Implant-based breast surgery and capsular formation: when, how and why?-a narrative review.

Background and Objective: Implant-based breast surgery is a common procedure for both reconstructive and aesthetic purposes. Breast implants, like any foreign object, trigger the formation of a capsule around them. While generally harmless, the capsule can undergo fibrotic changes leading to capsular contracture, which can negatively impact surgical outcomes and patient well-being. Additionally, rare but serious complications, such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and capsule-associated squamous cell carcinoma, have been reported. This paper aims to review the physiology of capsular formation, identify factors contributing to capsule-related pathologies, and discuss their clinical implications. Methods: A review of relevant literature was conducted by searching databases for articles published between inception and September 2022. The search included but not limited to terms such as "capsular formation" and "capsular contracture". Selected articles were critically analyzed to address the objectives of this review. Key Content and Findings: Capsular formation involves interactions between the implant surface, surrounding tissues, and the immune system. Factors influencing pathological changes in the capsule include genetic predisposition, bacterial contamination, implant characteristics, and surgical techniques. Capsular contracture, characterized by tissue hardening, pain, and implant distortion, remains the most common complication. Rare but life-threatening conditions, such as BIA-ALCL and capsule-associated squamous cell carcinoma, necessitate vigilant monitoring and early detection. Conclusions: Understanding the physiology of capsular formation and its associated pathologies is crucial for healthcare providers involved in implant-based breast surgery. Efforts should focus on minimizing the risk of capsular contracture through improved implant materials, surgical techniques, and infection prevention. The emergence of BIA-ALCL and capsule-associated squamous cell carcinoma underscores the importance of long-term surveillance and prompt diagnosis. Further research is needed to uncover underlying mechanisms and develop preventive measures and treatments for these complications. Enhancing our knowledge and clinical management of capsular formation will lead to safer and more successful outcomes in implant-based breast surgery.

Nursing Students Reported More Positive Emotions about Training during COVID-19 After Using a Virtual Simulation Paired with an In-person Simulation.

Background: Virtual simulations (VS) are educational tools that can help overcome the limitations of in-person learning highlighted during the COVID-19 pandemic. Research has illustrated that VS can support learning, but little is known about the usability of VS as a distance learning tool. Research on students' emotions about VS is also scarce, despite the influence of emotions on learning. Methods: A quantitative longitudinal study was conducted with undergraduate nursing students. 18 students participated in a hybrid learning experience involving a virtual simulation (VS) followed by an in-person simulation. Students completed questionnaires about their emotions, perceived success, and usability and received a performance score from the VS. Results: Nursing students reported statistically significant improvements in their emotions about completing their program after completing both VS and in-person simulations compared to their emotions before the pair of simulations. Emotions directed toward the VS were weak-to-moderate in strength, but predominantly positive. Positive emotions were positively associated with nursing students' performance. Findings replicated "okay" approaching "good" usability ratings from a recent study with key methodological differences that used the same software. Conclusions: VS can be an emotionally positive, effective, efficient, and satisfying distance learning supplement to traditional simulations.

Dissecting Medical Litigation: An Analysis of Canadian Legal Cases in Plastic Surgery.

Introduction: Plastic surgeons are more likely to face medical litigation, compared to other specialists. Although this has been previously studied in other countries, there is a paucity of data regarding legal medical cases within Canada. The goal of this study was to compile and analyze all medical litigations in plastic surgery in Canada and identify themes associated them. Methods: A systematic search of the 2 largest Canadian online legal databases, LexisNexis Canada and WestLawNext Canada, was conducted to retrieve all legal medical cases against plastic surgeons in Canadian courts. Quantitative and qualitative analyses were performed to dissect the characteristics of plastic surgery litigation in Canada. Results: A total of 105 legal cases were included in this analysis, including 81 lawsuits and 24 appeals. The preponderance of cases was related to breast surgeries (47.0%), followed by head and neck surgeries (18.1%), with 76.5% being related to cosmetic surgery; 64.2% were ruled in favour of the surgeon. The lack of preoperative informed consent was highly associated with a final ruling in favour of the patient (P < .0001). The average monetary value of damages awarded was $61 076. There was no significant difference in monetary value between cosmetic and reconstructive cases. Conclusion: The majority of medical litigation in plastic surgery in Canada is associated with cosmetic surgeries, most commonly of the breast. Lack of informed consent is associated with judicial rulings in favour of patients. By understanding the themes underlying these legal cases, we hope to highlight the main issues that lead to litigation in plastic surgery.

