Annals of Plastic Surgery最新文献

Background: Breast reduction surgery has witnessed significant advancements in recent years; however, it continues to pose challenges for both surgeons and patients when dealing with cases involving excessive breast volume and severe breast ptosis. This study aimed to assess the aesthetic outcomes and the impact on the quality of life, as measured by the BREAST-Q questionnaire, in patients with gigantomastia and severe breast ptosis who underwent reduction mammaplasty using the superomedial-based pedicle technique.

Methods: We present a retrospective series comprising 84 patients who underwent reduction mammoplasty utilizing the superomedial pedicle technique. The surgical resections exceeded 1 kg per breast, with a mean resection weight of 1506.58 g (right breast) and 1500.32 g (left breast). The preoperative mean suprasternal notch to nipple distance measured 40.50 cm (right breast) and 40.38 cm (left breast). Postoperatively, the patients were followed up for a minimum of 6 months. Both preoperative and postoperative BREAST-Q surveys were administered to the participants, and scores were analyzed using descriptive statistics.

Results: Complications were observed in 3 patients (3.57%), characterized by partial loss of the areola, which resolved spontaneously over time. Additionally, 2 cases of hematoma and 2 instances of minor delayed wound healing were reported. All patients expressed satisfaction with their aesthetic outcomes, as they achieved a natural breast shape and minimal scarring, along with symptomatic relief.

Conclusions: The superomedial pedicle reduction mammaplasty technique has demonstrated its ability to produce satisfactory aesthetic outcomes and long-term benefits in patients with excessively large breasts. Careful patient selection and postoperative management are vital for achieving optimal results. Further investigations involving larger sample sizes and longer follow-up periods are warranted to validate our findings.

Level of evidence: IV.

Abstract: Absenteeism among clinical patients is a significant source of inefficiency in the modern American health care system. Routine absenteeism limits access to care for indigent patients, thus providing additional strain on the health care system and timely administration of care.This quality improvement project set out to quantify, understand, and potentially reduce patient absenteeism in our weekly plastic and reconstructive surgery resident indigent care clinic. One year prior to our study was retrospectively reviewed to determine a baseline rate of absenteeism (no shows). The daily and monthly no-show percentages were calculated. Then, three consecutive 2-month Plan, Do, Study, Act (PDSA) cycles were performed and data were recorded.The initial year analysis demonstrated an average no-show rate of 25%. The first PDSA cycle attempted to ascertain factors contributing to absenteeism and to get patients rescheduled. The rate of clinical absenteeism was 27% over this period compared with a rate of 18% in the control period. During this period, we discovered a limitation of our institution's electronic medical record (EMR). Rescheduled patients were removed from the original schedule and were not counted as a missed appointment even though the opportunity for care was missed. The second PDSA cycle attempted to collect raw data while trying to understand the EMR error and rescheduling process. During this period, there was a 33% no-show rate compared with 27% in the control period. The third PDSA cycle attempted again to establish factors contributing to clinical absenteeism with a better understanding of the limitations of our EMR. A 33% no-show rate during this cycle was recorded compared with 22% in the control period. After three PDSA cycles were completed, our clinic had an average no-show rate of 31% compared with 25% during the same months in the previous year.This project brought to realization that our data were initially skewed by our ignorance of an EMR flaw that did not track patients who either canceled or rescheduled their appointments. We also learned that there is a certain subset of patients who are not able to be contacted and who do not follow up.

Abstract: Magnetic resonance imaging (MRI) is a potentially powerful novel peripheral nerve diagnosis technique. To determine its validity, in-vivo preclinical studies are necessary. However, when using a rodent model, positioning rats and achieving high-resolution images can be challenging. We present a short report that outlines an optimal protocol for positioning rats for in-vivo MRI acquisition. Female Sprague-Dawley rats with sciatic nerve injury were induced into anesthesia using 4% isoflurane in oxygen and maintained at 1.5%. Rats were placed into a plexiglass cradle in a right lateral recumbent position, and a surface coil was placed over the left leg. Respiration rate and body temperature were monitored throughout the scan. Our protocol was successful as rats were able to undergo MRI scanning safely and efficiently. There were no adverse reactions, and clear images of the left sciatic nerve were obtained. Animal positioning took 30 minutes, and 5 different acquisitions were obtained in 2 hours. The total time from anesthesia induction to recovery was under 3 hours. Given the increasing interest in MRI diagnostic techniques, we hope this report aids other researchers studying peripheral nerve injury imaging in rat models.

