Jewish Contributions to Plastic and Reconstructive Surgery.

The Level of Evidence Pyramid: Indicating Levels of Evidence in Plastic and Reconstructive Surgery Articles

The Launch of PRS GO

Plastic Surgeonsʼ Performance during the February 27 Earthquake in Chile

Sir: After the initiative by Plastic and Reconstructive Surgery and the American Society of Plastic Surgeons to promote evidence-based medicine1 and to strive for high levels of reporting quality,2 it is current belief that randomized controlled trials are the key to guiding and helping clinical decision making. The broad field of plastic surgery with its subdisciplines reconstructive surgery, burn surgery, aesthetic surgery, and hand surgery often lacks a fair amount of published randomized controlled trials. However, to date, there is no comparative analysis on the recent developments of randomized controlled trials in reconstructive, burn, aesthetic, and hand surgery. Furthermore, reporting quality of randomized controlled trials was addressed by the Consolidated Standards of Reporting Trials group first in 1996, and was updated in 2001 and very recently in 2010.3 The Consolidated Standards of Reporting Trials items aim to improve the reporting quality of randomized controlled trials in full article and in abstract form.4 Using the Consolidated Standards of Reporting Trials items, one can compare the reporting quality of randomized controlled trial conference abstracts, which was a second aim of this analysis. To analyze up to date, we decided to analyze various conferences rather than full articles, given the fact that not all randomized controlled trials presented as abstracts will find their way to a full article within the next 5 years. We analyzed 65 oral abstracts and 94 poster abstracts from the 2008 meeting of the American Society of Plastic Surgeons by two independent researchers. In addition, 152 oral and 100 poster presentations from the 2008 meeting of the American Burn Association were analyzed, as were102 abstracts from the American Society for Surgery of the Hand annual meeting. We determined the evidence-based medicine level of evidence for study design. Furthermore, the level of reporting quality according to the Consolidated Standards of Reporting Trials recommendations was determined with a maximum score of 17 of 17 points. We found that at the American Society of Plastic Surgeons 2008 meeting, 9 percent (5 percent oral and 4 percent poster abstracts) of presentations were randomized controlled trials. Reporting quality at the American Society of Plastic Surgeons meeting was 6.7 ± 1.2 for oral randomized controlled trials and 7.3 ± 1 for poster randomized controlled trials (p = 0.498; 95 percent confidence interval, –2.62 to 1.46) of 17 achievable points according to Consolidated Standards of Reporting Trials criteria. At the American Burn Association Annual Meeting, 7 percent randomized controlled trials were presented, with 5 percent oral and 2 percent poster presentations. Reporting quality according to Consolidated Standards of Reporting Trials criteria was not significantly different for oral versus poster randomized controlled trials (7.2 ± 1.4 versus 6.5 ± 1 of 17 points, p = 0.552; 95 percent confidence interval, –1.78 to 3.06). We identified 10 percent randomized controlled trials at the American Society for Surgery of the Hand meeting. Consolidated Standards of Reporting Trials reporting quality was 8.2 ± 1.4 of 17, somewhat higher than for randomized controlled trials presented at the American Society of Plastic Surgeons meeting. Our results indicate that the amount of randomized controlled trials presented either in oral or poster abstract form at American Society of Plastic Surgeons, American Burn Association, and American Society for Surgery of the Hand meetings is still below 10 percent of all presentations. Given the fact that not every conference abstract will be followed by a full article, these numbers should be discussed. In 1996, Amadio and colleagues studied the rate of full article randomized controlled trials from volume 1 to volume 19 (1994) of The Journal of Hand Surgery. From 3107 articles, letters, and abstracts, they identified 25 controlled clinical trials and eight randomized controlled trials (0.26 percent).5 A 10-year analysis of publications in Plastic and Reconstructive Surgery, Annals of Plastic Surgery, and Aesthetic Surgery Journal revealed a randomized controlled trial publication rate of 3.2 percent.6 A 16-year analysis of all articles published in Aesthetic Plastic Surgery revealed only a 1 percent randomized controlled trial publication rate (11 of 1048 original articles).7 In Plastic and Reconstructive Surgery, the number of randomized controlled trials published increased from 1983 to 2003 from 0 percent to 7 percent.8 As far as reporting quality is concerned, all conference abstracts presented at American Society of Plastic Surgeons, American Burn Association, and American Society for Surgery of the Hand meetings have plenty of room for improvement, with the Consolidated Standards of Reporting Trials statement to be endorsed substantially. Karsten Knobloch, M.D. Uzung Yoon Peter M. Vogt, M.D., Ph.D. Plastic, Hand, and Reconstructive Surgery Hannover Medical School Hannover, Germany

A Discussion of Conflicts of Interest in Plastic Surgery and Possible Remedies.

