap the key to regenerative surgery?

Objectives“Form and function restoration” is the ultimate goal of reconstructive surgery, which is oriented toward regeneration rather than reparation. Recently, research in reconstructive surgery has focused on the regenerative potential of the adipose tissue. The aim of the study is to illustrate the surgical methods and show the functional and aesthetic results achieved by the reconstruction of finger soft-tissue defects using homodigital dorsal adipofascial reverse flap (HDARF). Materials and methodsA total of 63 cases (45 acute and 18 elective) were included between September 2010 and August 2016. In each case, we preliminarily performed surgical debridement and then harvested an adipofascial flap from the back of the finger. Nine injured thumbs that were repaired with the flap as emergency cases were also included. The average age of the patients was 46 (range: 4–69) years. ResultsAll flaps survived without any complications during the 24-month follow-up. Good nail regrowth through the flap and full regeneration were observed in approximately all cases. Sensitivity tests and histological analysis of biopsy samples of the regenerated fingers confirmed full regeneration of the epidermis, dermis, cutaneous adnexa, and nerves. All the patients were satisfied with the hand functionality and aesthetic appearance. ConclusionThe HDARF represents a very useful alternative for the reconstruction of nailbed crushes, achieving regeneration of injured segments in deformities caused by trauma or infection.

Sources of Federal Funding in Plastic and Reconstructive Surgery Research

In the last several years, federal funding has become increasingly difficult to obtain. The purpose of this project was to define the level of federal funding among plastic surgeons in the modern era. The authors evaluated members of the Plastic Surgery Research Council because of their expected invested interested in research. The authors collected information from 1998 to 2012 on funding using curricula vitae and publically available online tools. Data on Plastic Surgery Foundation funding was also collected to determine its role in supporting federally funded investigators. Of 256 individuals, the authors found 41 to be primary investigators on federally funded grants, with the majority receiving one to two awards. Common subtypes of awards included National Institutes of Health R01 (n = 15), K08 (n = 9), and R21 (n = 6). Limited funding from the National Science Foundation and the Department of Defense was identified. Despite a steady number of available National Institutes of Health awards, plastic surgery recipients have grown in number over the past 15 years. In a review of 20 years of Plastic Surgery Foundation awards, 113 Plastic Surgery Research Council members (44.1 percent) were awardees, averaging 1.8 awards per person. Twenty-nine Plastic Surgery Foundation awardees were also recipients of federal funding; 12 individuals received federal funding without prior Plastic Surgery Foundation funding. A search of plastic surgeons indicates a limited but increasing number of individuals receive federal funding. Plastic Surgery Foundation awards appear to be helpful in supporting investigators as they move to larger federal awards.

Classic Citations in Main Plastic and Reconstructive Surgery Journals

The number of citations of an article in scientific journals reflects its impact on a biomedical specialty and its recognition in the scientific community. In this study, we identified and analyzed the 100 most highly cited articles published between 1971 and 2011 in journals pertaining to plastic and reconstructive surgery research. We selected 6 high-impact journals for literature search in the database of the Science Citation Index (1971 to 2011). We identified the 100 most frequently cited articles published in these journals, and analyzed them. The most cited article received 1007 citations and the least cited article received 165 citations, with a mean of 274 citations per article. These citation classics were published in 5 high-impact journals, led by Plastic and Reconstructive Surgery (76 articles). The articles came from 17 countries, with the United States producing 57 articles. Sixty-two institutions produced these 100 top-cited articles, led by Royal Mountain Hospital, University of Melbourne (7 articles). Twenty-three authors published 2 or more of the top-cited articles, led by Taylor GI who authored 10 classic papers. This analysis of the top citation classics allows for the recognition of major advances and supplies a historic perspective on the progress of plastic and reconstructive surgery research.

A Novel Laser-Doppler Flowmetry Assisted Murine Model of Acute Hindlimb Ischemia-Reperfusion for Free Flap Research

Suitable and reproducible experimental models of translational research in reconstructive surgery that allow in-vivo investigation of diverse molecular and cellular mechanisms are still limited. To this end we created a novel murine model of acute hindlimb ischemia-reperfusion to mimic a microsurgical free flap procedure. Thirty-six C57BL6 mice (n = 6/group) were assigned to one control and five experimental groups (subject to 6, 12, 96, 120 hours and 14 days of reperfusion, respectively) following 4 hours of complete hindlimb ischemia. Ischemia and reperfusion were monitored using Laser-Doppler Flowmetry. Hindlimb tissue components (skin and muscle) were investigated using histopathology, quantitative immunohistochemistry and immunofluorescence. Despite massive initial tissue damage induced by ischemia-reperfusion injury, the structure of the skin component was restored after 96 hours. During the same time, muscle cells were replaced by young myotubes. In addition, initial neuromuscular dysfunction, edema and swelling resolved by day 4. After two weeks, no functional or neuromuscular deficits were detectable. Furthermore, upregulation of VEGF and tissue infiltration with CD34-positive stem cells led to new capillary formation, which peaked with significantly higher values after two weeks. These data indicate that our model is suitable to investigate cellular and molecular tissue alterations from ischemia-reperfusion such as occur during free flap procedures.

Reply: Patient Assessments of Scarring: Patient-Reported Impact of Scars Measure or Patient Scar Assessment Questionnaire?

Reply: Patient Assessments of Scarring: Patient-Reported Impact of Scars Measure or Patient Scar Assessment Questionnaire?

The emerging role of &lt;em&gt;Clostridium histolyticum&lt;/em&gt; collagenase in the treatment of Dupuytren disease

Dupuytren disease (DD) is a common fibroproliferative disease of unknown etiopathogenesis affecting the palmar aponeurosis, causing reduced hand function and resulting in fixed flexion contractures of the digits. Current gold standard treatment for the management of DD is surgical excision involving removal of the affected palmar fascial tissue. However, there are potential complications associated with surgery as it is costly and a positive surgical outcome is often short-lived because the disease tends to recur. Therefore, there is growing interest in nonsurgical, outpatient-based treatments that could be quicker, cheaper, reduce morbidity, show a decreased rate of recurrence, and give DD patients an improved quality of life when compared with traditional surgical management. Of the available nonsurgical options, injectable Clostridium histolyticum collagenase (CHC) has received recent clinical interest. In this article, a brief overview of DD surgical and nonsurgical treatments utilized is given, followed by a detailed examination of the nine papers published to date on the use of CHC in DD (and similar fibrotic disorders). These papers have investigated safe and efficacious doses for the injection of CHC to treat palpable DD cords in adult patients and have shown significant short- to mid-term results for correction to near-full digital extension (≤5° extension) following CHC injection of DD cords. CHC has been shown to target the collagen-based DD cords while sparing surrounding neurovasculature, with a complication profile that appears comparable to that of the surgical methods currently utilized. In conclusion, clostridial collagenase is a novel nonsurgical treatment option of considerable potential in the management of DD when administered by specialist hand surgeons with detailed knowledge of the disease and the relevant anatomy. Nonetheless, there is a need for further data on long-term results, complications, and rate of recurrence with the use of this emerging treatment option.