Plastic surgery最新文献

Introduction: Peripheral nerve injury (PNI) is a complex, debilitating condition that is increasingly being treated in interdisciplinary clinics. Patients see peripheral nerve surgeons, neurologists, physiatrists, and electrodiagnostic technicians in a single encounter. No studies have evaluated patient experience within this unique interdisciplinary care model. This study aims to assess patients' perceptions of the effectiveness of delivery of care and health care information in an interdisciplinary PNI clinic. Methods: A cross-sectional mixed-methods study was conducted using a 23-question survey that was by a lived-experience partner (an individual who had a brachial plexus injury) in research who helped design the survey. Participants attended an interdisciplinary clinic for PNI 1-2 days prior to taking the survey. The survey included 5-point Likert scales for measuring patient understanding and qualitative questions that were categorized into themes, using conventional content analysis. Results: Of the 20 participants, 65% were male, 35% were female and the mean age was 42.6 ± 17.8. Median scores of 4 were obtained for the patient understanding of the testing purposes, test results, nerve recovery after PNI, and surgical decision-making (full understanding = 5). On improving the clinical experience, 58% indicated no improvements were necessary, while 17% indicated the clinic felt rushed or overwhelming. When asked about positive aspects of their clinical experience, 64% appreciated the team approach to care, 27% valued the informative nature of the clinic, and 27% appreciated the progress they felt when providers at the clinic performed nerve testing. Conclusions: The results demonstrate that patients with PNI have overall positive perceptions of the delivery of care and information in an interdisciplinary PNI clinic. These results provide new insight into how interdisciplinary care may be beneficial to PNI patients based on the perceived effectiveness of knowledge translation.

Background: Gaps remain in surgical education regarding the representation of skin tone diversity. To improve equity and prevent misdiagnosis leading to worsened health outcomes, efforts must be made to ensure educational photographs are representative of the diverse patient populations plastic surgery residents will be treated in their future practices. Methods: Four study investigators examined 96 h of recorded lecture seminars from a Canadian plastic surgery resident education curriculum from May 2020 to December 2021. Using Fitzpatrick skin type to codify skin tone, photographic images were individually classified and compared. Program lecturers and residents were invited to participate in an online anonymized survey to explore related perceptions of the curricula. Results: A total of 1990 images were included for analysis. Of these, 83.2% were Fitzpatrick types I to III, 13.1% were Fitzpatrick types IV to V, and 3.7% were Fitzpatrick type VI. There was a statistically greater proportion of Fitzpatrick I to III compared to types IV to V (P < .01), and type VI (P < .01). Fleiss' Kappa was calculated to be 0.896, representing near-perfect agreement. In the survey, 61% (14/22) of faculty respondents believe they include enough diversity in their photographs, however, 46% (4 of 9) of resident respondents would like to see more diversity in lecturers' photographs. Conclusions: There is an underrepresentation of medium (Fitzpatrick types IV-V) and dark (Fitzpatrick VI) images in plastic surgery resident educational images. Providing a curriculum that represents diverse patient populations is crucial to enabling competency and equity of care, particularly in a highly visual field. Incorporating skin tone diversity into educational curricula should be a priority for all plastic surgery programs.

Introduction: Microsurgical learning is a difficult and stressful process, requiring self-control to achieve relaxation. The purpose of this study is to evaluate peripheral and central nervous system relaxation during microsurgical training. Methods: This cohort study included ten medical students with no previous experience in microsurgery. The somatic peripheral nervous system was evaluated by the force applied to a custom-designed microsurgical needle holder. The autonomic peripheral nervous system was assessed by a heart rate monitor. Central nervous system relaxation was evaluated by the State and Trait Anxiety Inventory scores. The quality of the anastomosis was graded by the Microsurgical Anastomosis Rating Scale (MARS10). These data were compared to a group of 5 senior microsurgeons who underwent a single assessment. Results: The time to complete the anastomosis and the force decreased significantly with training after only 2 weeks (P < .05). After 4 weeks of training, no statistical difference was observed between students and experts regarding force while the time of suture was still significantly different at 30 days (P = .001). The maximum heart rate decreased significantly at 2 weeks (P = .01). Anxiety scores decreased significantly between days 1 and 15 (P = .002 and P = .036). The MARS10 score demonstrates that the quality of the suture increases significantly during the first 15 days (P = .006). Conclusion: Peripheral and central nervous system relaxation as well as the quality of the microsurgical anastomosis increase significantly after only 15 days of learning. The force-sensing microsurgical needle holder offers a new tool for the evaluation of relaxation and can function as a learning aid.

