Patient Reviews: Yelp, Google, Healthgrades, Vitals, and RealSelf.

BACKGROUND: Online reviews play a significant role in influencing a patient's choice of a plastic surgeon. The purpose of this article is to help the practicing plastic surgeon understand reviews and review websites. METHODS: A review of both the medical literature and online blogs was performed to identify the most current information pertinent to plastic surgeons. RESULTS: Negative reviews can impact a potential patient's decision on where to seek plastic surgery, and the best way to dilute that impact is to attract good reviews. Good reviews result from running an excellent practice, and patient surveys can help identify and address problems. The qualities of each of the seven online patient review websites are summarized, along with practice advice on how to attract reviews and how to deal with fake, fraudulent, and negative reviews. CONCLUSIONS: Reviews impact plastic surgeons, whether or not they are aware of what patients are saying about them online. This article helps plastic surgeons become familiar with how to use reviews for practice growth and how to protect their online reputation.

A randomized controlled trial of the embrace advanced scar therapy device to reduce incisional scar formation.

BACKGROUND: Scarring represents a significant biomedical burden in clinical medicine. Mechanomodulation has been linked to scarring through inflammation, but until now a systematic approach to attenuate mechanical force and reduce scarring has not been possible. METHODS: The authors conducted a 12-month, prospective, open-label, randomized, multicenter clinical trial to evaluate abdominoplasty scar appearance following postoperative treatment with the embrace Advanced Scar Therapy device to reduce mechanical forces on healing surgical incisions. Incisions from 65 healthy adult subjects were randomized to receive embrace treatment on one half of an abdominoplasty incision and control treatment (surgeon's optimal care methods) on the other half. The primary endpoint for this study was the difference between assessments of scar appearance for the treated and control sides using the visual analogue scale scar score. RESULTS: Final 12-month study photographs were obtained from 36 subjects who completed at least 5 weeks of dressing application. The mean visual analogue scale score for embrace-treated scars (2.90) was significantly improved compared with control-treated scars (3.29) at 12 months (difference, 0.39; 95 percent confidence interval, 0.14 to 0.66; p = 0.027). Both subjects and investigators found that embrace-treated scars demonstrated significant improvements in overall appearance at 12 months using the Patient and Observer Scar Assessment Scale evaluation (p = 0.02 and p < 0.001, respectively). No serious adverse events were reported. CONCLUSIONS: These results demonstrate that the embrace device significantly reduces scarring following abdominoplasty surgery. To the authors' knowledge, this represents the first level I evidence for postoperative scar reduction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Improving cutaneous scar formation by controlling the mechanical environment: large animal and phase I studies.

OBJECTIVE: To test the hypothesis that the mechanical environment of cutaneous wounds can control scar formation. BACKGROUND: Mechanical forces have been recognized to modulate myriad biologic processes, but the role of physical force in scar formation remains unclear. Furthermore, the therapeutic benefits of offloading cutaneous wounds with a device have not been rigorously tested. METHODS: A mechanomodulating polymer device was utilized to manipulate the mechanical environment of closed cutaneous wounds in red Duroc swine. After 8 weeks, wounds subjected to different mechanical stress states underwent immunohistochemical analysis for fibrotic markers. In a phase I clinical study, 9 human patients undergoing elective abdominal surgery were treated postoperatively with a stress-shielding polymer on one side whereas the other side was treated as standard of care. Professional photographs were taken between 8 and 12 months postsurgery and evaluated using a visual analog scale by lay and professional panels. This study is registered with ClinicalTrials.gov, number NCT00766727. RESULTS: Stress shielding of swine incisions reduced histologic scar area by 6- and 9-fold compared to control and elevated stress states, respectively (P < 0.01 for both) and dramatically decreased the histologic expression of profibrotic markers. Closure of high-tension wounds induced human-like scar formation in the red Duroc, a phenotype effectively mitigated with stress shielding of wounds. In the study on humans, stress shielding of abdominal incisions significantly improved scar appearance (P = 0.004) compared with within-patient controls. CONCLUSIONS: These results indicate that mechanical manipulation of the wound environment with a dynamic stress-shielding polymer device can significantly reduce scar formation.