Plastic surgery最新文献

Background:Qualitative research incorporates patients' voices into scientific literature. To date, there has been no formal review of qualitative research in plastic surgery. The primary objective of this study was to evaluate the reporting quality of "breast specific" plastic surgery qualitative research. Secondary objectives were to record study methodology and examine associations between reporting quality and publication/journal characteristics. Methods: MEDLINE, Embase, Psychinfo, and PubMed were searched to identify qualitative studies in breast plastic surgery. Findings were presented with descriptive analysis. Reporting quality was evaluated using the Standards for Reporting Qualitative Research (SRQR), a 21-item checklist. Results: Eighty studies were included. The median SRQR score was 17/21 (range: 6-21). The lowest reported SRQR items were qualitative approach (n = 29/80, 36%) and data collection method (n = 36/80, 45%). Nine (11%) studies described following a reporting guideline. Articles published in nursing journals had the highest average SRQR scores (18.4/21). There was no significant difference between studies published before or after the publication of SRQR (P = .06). Eighty-six percent of studies focused on patient experiences with breast reconstruction (n = 69/80). Conclusions: The introduction of the SRQR has not led to significant improvement in the reporting of qualitative research. Rationale for methodology was frequently missing. We recommend that investigators conducting qualitative research in breast plastic surgery ensure they provide a rationale for their methodology and become familiar with the SRQR reporting guideline.

Background: Opioid dependence can occur in 6% to 10% of patients undergoing breast reconstruction. With the expansion of interdisciplinary initiatives to decrease opioid use after surgery, an updated look at the incidence of and risk factors for prolonged opioid dependence after free flap breast reconstruction is essential. Methods: We retrospectively identified all cases of free flap breast reconstruction completed at our institution from 2017 to 2020. Patients undergoing additional surgery within 120 days of the free flap procedure were excluded. Postoperative opioid prescriptions were identified; prolonged opioid use was defined as the receipt of additional prescriptions 91 to 120 days after surgery. Demographic and perioperative variables were assessed for their relationship with prolonged opioid use by logistic regressions. Results: A total of 732 patients were included in the final analysis; of these, 15 patients (2%) received additional opioid prescriptions 91 to 120 days after surgery (ie, had prolonged opioid use). Univariable associations were identified between prolonged opioid use and intraoperative morphine milliequivalents (OR = 2.3 per 50 units [95% CI, 1.5-3.5]; P < .001), opioid prescriptions 31 to 60 days after surgery (OR = 16.1 [95% CI, 4.0-65.0]; P < .001) and 61 to 90 days after surgery (OR = 89.4 [95% CI, 13.7-584.5]; P < .001), and history of substance use disorder (OR = 8.3 [95% CI, 2.2-31.6]; P = .002), anxiety (OR = 3.8 [95% CI, 1.2-12.1]; P = .023), or mood disorder (OR = 12.7 [95% CI, 1.3-121.3]; P = .027). Conclusion: In our cohort, 2% of patients who underwent autologous breast reconstruction (15/732) had prolonged opioid use. The currently used perioperative opioid minimization initiatives may benefit patients undergoing autologous breast reconstruction.

Background: Gender disparities in academic leadership positions may be influenced by several factors, including research productivity. We aimed to describe the publication gender gap in major plastic surgery journals, assess gender-related and gender-neutral research publications, and identify any potential gender disparities associated with publication characteristics. Methods: For this cross-sectional study, we reviewed all original research publications in Plastic and Reconstructive Surgery, JAMA Facial Plastic Surgery, and Aesthetic Surgery Journal from 2014 through 2018. Genderize.io was used to identify the gender of all authors. Each publication was classified as either gender-neutral, transgender health, women's health, or men's health-related based on the article's content. Results: Of the 12,718 authors across 2234 publications analysed, females were first authors in 30%, last authors in 17%, and all authors in 27%. Among the publications, 1782 (79.8%) were focused on gender-neutral, 419 (18.8%) on women's health, 18 (0.8%) on transgender health, and 15 (0.7%) on men's health. Male first authors were more likely to be associated with women's and transgender health articles (OR [95% CI]  =  1.4 [1.1-1.8] and OR [95% CI]  =  51.0 [47-55], p < .001) and had a higher mean number of citations compared to gender-neutral articles (p < .001). Male first authors were more likely to be associated with women's and transgender health articles (OR [95% CI]  =  1.4 [1.1-1.8] and OR [95% CI]  =  51.0 [47-55], p < .001) and had a higher mean number of citations compared to gender-neutral articles (p < .001). Conclusion: The publication gender gap persists in academic plastic surgery. The academic community should continue to prioritize addressing gender disparity from the perspective of research productivity.

