Plastic surgery最新文献

Introduction: Trends within the Canadian plastic surgery workforce demonstrated that most work in academic or medium-large community practice. Recent studies observed more plastic surgeons are incorporating aesthetics into their practice. This study aims to identify factors influencing how plastic surgery residents and early-career plastic surgeons in Canada choose their eventual practice with respect to practice type and practice location. Methods: A REDCap survey was distributed to plastic surgery residents and early-career plastic surgeons across Canada between February and May 2024. Demographics, training information, career information, and Likert-scale questions for factors involved in decision-making were surveyed. Data analysis included descriptive statistics and Fisher exact tests. Results: There were 45 residents and 30 early-career plastic surgeon respondents. Mixed practices that included aesthetics were the most popular practice types among residents (73%) and early-career surgeons (77%). Half (53%) of early-career surgeons were working in urban settings with more than 1 million people, and 44% of residents desired these locations. Hometown factors heavily influenced practice type and location (P < .0001), more than training experiences. Positive interactions (94%), operating time (90%), partner opinion (87%), and hospital resources (86%) were ranked as the most important factors involved in practice decisions. Conclusion: Mixed practices that include aesthetics were the most popular among our up-and-coming Canadian workforce, especially in urban settings. These changing practice trends may impact our ability as a specialty to adequately meet the needs of the Canadian population. Recruitment efforts should focus on promoting a supportive workplace and local environment, with adequate operating time and resources.

Background: Reporting the 50 most cited manuscripts on virtual surgical planning (VSP) for craniofacial surgery, thereby providing a comprehensive review of landmark papers. Methods: The Web of Science Citation Index was used to identify the 50 most cited manuscripts on VSP in craniofacial surgery. These were classified by level of evidence, type of study, topic of interest, and anatomic site. Results: The mean number of citations was 126.3 ± SD 51.7. Twenty were clinical papers: 9 reviews, and 21 workflow or technology. The most common level of evidence (LoE) was 4 (n = 12), followed by 3 (n = 6), 2 (n = 1), and 5 (n = 1). Thirty-nine of 50 articles focused on the maxillomandibular area of the face, 5 zygomatic, 5 orbit, 2 cranial vault, and 1 nasal ethmoid bone. The majority of articles (37 of 50) were on orthognathic surgery, 11 facial reconstruction, 2 calvarium reconstruction or craniosynostosis, and 2 free flap procedures. Year of publication ranged from 2000 to 2019; 34 articles were published in craniomaxillofacial journals. Conclusion: VSP is a relatively new technology and most highly cited articles on this topic pertain to workflow, technology, and protocols, as these are necessary for its integration into clinical practice. In our list, VSP was most used in orthognathic surgery; however, due to the potential increased efficiency and accuracy, it is being explored in other areas of craniofacial surgery such as facial reconstruction and craniosynostosis. Accordingly, we expect to see increasingly widespread usage of VSP in other areas of surgery, which could potentially lead to highly cited papers.

Introduction: Abdominoplasty is a common aesthetic surgical procedure primarily performed under general anesthesia (GA). However, GA is aerosol-generating and involves extended immobilization associated with systemic complications like venous thromboembolisms (VTEs). There is increasing interest in performing abdominoplasties without GA because of potential lower complication rates and shorter postoperative recovery time. This review sought to summarize all available literature on the safety and outcomes of abdominoplasty performed without GA. Methods: A scoping review was conducted with no date limits in October 2023 encompassing Medline, Embase, Web of Science, and CINAHL. The type of anesthesia was separated into 3 categories: conscious or intravenous (IV) sedation, regional anesthetic blocks (RAB: spinal and epidural), and local anesthesia (direct local infiltration and field blocks). Results: A total of 28 studies were included. Safety data was reported for abdominoplasty alone (n = 6), with liposuction (n = 14), or both (n = 1). The employed anesthesia methods were IV and local (n = 13), RAB and local (n = 3), IV and RAB (n = 2), IV and RAB and local (n = 2), and IV only (n = 1). A total of 48 379 patients were identified, with 30 cases of VTEs reported. Two studies reported GA conversion rates between 4.8% and 6.0%. A total of 11 studies assessed abdominoplasty outcomes, highlighting high patient satisfaction and low postoperative pain. The majority of analyzed studies had a "high" or "critical" risk of bias. Conclusion: Our review provides preliminary evidence that performing abdominoplasty without GA is safe and feasible. Additional high-quality studies are necessary to further validate our findings and to develop a standardized approach.

