Validation of a synthetic simulation model of endoscopic rectus sheath plication.

PURPOSE: Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. METHODS: A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. RESULTS: Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. CONCLUSION: Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.

Global Resilience in Plastic Surgery Study (GRIPS): Resilience is Associated with Lower Burnout Rates.

Burnout has earned notoriety in medicine. It affects medical students, residents and surgeons, causing a decrease in career satisfaction, quality of life, and increased risk of depression and suicide. The effect of resilience against burnout is yet unknown in plastic surgery trainees. Methods: A survey was sent via email to the members of plastic surgery societies (ICOPLAST) and the trainees from (ASPS) Resident Council from November 2021 through January 2022. The data included: demographics, training program characteristics, physician wellness resources, and single item Maslach-Burnout Inventory and Connor-Davidson Resilience Scale questionnaire. Results: One-hundred seventy-five plastic surgery trainees responded to the survey. Of these, 119 (68%) trainees from 24 countries completed the full survey. Most respondents 110 (92%) had heard of physician burnout, and almost half of respondents (45%) had burnout. The average Connor-Davidson Resilience Scale score varied significantly amongst trainees self-reporting burnout and those who did not (28.6 versus 31.3, P = 0.008). Multivariate logistic regression demonstrated that increased work hours per week were associated with an increased risk of burnout (OR = 1.03, P = 0.04). Higher resilience score (OR = 0.92; P = 0.04) and access to wellness programs (OR = 0.60, P = 0.0004) were associated with lower risk of burnout. Conclusions: Burnout is prevalent across plastic surgery trainees from diverse countries. Increased work hours were associated with burnout, whereas access to wellness programs and higher resilience scores were "protective." Our data suggest that efforts to build resilience may mitigate burnout in plastic surgery trainees.

Plastic Surgery Training across Seven Continents: Results from the First Global Trainee Survey.

Little is known about the demographics and ambitions of plastic surgery trainees and if these differ between regions. This study sought opinion from current and recently graduated plastic surgery trainees to map demographics, training structure, and ambitions of plastic surgery trainees worldwide. Methods: A cross-sectional study was designed and administered by the international trainee organization International Confederation of Societies of Plastic Surgery Trainees. A questionnaire of 45 questions was distributed digitally through several international channels using the REDCap platform. Results: A total of 290 junior plastic surgeons, of whom 124 (42.8%) were women, from all seven International Confederation of Societies of Plastic Surgery regions, participated in this study. Of the trainees, 21% have emigrated, and 75% expressed a desire to undertake a part of their training abroad. The most common length of training in plastic surgery is 5 years. There is a difference in working hours between regions, where more than 80-hour work weeks are most common in Asia (24.1%), and work weeks of less than 40 hours are most common in Middle East (30.8%). A majority of trainees (85%) reported a research interest, and we found a negative correlation between the extent of research ambition and reported clinical workload. Conclusions: We present here the first international investigation of trainee experiences of plastic surgery training. We show that training structure and organization vary between institutions, and that plastic surgery trainees report a strong interest in international training as well as in research.

Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico / Proposal of an informed consent form to obtain audiovisual material from patients

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

Watch One, Do One? A Systematic Review and Educational Analysis of YouTube Microsurgery Videos, and a Proposal for a Quality Assurance Checklist.

Background Educational resources on the internet are extensively used to obtain medical information. YouTube is the most accessed video platform containing information to enhance the learning experience of medical professionals. This study systematically analyzed the educational value of microsurgery-related videos on this platform. Methods A systematic review was conducted on YouTube from April 18 to May 18, 2020, using the following terms: "microsurgery," "microsurgical," "microsurgical anastomosis," "free flap," and "free tissue transfer." The search was limited to the first 100 videos, and two independent reviewers screened for eligible entries and analyzed their educational value using validated scales, including a modified version of the DISCERN score (M-DISCERN), Journal of the American Medical Association (JAMAS) benchmark criteria, and the Global Quality Score (GQS). Evaluation of video popularity was also assessed with the video power index (VPI). Results Of 356 retrieved videos, 75 (21%) were considered eligible. The educational quality of videos was highly variable, and the mean global scores for the M-DISCERN, JAMAS, and GQS for our sample were consistent with medium to low quality. Conclusions A limited number of videos on YouTube for microsurgical education have high-educational quality. The majority scored low on the utilized criteria. Peer-reviewed resources seem to be a more reliable resource. Although the potential of YouTube should not be disregarded, videos should be carefully appraised before being used as an educational resource.