Abstract: Congenital flexion contracture of ulnar digits is a rare entity with few cases reported in medical literature. This condition is often misdiagnosed as Volkmann ischemic contracture as both have similar presentation. The patient history, physical examination, radiological investigation, and intra-operative findings can differentiate these 2 conditions clearly. A 14-year-old female presented to a tertiary care hospital with flexion deformity of the left long, ring, and little fingers without neurological deficit since she was 3 years old. Patient had decreased handspan with difficulty in grasping daily life objects. Finger flexion deformity was also not aesthetically acceptable due to social stigma. Patient finger contracture was managed with flexor pronator slide (Max-Page) operation. The muscle slide operation was done using concealed medial incision. Aesthetic and functional correction was achieved with no recurrence at subsequent follow-ups.

Background: Contemporary medical education devotes little time to plastic surgery topics. This deficiency is potentially greater at institutions without a dedicated plastic surgery training program. Lack of exposure to plastic surgery results in many medical students developing limited awareness to the full scope of the field. As a result, these future physicians may be unaware of many conditions treated by the plastic surgeon, resulting in referrals being diverted to alternative specialist and furthering scope of practice creep. This study aims to assess medical students' exposure to plastic surgery and evaluate institutional-based differences in plastic surgery education by comparing medical schools with and without a plastic surgery training program.

Methods: Surveys were distributed to medical students at 2 institutions in the same United States city: 1 with a plastic surgery training program (TP) and 1 with no training program (NTP). Surveys assessed students' clinical experiences, exposure to plastic surgery, and understanding of the scope of plastic surgery.

Results: The response rate was 24.3% (306 of 1261). Many students reported having "little" or "no" exposure to plastic surgery during preclinical (93.5%) and clinical (77.7%) phases. NTP students were more likely to report "no" exposure to plastic surgery during both the preclinical ( P = 0.0145) and clinical ( P = 0.045) years. Consequently, approximately half of all students felt uncomfortable knowing when to refer a patient (46.1%) or place an inpatient consult (51.1%) to a plastic surgeon.When presented with clinical scenarios, plastic surgery was selected by only 53.4% of students. Performance between institutions was similar (53.0% TP vs 53.5% NTP, P = 0.936), with greater accuracy on cosmetic vignettes compared with hand and peripheral nerve vignettes. There was a statistically significant difference in 4 subspecialty domains between students who had prior exposure to plastic surgery and those who did not (hand/peripheral nerve, P < 0.0001; craniofacial, P = 0.007; breast/cosmetic, P = 0.001; and reconstruction/burn, P < 0.0001).

Conclusions: These findings add to the growing body of literature demonstrating that medical students have limited exposure to plastic surgery. Although limited in its scope, this study suggests that home TP status does not appear to overtly impact students' understanding. Increased exposure and overall surgical experience correlated with an increased understanding of the scope of plastic surgery.

Background: Often secondary to obesity, adult-acquired buried penis (AABP) is an increasingly common condition. AABP is often detrimental to urinary and sexual function, psychological well-being, and quality of life. Surgical treatment involves resection of excess soft tissue, with adjunct procedures, including a panniculectomy. However, few studies have been conducted investigating the risks of panniculectomy in the context of AABP surgical repair.

Methods: A systematic review of PubMed, Embase, and Cochrane databases was performed, following the PRISMA 2020 guidelines. Descriptive statistics regarding patient demographics, complications, and surgical technique were conducted. After this, an analysis of AABP patients within the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was conducted.

Results: Four studies including 57 patients reported panniculectomy as part of buried penis repair (PBPR). Surgical approaches included a modified trapezoid and traditional transverse incision. All authors utilized postoperative drains. Dehiscence and wound infection were the most frequent complications. Univariate NSQIP analysis revealed that PBPR patients had higher body mass index, more comorbidities, and greater wound complication rates. Multivariate analysis revealed that PBPR did not significantly increase 30-day complications compared to isolated BPR ( P > 0.05), while body mass index remained a significant predictor.

Conclusions: Surgical repair of AABP can greatly improve patient quality of life. The available literature and NSQIP-based analysis reveal that concurrent panniculectomy in AABP repair has a comparable complication profile. Future studies are necessary to better characterize the long-term outcomes of this PBPR.

