Strategies to Improve Resident Wellness in Plastic Surgery Training.

Residency is known to be a challenging time in a surgeon's career. Surgical residents must learn the breadth of their field and develop technical skills while maintaining relationships and well-being outside their training. High burnout rates are well documented among all medical specialties, particularly during residency. Proven strategies in medical education that help decrease burnout and improve resident well-being, while maintaining quality patient care, have been reported in the medical education literature. However, little has been published specific to plastic surgery training programs. We discuss strategies that can be implemented into the curricula and workflow at plastic surgery residency programs to maximize resident well-being. We advocate for a multifaceted approach that includes a night float system, day call, integrating advanced practice providers to offload noneducational resident tasks, and establishing a wellness program. It is our hope that these strategies may serve as a guide for plastic surgery residency programs to promote general wellness and prevent burnout among trainees.

Strategies to Reduce Congestion in the Resident Match: What Can Plastic Surgery Learn from Other Specialties?

Many medical specialties are experiencing congestion in the residency match process because of increasing competition amongst applicants to secure a training position. With rising application numbers for a stable number of positions, the result is an inefficient use of time and financial resources on behalf of both the residency applicants and programs. Solutions to address congestion in the match process have been proposed in the literature, and other specialties have implemented specialty-wide reforms. Methods: The Pubmed and Web of Science databases were queried using keywords related to the residency match and resident selection. The initial search yielded 372 results. Titles and abstracts were evaluated for inclusion and 93 articles met criteria for full-text evaluation. The bibliographies of these publications were reviewed for additional references. Results: Numerous strategies to reduce congestion in the match were identified across specialties. Implemented reforms include a centralized preference signaling system, an interview cap, a staged or consortia match, and publication of transparent program-specific resident selection criteria. We discuss pros and cons of different strategies to reduce congestion in the match and summarize the effects that recent reforms have had on other specialties. Conclusions: Plastic surgery as a field is at a distinct advantage to be a leader in transforming the residency match process, as we are a small and historically innovative group. We hope to spark discussion amongst students, residents, and program faculty with the goal of creating a more efficient match process.

Technical Refinement in Three-Dimensional Nipple-Areola Complex Tattooing of the Reconstructed Breast.

SUMMARY: Three-dimensional nipple-areola complex tattooing has previously been described as an alternative to surgical reconstruction using local flaps and grafts. This technique offers patients an option that can achieve aesthetically pleasing results without a donor site, changes in projection over time, or additional scarring. Plastic surgeons may be limited in their ability to create a realistic-appearing nipple-areola complex because of limited experience with basic tattooing techniques and unfamiliarity with the artistic principles of light and shadow required to create depth on a two-dimensional surface. Consistent results can be achieved with attention to the technical pearls discussed in this article.

Melanoma of the Hands and Feet (With Reconstruction).

Melanomas only account for 4% of all dermatologic cancers yet are responsible for 80% of deaths. Notably, melanomas of the hand and foot have a worse prognosis when compared with melanomas of other anatomic regions. Likely this is due to intrinsic biologic characteristics, delayed diagnosis, difficult surgical excision due to delicate anatomy, and lack of definitive diagnostic and therapeutic guidelines. The most common locations of melanoma of the hand, in order of decreasing frequency, are subungual area, dorsal surface, and palmar surface. The most common locations of melanoma of the foot are the plantar surface, dorsal surface, and subungual area, in decreasing frequency. Diagnosis of melanoma of the hand and foot can be difficult because the traditional "ABCDE" (asymmetric shape, border, color, diameter, evolution) rules do not apply. Newer acronyms have been proposed in literature including "CUBED" (colored, uncertain, bleeding, enlarged, delayed) and "ABC rule for Subungual Melanoma." Once diagnosed, treatment is primarily surgical excision and reconstruction. The goal for the surgeon is to maintain the function and anatomy of the hand or foot.

Preoperative Considerations for the Prevention of Surgical Site Infection in Superficial Cutaneous Surgeries: A Systematic Review.

Background: Surgical site infections (SSIs) pose challenges to the outcome of superficial cutaneous procedures. Objective: The objective of this study was to summarize published data regarding appropriate perioperative considerations to decrease SSI, including antiseptic use, topical decolonization, antibiotic prophylaxis, and clean versus sterile technique in superficial cutaneous procedures. A literature search was performed via PubMed and Cochrane Library by using relevant keywords. A total of 37 articles met the inclusion criteria. Strength of data was assessed according to the Oxford Centre criteria and a modified Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: Chlorhexidine is the antiseptic of choice in clean or outpatient superficial cutaneous procedures. Decolonization of carriers of Staphylococcus aureus with mupirocin is warranted for all superficial cutaneous procedures. Minor procedure rooms may be considered for superficial cutaneous procedures that possess an inherently low risk of SSI. Surgeons may consider nonsterile gloves instead of sterile gloves for clean or outpatient superficial cutaneous procedures. Postoperative use of topical antibiotics may be discontinued, as there are risks of adverse effects and increasing bacterial resistance without a significant reduction in SSI. Conclusion and Relevance: This systematic review provides new and updated evidence for the prevention of SSI in superficial cutaneous procedures through antiseptic use, antibiotic use, topical agents, and the surgical environment. The overall quality of evidence is good, with most articles being original research or systematic reviews. However, there is a need for dermatologic- and plastic surgery-specific studies regarding the prevention of SSI.