[Proposal of an informed consent form to obtain audiovisual material from patients]. / Panel de expertos para la elaboración de un modelo de consentimiento informado de obtención y uso de material audiovisual clínico.

BACKGROUND: An informed consent is mandatory to obtain any clinical audiovisual material from patients. Although there are some documents created for this purpose, there are some barriers for their application, such as the context in which they were created, the language and download availability. AIM: To create a proposal for an informed consent form (ICF) for the capture and different uses for audiovisual material from patients. MATERIAL AND METHODS: A bibliographic search was carried out to obtain different ICFs in Spanish and English, which were subjected to a process of translation, counter-translation and fragmentation. Subsequently, a panel of experts was formed by members of the Chilean Society of Plastic Surgery with extensive experience in social networks. Delphi methodology was applied to reach a consensus about the definitive content of the ICF based on the previously selected fragments. RESULTS: ICFs available for download were identified. The panel was made up of seven Plastic Surgeons and two Delphi rounds were carried out through electronic surveys. At the end of the process, an ICF proposal was obtained for therapeutic, academic or scientific purposes and another for dissemination or education in the mass media. CONCLUSIONS: The proposed ICFs were liberated for their use among health care professionals in Chile, who could use them, provided that they are approved by the local healthcare ethics committees.

MicrosimUC: Validation of a Low-Cost, Portable, Do-It-Yourself Microsurgery Training Kit.

BACKGROUND: Microsurgery depends largely on simulated training to acquire skills. Courses offered worldwide are usually short and intensive and depend on a physical laboratory. Our objective was to develop and validate a portable, low-cost microsurgery training kit. METHODS: We modified a miniature microscope. Twenty general surgery residents were selected and divided into two groups: (1) home-based training with the portable microscope (MicrosimUC, n = 10) and (2) the traditional validated microsurgery course at our laboratory (MicroLab, n = 10). Before the intervention, they were assessed making an end-to-end anastomosis in a chicken wing artery. Then, each member of the MicrosimUC group took a portable kit for remote skill training and completed an eight-session curriculum. The laboratory group was trained at the laboratory. After completion of training, they were all reassessed. Pre- and posttraining procedures were recorded and rated by two blind experts using time, basic, and specific scales. Wilcoxon's and Mann-Whitney tests were used to compare scores. The model was tested by experts (n = 10) and a survey was applied to evaluate face and content validity. RESULTS: MicrosimUC residents significantly improved their median performance scores after completion of training (p < 0.05), with no significant differences compared with the MicroLab group. The model was rated very useful for acquiring skills with 100% of experts considering it for training. Each kit had a cost of U.S. $92, excluding shipping expenses. CONCLUSION: We developed a low-cost, portable microsurgical training kit and curriculum with significant acquisition of skills in a group of residents, comparable to a formal microsurgery course.

Evaluation of Research Opportunities and Limitations for Plastic Surgery Residents: An International Survey.

BACKGROUND: Conducting research during specialty training provides an opportunity to develop critical thinking and leadership skills along with a better understanding of the scientific literature. However, trainees often find it difficult to undertake research, in the context of labor-intensive surgical training. The aim of this study is to evaluate the research output and limitations of plastic surgery residents in different countries. METHODS: An international cross-sectional study involving plastic surgery trainees and recent postgraduates from Brazil, Chile, Germany, and the United Kingdom was conducted. A survey inquiring into academic productivity, limitations to conducting research, and working-hours patterns was distributed among eligible participants. RESULTS: From September to December 2019, 106 surveys were retrieved. Most respondents declared having participated in at least 1 project that resulted in a presentation or publication during their training (90.6% in national presentations, 68% international presentations, 67% in national publications, and 66% international publications). Having completed a previous research fellowship was associated with a statistically higher academic output (P < 0.05). Seventy-nine percent of respondents felt that their participation in research activities would have been greater if limiting factors had been addressed, including lack of time (72.5%) and insufficient supervision and mentoring (55%). CONCLUSIONS: Optimizing plastic surgery trainees' participation in scientific research is beneficial both for residents and their mentors. Research fellowships can provide an opportunity for academically oriented trainees to further develop their research skills. Protected time and adequate mentoring can help not only to increase residents' research output, but also to recruit the next generation of academic plastic surgeons.

