Plastic Surgery in the Press

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

CONSORT

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.

James Stanislaus Calnan

Plastic Surgeonsʼ Performance during the February 27 Earthquake in Chile

Perspective: committed to excellence.

"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."

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

PURPOSE: Virtual and interactive learning are the future of plastic surgery education.1 This shift is essential in the COVID-19 era, as medical students have been displaced from clinical rotations into virtual classrooms resulting in losses of traditional opportunities to learn about plastic and reconstructive surgery. The impact of this pandemic is far-reaching and may adversely influence interest in surgical specialties, diversity in anatomic knowledge, and hands-on surgical experience. We aimed to provide medical students worldwide with a virtual educational opportunity and developed the Plastic and Reconstructive Surgery Virtual Curriculum (PRSVC), a structured, four-week, flipped classroom course with virtual clinical case discussions and surgical skills workshops. Additional programming was available for medical students applying to or considering applying into plastic surgery residency programs to socialize with each other and build community. METHODS: We designed and implemented a structured, four-week educational curriculum, which included curated learning modules that covered main topics within plastic surgery. Students were provided daily assignments from the American Society of Plastic Surgeons Resident Education Curriculum and DeckerMed Plastic Surgery Core Curriculum, which were available to all enrolled participants free of charge. As an adjunct to the educational coursework, students had opportunities to participate in biweekly, small group virtual flipped classroom case discussions and weekly surgical skills workshops. Pre- and postcourse surveys were administered and analyzed using SPSS. RESULTS: In total, 303 medical students and recent graduates (43.4% fourth-years) from 18 countries enrolled in the course in June 2020. An estimated 182 students completed the precourse survey (60% response rate), and of those, 50.0% (n = 91) completed the postcourse survey for paired comparison. About two-thirds were medical students in the United States and the remaining one-third of students were from Canada and other international countries. Over one-third did not have home plastic surgery programs, and almost half of the participants reported having an educational experience scheduled for June 2020 cancelled due to the COVID-19 pandemic. Students reported significant improvement in confidence discussing the relevant anatomy, work-up, and surgical approaches to clinical cases, as well as confidence in knowledge of all topic areas (P < 0.001). Confidence in suturing and knot-tying techniques significantly improved among workshop participants (P < 0.001). Students applying to residency programs this cycle felt significantly more prepared for sub-internships (P < 0.001) and significantly more connected to the community of applicants (P < 0.001). CONCLUSIONS: The Plastic and Reconstructive Surgery Virtual Curriculum improved knowledge, surgical skills, and community in the field among medical student participants. This course may serve to inform other surgical subspecialties in developing similar virtual educational opportunities and also serve to provide a paradigm for structured virtual learning activities for students interested in plastic surgery. REFERENCE: 1. Ali K, Colchado D, Davis MJ, et al. Online resources in plastic surgery education: a toolbox for modern trainees and plastic surgeons. Plast Reconstr Surg Glob Open. 2020;8(7):e2894. Published 2020 Jul 17. doi:10.1097/GOX.0000000000002894

So You Want to Be an Innovator?

