Pub Date : 2024-06-14DOI: 10.1177/22925503241258153
Alan P C Gou, M. Bonapace-Potvin, Blair R. Peters
Purpose: While visibility and acceptance of the transgender community have increased across Canada, barriers persist in accessing gender-affirming surgeries (GAS). This study aims to determine the current state of GAS care in Canada, focusing on insurance coverage by province and identifying regions needing the development of specialized GAS programs. Methods: This cross-sectional study was conducted by examining provincial health ministry webpages and contacting health authorities and gender clinics to collect data on GAS coverage. Information on various procedures, including chest surgery, facial GAS, and genital surgeries was collected to determine which procedures are covered in each respective province. Geographic distribution of clinics that perform GAS procedures in Canada was also collected and sorted by referrals in-province and out-of-province. Results: There are 32 unique gender-affirming procedures covered by Canadian provincial health plans. Prince Edward Island provides the highest coverage of GAS procedures, while Nunavut covers the least. Quebec offers the most comprehensive in-province GAS program, with some in-province care available in the other provinces. The three territories generally lack access to any in-province procedures. Conclusions: Coverage for gender-affirming surgical procedures in Canada varies widely. Genital procedures have the most comprehensive coverage, chest surgeries are covered by most provinces, and facial GAS were only covered in two provinces. There is also a disparity between coverage and availability of GAS in most provinces. Physicians should advocate for broader coverage and targeted training and recruitment of GAS specialized surgeons in key geographic regions.
目的：虽然变性人群体在加拿大各地的可见度和接受度都有所提高，但在接受性别确认手术（GAS）方面仍存在障碍。本研究旨在确定加拿大 GAS 护理的现状，重点关注各省的保险覆盖范围，并确定需要制定专门 GAS 计划的地区。研究方法：这项横断面研究通过检查各省卫生部的网页、联系卫生当局和性别诊所来收集有关 GAS 保险的数据。我们收集了各种手术的信息，包括胸部手术、面部 GAS 和生殖器手术，以确定各省覆盖了哪些手术。此外，还收集了加拿大实施 GAS 手术的诊所的地理分布情况，并按省内和省外转诊情况进行了分类。结果：加拿大各省医疗计划共涵盖 32 种独特的性别确认程序。爱德华王子岛省的性别确认手术覆盖率最高，而努纳武特地区的覆盖率最低。魁北克省提供最全面的省内 GAS 计划，其他省份也提供一些省内护理。这三个地区一般不提供任何省内治疗。结论：在加拿大，性别确认外科手术的覆盖范围差别很大。生殖器手术的覆盖面最广，胸部手术在大多数省份都有覆盖，而面部 GAS 仅在两个省份有覆盖。在大多数省份，GAS 的覆盖范围和可用性之间也存在差异。医生应倡导扩大覆盖范围，并在主要地理区域有针对性地培训和招聘 GAS 专业外科医生。
{"title":"Accessibility and Insurance Coverage for Gender-affirming Surgery in Canada: A Cross-Sectional Analysis","authors":"Alan P C Gou, M. Bonapace-Potvin, Blair R. Peters","doi":"10.1177/22925503241258153","DOIUrl":"https://doi.org/10.1177/22925503241258153","url":null,"abstract":"Purpose: While visibility and acceptance of the transgender community have increased across Canada, barriers persist in accessing gender-affirming surgeries (GAS). This study aims to determine the current state of GAS care in Canada, focusing on insurance coverage by province and identifying regions needing the development of specialized GAS programs. Methods: This cross-sectional study was conducted by examining provincial health ministry webpages and contacting health authorities and gender clinics to collect data on GAS coverage. Information on various procedures, including chest surgery, facial GAS, and genital surgeries was collected to determine which procedures are covered in each respective province. Geographic distribution of clinics that perform GAS procedures in Canada was also collected and sorted by referrals in-province and out-of-province. Results: There are 32 unique gender-affirming procedures covered by Canadian provincial health plans. Prince Edward Island provides the highest coverage of GAS procedures, while Nunavut covers the least. Quebec offers the most comprehensive in-province GAS program, with some in-province care available in the other provinces. The three territories generally lack access to any in-province procedures. Conclusions: Coverage for gender-affirming surgical procedures in Canada varies widely. Genital procedures have the most comprehensive coverage, chest surgeries are covered by most provinces, and facial GAS were only covered in two provinces. There is also a disparity between coverage and availability of GAS in most provinces. Physicians should advocate for broader coverage and targeted training and recruitment of GAS specialized surgeons in key geographic regions.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141339737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-20DOI: 10.1177/22925503241255118
Stacy Fan, Stephanie Kim, Kaveh Farrokhi, Dianna Deng, Laryssa Laurignano, Devin Box, Aaron Grant, Sarah Appleton, Tanya DeLyzer