Background: The Calgary Kids' Hand Rule (CKHR) is a clinical prediction rule intended to guide referral decisions for pediatric hand fractures presenting to the emergency department, identifying "complex" fractures that require surgical referral and optimizing care through better matching of patients' needs to provider expertise. The objective of this study was to externally validate the CKHR in two different tertiary pediatric hospitals in Canada. Methods: We partnered with British Columbia Children's Hospital (BCCH) and the Children's Hospital of Eastern Ontario (CHEO) to externally validate the CKHR using data from retrospective cohorts of pediatric hand fractures (via electronic medical record and x-ray review). Model performance was evaluated at each site using sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and the C-statistic. Results: A total of 954 hand fractures were included in the analysis (524 at BCCH and 430 at CHEO. At BCCH, the CKHR had a sensitivity of 91.1% (133 predicted complex out of 146 total complex fractures), specificity of 71.4% (269 predicted simple out of 377 total simple fractures), and C-statistic of .81, 95% CI [0.78-0.84]. At CHEO, the CKHR had a sensitivity of 98.3%, specificity of 30.2%, and C-statistic of .64, 95% CI [0.61-0.67]. Conclusion: The CKHR performed well at two different tertiary care centres with high sensitivity, supporting its ability to facilitate hand fracture triage in other populations without further modification. This work should be followed by rigorous implementation analysis to determine its impact on patient care.

Introduction: Lipohypertrophy is the most reported cutaneous complication of insulin injection. In cases refractory to conservative management, liposuction has been proposed as a treatment. This review aims to evaluate the use of liposuction for the treatment of insulin-induced lipohypertrophy. Methods: A literature search was conducted to identify case reports and case series that met inclusion criteria. Demographic, procedural, and outcome data were collected and summarized. Results: Ten case reports and 1 case series met eligibility criteria; 18 patients (16 female) with a mean age of 31 years were included for analysis. The primary indication for lipectomy was cosmetic (100%), followed by pain (16.7%), injection difficulty (16.7%), and poor glycemic control (11.1%). Ten patients (55.6%) underwent general anesthesia for their procedure, while 8 (44.4%) received local anesthesia. Thighs (53.8%) were the most common anatomical site of liposuction, followed by the upper arm (19.2%), abdomen (15.4%), buttocks (7.7%), and the flank (3.8%). The median volume of adipose tissue removed per site was 300 mL (range: 25-600 mL), while the total volume per patient was 910.8 mL (range: 200-2900 mL). The average postoperative follow-up time was 5.3 months (range: 2-10 months). Three patients reported postoperative improvement of glycemic control; 100% of patients were satisfied with their procedure. Small surface irregularities were reported in 2 patients. Conclusion: Although future investigations are warranted, these results may indicate that the use of liposuction to treat insulin-induced lipohypertrophy is a safe and effective procedure that achieves improved cosmetics with high patient satisfaction and enhanced glycemic control.

Background: Breast implants were first introduced in the 1960s and have long been used for augmentation and reconstructive breast surgery. More recently, fat grafting for breast augmentation has gained popularity due to the 'natural' outcome and lack of implant-related complications. The aim of this study was to conduct a systematic review and meta-analysis comparing patient-related outcome measures between fat grafting and implant-based primary augmentation using the validated BREAST-Q questionnaire. Methods: A systematic review of the literature according to the PRISMA guidelines was conducted in PubMed®, Cochrane Library®, EMBASE®, MEDLINE®, and Scopus® databases. Papers were screened by two independent blinded reviewers. Quality was assessed using MINORS criteria. Results: Fourteen studies were included in the meta-analysis representing a total of 81 fat grafting augmentations and 1535 implant augmentations. The average overall patient satisfaction mean post-operative scores were 13.0 points higher in the implant group based on meta-regression (95% CI: 2.4-23.5; P = .016). There was no statistical difference in reported post-operative sexual well-being, psychosocial well-being, or physical well-being BREAST-Q scores. Conclusion: Although implant-based augmentation resulted in higher post-operative overall satisfaction scores, fat grafting remains a highly desirable alternative for augmentation in the right patient. This meta-analysis strongly highlights that careful patient selection and evaluation of patient goals must be assessed when selecting an augmentation method.

Background: Rectovaginal fistula (RVF) remains a complex complication following gender-affirming vaginoplasty. This review aims to evaluate RVF repair techniques and outcomes following vaginoplasty. Methods: A systematic review was performed per PRISMA guidelines. Ovid MEDLINE, Ovid EMBASE, Cochrane, and Web of Science were queried for records pertaining to RVF repair following vaginoplasty. Study characteristics, operative details, and demographics were collected. Outcomes included RVF repair method, recurrence rate, and complications. Results: Among 282 screened citations, 17 articles representing 41 patients were included. Rectovaginal fistula repair methods identified included 4 conservative management approaches (n = 12 patients), primary closure with or without fistulectomy and ostomy (n = 22), 10 reconstructive surgical techniques (n = 18). The most common reconstructive techniques were V-Y full-thickness advancement with rectal flap (n = 5) and infragluteal fasciocutaneous flap (n = 4). Median time to recurrence was 6 months (interquartile range 7.5). Reported RVF repair complications included RVF recurrence (n = 5, 14.7%) and wound complication or dehiscence (n = 2, 5.88%). Three cases of RVF recurred after primary closure with or without fistulectomy and ostomy, while 2 cases of recurrence followed reconstruction. Conclusion: There remains a high level of variability in the approach to RVF repair following vaginoplasty. Reconstructive surgical techniques may be a more optimal solution without necessitating ostomies, but this decision must be considered in the context of RVF location, individual patient expectations, and clinical presentation.