Introduction: Les chirurgiens plastiques sont plus susceptibles de faire face à un contentieux médical que d'autres spécialistes. Si cela a déjà été étudié dans d'autres pays, il y a peu de données sur les affaires judiciaires de nature médicale au Canada. L'objectif de cette étude était de compiler et analyser les contentieux médicaux en chirurgie plastique au Canada et d'identifier les thèmes qui leur sont associés. Méthodes: Une recherche systématique a été menée dans les deux grandes bases de données juridiques canadiennes sur internet, LexisNexis® Canada et WestLawNext® Canada, pour en tirer toutes les affaires judiciaires contre des chirurgiens plastiques passées devant les tribunaux canadiens. Des analyses quantitatives et qualitatives ont été réalisées pour disséquer les caractéristiques des contentieux en chirurgie plastique au Canada. Résultats: Un total de 105 cas judiciaires ont été inclus dans cette analyse, dont 81 poursuites en justice et 24 appels. Une prépondérance de cas avait trait à la chirurgie mammaire (47,0 %), suivie par la chirurgie de la tête et du cou (18,1 %), et 76,5 % étant liés à chirurgie cosmétique. Dans 64,2 % des cas, la décision a été en faveur du chirurgien. L'absence de consentement éclairé préopératoire a été fortement associée à des jugements définitifs en faveur des patients (P < 0,0001). La valeur monétaire moyenne des dommages et intérêts accordés était de 61 076 $. Il n'y a pas eu de différence significative de valeur monétaire entre les cas cosmétiques et la chirurgie reconstructrice. Conclusion: La majorité des cas de contentieux médicaux en chirurgie plastique au Canada est associée à la chirurgie cosmétique, le plus souvent la chirurgie mammaire. L'absence de consentement éclairé est associée aux décisions judiciaires favorables aux patients. En comprenant les thèmes sous-tendant ces affaires judiciaires, nous espérons souligner les principaux problèmes qui débouchent sur un contentieux en chirurgie plastique.

Exploring the roles of artificial intelligence in surgical education: A scoping review.

BACKGROUND: Technology-enhanced teaching and learning, including Artificial Intelligence (AI) applications, has started to evolve in surgical education. Hence, the purpose of this scoping review is to explore the current and future roles of AI in surgical education. METHODS: Nine bibliographic databases were searched from January 2010 to January 2021. Full-text articles were included if they focused on AI in surgical education. RESULTS: Out of 14,008 unique sources of evidence, 93 were included. Out of 93, 84 were conducted in the simulation setting, and 89 targeted technical skills. Fifty-six studies focused on skills assessment/classification, and 36 used multiple AI techniques. Also, increasing sample size, having balanced data, and using AI to provide feedback were major future directions mentioned by authors. CONCLUSIONS: AI can help optimize the education of trainees and our results can help educators and researchers identify areas that need further investigation.

Medical Student Mentorship in Surgery: Lessons Learnt and Future Directions.

BACKGROUND: Mentorship is one of the cornerstones of surgical education, providing students with the tools to navigate the challenges of the transition from a trainee to a surgeon. OBJECTIVES: Our study aims to describe the characteristics of successful mentorship of medical students who successfully matched into surgical fields, and to provide medical students practical information on how to successfully find and maintain successful mentoring relationships. METHODS: In this multi-center cross-sectional observational study, 2 surveys; 1 for mentees, defined as junior surgical residents (medical students who matched into surgical specialties), and 1 for mentors, defined as staff surgeons, were used to collect data between August 1, 2020 to November 1, 2020. The study was retrospective in nature and did not directly assess survey participants while they were in medical school, but rather while they were residents, retrospectively answering regarding their experiences as medical students. The surveys contained 24 questions pertaining to demographics, the dynamics of mentor-mentee relationships, qualities sought in a mentee, and barriers/benefits to mentorship. RESULTS: A total of 111 attending surgeons and 138 surgical residents completed the surveys. Seventy-eight percent of surgeons had mentored at least 1 medical student, while 74.6% of residents had at least 1 mentor during medical school. The top three mentee qualities reported by mentors were willingness to learn, being a hard worker, and curiosity. There was a significant disparity between mentors' and mentees' perceptions of the importance of scientific curiosity as a mentee trait (p < 0.05). Mentors and mentees have different perceived barriers to forming successful mentorships. CONCLUSIONS: While the majority of students have experienced fruitful mentoring relationships, the differences in perception of mentors and mentees still represent barriers to be overcome to allow mentorship in surgery to flourish.