Background: The deep inferior epigastric perforator artery (DIEP) free flap is the most commonly performed autologous breast reconstruction. Despite the relative reduction in donor site complications compared to nonmuscle-sparing options, there is still high morbidity associated with this surgery. The purpose of this study is to compare outcomes and complications at our institution and to discuss potential quality improvement initiatives. Methods: A retrospective cohort study was performed looking at patients who underwent delayed or immediate autologous breast reconstruction with a DIEP flap over a 6-year period (2015-2021) at our institution. Complication rates for abdominal infection, seroma, hematoma, wound dehiscence, delayed wound healing, umbilical necrosis, subjective abdominal weakness, abdominal bulge, and hernia were calculated. Additionally, a prospective cohort study was conducted using a portable ultrasound device to detect postoperative changes in the abdominal donor site, including fluid collections and postoperative edema. Results: One hundred seventeen patients underwent autologous breast reconstruction with a DIEP-free flap. Forty-one percent of patients experienced 1 or more donor site complications. Complication rates were 16.2%, 12.8%, 1.7%, 15.4%, 8.5%, 4.3%, 0%, 10.3%, and 2.6%, respectively, for the list above. There was a higher proportion of complications in patients who smoked within the past 3 months and those who had a body mass index (BMI) between 35 and 39.9, although this was not statistically significant. Bilateral reconstructions had higher rates of umbilical necrosis (24.5% vs 7.8%) and wound dehiscence (9.4% vs 0%) compared to unilateral. Twenty-one patients were included in the prospective analysis. No significant changes in abdominal wall edema were found. Twenty-four percent of the patients had detectible collections on ultrasound, and these were associated with wound dehiscence and the need for debridement. Discussion: Our institutional abdominal donor site complication rates in DIEP reconstruction patients are higher than those published in the literature. Similar complication rates were identified regardless of smoking status, BMI, and unilateral/bilateral surgery. Quality improvement initiatives could be considered and implemented to reduce future complications.
{"title":"Donor Site Outcomes Following Autologous Breast Reconstruction with DIEP Flap: A Retrospective and Prospective Study in a Single Institution","authors":"Stacy Fan, Stephanie Kim, Kaveh Farrokhi, Dianna Deng, Laryssa Laurignano, Devin Box, Aaron Grant, Sarah Appleton, Tanya DeLyzer","doi":"10.1177/22925503241255118","DOIUrl":"https://doi.org/10.1177/22925503241255118","url":null,"abstract":"Background: The deep inferior epigastric perforator artery (DIEP) free flap is the most commonly performed autologous breast reconstruction. Despite the relative reduction in donor site complications compared to nonmuscle-sparing options, there is still high morbidity associated with this surgery. The purpose of this study is to compare outcomes and complications at our institution and to discuss potential quality improvement initiatives. Methods: A retrospective cohort study was performed looking at patients who underwent delayed or immediate autologous breast reconstruction with a DIEP flap over a 6-year period (2015-2021) at our institution. Complication rates for abdominal infection, seroma, hematoma, wound dehiscence, delayed wound healing, umbilical necrosis, subjective abdominal weakness, abdominal bulge, and hernia were calculated. Additionally, a prospective cohort study was conducted using a portable ultrasound device to detect postoperative changes in the abdominal donor site, including fluid collections and postoperative edema. Results: One hundred seventeen patients underwent autologous breast reconstruction with a DIEP-free flap. Forty-one percent of patients experienced 1 or more donor site complications. Complication rates were 16.2%, 12.8%, 1.7%, 15.4%, 8.5%, 4.3%, 0%, 10.3%, and 2.6%, respectively, for the list above. There was a higher proportion of complications in patients who smoked within the past 3 months and those who had a body mass index (BMI) between 35 and 39.9, although this was not statistically significant. Bilateral reconstructions had higher rates of umbilical necrosis (24.5% vs 7.8%) and wound dehiscence (9.4% vs 0%) compared to unilateral. Twenty-one patients were included in the prospective analysis. No significant changes in abdominal wall edema were found. Twenty-four percent of the patients had detectible collections on ultrasound, and these were associated with wound dehiscence and the need for debridement. Discussion: Our institutional abdominal donor site complication rates in DIEP reconstruction patients are higher than those published in the literature. Similar complication rates were identified regardless of smoking status, BMI, and unilateral/bilateral surgery. Quality improvement initiatives could be considered and implemented to reduce future complications.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-02DOI: 10.1177/22925503231224195
Andrew Gorgy, Tyler Safran, J. Vorstenbosch
