International Residents' Perspectives on Education and Challenges in Microsurgery Training

Objective Microsurgery remains an integral component of the surgical skillset and is essential for a diversity of reconstructive procedures. The apprenticeship also requires overcoming a steep learning curve, among many challenges. The method of microsurgical training differs depending on the countries' regions and resources of their health care system. Methods The Journal of Hand and Microsurgery leadership held an international webinar on June 19, 2021, consisting of a panel of residents from 10 countries and moderated by eminent panelists. This inaugural event aimed to share different experiences of microsurgery training on a global scale, identifying challenges to accessing and delivering training. Results Residents shared various structures and modes of microsurgical education worldwide. Areas of discussion also included microsurgical laboratory training, simulation training, knowledge sharing, burnout among trainees, and challenges for female residents in microsurgical training. Conclusion Microsurgical proficiency is attained through deliberate and continued practice, and there is a strong emphasis globally on training and guidance. However, much remains to be done to improve microsurgical training and start acting on the various challenges raised by residents.Copyright © 2022. Society of Indian Hand & Microsurgeons. All rights reserved.

Hand Surgery in New Zealand.

Hand surgery in New Zealand has steadily grown from its origins in plastic surgery and orthopaedic surgery into its own discipline. There has been much progress and innovation in hand surgery that has originated from New Zealand and this review acknowledges the historical figures and events that have led to our present position. The current and future directions of hand surgery in our country are also discussed. As a small and remote country, we are very fortunate to have close relationships with other international hand societies. Through these relationships and the efforts of committed regional hand surgeons, the art and science of hand surgery in New Zealand continues to progress.

The Impact of COVID-19 on Plastic Surgery Residents Across the World: A Country-, Region-, and Income-level Analysis.

BACKGROUND: The COVID-19 pandemic has upended graduate medical education globally. We investigated the COVID-19 impact on learning inputs and expected learning outputs of plastic surgery residents across the world. METHODS: We administered an online survey capturing training inputs before and during the pandemic and retrieved residents' expected learning outputs compared with residents who completed their training before COVID. The questionnaire reached residents across the world through the mobilization of national and international societies of plastic surgeons. RESULTS: The analysis included 412 plastic surgery residents from 47 countries. The results revealed a 44% decline (ranging from - 79 to 10% across countries) and an 18% decline (ranging from - 76 to across 151% countries) in surgeries and seminars, respectively, per week. Moreover, 74% (ranging from 0 to 100% across countries) and 43% (ranging from 0 to 100% across countries) of residents expected a negative COVID-19 impact on their surgical skill and scientific knowledge, respectively. We found strong correlations only between corresponding input and output: surgeries scrubbed in with surgical skill (ρ = -0.511 with p < 0.001) and seminars attended with scientific knowledge (ρ = - 0.274 with p = 0.006). CONCLUSIONS: Our ranking of countries based on their COVID-19 impacts provides benchmarks for national strategies of learning recovery. Remedial measures that target surgical skill may be more needed than those targeting scientific knowledge. Our finding of limited substitutability of inputs in training suggests that it may be challenging to make up for lost operating room time with more seminars. Our results support the need for flexible training models and competency-based advancement. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Plastic surgery online, how accessible are our units?

BACKGROUND: The Covid-19 pandemic has highlighted the importance of remote patient and professional communication. This has been especially important for highly specialised and regionally-based specialties such as plastic surgery. The aim of this study was to review how UK plastic surgery units represent themselves online and their phone accessibility. PATIENTS AND METHODS: UK plastic surgery units were identified using the BAPRAS website and their websites and telephone accessibility assessed. RESULTS: Whilst a minority of units have clearly invested heavily in ensuring comprehensive webpages, nearly a third have no dedicated webpage at all. We found significant variation in quality and user-friendliness of online resources both for patients and for other healthcare professionals, with less than a quarter of units providing comprehensive contact details, emergency referral guidance, or information about changes to services due to Covid-19, to highlight a few areas. Communication with the BAPRAS website was also poor with less than half of web-links connecting to correct and relevant webpage and only 13.5% of phone numbers connecting directly to a useful plastic surgery number. In the phone component of our study we found that 47% of calls to 'direct' numbers went to voicemail but wait-times were significantly less than going through hospital switchboards and connections were more accurate. CONCLUSION: In a world where a business' credibility is so heavily based on their online appearance and, in an increasingly online era of medicine, we hope that this study may be a resource for units to improve their web-based resources and prompt further research in enhancing patient experience online.

