Plastic surgery最新文献

Background: Patients undergoing mastectomy for breast cancer treatment can have three-dimensional nipple areola complex (NAC) tattoos as part of their reconstructive journey. The generally accepted size and position of the NAC is noted in the literature, however, patients may have different preferences. Methods: All patients undergoing NAC tattoos were given the option to pick the size of the tattoo and location on their chest. Post-procedure measurements were obtained as well as BREAST-Q surveys to examine patient satisfaction. Results: In 104 patients, average NAC tattoo diameter was 3.62 cm (±0.45), average sternal notch to nipple was 19.53 cm (±2.66) and average nipple to inframammary fold was 8.59 cm (±2.64). On multivariable analysis, areola tattoo diameter was found to be significantly larger in patients with larger size implants (P = .02), and Asian women (P = .04). On multivariable analysis, sternal notch to nipple was significantly greater in patients with higher BMI (P = .04). In patients with pre-operative photos for comparison, post-tattoo size and position of the NAC reconstruction, was significantly smaller and higher on the chest compared to their pre-operative values with an average NAC diameter of 3.60 cm (±0.46) (P < .001), sternal notch to nipple of 19.45 cm (±2.87) (P < .001), and nipple to inframammary fold of 8.89 cm (±2.80) (P < .001). Sexual well-being significantly improved with an average score of 53 (±25) after micropigmentation. Conclusions: This study shows women prefer small areola size with a higher position compared to classic values, and these values may be influenced by race, BMI and implant size. Additionally, sexual well-being is improved after NAC reconstruction.

Introduction: As scientific publishing has transitioned online, open access and predatory publishers have surged. This study describes the frequency of publications in potentially predatory and open access journals among applicants to a Canadian plastic surgery residency program, and explores applicant characteristics associated with open access and predatory publishing. Methods: A retrospective review of plastic surgery resident applicants' curriculum vitae (CVs) from 2015 to 2018 was performed. Published articles listed in CVs were reviewed by 2 authors to identify publication availability, publication year, and publisher. Open access publications were identified using the Directory of Open Access Journals. Predatory publications were identified using Beall's list of potentially predatory publishers. Published applicants' characteristics were summarized. Applicant characteristics associated with open access and predatory publishing were explored using logistic regression. Results: Of the 186 applicants, 117 published 388 articles and were included in the final analysis. 156 (40.2%) articles were published in open access journals by 76 (40.8%) applicants. 14 (3.6%) articles were published in predatory journals by 14 (7.5%) applicants. Applicant characteristics associated with open access publishing included total number of publications (OR: 1.56, 1.18-1.93, P < .001) and presence of at least one post-baccalaureate degree (OR: 0.36, 0.13-0.95, P = .038). Only an applicant's total number of publications (OR: 1.25, 1.06-1.48, P = .010) was significantly associated with publishing in a predatory journal. Conclusion: These findings stress the importance of raising awareness within the plastic surgery community, including medical students, about the deceptive nature of predatory journals.

While panniculectomy is traditionally considered a cosmetic surgery, there is growing interest in the potential role of panniculectomy for the treatment of low back pain. We present a case of a 69-year-old man with a history of over 10 years of significant low back pain with radiculopathy rated as 7 out of 10 and resistant to conservative measures as well as multiple spinal decompression surgeries. He had undergone bariatric surgery 14 years prior and maintained a stable body mass index. He presented with a large pannus desiring panniculectomy for aesthetic purposes. He underwent an uncomplicated panniculectomy. As an unintended benefit of his procedure on his 1-month post-op visit, he reported near resolution of his low back pain and radiculopathy. His reported pain had been reduced to 1-2 out of 10. More research needs to be done to assess the potential of panniculectomy as a treatment for low back pain in patients with massive weight loss.

Reconstruction of large lower lip defects due to malignancies with good aesthetic result remains challenging. In this study we presented reconstruction of full thickness lower lip defect with modified hatchet flap. The charts of patients with 50% to 95% of the total lower lip defect due to lower lip tumor resection who had reconstruction with modified hatchet flap were reviewed. Seven of the patients had unilateral, two had bilateral modified hatchet flap. After follow-up period, it was concluded that this method provided a wide and functional mouth opening. Six of the patients stated that they were aesthetically satisfied with their appearance, while 3 patients found the result acceptable. None of the patients required additional surgical procedure. Modified hatchet flap is an easy-to-design, easy-to-remember flap with good aesthetic and functional results which makes it a reliable flap in the reconstruction of the large lower lip defects.