{"title":"Commentary: Current Practices and Trends of Plastic and Oncoplastic Breast Surgeons in Canada","authors":"Andrew Gorgy, Tyler Safran, J. Vorstenbosch","doi":"10.1177/22925503231224195","DOIUrl":"https://doi.org/10.1177/22925503231224195","url":null,"abstract":"","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139453160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-14DOI: 10.1177/22925503231219208
Michael J. Stein
{"title":"Commentary: Instagram Practices of Successful Plastic Surgeon Accounts: Is There a Magic Formula?","authors":"Michael J. Stein","doi":"10.1177/22925503231219208","DOIUrl":"https://doi.org/10.1177/22925503231219208","url":null,"abstract":"","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138974638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-13DOI: 10.1177/22925503231217513
Olachi O. Oleru, N. Seyidova, Peter J Taub
Background: Abdominal contouring after massive weight loss has positive impacts on quality of life. There are often cost and access barriers for patients who desire these procedures. Objectives: To examine levels of access to body contouring in the era of price transparency, this study aims to characterize the out-of-pocket expenses and physician/facility payments in abdominal contouring procedures. Setting: The IBM MarketScan Commercial Databases were queried to identify patients who underwent outpatient abdominal contouring surgeries in the United States in 2021. Methods: Financial variables of interest included gross payments to the provider (facility and/or physician) and out-of-pocket costs (total of coinsurance, deductible, and copayments). Univariate analysis and mixed-effects linear regression were utilized to study the variations in costs across regions, insurance plan types, and places of service. Results: A total of 1319 abdominal contouring episodes were identified. The average age was 44.7, and the majority of patients were female (91%) and in the South region (44%). Median out-of-pocket costs were low overall ($30, IQR $768) and median total physician/facility payments for abdominal contouring was $4982.47 (IQR $7392.46). Out-of-pocket costs were highest in the South ($105) and $0 in all other regions ( P < .05). The highest physician/facility payments were in the Northeast ($6392) and the lowest was in the South ($3936). Conclusions: Patients undergoing abdominal contouring incur relatively low out-of-pocket costs overall, but there is a need for further reimbursement negotiation in regions where physician payments are lower and out-of-pocket costs are higher. Further study should explore reimbursement and payment gaps in procedural coverage.
{"title":"Out-of-Pocket Costs and Physician Payment Variations in Abdominal Contouring: Evidence From United States Claims Data","authors":"Olachi O. Oleru, N. Seyidova, Peter J Taub","doi":"10.1177/22925503231217513","DOIUrl":"https://doi.org/10.1177/22925503231217513","url":null,"abstract":"Background: Abdominal contouring after massive weight loss has positive impacts on quality of life. There are often cost and access barriers for patients who desire these procedures. Objectives: To examine levels of access to body contouring in the era of price transparency, this study aims to characterize the out-of-pocket expenses and physician/facility payments in abdominal contouring procedures. Setting: The IBM MarketScan Commercial Databases were queried to identify patients who underwent outpatient abdominal contouring surgeries in the United States in 2021. Methods: Financial variables of interest included gross payments to the provider (facility and/or physician) and out-of-pocket costs (total of coinsurance, deductible, and copayments). Univariate analysis and mixed-effects linear regression were utilized to study the variations in costs across regions, insurance plan types, and places of service. Results: A total of 1319 abdominal contouring episodes were identified. The average age was 44.7, and the majority of patients were female (91%) and in the South region (44%). Median out-of-pocket costs were low overall ($30, IQR $768) and median total physician/facility payments for abdominal contouring was $4982.47 (IQR $7392.46). Out-of-pocket costs were highest in the South ($105) and $0 in all other regions ( P < .05). The highest physician/facility payments were in the Northeast ($6392) and the lowest was in the South ($3936). Conclusions: Patients undergoing abdominal contouring incur relatively low out-of-pocket costs overall, but there is a need for further reimbursement negotiation in regions where physician payments are lower and out-of-pocket costs are higher. Further study should explore reimbursement and payment gaps in procedural coverage.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-12DOI: 10.1177/22925503231219221
D. Courtemanche
{"title":"We Need a Bio-Psycho-Social-Spiritual Approach to Life","authors":"D. Courtemanche","doi":"10.1177/22925503231219221","DOIUrl":"https://doi.org/10.1177/22925503231219221","url":null,"abstract":"","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139007245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-12DOI: 10.1177/22925503231220368