Effect of the COVID-19 Pandemic on Global Interest in Plastic Surgery.

Introduction: Due to the SARS-CoV-2 (COVID-19) pandemic, many elective surgeries were canceled, including most aesthetic plastic surgery procedures. Although studies have shown COVID-19's effect on plastic surgery in the United States, no study to date has examined the international interest in plastic surgery procedures after the start of the COVID-19 pandemic. Thus, we sought to find this effect using the Google Trends tool. Material and Methods: The most common cosmetic procedures and top countries with the highest plastic surgery volume were selected from the International Society of Plastic Surgeons report and used as the search terms for Google Trends. Weekly search data from each procedure and country were collected from March 18, 2018 to March 13, 2022, split into 2 periods according to the start of the US COVID-19 lockdown, and compared. Results: Among the countries, the United States had the most plastic surgery interest after the COVID-19 pandemic, with India and Mexico closely following. On the other hand, Russia and Japan had the fewest changes in procedure interest. Regarding specific procedures, interest in breast augmentation, forehead lift, injectable filler, laser hair removal, liposuction, microdermabrasion, and rhytidectomy increased in all countries after the COVID-19 pandemic. Conclusions: After COVID-19, there has been increasing interest in almost all plastic surgery procedures globally, especially nonsurgical procedures and facial plastic surgery, with the greatest increases in the United States, India, and Mexico. These results can help inform plastic surgeons which procedures to focus on and which devices or technologies to invest in that are specific to their country.

The "Zoom Boom" of the Covid-19 Pandemic Was Ironically Linked to Body Procedures

Purpose of Study: Cosmetic surgery preference is a highly individual choice. However, societal factors may influence public preference resulting in certain surgeries becoming more popular during a particular time. During the COVID-19 pandemic, many factors emerged which may have influenced patient decision making. These include increased time at home, hospital closure, increased time on social media, and the release of stimulus checks. Google Trends generates user search data for specific inquiries and thus is useful in reporting trends in plastic surgery related searches. The purpose of this study to determine whether the COVID-19 pandemic resulted in increased interest in certain surgeries over others. Methods Used: Google Trends was used to obtain user search data from June 2018 to June 2022. The data was obtained through entering common surgical procedure names, as well as general plastic surgery related inquiries. Special attention was given to when terms "peaked". This was then compared to the average trend of all searches and to the COVID-19 pandemic in general. Summary of Results: On average, early during the pandemic searches went down, seen as a prominent dip around March 2020. They then went up in June and July of the same year and stayed constant until early 2021. There was then a marked increase in March of 2021, with subsequent months maintaining a high percentile of search interest. This peak coincided with the third and final stimulus check release, a total of 3200 USD over the three checks, with the third being the largest (1400 USD). Of the terms analyzed, surgeries related to body contouring appeared to peak around the same time, most often in the period of March-July of 2021. Terms related to facial procedures peaked either before or after this period. Conclusion(s): The results suggest that the "boom" seen in the average trendline was predominately due to body contouring procedures. While it is difficult to determine what exactly caused this phenomenon, it is hypothesized that increased time at home, decreased physical activity, as well as the release of stimulus checks may have resulted in a patient preference for body contouring over facial procedures. Further research could focus on real practice patient numbers by procedure, and thus determine if the trends reported by Google follow real patient preference.

Global Plastic Surgery: A Review of the Field and a Call for Virtual Training in Low- and Middle-Income Countries.