Advanced parental age: Is it contributing to an increased incidence of non-syndromic craniosynostosis? A review of case-control studies.

BACKGROUND: Craniosynostosis (CS) is a congenital birth defect characterized by the premature fusion of one or several calvarial suture(s). CS could lead to serious complications, such as intracranial hypertension and neurodevelopmental impairment. There is an increasing trend in the prevalence of CS - 75% of which are of non-syndromic type (NSCS). In parallel, there is a steady rise in the average maternal age. The goal of this paper was to review the literature to clearly identify any associations between parental age and NSCS. This review was performed and reported in compliance with PRISMA guidelines. METHODS: The PUBMED and EMBASE databases were systematically searched, and all studies that observed the relationship between maternal and/or paternal age on NSCS were included. The articles were then assessed for methodological quality using the Newcastle-Ottawa Scale (NOS). The effect of advanced maternal and/or paternal age on the incidence of NSCS was identified by the prevalence ratios reported at a confidence interval of 95%. RESULTS: Six retrospective case-control studies, reporting on a total of 3267 cases of NSCS were included in this review. While there were some inconsistencies in the findings of the different studies, the majority reported a positive correlation between advanced maternal and/or paternal age and an increased incidence of NSCS. CONCLUSION: This review identified an association between advanced parental age and an increased incidence of NSCS.

Treatment of Critical-Sized Calvarial Defects in Rats with Preimplanted Transplants.

The local environment and the defect features have made the skull one of the most difficult regions to repair. Finding alternative strategies to repair large cranial defects, thereby avoiding the current limitations of autograft or polymeric and ceramic prostheses constitute an unmet need. In this study, the regeneration of an 8 mm critical-sized calvarial defect treated by autograft or by a monetite scaffold directly placed in the defect or preimplanted (either cranial bone transplant or subcutaneous pocket) and then transplanted within the bone defect is compared. The data reveal that transplantation of preimplanted monetite transplant scaffolds greatly improves the skull vault closure compared to subcutaneously preimplanted or directly placed materials. Autografts, while clearly filling the defect volume with bone appear effective since bone volume inside the defect volume is obviously high, but are not well fused to the skull. The preimplantation site has a large influence on the regeneration of the defect. Transplantation of induced bone inside materials has the potential to reduce the need for autograft harvest without damaging the skeleton. This first demonstration indicates that cranial repair may be possible without recourse to bioactives or cultured cell therapies.

Flap versus fascial closure for gastroschisis: a systematic review and meta-analysis.

BACKGROUND: Flap closure represents an alternative to fascial closure for gastroschisis. We performed a systematic review and meta-analysis of outcomes comparing these techniques. METHODS: A registered systematic review ( PROSPERO: CRD42015016745) of comparative studies was performed, querying multiple databases without language or date restrictions. Gray literature was sought. Outcomes analyzed included: mortality, ventilation days, feeding parameters, length of stay (LOS), wound infection, resource utilization, and umbilical hernia incidence. Multiple reviewers independently assessed study eligibility and literature quality. Meta-analysis of outcomes was performed where appropriate (Revman 5.2). RESULTS: Twelve studies met inclusion criteria, of which three were multi-institutional. Quality assessment revealed unbiased patient selection and exposure, but group comparability was suboptimal in four studies. Overall, 1124 patients were evaluated, of which 350 underwent flap closure (210 immediately; 140 post-silo). Meta-analysis revealed no significant differences in mortality, LOS, or feeding parameters between groups. Flap patients had less wound infections (OR 0.40 [95%CI 0.22-0.74], P=0.003). While flap patients had an increased risk of umbilical hernia, they were less likely to undergo repair (19% vs. 41%; P=0.01). CONCLUSIONS: Flap closure has equivalent or superior outcomes to fascial closure for patients with gastroschisis. Given potential advantages of bedside closure and reduced sedation requirements, flap closure may represent the preferred closure strategy.