Celina Mekhele Nahanni, Laura Snell
{"title":"Commentary: Two-Eyed Seeing (Aistotsastip) and the Medicine Wheel for the Plastic Surgeon","authors":"Celina Mekhele Nahanni, Laura Snell","doi":"10.1177/22925503231220368","DOIUrl":"https://doi.org/10.1177/22925503231220368","url":null,"abstract":"","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-12DOI: 10.1177/22925503231217516
Dara Rykiss, R. Courtemanche, Sally Hynes
Introduction: There is limited data on the effects of tissue expansion (TE) surgery on quality-of-life (QOL) in pediatric patients. Evidence-based information may help clinicians, patients, and their families with treatment decision-making and post-operative expectations. This study explores QOL following TE in pediatric patients. Methods: A post-intervention QOL survey and retrospective chart review was performed. Patients who underwent TE at a pediatric tertiary hospital between October 2004 and March 2020 completed the Glasgow Children's Benefit Inventory or the Glasgow Benefit Inventory. Total scores range from −100(worsened QOL) to +100(improved QOL). Participants were also asked if they would recommend TE to other patients with the same indication. Results: The response rate was 38% (n = 20; 14 females, 6 males). The median QOL score was +17[−2,+49]. Higher QOL scores were found for TE indications of scar (+49) and alopecia (+40), compared to giant congenital melanocytic nevus (−2). Higher scores were also associated with shorter time in active treatment ( r = −0.65) and fewer complications ( r = −0.56). 18/20 participants would recommend TE. Participants whose QOL improved (n = 11, 55%) reported increased self-confidence, fitting in with peers, and improved function. Participants with unchanged or decreased QOL (n = 9, 45%) described a negative experience with residual scarring. However, 7/9 with unchanged or decreased QOL would still recommend TE. Conclusions: This preliminary descriptive study demonstrated variable QOL following TE. Patient and treatment-related factors impact QOL outcomes. Despite the range in QOL outcomes, the majority of participants would recommend TE. Further research evaluating QOL following TE is necessary to better understand this relationship.
简介：有关组织扩张（TE）手术对儿科患者生活质量（QOL）影响的数据十分有限。基于证据的信息可帮助临床医生、患者及其家属做出治疗决策和术后预期。本研究探讨了儿童患者接受组织扩张术后的生活质量。方法：进行干预后 QOL 调查和回顾性病历审查。2004 年 10 月至 2020 年 3 月期间在一家儿科三级医院接受 TE 的患者填写了格拉斯哥儿童受益量表或格拉斯哥受益量表。总分从-100（生活质量恶化）到+100（生活质量改善）不等。参与者还被问及是否会向其他有相同适应症的患者推荐 TE。结果：回复率为 38%（n = 20；14 名女性，6 名男性）。QOL 评分中位数为 +17[-2,+49]。与巨大先天性黑素细胞痣（-2）相比，TE适应症疤痕（+49）和脱发（+40）的QOL评分更高。较高的评分还与较短的积极治疗时间（r = -0.65）和较少的并发症（r = -0.56）有关。18/20的参与者推荐使用 TE。生活质量有所改善的参与者（11 人，55%）表示自信心增强，能够融入同龄人，功能也有所改善。质量、生活质量不变或下降的参与者（9 人，占 45%）对残留瘢痕有负面体验。不过，7/9 的 QOL 未变或下降者仍会推荐 TE。结论：这项初步描述性研究表明，TE 后的 QOL 存在差异。患者和治疗相关因素会影响 QOL 结果。尽管 QOL 结果存在差异，但大多数参与者仍会推荐 TE。为了更好地理解这种关系，有必要对 TE 后的 QOL 进行进一步的评估研究。
{"title":"An Assessment of Quality-of-Life Following Tissue Expansion in Pediatric Patients","authors":"Dara Rykiss, R. Courtemanche, Sally Hynes","doi":"10.1177/22925503231217516","DOIUrl":"https://doi.org/10.1177/22925503231217516","url":null,"abstract":"Introduction: There is limited data on the effects of tissue expansion (TE) surgery on quality-of-life (QOL) in pediatric patients. Evidence-based information may help clinicians, patients, and their families with treatment decision-making and post-operative expectations. This study explores QOL following TE in pediatric patients. Methods: A post-intervention QOL survey and retrospective chart review was performed. Patients who underwent TE at a pediatric tertiary hospital between October 2004 and March 2020 completed the Glasgow Children's Benefit Inventory or the Glasgow Benefit Inventory. Total scores range from −100(worsened QOL) to +100(improved QOL). Participants were also asked if they would recommend TE to other patients with the same indication. Results: The response rate was 38% (n = 20; 14 females, 6 males). The median QOL score was +17[−2,+49]. Higher QOL scores were found for TE indications of scar (+49) and alopecia (+40), compared to giant congenital melanocytic nevus (−2). Higher scores were also associated with shorter time in active treatment ( r = −0.65) and fewer complications ( r = −0.56). 18/20 participants would recommend TE. Participants whose QOL improved (n = 11, 55%) reported increased self-confidence, fitting in with peers, and improved function. Participants with unchanged or decreased QOL (n = 9, 45%) described a negative experience with residual scarring. However, 7/9 with unchanged or decreased QOL would still recommend TE. Conclusions: This preliminary descriptive study demonstrated variable QOL following TE. Patient and treatment-related factors impact QOL outcomes. Despite the range in QOL outcomes, the majority of participants would recommend TE. Further research evaluating QOL following TE is necessary to better understand this relationship.