Lack of surgical access severely harms countless populations in many low- and middle-income countries (LMICs). Many types of surgery could be fulfilled by the plastic surgeon, as populations in these areas often experience trauma, burns, cleft lip and palate, and other relevant medical issues. Plastic surgeons continue to contribute significant time and energy to global health, primarily by participating in short mission trips intended to provide many surgeries in a short time frame. These trips, while cost-effective for lack of long-term commitments, are not sustainable as they require high initial costs, often neglect to educate local physicians, and can interfere with regional systems. Education of local plastic surgeons is a key step toward creating sustainable plastic surgery interventions worldwide. Virtual platforms have grown popular and effective-particularly due to the coronavirus disease 2019 pandemic-and have shown to be beneficial in the field of plastic surgery for both diagnosis and teaching. However, there remains a large potential to create more extensive and effective virtual platforms in high-income nations geared to educate plastic surgeons in LMICs to lower costs and more sustainably provide capacity to physicians in low access areas of the world.

Le manque d'accès à la chirurgie nuit sévèrement aux vastes populations de nombreux pays à revenus intermédiaires et faibles (PRIF). De nombreux types d'interventions chirurgicales pourraient être exécutés par les chirurgiens plastiques, car les populations de ces régions ont souvent des traumatismes, des brûlures, des fentes labio-palatines et d'autres problèmes médicaux pertinents. La chirurgie plastique continue d'accorder beaucoup de temps et d'énergie à la santé globale, principalement en participant à de courtes missions ayant pour but de résoudre de nombreux problèmes chirurgicaux dans un court laps de temps. Ces voyages, bien que rentables et influenceurs à court terme, n'ont pas d'effet durable, car ils ont des coûts initiaux élevés, négligent souvent d'éduquer les médecins locaux et peuvent perturber les systèmes régionaux. La formation de chirurgiens plastiques locaux est une étape essentielle pour la création d'interventions de chirurgie plastique durables dans le monde. Les plateformes virtuelles sont devenues populaires et efficaces, en particulier à cause de la pandémie de COVID-19, et ont montré leurs avantages dans le champ de la chirurgie plastique en matière de diagnostic et d'enseignement des divers facteurs de chirurgie plastique. Il existe un vaste potentiel pour la création de plateformes virtuelles permettant à des experts des pays à revenus élevés de former des chirurgiens plastiques de PRIF afin d'offrir des moyens plus rentables et durables à ces médecins exerçant dans des régions du monde où l'accès aux soins est plus limité.

The application of augmented reality in plastic surgery training and education: A narrative review.

Continuing problems with fewer training opportunities and a greater awareness of patient safety have led to a constant search for an alternative technique to bridge the existing theory-practice gap in plastic surgery training and education. The current COVID-19 epidemic has aggravated the situation, making it urgent to implement breakthrough technological initiatives currently underway to improve surgical education. The cutting edge of technological development, augmented reality (AR), has already been applied in numerous facets of plastic surgery training, and it is capable of realizing the aims of education and training in this field. In this article, we will take a look at some of the most important ways that AR is now being used in plastic surgery education and training, as well as offer an exciting glimpse into the potential future of this field thanks to technological advancements.

Emergence of Online Teaching for Plastic Surgery and the Quest for Best Virtual Conferencing Platform: A Comparative Cohort Study.

Background As the coronavirus disease 2019 virus made its way throughout the world, there was a complete overhaul of our day-to-day personal and professional lives. All aspects of health care were affected including academics. During the pandemic, teaching opportunities for resident training were drastically reduced. Consequently, medical universities in many parts across the globe implemented online learning, in which students are taught remotely and via digital platforms. Given these developments, evaluating the existing mode of teaching via digital platforms as well as incorporation of new models is critical to improve and implement. Methods We reviewed different online learning platforms used to continue regular academic teaching of the plastic surgery residency curriculum. This study compares the four popular Web conferencing platforms used for online learning and evaluated their suitability for providing plastic surgery education. Results In this study with a response rate of 59.9%, we found a 64% agreement rate to online classes being more convenient than normal classroom teaching. Conclusion Zoom was the most user-friendly, with a simple and intuitive interface that was ideal for online instruction. With a better understanding of factors related to online teaching and learning, we will be able to deliver quality education in residency programs in the future.

