Impact and Implementation of Plastic Surgery Interest Groups: National Survey of Plastic Surgery Interest Group Leadership.

Background: Plastic surgery interest groups (PSIGs) provide an invaluable opportunity to enhance medical students' exposure to and knowledge of plastic surgery. Despite this, there have been no studies that provide information on the formation of these groups as well as the aspects that make for a productive PSIG. Methods: An anonymous survey was distributed by email via RedCAP to US medical students who hold leadership positions within their medical school's PSIG. Participants were asked baseline medical school information, the structure of their interest group, and perspectives on the most impactful and challenging components of their interest group. Results: Sixteen members (27.6%) of PSIG leadership completed the survey. Eighty percent reported having a membership of greater than 20 students. Fifty percent of the PSIGs were led by advisors who were medical school or hospital-affiliated faculty. Sixty-nine percent of groups were allocated a predetermined amount of money to fund activities and events throughout the academic year. Based on member feedback, groups reported that interactions with plastic surgery faculty, mentorship opportunities, and research opportunities were the most impactful and beneficial components of their PSIG. Forty-four percent reported that the biggest challenge faced by their PSIG was having a small active member group, followed by a lack of funding. Conclusion: Our study provides an in-depth look at the current structure and impact of PSIGs in the United States. It also provides a framework for medical schools that wish to start a PSIG and suggestions for established groups who wish to revitalize their PSIG structure.

Contexte: Les groupes d'intérêt en chirurgie plastique (GICP) offrent la possibilité inestimable d'améliorer l'exposition et les connaissances des étudiants envers la chirurgie plastique. Malgré cela, il n'y a pas eu d'études apportant d'information sur la formation de ces groupes ainsi que sur les éléments qui font qu'un GICP soit productif. Methodes: Une enquête anonyme a été distribuée par courriel via RedCAP aux étudiants en médecine des États-Unis qui ont un rôle de leadership au sein du GICP de leur école de médecine. Les questions posées aux participants incluaient des demandes d'information basique sur l'école de médecine, la structure de leur groupe d'intérêt et des points de vue sur les éléments de leur groupe d'intérêt les plus stimulants et ceux ayant le plus d'impact. Résultats: Seize membres (27.6%) du leadership de GICP ont répondu à l'enquête. Quatre-vingts pour cent ont déclaré avoir plus de 20 étudiants adhérents. Cinquante pour cent des GICP étaient menés par des conseillers qui étaient des enseignants de l'école de médecine ou affiliés à un hôpital. Soixante-neuf pour cent des groupes recevaient des sommes prédéterminées pour financer leurs activités et événements tout au long de l'année universitaire. En fonction du retour d'informations des membres, les groupes ont déclaré que les interactions avec les enseignants en chirurgie plastique, des occasions de mentorat et des possibilités de recherchez étaient les éléments les plus bénéfiques et ayant le plus d'impact de leur CGIP. Quarante-quatre pour cent que le plus grand défi de leur CGIP était d'abord d'avoir un petit groupe de membres actifs, et ensuite de manquer de financement. Conclusion: Notre étude procure un regard approfondi sur la structure actuelle et l'impact des CGIP aux États-Unis. Elle fournit aussi un cadre pour les facultés de médecine qui souhaitent lancer un CGIP et des suggestions pour les groupes établis qui souhaitent revitaliser la structure de leur CGIP.

In the Age of Social Media, How Does the Public Choose a Plastic Surgeon? A Crowdsourcing Analysis of Major Deciding Factors.

BACKGROUND: Patients consider many factors when selecting a plastic surgeon. Previous studies have demonstrated the importance of board certification and reputation in this decision. Despite this, there is a paucity of knowledge on the role that cost of procedure, social media, and surgeon training have on the decision-making process. METHODS: The authors' study used a population-based survey administered by Amazon Mechanical Turk. Adults 18 years and older and residing in the United States were asked to rank the importance of 36 factors from 0 (least important) to 10 (most important) when selecting a plastic surgeon. RESULTS: A total of 369 responses were analyzed. The mean age of respondents was 36.9 years (SD, 10.9 years), and 174 participants (47.2%) were female. Of those surveyed, 216 (55.0%) had previously undergone plastic surgery, and all respondents were considering plastic surgery either at the time of survey or in the future. The most common first step for respondents in identifying a plastic surgeon was a web-based search (32.2%). The top three most important factors in selecting a plastic surgeon were surgeon's experience with the desired procedure (7.48), surgeon's board certification (7.38), and surgeon's years in practice (7.36). The three least important factors were the surgeon's race (5.43), number of social media posts (5.62), and television appearances (5.64). CONCLUSIONS: The authors' survey provides insight into the role that different elements play in the decision of selecting a plastic surgeon in the United States. Understanding how patients select a plastic surgeon can help surgeons optimize these elements in their practices.

Capitalizing on social media: An evaluation of the public's preferences for plastic surgery social media content.