Introduction: Antimicrobial prophylaxis is crucial in reducing surgical site infections (SSIs). First-generation cephalosporins are commonly first line, but issues arise when patients report a penicillin allergy. Although up to 10% of Americans report a penicillin allergy, up to 95% are not truly allergic. Even patients with true penicillin allergy likely tolerate cephalosporins due to low cross-reactivity. Nevertheless, providers are less likely to prescribe cefazolin for these patients, increasing the risk of SSI. We seek to characterize the pattern of perioperative antibiotic use and rate of reaction in plastic surgery patients who endorse a penicillin allergy. Method: This was a single-center retrospective chart review of adults who received body contouring plastic surgery from January 1, 2021 to December 31, 2021. The presence of reported penicillin allergy and administration of cefazolin versus alternative agent were evaluated, and the outcome was measured in number of anaphylactic reactions and SSI events. Results: The study included 457 patients in total; 437 (96%) were female; 106 (23%) had listed allergy to penicillin, cephalosporin, or both - 17 (16%) were listed as having anaphylaxis to penicillin, 62 (58.5%) endorsed a nonanaphylactic allergic reaction to penicillin, 8 (7.5%) endorsed an allergy without a documented reaction to penicillin, and 19 (18%) reported a prior cephalosporin allergy. All patients with a beta-lactam allergy who received cefazolin perioperatively did not have any anaphylaxis events. Three patients who received clindamycin and 1 patient who received cefazolin developed SSI postoperatively. Conclusion: Cephalosporins should be the first line for appropriate patients with a penicillin allergy, as alternative agents have increased SSI risk.

Background: There is a lack of previous studies investigating oncoplastic practice trends for breast reconstruction in Canada, particularly from the plastic surgeon perspective. Given the rising popularity of oncoplastic techniques, this study aimed to identify current practice trends for breast and plastic surgeons in Canada. Methods: A cross-sectional survey study of breast and plastic surgeons performing oncoplastic surgery across Canada was conducted. Results: Ninety-five surgeons were invited to complete the survey, with 58 respondents (response rate 61%), of which 29 (50.0%) were breast surgeons and 29 (50.0%) were plastic surgeons. Compared to plastic surgeons, breast surgeons performed significantly more level 1 surgeries (27.6 vs 3.45%, P < .001). Plastic surgeons performed more level 2 (37.9% vs 13.8%, P = .0475) and level 3 (31.4% vs 10.3%, P = .00814) surgeries. Breast surgeons identified significant perceived barriers including unfamiliarity with techniques (P = .00513), adjuvant therapy delays (P = .00612), lack of plastic surgery support (P < .001), lack of radiation oncology support (P = .0485), increased OR time (P < .001), lack of OHIP billing codes (P < .001), and post-operative complication management (P = .0372). Breast surgeon comfort with oncoplastic techniques was not correlated with practice duration (R-square = .037, P-value = .853). Breast surgeon comfort with contralateral surgery was not correlated with practice setting (R-square = .071, P-value = .632). Conclusions: Breast surgeons perceive a lack of training, a lack of support from plastic surgery, concerns regarding appropriate financial remuneration, and worries of increased OR time as barriers in oncoplastic surgery. Collaboration between general breast surgery and plastic surgery is needed for improving training options for oncoplastic surgery in Canada and for providing excellent breast cancer care overall.

Introduction: The goal of this study is to determine factors associated with acceptance into Canadian plastic surgery (PS) residency programs by Saudi Arabian Medical Graduates. Methods: This is a cross-sectional study targeting eligible Saudi Arabian applicants to any Canadian PS residency program between 2017 and 2022. Collected data included demographics, education/licensure, electives in Canada, and letter of reference. The 2 main outcomes analyzed were "invited for an interview" and "offered a residency position." Results: We reviewed 52 applications. Of these, 18 applicants received an invitation for an interview and 8 were offered a residency training position. Significant variables associated with receiving an invitation for an interview were completing an elective in Canada (P = .016), having a master's degree (P = .012), and completion of an English test (P = .032). The variables most likely to influence receiving a residency position offer are completion of elective training in Canada (P = .004) and receiving a letter of reference from a Canadian plastic surgeon (95% CI: 0.77 to 76.69: OR: 8.90). Conclusion: Completion of an elective rotation in Canada and obtaining Canadian letters of reference were found to be the most important factors for Saudi Arabian physician applicants to be accepted into a Canadian PS residency program. Other factors that were less critical but improved their chances of being considered include completion of an English assessment test and having a master's degree. This study offers valuable guidance for any Saudi Arabian candidates interested in PS residency in Canada and may aid Canadian programs in their assessment of potential residents.