A rare post-coronavirus disease 2019 complication of maxillary mucormycotic osteomyelitis in a Southeast Asian patient

Mucormycosis, a rapidly invasive form of fungal infection caused by Mucorales fungi, has high morbidity and mortality rates. Rhino-orbital-cerebral mucormycosis is the most common form of mucormycosis. With the coronavirus disease 2019 (COVID-19) outbreak, a causal correlation between mucormycosis and COVID-19 has been suspected, contributing to the abrupt increase in opportunistic fungal infection cases. We present a case of a Southeast Asian woman in her 60s with complaints of pus discharge in the palatal region with maxillary teeth mobility for 3 months. Physical examination revealed multiple nonvital upper teeth with severe mobility. Incisional biopsy of the maxilla and multidetector computed tomography of the head and neck confirmed the diagnosis of osteomyelitis of the maxilla secondary to mucormycosis. Surgical treatment was performed, and amphotericin B and posaconazole were administered. No operative complications or further bone destruction were observed at 8 months postoperatively. © 2022 China Medical Cosmetology Press Co. Ltd.

Bridging the gap with Pando

The Pando app is UK based and part of the NHS Clinical Communication Procurement Framework, which is designed to provide continuity of care with virtual patient management (https://www.bad.org.uk/healthcare-professionals/covid-19/re mote-dermatology-guidance), and drive tech-enabled connectivity across the National Health Service (NHS). This has also been used in the British Army to help defence medical staff connect with and seek advice from their colleagues in the UK while in the field (www.hellopando.com). Lack of on-site medical illustration, the COVID-19 pandemic and plastic surgeons operating in a NHS-funded private setting with no access to Picture Archiving and Communication System (PACS) in our Trust prompted use of the Pando app to capture prebiopsy pictures, avoid wrong-site surgery and improve interdepartmental communication. We present our multidisciplinary quality improvement project, involving dermatology and plastic surgery, evaluating the use of the Pando app from September to December 2020, mostly from 2-week-wait skin cancer clinics. All dermatology and plastic surgery colleagues downloaded the Pando app to their mobile phones and created a group entitled 'Dermatology/Plastics' to share their patient photos with identity labels. Patient photos could also be emailed to the clinicians' NHS email addresses - all done with patient consent. We evaluated our project with pre-and post-Pando feedback questionnaires. In the pre-Pando questionnaires, the majority of 14 colleagues involved were concerned with the varying quality of photos emailed by patients, the time lag in photos being uploaded to PACS and any likelihood of compromising patient safety. With post-Pando questionnaires, the majority found the app to be user-friendly, that the photographs taken were of superior quality, that there were no reported concerns with patient consent and they preferred using the app to the previous pathway. Comments suggested the Pando app to be invaluable for site recognition in patients with cognitive impairment, multiple lesions, difficult-to-see areas, medicolegal, educational and audit purposes, and local cancer multidisciplinary discussions. The drawbacks were the lack of seamless connection between the app and PACS, the inability to search for pictures in the app with patient identification and lack of access to previously shared pictures for new users. Despite some limitations, the Pando app has immensely improved patient safety and proved to be invaluable for our joint dermatology and plastic surgery interactions. However, there is an unmet need for a system with the ability to instantly transfer pictures to PACS and patient electronic records, to improve things further.

Two-week wait skin cancer referrals to a paediatric dermatology clinic: a service evaluation