Introduction: Venous thromboembolism (VTE) is a devastating complication in aesthetic plastic surgery. Plastic surgeons are advised to approach VTE prevention proactively by modifying the perioperative risk profile of their patients. Herein, the authors review the evidence of pharmacologic prevention of VTE in plastic surgery, caution surgeons that blanket treatment based on Caprini score alone should be avoided, and advocate for case-by-case individualized therapy for every patient. Methods: A review of evidence for the pharmacologic prevention of VTE in plastic surgery was performed. Results/Conclusion: A proactive approach to VTE prevention can be achieved by employing both nonpharmacologic and pharmacologic evidence-based interventions. While the choice to use anticoagulation medications should be guided by calculation of a Caprini score for each patient, surgeons should continue to maintain their clinical judgment to prevent complications from over and under treatment.

Introduction: Reduction mammaplasty is often performed to alleviate symptoms of macromastia or for symmetry after a lumpectomy in the contra-lateral breast. Abnormal pathology including breast cancer can be incidentally found in reduction mammaplasty specimens, but there is no consensus on risk factors or detection rates. This study aimed to elucidate the incidence of malignant and high-risk pathology findings in patients undergoing breast reduction in a Canadian context. Methods: We conducted a retrospective review of all reduction mammaplasty cases performed by 5 surgeons between January 2001 and May 2023. Patients were categorized into Group A, those undergoing bilateral reduction for macromastia symptoms, and Group B, those with a history of breast-conserving surgery seeking unilateral reduction postlumpectomy. Results: In total, 1383 breasts from 872 patients were examined: 1022 in Group A and 361 in Group B. Group B was significantly older (56.9 ± 9.3 vs 44.0 ± 13.9 years) whereas Group A had a significantly higher BMI (33.1 ± 8.4 vs 30.1 ± 5.8). High-risk and malignant pathology incidence was 1.4% overall. The sole malignancy detected was in a patient in Group A without prior breast cancer history. Multivariate analysis revealed BMI as a significant predictor for high-risk pathologies (OR 1.134, 95% CI [1.012-1.271]). Conclusions: Our findings align with previously reported incidence rates of pathological findings in mammaplasty specimens and highlight the correlation between BMI and pathology risk. These results underscore the importance of a comprehensive history and preoperative counselling about the possibility of further treatment following pathological discoveries during reduction mammaplasty.

Background: Wide-awake local anesthesia no tourniquet (WALANT) surgery has demonstrated its value in hand surgery allowing surgeons to safely operate patients in different settings outside of a formal operating room (OR). Flexor tendon lacerations have historically been repaired in the controlled setting of an OR. Plastic surgeons at our university-affiliated center have increasingly been performing flexor repairs in clinic-based procedure rooms (PRs). This study set out to evaluate the safety and complication rates of primary flexor tendon repair performed in PRs compared to those performed in the OR. Method: A unicentric retrospective study was conducted with patients who underwent primary flexor tendon repair between 2019 and 2023 in both clinic-based PRs and the OR. Primary outcomes included presence of tendon rupture and secondary outcomes included infection, adhesion, reintervention, and presence of any complication. Results are reported using odds ratios with 95% confidence intervals. Results: One hundred seventy-four patients underwent flexor tendon repair. There was no association between rupture rate and surgical setting (OR 1.05 95% CI [0.30-3.78]; P = .94). Surgeries performed in clinic-based PRs showed a reduction in the odds of observing at least one complication (OR = 0.49 [0.24-0.97]; P = .041). A subanalysis of single digit cases showed a similar association between the rate of complications and surgical setting (OR = 0.39 [0.16-0.96]; P = .039). Conclusions: This study confirms the safety of performing flexor repair in clinic-based PRs. Such settings also offer the advantage of reduced cost of surgery and minimized delay between diagnosis and surgery.

Introduction: The concept of failure in breast reconstruction can occur when negative outcomes dominate the patient experience. The primary objective of this review was to identify experiences of failure in breast reconstruction from the patient's perspective in the qualitative literature. Methods: MEDLINE, Embase, Psychinfo, Emcare, and CINAHL were searched on July 31, 2023 using terms related to breast reconstruction and qualitative research. Thematic analysis was performed on direct quotations from included studies. Confidence in the Evidence from Reviews of Qualitative (CERQual) Research was used to assess confidence of the final findings. Results: Forty-two studies were identified. The following themes were identified in breast reconstruction failure: (1) failure occurs when expectations of restoring the original breast are not met with reconstruction, (2) failure occurs when unexpected outcomes were associated with the reconstruction, and (3) healthcare providers negatively impact the experience of breast reconstruction failure through lack of transparency when educating patients on expected results and poor relational support in the post-operative period. The evidence supporting themes 1-3 scored high confidence with CERQual. Conclusion: Breast reconstruction failure from the patient perspective arises from the limitations and adverse outcomes of the surgery. They may also arise even when the procedure was deemed "successful" from the surgeon's perspective. Dissatisfaction with result is increased by procedural complications. Healthcare providers can aggravate the perception of failure through inadequate patient education. Incorporating these perceptions of failure into discussions with patients can aid in their decision making.

