journal article
LitStream Collection
Home
Li, Jie; Ng, Sally Kiu-Huen; Xu, Yuanjin; Li, Qingfeng; Wang, Li; Zhang, Yixin
doi: 10.1097/prs.0000000000008370pmid: 34550950
Background: Effective leadership is an integral component for optimal academic performance of surgical units. As one of the leading plastic surgery academic medical centers in China, the authors would like to share their experiences of using the combined parental and shared leadership approach in managing their surgical staff within the department. It has taken into account the essence of Eastern moral philosophies and Western leadership theories. Methods: The authors performed a review of the academic development of their staff and changes in the academic productivity of the department between 1999 and 2018. The difference between the first 10 years (1999 to 2008) and second 10 years (2009 to 2018) was analyzed to assess the effectiveness of the authors’ leadership approach. Results: There is an increase in the number of Science Citation Index articles published in the past decade with a higher impact factor and more articles published in international journals. The timing to promotion was on average 8.4 years. The average age of promotion to consultants has increased, likely because of a later start in the training. With similar average age, prior education, and gender ratio of surgeons in the unit, the department also received 14 times more in research funding and four times more in national key topic research topic. Conclusions: The effective application of this combined leadership approach has significantly improved the academic productivity and quality of the authors’ residents and surgeons and the academic advancement of the unit.
Kwon, Jin Geun; Pereira, Nicolas; Tonaree, Warangkana; Brown, Erin; Hong, Joon Pio; Suh, Hyunsuk Peter
doi: 10.1097/prs.0000000000008388pmid: 34550945
Background: A superficial circumflex iliac artery perforator flap has several advantages, such as reduced thickness, minimal donor-site morbidity, and inconspicuous scar. However, the application of a superficial circumflex iliac artery perforator flap is restricted because of its limited pedicle length. The aim of this article was to outline the technical modifications of superficial circumflex iliac artery perforator flap elevation to obtain long pedicles. Methods: This is a prospective study of 31 consecutive patients who required a long pedicled superficial circumflex iliac artery perforator flap between September of 2016 and December of 2019 at the authors’ center. According to a preoperatively marked pathway of the superficial branch of the superficial circumflex iliac artery, the superficial circumflex iliac artery perforator flap was designed. During the elevation, the design was modified according to the perforator location in the free-style technique. The characteristics of the patients and the flaps, including pedicle length, were recorded. The revision rate, complication rate, and need for a secondary procedure were analyzed. Results: The mean follow-up period was 563 days (range, 92 to 1383 days). The mean length of the pedicle obtained was 6.9 cm (range, 6 to 8 cm) from the point where the pedicle merges into the flap. Long pedicles were anastomosed to the main source vessel or branch without tension. No major complications were reported. Conclusions: Overcoming the short pedicle length of a superficial circumflex iliac artery perforator flap by designing the flap laterally and performing an intraflap dissection is a reliable option when a longer pedicle is required, irrespective of the specific anatomy of the superficial circumflex iliac artery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Klifto, Kevin M.; Yesantharao, Pooja S.; Lifchez, Scott D.; Dellon, A. Lee; Hultman, C. Scott
doi: 10.1097/prs.0000000000008315pmid: 34550938
Background: A model that predicts a patient’s risk of developing chronic, burn-related nerve pain may guide medical and/or surgical management. This study determined anatomy-specific variables and constructed a mathematical model to predict a patient’s risk of developing burn-related nerve pain. Methods: A retrospective analysis was conducted from 1862 adults admitted to a burn center from 2014 to 2019. One hundred thirteen patients developed burn-related nerve pain. Comparisons were made using 11 anatomy-specific locations between patients with and without burn-related nerve pain. The modified Delphi technique was used to select 14 potential risk variables. Multivariate regression techniques, Brier scores, area under the curve, Hosmer-Lemeshow goodness-of-fit, and stratified K-fold cross-validation was used for model development. Chronic pain was defined as pain lasting 6 or more months after release from the Burn Center. Results: Prevalence rates of burn-related nerve pain were similar in the development (6.1 percent) and validation (5.4 percent) cohorts [Brier score = 0.15; stratified K-fold cross-validation (K = 10): area under the curve, 0.75; 95 percent CI, 0.68 to 0.81; Hosmer-Lemeshow goodness-of-fit, p = 0.73; n = 10 groups]. Eight variables were included in the final equation. Burn-related nerve pain risk score = −6.3 + 0.02 (age) + 1.77 (tobacco use) + 1.04 (substance abuse) + 0.67 (alcohol abuse) + 0.84 (upper arm burn) + 1.28 (thigh burn) + 0.21 (number of burn operations) + 0.01 (hospital length-of-stay). Burn-related nerve pain predicted probability = 1 − 1/[1 + exp(burn-related nerve pain risk score)] for 6-month burn-related nerve pain risk score. As the number of risk factors increased, the probability of pain increased. Conclusions: Risk factors were identified for developing burn-related nerve pain at 11 anatomical locations. This model accurately predicts a patient’s risk of developing burn-related nerve pain at 6 months. Age, tobacco use, substance abuse, alcohol abuse, upper arm burns, thigh burns, the number of burn operations, and hospital length of stay represented the strongest predictors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Rohrich, Rod J.; Cohen, Joshua M.; Savetsky, Ira L.; Avashia, Yash J.; Chung, Kevin C.
doi: 10.1097/prs.0000000000008368pmid: 34495896
Summary: Evidence-based medicine, as described by Dr. Sackett, is defined as the “conscientious, explicit, and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients.” In the late 2000s, seminal articles in Clinics in Plastic Surgery and Plastic and Reconstructive Surgery introduced evidence-based medicine’s role in plastic surgery and redefined varying levels of evidence. The American Society of Plastic Surgeons sponsored the Colorado Springs Evidence-Based Medicine Summit that set forth a consensus statement and action plan regarding the increased incorporation of evidence-based medicine into the field; this key meeting ushered a new era among plastic surgeons worldwide. Over the past decade, Plastic and Reconstructive Surgery has incorporated evidence-based medicine into the Journal through an increase in articles with level I and II evidence, new sections of the Journal, and the introduction of validated tools to help authors perform prospective and randomized studies that ultimately led to best practices used today. Plastic surgery is a specialty built on problem-solving and innovation, values starkly in-line with evidence-based medicine. Evidence-based medicine is becoming more ingrained in our everyday practice and plastic surgery culture; however, we must work actively to ensure that we continue this trend. In the next decade, we will possibly see that level I and II evidence articles start to inhabit many of our journal issues.
Showing 1 to 10 of 79 Articles