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139010112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The distinction between reconstructive and aesthetic surgery becomes less apparent when body image and self-esteem secondary to congenital deformities affect psychosocial well-being. Parents and plastic surgeons debate the appropriate age to correct non-life-threatening congenital defects to avoid a psychologically distressing event to the child. Furthermore, an ethical debate emerges when parents make decisions on behalf of children below the age of consent and lack the necessary cognitive development. This challenging responsibility then rests upon the operating practitioner to prioritize the child's best interests. This paper examines three hypothetical cases to explore the psychosocial and ethical aspects of conducting external ear surgery in the pediatric population and determining the ideal timing.
{"title":"Ethical Considerations in Pediatric External Ear Surgery","authors":"Becher Al-Halabi, Abdulaziz Alabdulkarim, Sabrina Cugno","doi":"10.1177/22925503231213868","DOIUrl":"https://doi.org/10.1177/22925503231213868","url":null,"abstract":"The distinction between reconstructive and aesthetic surgery becomes less apparent when body image and self-esteem secondary to congenital deformities affect psychosocial well-being. Parents and plastic surgeons debate the appropriate age to correct non-life-threatening congenital defects to avoid a psychologically distressing event to the child. Furthermore, an ethical debate emerges when parents make decisions on behalf of children below the age of consent and lack the necessary cognitive development. This challenging responsibility then rests upon the operating practitioner to prioritize the child's best interests. This paper examines three hypothetical cases to explore the psychosocial and ethical aspects of conducting external ear surgery in the pediatric population and determining the ideal timing.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136351294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-13DOI: 10.1177/22925503231213872
Jamie A. Mawhinney, Craig A. Mounsey, Nick A. Johnson, Peter G. Russell
Radial forearm free flaps (RFFF) are a versatile option for the reconstruction of a wide variety of soft tissue defects and are particularly common in head and neck surgery. Benefits of RFFF include a relatively short operating time, a long pedicle, and a thinner, more pliable flap. However, in addition to its role in reconstructive surgery, the radial artery may be utilized for a number of other procedures including coronary angiography and percutaneous coronary interventions. Concern has previously been raised that prior catheterization may deleteriously affect the function of the radial artery and in the field of cardiothoracic surgery, individuals are increasingly advising against its use as a graft for coronary artery bypass graft surgery in such circumstances. Despite this, little is known about the effect on RFFF. In this review article, we concisely consider the available evidence of the effect of previous transradial catheterization on the radial artery and discuss the implications for reconstructive surgery. We then summarize the key considerations regarding their use in current practice.
{"title":"The Effect of Previous Transradial Catheterization on Radial Forearm Free Flaps","authors":"Jamie A. Mawhinney, Craig A. Mounsey, Nick A. Johnson, Peter G. Russell","doi":"10.1177/22925503231213872","DOIUrl":"https://doi.org/10.1177/22925503231213872","url":null,"abstract":"Radial forearm free flaps (RFFF) are a versatile option for the reconstruction of a wide variety of soft tissue defects and are particularly common in head and neck surgery. Benefits of RFFF include a relatively short operating time, a long pedicle, and a thinner, more pliable flap. However, in addition to its role in reconstructive surgery, the radial artery may be utilized for a number of other procedures including coronary angiography and percutaneous coronary interventions. Concern has previously been raised that prior catheterization may deleteriously affect the function of the radial artery and in the field of cardiothoracic surgery, individuals are increasingly advising against its use as a graft for coronary artery bypass graft surgery in such circumstances. Despite this, little is known about the effect on RFFF. In this review article, we concisely consider the available evidence of the effect of previous transradial catheterization on the radial artery and discuss the implications for reconstructive surgery. We then summarize the key considerations regarding their use in current practice.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136282352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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