Aesthetic Scrotoplasty: Systematic Review and a Proposed Treatment Algorithm for the Management of Bothersome Scrotum in Adults.

BACKGROUND: Increased scrotal laxity is a poorly defined entity often associated with discomfort while wearing loose clothes, walking, doing sports and during intercourse. In our experience, this condition is produced by an enlarged scrotal bag hanging more than 1-2 cm below the tip of the penis and can be associated with persistent penoscrotal webbing. Our objective was to perform a systematic literature review addressing the diversity of this entity and its surgical treatment, as well as propose a diagnostic and therapeutic approach. METHODS: A systematic search strategy was performed following PRISMA guidelines under the terms: Scrotum(Mesh), Plastic Surgery(Mesh), Reduction Surgery, Scrotoplasty, Ventral Phalloplasty, Scrotomegaly, Penoscrotal Web, Webbed Penis(Mesh), Scrotal Lifting, Scrotopexy and Scrotal Tuck. Articles referring to scrotum reduction or plasty in male genital rejuvenation context and ventral phalloplasty related to adult penoscrotal webbing correction were considered eligible for analysis. A management algorithm and surgical technique is proposed along with the results. RESULTS: A total of 1430 articles were found. After removing duplicates and applying inclusion and exclusion criteria, 11 articles were eligible for analysis. Most articles corresponded to case reports or surgical technique descriptions. Based on correcting excessive scrotal skin and/or penoscrotal webbing, we propose a vertical midline scrotal skin resection and a penoscrotal junction Z plasty, respectively. CONCLUSIONS: Aesthetic scrotoplasty and scrotal rejuvenation surgical techniques still remain as entities poorly addressed in the international literature. More reported experiences are needed in order to complement our proposed management algorithm and develop a nomenclature, diagnostic and treatment consensus. LEVEL OF EVIDENCE IV: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 . Genital Surgery.

Avoiding a Second Wave of Medical Errors: The Importance of Human Factors in the Context of a Pandemic.

The COVID-19 pandemic has had an unprecedented impact on the delivery of healthcare services around the globe. This has resulted in important loss of life for our communities, including health professionals that have been exposed to the disease in their workplace. A human factors approach to the recent changes introduced due to the pandemic can help identify how we can minimize the impact of human error in these circumstances. We hereby present a case study illustrating the application of human factors in the difficult times we are going through at present.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 www.springer.com/00266 .

Autologous versus prosthetic reconstruction for women with breast cancer who will undergo post-reconstruction radiotherapy. / Reconstrucción autóloga versus reconstrucción protésica para mujeres con cáncer de mama que serán sometidas a radioterapia post reconstrucción.

INTRODUCTION: Radiotherapy is frequently used after breast reconstruction in patients with locally advanced breast cancer or metastases in axillary lymph nodes. However, there might be differences between autologous and prosthetic reconstruction in terms of effectiveness and safety of post-reconstruction radiotherapy. METHODS: To answer this question we searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including nine primary studies overall, of which all were observational studies. We concluded that in patients who will undergo post reconstructive radiotherapy, autologous breast reconstruction could reduce reoperations due to general complications compared to prosthetic breast reconstruction. However, it probably increases the risk of skin or flap necrosis. It is not clear whether there are differences in other outcomes as the certainty of evidence has been assessed as very low.

INTRODUCCIÓN: La radioterapia se utiliza cada vez con más frecuencia después de la reconstrucción mamaria en pacientes con cáncer de mama localmente avanzado o con metástasis en linfonodos axilares. Sin embargo, se ha propuesto que podrían existir diferencias en la efectividad y seguridad de la radioterapia post reconstrucción dependiendo de qué tipo de reconstrucción mamaria se utilice, ya sea esta reconstrucción autóloga o protésica. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, re analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron nueve estudios primarios, todos los cuales corresponden a estudios observacionales. Concluimos que la reconstrucción mamaria autóloga podría disminuir las reoperaciones atribuidas a complicaciones generales en comparación a la reconstrucción mamaria protésica en pacientes sometidas a radioterapia post reconstrucción, pero probablemente aumenta el riesgo de necrosis de piel o colgajo. No está claro si existen diferencias en otros desenlaces, debido a que la certeza de la evidencia ha sido evaluada como muy baja.