Skin cancer in children is rare. Data from the USA indicate that paediatric melanoma accounts for approximately 1% of melanomas and up to 5% of all childhood cancers, and its incidence is declining. Paediatric nonmelanoma skin cancer (NMSC) is also rare and often associated with genetic conditions or iatrogenic risk factors such as prolonged immunosuppression. In the UK, suspected cancers are referred from primary care via the '2-week wait' (2WW) pathway. National Institute for Health and Care Excellence guidance (NG12) provides criteria to guide recognition and referral, aimed at improving cancer outcomes through early detection and diagnosis. Melanoma and squamous cell carcinoma are diagnosed in approximately 6% of all 2WW skin cancer referrals;however, the vast majority of these are in adults. We evaluated all urgent paediatric dermatology referrals made via the 2WW skin cancer pathway over a 21- month period (August 2019-May 2021). In total, 172 referrals were made. Fifty-two per cent were female and mean age at time of referral was 10 years (range 2 months-17 years). The mean wait time from referral to clinical review was 9.9 days (range 1-28). Skin biopsy was arranged in 27 (15.6%) patients;nine (33.3%) of these biopsies were completed by paediatric dermatologists and 18 (66.6%) were referred to plastic surgery. There were no confirmed cases of skin cancer. Referrals were deemed inappropriate in 22% of cases. Of these, 15 (41%) were misdirected referrals and the remainder included nonlesional dermatology, including cutaneous infections (24%) and inflammatory conditions (22%). The histological diagnoses are outlined in the Table. As 2WW referrals rise, services must plan efficient and cost-effective pathways for the provision of care. Referral rates for any suspected cancer are disproportionately high in young people, including for melanoma. Signs of a 'changing mole' are less sensitive in a paediatric cohort where melanoma is more likely to present as an amelanotic or nodular lesion. Over a 21-month period, we did not identify a paediatric skin cancer among patients referred on a 2WW pathway. The service burden related to 'stopping the clock' and patient tracking is considerable and has not been formally costed. As we attempt recovery following the COVID-19 pandemic, we plan to introduce greater use of teledermatology triage to address this issue. (Table Presented).

E-Health and telemedicine applications in plastic surgery and the treatment of facial palsy

Facial palsy (FP) is a life changing condition with physical, aesthetic, functional and psychosocial consequences, which requires specialized diagnosis, rehabilitation and (surgical) management to improve facial function and reduce its negative effects. Since patients remain in follow-up during their life and often have to travel far to receive treatment, improvements can be made in the field of telemedicine. Telemedicine is a growing field of study in medical practice and several advances have been made in the field of plastic surgery. Especially during the COVID-19 pandemic, considerable experience was gained in this way of consultation. This review provides an overview of current research available in the field of E-Health and M-Health in plastic surgery and for patients with a peripheral facial palsy.Copyright © 2021 The Author(s)

Making Sense of Sentiments for Aesthetic Plastic Surgery

With social media pervading all aspects of our life, the opinions expressed by netizens are a gold mine ready to be exploited in a meaningful way to influence all major public do-mains. Sentiment analysis is a way to interpret this unstructured data using AI tools. It is a well-known fact that there has been a 'Zoom Boom' in the field of aesthetic plastic surgery due to the COVID-19 pandemic and the same has put the focus of attention sharply on our appearance. Polarity detection of tweets published on popular aesthetic plastic surgery procedures before and after the onset of COVID can provide great insights for aesthetic plastic surgeons and the health industry at large. In this work, we develop an end-to-end system for the sentiment analysis of such tweets incorporating a state-of-the-art fine-tuned deep learning model, an ingenious 'keyword search and filter approach' and SenticNet. Our system was tested on a large database of 196,900 tweets and the results were visualized using affectively correct word clouds and also subjected to rigorous statistical hypothesis testing to draw meaningful inferences. The results showed a high level of statistical significance. © 2022 IEEE.

The COVID-19 Pandemic Changed the Prevalence of Plastic Surgery in Israel

BACKGROUND: In late 2019, a new strain of coronavirus (coronavirus disease 2019 [COVID-19]) spread rapidly throughout the world. The American Society of Plastic Surgeons reported a pandemic-related surge in the demand for aesthetic surgery compared to the same popularity of procedures prior to the pandemic. OBJECTIVE(S): To determine whether this phenomenon also occurred in Israel. METHOD(S): We collected data from three leading private medical centers in Tel Aviv. Data were compared for the years 2019 and 2020 by surgical procedure. Number of orthopedic, gynecologic, and hand procedures served as control data. RESULT(S): We present a detailed pandemic-related timeline relevant to aesthetic surgery in Israel. Overall, the demand for aesthetic surgery increased, with a marked trend toward body contouring procedures. CONCLUSION(S): The Israeli aesthetic surgery market was affected by the COVID-19 pandemic, with a post-closure surge. The popularity and number of procedures are unique to the Israeli market.

