Satisfaction From Plastic Surgery Residency: A National Survey.

BACKGROUND: Plastic surgery residency programs in Israel have undergone several changes over the years, but the perspectives and satisfaction of the residents have not been investigated. METHODS: An anonymous national survey of plastic surgery residents in Israel was performed. Demographic, professional, and education variables were summarized using descriptive statistics, and findings were related to self-reported satisfaction levels using univariate analysis. RESULTS: The response rate was 75.9%. Response rates to surgery and education-related items were as follows: 60% performed 5 to 15 surgeries/month; 60.3% performed fewer than 5 surgeries/month as the primary surgeon; 57.3% and 77.8%, respectively, received surgical and academic instruction from fewer than half the attending physicians; 33.9% and 32.3%, respectively, had little or no in-hospital exposure to aesthetic surgeries. The average overall satisfaction rate was 3.33/5. Ten variables were significantly associated with increased satisfaction: total number of surgeries performed (P = 0.01); active participation in complex procedures (P = 0.0009); performing preoperative and postoperative management for one's patients (P = 0.016); marking one's patients preoperatively (P = 0.037); managing complications of one's patients (P = 0.0027); receipt of surgical instruction (P = 0.0035); receipt of academic medical instruction (P < 0.0001); sense that the training will provide the proper professional level (P < 0.0001) and independence (P = 0.0002); and subjective correspondence between demands and capabilities (P = 0.0004). CONCLUSIONS: This study identifies several factors associated with plastic surgery resident satisfaction. It highlights factors that warrant changes by plastic surgery departments and faculty to improve resident training and increase their satisfaction. The questionnaire can also serve as a diagnostic and follow-up tool.

Is Being Left Handed an Advantage toward a Plastic Surgery Residency?

Left hand dominance is a minority trait historically regarded as disadvantageous for surgeons. Contemporary scientific literature and folklore have shed new light on left handedness as a "boutique trait" and possible marker of gifted and exceptional individuals. Our subjective impression that left handedness is prevalent in the unique field of plastic surgery raised questions regarding the scope and possible causality of this phenomenon. METHODS: One hundred eleven medical doctors in our medical center filled out a 13-item questionnaire regarding hand dominance, medical speciality, and various creative outlets or hobbies. RESULTS: Sixty-four percent of the participating plastic surgeons were left handed (significantly higher than the approximate 12% of the general population; P = 0.007). Many of the left-handed doctors admitted to practicing musical instruments and various arts, crafts, and other hobbies. CONCLUSIONS: Plastic surgery is a unique profession requiring astute minds capable of creative and "outside-the-box" thinking; traits we have learned in recent decades may be particularly keen in left-handed individuals, perhaps suggest a causal relationship to the conglomeration of a majority of left-handed plastic surgeons.

Innervation of an engineered muscle graft for reconstruction of muscle defects.

Autologous muscle flaps are commonly used to reconstruct defects that involve muscle impairment. To maintain viability and functionality of these flaps, they must be properly vascularized and innervated. Tissue-engineered muscles could potentially replace autologous muscle tissue, but still require establishment of sufficient innervation to ensure functionality. In this study, we explored the possibility of innervating engineered muscle grafts transplanted to an abdominal wall defect in mice, by transferring the native femoral nerve to the graft. Six weeks posttransplantation, nerve conduction studies and electromyography demonstrated increased innervation in engineered grafts neurotized with the femoral nerve, as compared to non-neurotized grafts. Histologic assessments revealed axonal penetration and formation of neuromuscular junctions within the grafts. The innervation process described here may advance the fabrication of a fully functional engineered muscle graft that will be of utility in clinical settings.

Chest Wall-Based Flap for Repairing Partial Mastectomy Defects: A Multipurpose Flap.

OBJECTIVE: The objective of this study is to introduce a single and reproducible tissue-rearrangement oncoplastic technique that is applicable for all quadrants partial-mastectomy defects in small- to medium-sized breasts, using grounds drawn from cosmetic surgery. METHODS: Eleven small- to medium-sized breast cancer patients with tumor involvement of more than a quarter of the breast were operated on using the chest wall-based flap technique. The procedure is described in detail, and the results are analyzed in terms of both cosmetic and oncological results. RESULTS: The flap successfully reached all breast quadrants as necessary, as well as the areola-nipple complex. The resection borders were found to be free of tumor in all cases, and there were no perioperative complications. Patients rated nearly all the cosmetic parameters as "somewhat satisfied" or "very satisfied," and there was no evidence of fat necrosis in the postoperative mammography examinations. CONCLUSIONS: Applying principles taken from the cosmetic plastic surgery lies at the base of any high standard reconstructive surgery in general and oncoplastic breast surgery in particular. The chest wall-based flap is suitable for the reconstruction of a wide range of breast lumpectomy defects and is feasible for small- to medium-sized breasts, which are usually not easily amenable to tissue rearrangement techniques. The learning curve is short, with replicable results.