Research productivity is commonly used as an objective metric for applicant differentiation in the integrated plastic and reconstructive surgery match process. Few studies have examined the content, timing, and predictive value of peer-reviewed research output among matched plastic and reconstructive surgery applicants. In this cross-sectional study, first-year residents matched into integrated plastic surgery programs during the 2024-2025 cycle were identified. Research metrics were collected from PubMed, Google Scholar, and ResearchGate, and subspecialty focus and journal characteristics were categorized for all publications. Statistical analyses included Spearman correlation, Mann-Whitney U tests, and a multivariable logistic regression to identify independent predictors of matching at a top 20 Doximity-ranked program. Among 224 matched applicants, the median total publication count was 10 (IQR: 5-18), with 6 plastic surgery-specific publications (IQR: 2-12), 3 first-author publications (IQR: 1-5), and an H-index of 5 (IQR: 3-6). Most applicants had their first plastic surgery publication one year prior to the match (IQR: 0-2). General plastic surgery (67.4%) and education/nonclinical (50%) topics were the most represented subspecialties among applicants' research. Publications in craniofacial surgery (42.9%), microsurgery (29%), aesthetics (25%), gender-affirming surgery (17.9%), hand surgery (17.4%), peripheral nerve surgery (11.2%), and burn surgery (9.4%) were less common among applicants. Applicants most frequently published in Plastic and Reconstructive Surgery Global Open (240 publications), Annals of Plastic Surgery (213 publications), and the Journal of Craniofacial Surgery (196 publications). In multivariable analysis, no individual research metric independently predicted matching at a top 20 program, though the overall model demonstrated fair discriminative ability (AUC = 0.731). Among matched plastic surgery applicants in the most recent 2024-2025 application cycle, research productivity was high with a wide variety of subspecialty interest.

The Belgian Society of Plastic Surgery was founded in 1955. The five founding members were Dr. M. Coelst, Dr. A. de Coninck, Dr. J. Polus, Dr. A. Fardeau and Dr. C. Steenebruggen. Dr. Maurice Coelst was the initiator and first president, and later became the first honorary member. The purpose of the Society was the scientific study of plastic surgery and related specialties, and the organization of congresses and conferences to promote the development of plastic surgery. From a very small group of five members, the Society has grown to a considerable size: 80 full members, 20 associated members and 75 candidate members. The Society also counts 12 honorary members and 16 foreign members. Full members are officially-certified Belgian and Luxembourg plastic surgeons who limit their activities to the domain of plastic, reconstructive and aesthetic surgery and who have made significant scientific contributions to the activities of the Society. These activities have grown from informal evening meetings in the 1950’s to presently two full-day congresses every year, during which communications of high scientific standard are presented and discussed. Because of the expansion of plastic surgery, the name of the Society has been changed into ‘‘Belgian Society of Plastic, Reconstructive and Aesthetic Surgery’’ and comprises subchapters for the study of burns, microsurgery and aesthetic surgery. The Society sponsors a two-yearly prize, which is attributed to a personal scientific study of exceptionally high standards by a Belgian or Luxembourg plastic surgeon or trainee. The Society also sponsors the activities of the Collegium Chirurgicum Plasticum Belgicum. This Collegium organizes teaching days and yearly examinations for all plastic surgery trainees on a national scale. Successfully passing these evaluations has become a prerequisite for obtaining certification as a specialist in plastic, reconstructive and aesthetic surgery. Together with a training of 6 years: 2 years of basic general surgery and 4 years of plastic surgery in one of the seven certified training centers in Belgium and Luxembourg,this system ensures a very high standard of specialization in plastic surgery. Many members participate very actively in many scientific societies in Belgium and abroad. The Belgian participation in EURAPS is very strong, and the prize for the best presentation has been awarded to Belgian plastic surgeons several times. The Society has a close relationship with its Dutch sister Society. Every 2 years a joint meeting is held, alternately in Belgium and in The Netherlands. In 2005 the Belgian Society of Plastic, Reconstructive and Aesthetic Surgery will celebrate its 50th anniversary with a 2-day Congress in Brussels on May 6 and 7. On the occasion of the Congress, a commemorative book will be published highlighting and illustrating the history of the Society. Finally, the Society is very grateful to Ian Jackson for allowing its members to fill an entire issue of the European Journal of Plastic Surgery.