Background: Being named in a medicolegal complaint can be a lengthy process filled with uncertainties. Its current impact on Canadian plastic surgeons is unknown. We aim to review the impact of medicolegal complaints and provide advice for surgeons on how to prevent, minimize, and navigate through the medicolegal process. Method: An anonymous survey was sent to registered Royal College of Physicians and Surgeons of Canada certified plastic surgeon members. The survey collected data on surgeon demographics (clinical status, gender, practice type, volume), medicolegal complaint history and outcome, impact on practice, and insights into the process. Surgeons with an inactive practice and invalid contact information were excluded. Results: Out of 456 invited plastic surgeons, 100 responses were included, 73% were male, with an even distribution of practice types and years in practice. Most were Canadian Medical Protective Association (CMPA) members. A significant portion (62%) had been named in a medicolegal action, primarily related to treatment complications (42%) and poor outcomes/disease progression (34%). Factors associated with complaints were greater years in practice (P<.01), and a higher annual volume of operating room cases (P=.02). The duration of the medicolegal process varied, with the majority taking 1-2 years. Respondents predominantly agreed that CMPA provided adequate legal defence (83%, 53/64). However, most surgeons felt the process had a significantly negative impact on their mental health (75%, 48/64). After being involved in a complaint, many surgeons modified their practice pattern by increasing documentation/consent process (45%, 29/64), avoiding certain procedures (22%, 14/64), and avoiding care of high-risk patients (19%, 12/64). Conclusion: Despite legal resolution in favour of the physicians, the results of this survey indicate the medicolegal complaint process has a significant impact on plastic surgeons' practices, time, and mental health. Understanding the medicolegal process and outcome is crucial for risk mitigation.

Background: Artificial intelligence (AI) has significantly influenced various sectors, including healthcare, by enhancing machine capabilities in assisting with human tasks. In surgical fields, where precision and timely decision-making are crucial, AI's integration could revolutionize clinical quality and health resource optimization. This study explores the current and future applications of AI technologies in reconstructive breast surgery, aiming for broader implementation. Methods: We conducted systematic reviews through PubMed, Web of Science, and Google Scholar using relevant keywords and MeSH terms. The focus was on the main AI subdisciplines: machine learning, computer vision, natural language processing, and robotics. This review includes studies discussing AI applications across preoperative, intraoperative, postoperative, and academic settings in breast plastic surgery. Results: AI is currently utilized preoperatively to predict surgical risks and outcomes, enhancing patient counseling and informed consent processes. During surgery, AI supports the identification of anatomical landmarks and dissection strategies and provides 3-dimensional visualizations. Robotic applications are promising for procedures like microsurgical anastomoses, flap harvesting, and dermal matrix anchoring. Postoperatively, AI predicts discharge times and customizes follow-up schedules, which improves resource allocation and patient management at home. Academically, AI offers personalized training feedback to surgical trainees and aids research in breast reconstruction. Despite these advancements, concerns regarding privacy, costs, and operational efficacy persist and are critically examined in this review. Conclusions: The application of AI in breast plastic and reconstructive surgery presents substantial benefits and diverse potentials. However, much remains to be explored and developed. This study aims to consolidate knowledge and encourage ongoing research and development within the field, thereby empowering the plastic surgery community to leverage AI technologies effectively and responsibly for advancing breast reconstruction surgery.

Introduction: Treatment of breast cancer requires a multimodal approach with numerous independent specialists. Immediate breast reconstruction (IBR) adds another layer of coordination to comprehensive breast cancer care. To optimize health outcomes for patients seeking IBR, it is essential to efficiently coordinate the temporal sequence of care modalities inclusive of reconstruction. Methods: In this cross-sectional study, patients undergoing IBR following complete or partial mastectomy at one health centre from 2015 to 2021 were included. Patients were categorized into two main groups defined by the first treatment modality received, namely surgery first and Neoadjuvant Chemotherapy. Primary outcome measures were wait times for diagnostic investigations, initiation of treatment, and transitions between therapeutic modalities. Results: Of 195 patients, 158 underwent surgery first, and 37 underwent neoadjuvant chemotherapy. Median wait time from first consultation to first treatment initiated in the neoadjuvant cohort was shorter by 11.5 days as compared to the Surgery First cohort (21.5 +/- 19 vs 33.0 +/- 28 days; P = 0.001). Twenty-three (82%) of the surgery first and 11 (38%) of the neoadjuvant cohort patients waited longer than 8 weeks for initiation of radiotherapy (P = 0.001). Following surgical intervention, the majority of patients failed to meet target benchmarks for transition to chemotherapy (n = 25, 53%) and transition to radiotherapy (n = 26, 93%; P < 0.001). Conclusion: Patients undergoing IBR may incur delays in the setting of upfront surgery and in transitioning to adjuvant therapies. In the setting of breast reconstruction, further efforts are required to achieve target wait-times in multimodal breast cancer care.