Rates of hepatic artery thrombosis in liver transplantation with the use of a microscope: A systematic review.

OBJECTIVE: Hepatic artery anastomosis in liver transplantations requires a meticulous technique to minimize the risk of hepatic artery thrombosis (HAT). The microscope helped improve anastomosis techniques in pediatric patients with small caliber vessels. The aim of this review was to compare microsurgical and non-microsurgical techniques on the incidence of HAT in liver transplantations. The secondary objective was to compare HAT incidence between pediatric and adult cohorts and between plastic and transplant surgeons. METHODS: A systematic review of the literature using Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted on studies involving HAT in liver transplantations with microsurgery. Three reviewers performed a full article review and data extraction for studies meeting the eligibility criteria of the study. RESULTS: Forty-five studies were incorporated in the final analysis. A total of 7346 patients and 7506 liver transplants were included. The mean age was 17 years old with an equivalent distribution between pediatric (51%, n = 3218) and adult patients (49%, n = 3145). A total of 6351 of these transplantations underwent microsurgical repair, against 1157 with non-microsurgical techniques. The overall HAT rate was 4.9%, including 4.2% in the microsurgical group (n = 268) and 8.5% in the non-microsurgical group (n = 98), a statistically significant increase of 4.3%. The occurrence of HAT was 2.6% with a plastic surgeon versus 4.6% with other types of surgeons. When using microsurgical techniques, the HAT rate was 4.2% with living donors versus 7.7% with deceased donors. CONCLUSIONS: HAT and subsequent liver transplant failure are lower when microsurgical techniques, living donors, and plastic surgeons with a microsurgical training are involved in the operation.

Publication Rates and Author Characteristics From 3 Plastic Surgery Journals in 2006 and 2016.

BACKGROUND: Areas of surgical care in which, traditionally, plastic surgeons were exclusively involved are now routinely offered by other surgical specialists. Whether this shift in clinical responsibilities influenced publication rates of plastic surgeons remains unknown. The current article investigates the proportion of contributions in plastic surgery journals originating from authors with a plastic surgery background as well as publication rates and author demographics. METHODS: A cross-sectional sample study of every publication originating from Annals of Plastic Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, and Plastic and Reconstructive Surgery was performed for 2006 and 2016. Data about the articles' methodological design and branch of plastic surgery as well as authors' country of origin, educational degree and specialty training were analyzed. RESULTS: From 1721 publications included, head and neck reconstruction was the branch of plastic surgery with the highest number of publications at 18% and most articles (30%) were retrospective cohort studies. From 3381 authors analyzed, a significant proportion originated from United States (34%). More than 85% of authors were physicians as opposed to other health care professionals. The specialty with the highest representation was plastic surgery at 72%, but the proportion decreased in all 3 journals by a mean rate of 3.8% in 2016. CONCLUSIONS: A slight decrease in publication rates from plastic surgeons occurred in Annals of Plastic Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, and Plastic and Reconstructive Surgery from 2006 to 2016. Publications rates and author characteristics in plastic surgery journals provide valuable insight on plastic surgeons' contribution to contemporary scientific literature.