Within plastic surgery, a patient's most commonly used first point of information before consulting a surgeon is the internet. Free-to-use artificial intelligence (AI) websites like ChatGPT (Generative Pre-trained Transformers) are attractive applications for patient information due to their ability to instantaneously answer almost any query. Although relatively new, ChatGPT is now one of the most popular artificial intelligence conversational software tools. The aim of this study was to evaluate the quality and readability of information given by ChatGPT-4 on key areas in plastic and reconstructive surgery. The ten plastic and aesthetic surgery topics with the highest worldwide search volume in the 15 years were identified. These were rephrased into question format to create nine individual questions. These questions were then input into ChatGPT-4. The response quality was assessed using the DISCERN. The readability and grade reading level of the responses were calculated using the Flesch-Kincaid Reading Ease Index and Coleman-Liau Index. Twelve physicians working in a plastic and reconstructive surgery unit were asked to rate the clarity and accuracy of the answers on a scale of 1-10 and state 'yes or no' if they would share the generated response with a patient. All answers were scored as poor or very poor according to the DISCERN tool. The mean DISCERN score for all questions was 34. The responses also scored low in readability and understandability. The mean FKRE index was 33.6, and the CL index was 15.6. Clinicians working in plastics and reconstructive surgery rated the questions well in clarity and accuracy. The mean clarity score was 7.38, and the accuracy score was 7.4. This study found that according to validated quality assessment tools, ChatGPT-4 produced low-quality information when asked about popular queries relating to plastic and aesthetic surgery. Furthermore, the information produced was pitched at a high reading level. However, the responses were still rated well in clarity and accuracy, according to clinicians working in plastic surgery. Although improvements need to be made, this study suggests that language models such as ChatGPT could be a useful starting point when developing written health information. With the expansion of AI, improvements in content quality are anticipated.

Citation of published articles by peers provides an indication of the relevance of the scientific work. Still, it is unknown what kinds of plastic surgery articles are cited most often. The authors set out to identify the characteristics of the 50 top-cited articles as published in four international, peer-reviewed, PubMed-indexed general plastic surgery journals. The 50 most-cited articles were identified in each of the following journals: Plastic and Reconstructive Surgery, the British Journal of Plastic Surgery, the Annals of Plastic Surgery, and the Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. These 200 articles were ranked after their citation index, defined as the mean number of times they were cited per year during the first 16 years after publication. The top-50 articles thus ranked were analyzed for citation and journal distribution, geographic and institutional origin, surgical and anatomical subject, and level of evidence. Forty-one of the 50 top-cited articles (82 percent) were published in Plastic and Reconstructive Surgery and 35 articles (70 percent) originated from institutions within the United States. Most of the articles dealt with the reconstruction of acquired defects (45 percent) and with basic or experimental research (41 percent). Research that offered means for clinical improvement, rather than a high level of evidence or the results of multi-institutional collaboration, was most often cited. An article featuring a clinical or nonclinical innovation, observation, or discovery that leads to clinical improvement has the best potential to become a "classic."

Publication in peer-reviewed journals is a duty and privilege. It is essential to the advancement of evidence-based medicine and often used as a proxy for academic achievement, contributing to decisions around promotion in academia. Within plastic surgery, authors have historically been male surgeons affiliated with academic institutions, lacking representation of women, private practice, medical students, and international collaboration. This study analyzes differences in authors' gender, practice affiliation, degree of education, and international collaboration in articles published in Plastic and Reconstructive Surgery, which was chosen as the representative journal given its high impact factor (3.946) and consistent ranking as the number one journal in plastic surgery worldwide. A list of Breast, Cosmetic, and Hand/Peripheral Nerve articles published between 2006 and 2019 was compiled from the online archive of Plastic and Reconstructive Surgery. Demographic author characteristics were recorded, and statistical analyses were performed to identify trends over time. A total of 2688 articles were analyzed. The proportion of articles written by female authors in the Breast category, authors in private practice with academic affiliation in the Cosmetic section, and U.S. collaboration with other countries increased over time (p = 0.038, p = 0.029, p < 0.001, respectively). First authors with bachelor's, master's, and doctorate degrees have also been contributing increasingly. This analysis revealed increasing demographic heterogeneity of authors in Plastic and Reconstructive Surgery over time, with increasing contributions from women, surgeons in private practice with academic affiliation, medical students, and international collaborations. The Journal is capturing contributions from an increasingly diverse authorship, consistent with the changing demographics of plastic surgeons.