Introduction: Breast cancer care requires both oncologists and plastic surgeons. Coordinating these specialists and combining extirpative and reconstructive procedures before adjunctive therapies can cause delays in care. For patients with less advanced disease, surgery is performed before adjunctive therapies, requiring early specialist coordination and the possibility of surgical complications. We compare these patients to those with more advanced disease requiring adjunctive therapies before surgery. Methods: A retrospective chart review identified 337 post-mastectomy + immediate breast reconstruction (IBR) patients. Patients were divided into surgery first (SF) and neoadjuvant chemotherapy (NC) first groups with reconstructive subgroups. Wait times between care pathway milestones were compiled and compared to national standards. Results: SF experienced longer wait times from consultation to treatment initiation (47 ± 51.5 vs 22 ± 22, P<.001) and from first to second treatment modality (62 ± 35 vs 39 ± 17, P<.001). Furthermore, only 29% of SF met the standard of receiving treatment within 4 weeks from consultation compared to 63% of NC (P<.001). Within subgroups, SF alloplastic reconstructions had shorter wait times compared to SF autologous reconstructions. For SF, only 31% of alloplastic and 24% of autologous reconstruction initiated treatment within 4 weeks of consultation. Conclusion: In this cohort of Canadian breast cancer patients, those receiving surgery first experienced prolonged wait times to treatment, particularly with autologous reconstruction. Patients should be informed of the potential impact on adjunctive therapies when considering reconstructive modality.

Background: Abdominoplasty continues to be a frequently performed plastic surgery procedure. Futhermore, an increase in both surgical and medical weight loss is contributing to the procedure's increasing popularity. Technical refinements have improved surgical outcomes and safety. Despite this, it remains a procedure with one of the highest morbidity and mortality risks in aesthetic plastic surgery. Methods: A review of abdominoplasty complications and best practices was performed in order to provide a succinct review of the most prevalent safety issues in abdominoplasty surgery. Proposal: In order to mitigate the risk of complications, risk stratification, patient selection, and using evidence-based techniques are essential. In the present study, the authors provide recommendations for approaching the most common safety considerations of this procedure. Conclusion: Appropriate patient selection, surgical technique and proper protocols, ensures surgeons control the modifiable risk factors that increase complications. Implementing nonpharmacologic and pharmacologic interventions reduce the risk of venous thromboembolism. Using evidence-based techniques tailored to the specific patient's anatomy ensures the vascular territories of the abdominoplasty flap are respected and perfusion for wound healing is optimized.

Purpose: The purpose of this study was to determine the necessity and cost-effectiveness of radiologists' interpretation of plain hand radiographs for diagnosing and managing different hand pathologies in the plastic surgery outpatient clinic setting. Methods: Through a retrospective cohort study, we identified new patient encounters from January 2021 to December 2022 in an outpatient hand clinic. We included patients with radiology reports that were submitted subsequent to the surgeon's consult note in clinic. Plastic surgeons' interpretations were compared with radiology reports, and findings were categorized as concordant, discrepant (different with no impact on management), or discordant (different with an impact on management). Analysis included radiograph type, underlying mechanism, site of pathology, and hand fellowship training for surgeons. Direct cost was calculated using billing code fees. Results: A total of 241 cases were included in the study: 187 were concordant (77.6%), 53 were discrepant (22%) and only one was discordant (0.4%). Trauma was the predominant reported mechanism (90.5%). Most pathologies were in the phalanges (53.5%), followed by metacarpals (30.7%) and carpals (15.8%). Univariate analysis demonstrated no significant association between radiograph type (P = .829), underlying mechanism (P = .172), site of pathology (P = .482), surgeon's training (P = .551) and concordance with radiology reports. Total direct cost of radiographs reporting in this study was 8477 CAD. Conclusion: The study identified high concordance rates of hand radiograph findings between plastic surgeons and radiologists, with radiology reports rarely impacting patient management. Given the significant patient volume in plastic surgery hand clinics, these findings prompt further considerations in optimizing cost-effective diagnostic practices.