Respuesta a la carta del Dr. Iván Herández: La importancia del impulso a la investigación científica en la Sudamérica emergente / No disponible

No disponible

Tendencias y perfil de publicación de los cirujanos plásticos de los 22 países miembros de la FILACP, revisión de los últimos 20 años / Publishing trends and profile of plastic surgeons from the 22 countries members of the FILACP, revision of the last 20 years

Introducción y Objetivo: La publicación científica es una actividad académica fundamental, constituyendo una fuente de conocimiento y actualización. El objetivo de este trabajo es conocer el perfil y la tendencia de publicación de los cirujanos plásticos de las 22 naciones que componen la Federación Ibero Latinoamericana de Cirugía Plástica (FILACP) durante los últimos 20 años. Material y Método: Revisión en Pubmed, Lilacs, Scielo, Central (Cochrane) y Tripdatabase, desde el 1 de enero de 1998 al 1 de enero del 2018 bajo los términos: (Cirugía Plástica OR Plastic Surgery) AND: Chile, Argentina, Bolivia, Perú, Colombia, Brasil, Venezuela, Ecuador, Uruguay, Paraguay, Panamá, Costa Rica, Nicaragua, Guatemala, Honduras, El Salvador, México, República Dominicana, Cuba, Puerto Rico, España y Portugal, cada país por separado. Consideramos todos los trabajos que incluyeran entre sus autores al menos un cirujano plástico de su respectivo país y analizamos: pertenencia a su Sociedad Nacional de Cirugía Plástica (SNCP), participación de residentes, centro o campo clínico, tema, grupo etario objetivo, año de publicación y revista. Resultados: Revisamos 6387 publicaciones; 3000 artículos cumplieron criterios de inclusión. Los países con mayor número de publicaciones fueron Brasil (998), España (989) y México (310), seguidos de Portugal (167), Argentina (162), Chile (125) y Colombia (95). En global, el 89.3% de los autores eran miembros de su respectiva SNCP. Predominó como temática lo reconstructivo (47.6%), los estudios en adultos (73.2%) y los centros universitarios (58.2%). Las principales revistas de publicación corresponden a Cirugía Plástica Ibero-Latinoamericana y Plastic and Reconstructive Surgery. Conclusiones: Existe un aumento sostenido en la publicación científica por parte de los cirujanos plásticos de los países de la FILACP, en especial en la última década. Llama la atención la poca participación de residentes (8.4%), lo cual creemos corresponde a un reporte insuficiente de su calidad de residentes entre los autores

Background and Objective: Scientific publication is a fundamental academic activity, constituting a source of update and knowledge. The objective of this article was to find out about the publishing profile and trend of plastic surgeons from the 22 countries that conform the Ibero Latin American Federation of Plastic Surgery (FILACP) during the last 20 years. Methods: Literature Review in Pubmed, Lilacs, Scielo, Central (Cochrane) and Tripdatabase, from January 1, 1998 to January 1, 2018 under the terms: (Plastic Surgery OR Cirugía Plástica) AND: Chile, Argentina, Bolivia, Peru, Colombia, Brazil, Venezuela, Ecuador, Uruguay, Paraguay, Panama, Costa Rica, Nicaragua, Guatemala, Honduras, El Salvador, Mexico, Dominican Republic, Cuba, Puerto Rico, Spain and Portugal, each country separately. Articles with at least one plastic surgeon from the respective country between the authors were included and analyzed by: membership of their National Plastic Surgery Society, resident participation, center, subject, objective age group, year of publication and journal. Results: 6387 publications were reviewed; 3000 articles met inclusion criteria. The countries with the highest number of publications were Brazil (998), Spain (989) and Mexico (310), followed by Portugal (167), Argentina (162), Chile (125) and Colombia (95). Overall, 89.3% of the authors were members of their corresponding National Plastic Surgery Societies. Reconstructive themed papers predominated (47.6%), as well as studies in Adults (73.2%) and Academic centers (58.2%). The main publication journals were Cirugía Plástica Ibero-Latinoamericana and Plastic and Reconstructive Surgery. Conclusions: There is a sustained increase in scientific publication by plastic surgeons from the countries of the FILACP, especially in the last deca- de. The low participation of residents draws attention (8.4%), however we believe it corresponds to an insufficient report about their role as residents among the authors