Abstract: Physician assistants (PAs) play a vital role in the US health care system, particularly amid the persistent surgeon shortage and escalating health care demands. We aim to characterize the current cohort of PAs in plastic surgery by comparing them to PAs in all other specialties. Using a cross-sectional analysis of the 2022 National Commission on Certification of PAs dataset, we examined demographic and practice characteristics of PAs in plastic surgery with those in all other specialties. Analysis included descriptive and bivariate statistics. In 2022, 1.0% of PAs worked in plastic surgery, with the specialty's numbers nearly doubling from 2015 (n = 647) to 2022 (n = 1186). Bivariate analysis among PAs in plastic surgery and those in other settings revealed several important attributes (all P's < 0.001); PAs in plastic surgery were younger (median age, 36 vs 39), identified as female (91.0% vs 69.4%), resided in urban locations (97.6% vs 92.5%), and performed a higher proportion of clinical procedures (66.5% vs 33.9%). Furthermore, a statistically significant higher percentage of PAs in plastic surgery reported high job satisfaction and was more likely to report no symptoms of professional burnout. The expanding PA profession amid the scarcity of surgeons presents an ideal prospect for enhanced collaboration. In an era where surgeon burnout is increasingly common and PAs express a readiness to function at an advanced level, expanding PAs' role becomes desirable and imperative. This collaborative approach has the potential to address workforce challenges, elevate patient care, and enhance provider satisfaction.

Background: Unlike most health care sectors, patients can select an aesthetic surgery provider without considering insurance coverage. Patients therefore must be able to make informed choices regarding provider selection. Surgeon qualifications are part of the data patients evaluate in their decision making. To characterize the provider landscape that patients face, this study compares the certification requirements of various boards within the aesthetic marketplace.

Methods: Four boards were identified for analysis based on a Google search of "board of plastic surgery": the American Board of Plastic Surgery (ABPS), the American Board of Cosmetic Surgery (ABCS), the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS), and the American Board of Facial Cosmetic Surgery (ABFCS). Information on certification requirements was obtained from each board's official website.

Results: ABPS requires that diplomates complete an Accreditation Council for Graduate Medical Education (ACGME)-accredited plastic surgery residency, pass a written and oral examination that includes a case collection, and meet continual standards to maintain certification. ABCS and ABFCS both require an American Academy of Cosmetic Surgery (AACS) cosmetic surgery fellowship and passage of a written and oral examination. Neither board has case collection or continuing certification requirements. ABFPRS requires completion of either an ACGME-accredited otolaryngology or plastic surgery residency. Its examination process includes written and oral components as well as a case log. ABFPRS has enacted continuing certification requirements for diplomates credentialed in 2001 and later. ABPS is the only board that is a member of the American Board of Medical Specialties (ABMS).

Conclusions: ABPS stands apart as the only board within the aesthetic marketplace with rigorous standards for precertification training, demonstrating competency through examinations and case logs, and maintaining certification. Being an ABMS member board also contributes to ABPS being the preeminent organization for identifying physicians who practice safe, effective aesthetic surgery.

Introduction: Research is a critical component of academic medicine that may or may not be prioritized in centers with high clinical volumes. The benefits of research expansion go beyond notoriety and industry partnerships, expanding into resident training and preparation of the next generation of physician-scientists. Improving a division or department's research portfolio requires a commitment to reorganizing structure, personnel, resources, and a dedication to innovative funding models. To improve research productivity and quality, our group placed several initiatives into motion beginning in August 2017 that we have outlined and evaluated in the present study. Some of these initiatives included restructuring leadership, resourcing both bench and clinical outcomes research, providing initial funding directly from clinical profits and rewarding research fiscally.

Methods: Reviews of hiring records, publications, grant allocations, and interviews with key personnel were used to generate a road map of initiatives. Average impact factor was calculated by averaging journal impact factors for all publications from the department each year, excluding any publications with greater than 5 times the raw average, and creating a corrected average that more accurately represented the work. Student t tests were used to compare mean number of publications and impact factors from 2010 to 2017 to those from 2018 to 2022.

Results: Prior to restructuring (2010-2017), the department published an average of 9 articles annually, which increased to an average of 42 articles since that time (P < 0.01). Average impact increased from 0 in 2010 to 4.02 in 2022, with the number of publications in top 10 plastic surgery journals following a similar trajectory with 1 publication in 2010 and 31 in 2023. Following an initial $1 million investment to create an institutionally directed fund in 2018, the department leveraged its research to earn $3 million in endowments, $1.25 million in industry partnerships, $3.23 million in Department of Defense funding, and $1.65 million from a multi-institutional National Institutes of Health grant.

Conclusion: Deliberate prioritization of research initiatives as noted above has led to remarkable growth in academic output.