Introduction: Brachial plexus birth injury (BPBI) is a condition affecting newborns and involves damage to the nerve fibers compromising the brachial plexus during birth. Although most newborns recover spontaneously, a large subset require surgery to regain function, and others will have permanent disability despite intervention. Deciding when to pursue surgical intervention remains a challenge for clinicians treating BPBI. Methods: A comprehensive search of the literature was conducted using PubMed, Scopus, and MEDLINE databases. A total of 24 primary and secondary sources were chosen for inclusion following full-text assessments. All sources were analyzed to provide a comprehensive review on the development of BPBI treatments and interventions over time. Results: Spontaneous recovery can be achieved in many cases of BPBI, but most patients require physical therapy and other forms of treatment to avoid muscle imbalance and prevent contracture formation. In addition to physical therapy, the most common non-surgical interventions include botulinum toxin injections and splinting. In cases requiring surgery, clinicians may use several tests and diagnostic imaging to aid in decision making. Common surgical interventions for BPBI include nerve grafting, nerve transfers, and muscle and tendon transfers. Conclusion: Most newborns recover from BPBI within the first 3 months of life. However, some require treatment to restore optimal function. In general, non-surgical interventions should be the primary course of treatment, and surgery should be avoided unless the patient is deemed unable to recover with any other treatment.

Background: In May 2022, we challenged our colleagues to evaluate their educational approaches, policies, recruitment strategies, and leadership organizations with an Equity, Diversity, and Inclusion (EDI) lens. Methods: Two virtual national round table meetings were held in 2023 to discuss approaches to integration of the EDI principles into current Canadian plastic surgery training programmes. Additionally, integrative documents and processes were established within our programme to act as a guide for integration of the principles of EDI in the areas of resident education, recruitment, and retention. Results: There is an increasing awareness amongst Canadian plastic surgeons of the importance of integrating EDI education into our plastic surgery training programmes, yet there is a lack of experience and/or lack of resources available to facilitate these changes. Our taskforce (Division of Plastic Surgery at the University of Toronto) implemented an EDI curriculum in our programme in 2 main domains: Education and Recruitment Strategies. Conclusions: Breaking down some of the long-entrenched inequities in our healthcare system is an ongoing process. More work needs to be done toward increasing our trainee and faculty exposure to EDI principles, so that they can integrate these skills into their clinical practice, leadership, and beyond. Our taskforce's successes and challenges can act as a useful resource to other programmes desiring to initiate similar change.

Introduction: Every industry has greenhouse gas emissions, with healthcare a significant contributor. In Canada, the healthcare sector is directly and indirectly responsible for 4.6% of the country's greenhouse gas emissions. Operating rooms (ORs) are major contributors to hospital waste, making the OR low hanging fruit for analyzing environmental practices. The OR can adopt a green mindset to reduce its carbon footprint, yet barriers to going green exist. Herein we study non-hospital surgical centres in British Columbia to assess current green practices, attitudes towards environmental sustainability, and barriers to implementation.

Methods: All accredited non-hospital surgical centres in BC were invited to complete a survey on current practices and plans to reduce their environmental impact.

Results: Of 56 non-hospital surgical centres contacted, 18 responded, with 89% willing to adapt their practice to promote environmental sustainability, yet lacked current knowledge (56%) and formal plans (0%). The wide use of anesthetic gases with high global warming potential (64%) and disposable drapes/ gowns (78%/ 67%) were noted. Barriers to adopting green practices included: cost (44%), infrastructure (44%), regulatory guidelines (39%), knowledge (39%), and safety (28%).

Conclusions: Transitioning to more environmentally sustainable practices in ORs can enhance healthcare value by reducing both costs and greenhouse gas emissions. The greatest effect can be achieved through prudent choice of anesthetic gas agent, followed by reusable linens and drapes. Education and regulatory leadership were identified as crucial for overcoming these barriers. This study underscores the need for education, guidelines, and economically viable options to transition from awareness to action.