A Unique Case of Pericardial Effusion and Tamponade

Background We present a unique case of a female who developed a large pericardial effusion (PEff) from a rare cause. Case A 36-year-old female with recent COVID-19 infection presented with acute dyspnea. She had undergone liposuction, rectus plication and breast augmentation two months ago. Heart rate was 90/min and blood pressure 86/57mmHg. CT angiogram of the chest revealed a massive PEff with tamponade. She had large right-sided pleural effusion also. She underwent ultrasound-guided pericardiocentesis with the removal of 950 milliliters of serosanguineous fluid. Follow-up echocardiogram showed re-accumulation of fluid. Due to the rapid onset of PEff, she underwent a pericardial window and bilateral chest tube placement. Decision-making Pleural and pericardial fluid analysis showed silicone-gel particles (Figure. 1). Pericardial biopsy showed nonspecific chronic inflammation. Autoimmune workup was unremarkable. Elevated ESR and CRP in the presence of embolized gel particles indicated foreign body reaction from silicone embolism. Plastic surgery advised implant removal. Silicone embolism is known to cause silicone thorax, pleural effusions, and anaplastic large cell lymphoma. To our knowledge, this is the first reported case of PEff due to silicone embolism from breast implants. Conclusion Cardiologists should be aware of this rare but serious complication. Silicone embolism should be considered in the differential of PEff in patients with breast implants. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

How has COVID-19 Changed the Activities of Plastic Surgery? A Bicentric Study

The aim of the present work is to assess the impact of the Covid-19 epidemic on the activity of the Department of Plastic Surgery in the University Hospital "San Giovanni di Dio and Ruggi d'Aragona” of Salerno and the hospital "A.O.R.N. Antonio Cardarelli” of Naples (Italy). Coronavirus disease 2019 (COVID-19), has spread since December 2019 and is a respiratory infection that has changed the healthcare environment, in fact hospitals have had to reorganize departments to better manage resources and make processes efficient. In order to assess the effect that Covid-19 had on the department, data were collected for the year 2019 (in the absence of Covid-19) and in the year of the pandemic 2020. In the work was used the logistic regression technique to study the following variables: age, gender, length of stay (LOS), relative weight of DRG, admission procedure, and the results of the two hospitals were used to make a comparison. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Impact of Virtual Resources and Effect of COVID-19 Pandemic on Plastic Surgery Residency and Training among Residents in Southern Nigeria.

Background: Despite the increased usage of virtual, nonphysical resources for medical education during the coronavirus disease-2019 (COVID-19) pandemic, plastic surgical training still suffered adversely in some aspects. Objectives: The aim of this study was to explore the overall impact of virtual resources and effect of the COVID-19 pandemic on plastic surgery training among residents in Southern Nigeria. Materials and Methods: This was a cross-sectional study conducted among senior plastic surgery residents in southern Nigeria using a well-structured online questionnaire carried out over a 3-month period. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. Measures were taken to significantly minimise response, answer order, and other survey research errors/bias. A pilot study was done. Consent was obtained from all participants. Results: A total of 29 plastic surgery residents completed the questionnaire. Mean age was 35.15 years with standard deviation of 6.31. The response rate was 72.5%. According to a majority of the residents, there were no significant changes in the frequency of burn, hand, and facial injury cases during the pandemic; training courses on plastic surgery (44.3%) and operative cases decreased (48.3%), whereas there was a significant increase in intraoperative teaching (27.6%) as well as simulations and conferences (41.4%). Majority of the respondents also alluded to the significant financial and psychological impacts of the pandemic on residents and a significant decline in cases with general anaesthesia as compared with cases with local anaesthesia. Conclusion: The COVID-19 pandemic has caused a mixture of significant positive and negative changes in the plastic surgery training of residents.