Starting an autologous breast reconstruction program after plastic surgical training. Is it as good as it gets?

BACKGROUND: Today, the deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard in microvascular breast reconstruction. Although this procedure is known as technically demanding, novice plastic surgeons must be able to perform these procedures to meet the rising demand. The purpose of this study was to evaluate if the young junior professional is trained adequately to set up and safely perform microsurgical breast reconstructions. METHODS: We compared outcomes of three identically trained novice plastic surgeons who introduced the DIEP flap in their working environment. Their hospitals differed in size and experience in microsurgery. Outcomes were compared between all start-ups and a center of excellence (EMC). RESULTS: A total of 152 DIEP flaps were performed in 123 patients among all start-ups together. Baseline characteristics and major complications were comparable between all groups. The total flap loss rate was 2% in the start-ups versus 3.9% in the control group (p = 0.5). Although there seems to be a trend in a longer operating time in both training and nontraining academic centers, no statistical significance was found between start-ups (p = 0.13) and the control group (p = 0.17). However, a learning curve seems to be present when it comes to duration of surgery and is greatest in the community centers with zero experience in microsurgery (ZGT p = 0.002, Amphia p = 0.065). The same accounts for hospital stay. CONCLUSION: Although there seems to be a learning curve in terms of duration of surgery in hospitals with no experience in microsurgery, it is safe to perform microvascular breast reconstructions as a novice plastic surgeon.

Dupuytren disease is highly prevalent in male field hockey players aged over 60†years.

BACKGROUND/AIM: Dupuytren disease is a fibroproliferative hand condition. The role of exposure to vibration as a risk factor has been studied with contradictory results. Since field hockey is expected to be a strong source of hand-arm vibration, we hypothesised that long-term exposure to field hockey is associated with Dupuytren disease. METHODS: In this cross-sectional cohort study, the hands of 169 male field hockey players (IQR: 65-71 years) and 156 male controls (IQR: 59-71 years) were examined for signs of Dupuytren disease. Details about their age, lifestyle factors, medical history, employment history and leisure activities were gathered. Prior to the analyses, the groups were balanced in risk factors using propensity score matching. The association between field hockey and Dupuytren disease was determined using a subject-specific generalised linear mixed model with a binomial distribution and logit link function (matched pairs analysis). RESULTS: Dupuytren disease was observed in 51.7% of the field hockey players, and in 13.8% of the controls. After propensity score matching, field hockey playing as dichotomous variable, was associated with Dupuytren disease (OR=9.42, 95% CI 3.01 to 29.53). A linear dose-response effect of field hockey (hours/week x years) within the field hockey players could not be demonstrated (OR=1.03, 95% CI 0.68 to 1.56). DISCUSSION: We found that field hockey playing has a strong association with the presence of Dupuytren disease. Clinicians in sports medicine should be alert to this less common diagnosis in this sport.