On the alley’s main entrance of the Jalisco Reconstructive Surgery Institute, stands proudly the first mural of Plastic Surgery History. It is a one of a kind painting depicting an artistic visual summary of the most important historical surgeons and physicians that have molded Plastic Surgery. The mural was entitled: ‘‘Plastic and Reconstructive Surgery History and Philosophy,’’ and its mere essence is a tribute to Plastic Surgery Worldwide through the ages. The mural’s size is six meters long and three meters wide. It is divided into a historical (two vertical and one horizontal canvas) and philosophical theme (central canvas) illustrating a timeline of Plastic Surgery (Fig. 1). On the left vertical canvas, a glance to Ancient History remarkably pinpoints figures from early civilizations such as the Egyptian surgeon Imhotep, Indian physician Susruta, Roman alchemist Celsus, and Aztec witch doctor Tictil. A lower horizontal canvas characterizes Renaissances’ illumined scientists such as French Ambrose Pare and Italian Gaspare Tagliacottsi. Following the same lane, Early Modern History characters such as French Dupuytren and Reverdin are also drawn. On the right vertical canvas, the Twentieth Century is represented by the New Zealand-born and British-based surgeon Sir Harold Gillies and Russian Filatov. America’s surgical legacy is represented by ingenious Padgett and prolific Converse. The mural’s central canvas sketches a Plastic Surgeon’s hand holding a scalpel, ready to improve and correct wounds or deformities through modeling, creating, or reconstructing. The value of the mural is comparable to many others painted by the late twentieth-century avant-garde movement of Mexican muralists such as Rivera, Orozco, and Siqueiros. The mural’s completion took 9 months, and the Guadalajara-born muralist Guillermo Chavez Vega under the Institute’s founder guidance created the mural. As part of the Jalisco Reconstructive Surgery contribution to the world, the lingual flap and the platysma’s muscle management for age rejuvenation are also incorporated on the central canvas. On a lateral wall adjacent to the mural, a place was left for the muralist to perform a free painting with a theme that traces half a body flaccid and fattened and half a body cosmetically improved this in 1981, the year in which liposuction was introduced to America from the European continent. The hospital is an international academic and health provider institution with a 57-year-old history with aesthetic and reconstructive excellence. Hundreds of plastic surgeon generations from every corner of the world have graduated from this prestigious institution joining forces with the second most important public university of Mexico, Universidad de Guadalajara. The institute’s vision and legacy of forming and molding plastic surgeons has been a constant ever since its conception. Art and science have intersected in so many ways and so many times, and & Jose Guerrerosantos joseguerrerosantos@hotmail.com

Many beginning writers, especially medical residents, feel difficulties in writing journal articles. However, illogical and unscientific papers are not accepted for publication even if their topics are creative and interesting. The authors should do their best to convince reviewers and readers of their opinions using evidence through reasoning, explanation, and data interpretation.

Professional advancement in academic plastic surgery may depend on scholarly activity. The authors evaluate gender-based publishing characteristics in three international plastic surgery journals. A retrospective review of all articles published in 2016 in the following journals was undertaken: Plastic and Reconstructive Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, European Journal of Plastic Surgery, Annals of Surgery, and New England Journal of Medicine. Data were collected on lead author gender (first or senior author) and differences in author gender proportions, by journal, by article topic, and by geographic location were evaluated. Overall, 2610 articles were retrieved: 34.1 percent were from plastic surgery journals, 12.8 percent were from the Annals of Surgery, and 53.1 percent were from the New England Journal of Medicine. There was a lower proportion of female lead authors among plastic surgery journals compared with the Annals of Surgery and the New England Journal of Medicine (31 percent versus 39 percent versus 39 percent; p = 0.001). There were no differences in female lead author geographic location in the Annals of Surgery or the New England Journal of Medicine; within the plastic surgery journals, there were differences (p = 0.005), including a lower proportion arising from East Asia (15 percent) and a higher proportion arising from Canada (48 percent). Within plastic surgery, Plastic and Reconstructive Surgery had the lowest proportion of female lead author (p < 0.001). The proportion of female lead author varied by article topic (p < 0.001) and was notably higher in breast (45.6 percent) and lower in head and neck/craniofacial-orientated articles (25.0 percent). There are gender disparities in three mainstream plastic surgery journals-Plastic and Reconstructive Surgery, the Journal of Plastic, Reconstructive and Aesthetic Surgery, the European Journal of Plastic Surgery-and there are lower proportions of lead female authorship compared with the Annals of Surgery and the New England Journal of Medicine. Further research should focus on understanding any geographic disparities that may exist.

Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System. Received for publication September 25, 2013; accepted September 26, 2013. Disclosure: The authors have no financial interest to declare in relation to the content of the Discussion or of the associated article. Kevin C. Chung, M.D., M.S., Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, Mich. 48109-5340, [email protected]

Coronavirus disease of 2019 (COVID-19) has spread rapidly throughout the world, and the impact on global and national health care, including plastic surgery, has been dramatic and unpredictable. Plastic surgery departments and divisions went into limbo after the American College of Surgeons, American Society of Plastic Surgeons, and The Aesthetic Society, advised that elective and nonessential cases be canceled.1 All large plastic surgery meetings were canceled. Aspiring plastic surgeon trainees are among those affected by the pandemic; the Association of American Medical Colleges called for a halt in all clinical rotations of at least 4 weeks' duration in the 2020/2021 application cycle, a critical time for fourth-year medical students applying to integrated plastic surgery programs.2 Medical students typically dedicate April to September rotating as subinterns on the plastic surgery service at their home institution and at several "away institutions" throughout the United States. Away rotations play a significant role in the plastic and reconstructive surgery match process; 67 percent of successful applicants in a given year participated in a rotation at the institution they matched into.3 Students also attend national meetings for the opportunity to present their research, meet renowned faculty members across the country, and receive feedback on their application and performance. Often faculty, residents, and students at such events become lifelong colleagues and mentors.4,5 These opportunities are now no longer available for students applying in the current COVID-19 pandemic. Plastic surgery residency applicants applying in the 2020/2021 cycle era are facing the daunting unknown with more limited opportunities for meeting influential individuals in the field. Students at institutions that do not have a plastic surgery home program may be affected the most. Consequently, mentorship of future trainees is arguably more important than ever, as it provides prospective applicants with a unique opportunity to connect students with faculty across the country to discuss research and personal career development and to expand one's network of mentors and colleagues. In 2015, the Plastic Surgery Research Council established a formal mentorship program with the goal of facilitating relationships between trainees and senior figures and of fostering unique guidance regarding career development. Medical student members and plastic surgery applicants can be paired with mentors across the nation from diverse backgrounds, and mentors can provide invaluable advice electronically regarding research endeavors and residency applications. With the current restrictions imposed by the evolving COVID-19 pandemic, electronic mentee-mentor interactions may be the only chance that prospective plastic surgery residents have to appreciate and converse with faculty and residents from different institutions, We thus want to emphasize the value of mentorship relationships and formal mentorship programs such as that offered by the Plastic Surgery Research Council. It is critically important to connect medical students/trainees with faculty members to help them learn the nuances of plastic surgery programs in institutions across the nation. Reaching beyond the classroom and expanding our horizons can help us confront the realities we could not have anticipated. DISCLOSURE The authors have no potential conflicts of interest to disclose.

"Background: Robotic surgery currently offers a number of benefits in specific areas of plastic and reconstructive surgery such as head and neck and microsurgery, however, many subspecialties are yet to benefit from robotic operating techniques. In this paper we review recent developments in the use of robotics for head and neck, breast reconstruction, microneural, lymphoedema, craniofacial and aesthetic surgery. Methods: A literature review of English-only articles on the use of robots in plastic and reconstructive surgery was conducted using the PubMed and Web of Science databases along with a free text search using the terms ‘robotic surgery plastic surgery’, ‘robotic-assisted plastic surgery’, ‘robot-assisted reconstructive surgery’, ‘da Vinci plastic surgery’, ‘da Vinci reconstructive surgery’ and ‘supermicrosurgery’. No limitation was placed on time from publication. Results: Of the studies reviewed, the most beneficial to reconstructive surgery is the area of the head and neck, with the most common procedures being transoral surgeries and microvascular procedures. Robotic assisted breast reconstructive surgery is a promising field. The main current limitations are the lack of adequate microsurgical instrumentation and the prolonged setting-up and operative time. Conclusion: As technology improves the outlook for robotic surgery is optimistic. Areas like microsurgery, head and neck, cleft palate, breast reconstructive surgery, lymphatic and microneural surgery already demonstrate promising results. Further technological advances and evidence-based studies are necessary to address current limitations such as appropriate microsurgical instrumentation, high costs and prolonged operative time."

CONSORT

James Stanislaus Calnan

Perspective: committed to excellence.

Where is Archives of Plastic Surgery Now? And Where is It Heading?