BACKGROUND: The effectiveness of utilizing social media platforms to promote clinical practices and attract patients has been well established. This study aimed to assess what plastic surgery social media content and educational material the public is most responsive to. METHODS: An anonymous 25-question survey was distributed using REDCap and Amazon's Mechanical Turk to ascertain demographic information, patterns of social media use, levels of interest in plastic surgery, and preferences for plastic surgery content. RESULTS: Of 401 participants, the typical respondent was between 25 and 34 years old and on social media daily. Almost half of the respondents (46.1%) have intentionally viewed plastic surgery content on social media, of which most used Instagram (71.1%) and Facebook (55.4%). Participants grouped as either younger or older than 35 years old were equally likely to have viewed plastic surgery content (p = 0.33). Content categories with the highest interest were before and after results (mean Likert weight 4.00 ±â€¯1.10), patient testimonials (3.73 ±â€¯1.15), and recovery process (3.67 ±â€¯1.14). Content on celebrities (2.89 ±â€¯1.17), comedic videos (2.79 ±â€¯1.19), and surgeons' private lives (2.51 ±â€¯1.08) received negative interest. Photo posts (51.4%) were preferred more than video posts (27.2%). Before and after results on social media were the most influential factor in the selection of a plastic surgeon (45.9%). CONCLUSIONS: The importance of social media for plastic surgeons to be able to interact with patients is at unprecedented heights. Understanding patterns of the public's social media content preferences will help plastic surgeons optimize their social media reach and influence their target audience.

The Upcoming Pass/Fail USMLE Step 1 Score Reporting: An Impact Assessment From Medical School Deans.

Background: The US Medical Licensing Examination (USMLE) Step 1 change to pass/fail has been met with mixed reviews, and the impact on medical student education and residency match is unknown. We surveyed medical school student affairs deans regarding their thoughts on the upcoming transition of Step 1 to pass/fail. Methods: A questionnaire was emailed to medical school deans. Deans were asked to rank the importance of the following after the Step 1 reporting change: Step 2 Clinical Knowledge (Step 2 CK), clerkship grades, letters of recommendation, personal statement, medical school reputation, class rank, Medical Student Performance Evaluation, and research. They were asked how the score change will affect curriculum, learning, diversity, and student mental health. Deans were asked to select 5 specialties they thought would be most affected. Results: Regarding perceived importance of residency applications following the scoring change, the most frequent number 1 choice was Step 2 CK. The majority of deans (93.5%, n = 43) felt that the change to pass/fail would benefit medical student education/learning environment; however, most (68.2%, n = 30) did not believe their school curriculum would change. Students applying to dermatology, neurosurgery, orthopedic surgery, ENT, and plastic surgery were felt to be most affected by the scoring change; 58.7% (n = 27) felt it would not adequately address future diversity. Conclusion: The majority of deans feel the USMLE Step 1 change to pass/fail would benefit medical student education. Deans feel that students applying to traditionally more competitive specialties (ie, programs with fewer overall residency positions available) will be most affected.

Contexte : Le changement de l'épreuve 1 de l'USMLE pour un résultat de type réussite/échec a été accueilli par des opinions variées et son impact sur la formation des étudiants en médecine et l'adéquation des résidences est inconnu. Nous avons mené une enquête auprès des doyens des affaires étudiantes des facultés de médecine pour connaître leur opinion sur la transition prochaine de l'épreuve 1 à un score réussite/échec. Méthodes : Un questionnaire a été envoyé par courriel aux doyens des facultés de médecine. Il leur a été demandé de classer l'importance des éléments suivants après la modification de déclaration des résultats de l'Épreuve 1: Épreuve 2 CK, notes d'externat, lettres de recommandation, déclaration personnelle, réputation de l'école de médecine, classement, évaluation des performances des étudiants en médecins (MSPE) et recherche. Il leur a été demandé comment le changement de notation allait affecter les programmes, l'apprentissage, la diversité et la santé mentale des étudiants. Les doyens devaient sélectionner les 5 spécialités qui, à leur avis, allaient être les plus touchées. Résultats : Pour ce qui concerne l'importance perçue des demandes de résidence après le changement de notation, le choix numéro 1 le plus fréquent a été l'épreuve 2 CK. La majorité des doyens (93,5%, n = 43) a eu le sentiment que le changement en Réussite/Échec serait bénéfique pour la formation des étudiants en médecine et leur environnement pédagogique; toutefois, la plupart d'entre eux (68,2%, n = 30) ne croyaient pas que les programmes d'études changeraient. Les étudiants faisant des demandes en dermatologie, neurochirurgie, chirurgie orthopédique, ORL, et chirurgie plastique étaient perçus comme les plus touchés par le changement de notation. Par ailleurs 58,7% des répondants (n = 27) ont estimé que cela n'aborderait pas de manière adéquate la diversité future. Conclusion : La majorité des doyens a le sentiment que le passage à une notation Réussite/Échec de l'Épreuve 1 de l'USMLE serait bénéfique à la formation des étudiants en médecine. Les doyens estiment que les étudiants faisant des demandes pour des spécialités où règne traditionnellement une plus grande concurrence (c.-à-d. les programmes avec un moins grand nombre global de postes de résidents) seront les plus touchés.

Evaluation of the i10-Index in Plastic Surgery Research and its Correlation with Altmetric Attention Scores and Traditional Author Bibliometrics: An Evaluation of a Single Journal.

Background Although the Hirsch index (H-index) has become one of the most accepted measures of scholarly output, its limitations have led to the proposition of newer alternative metrics. The i10-index, notable for being easy to calculate and free to access, has potential, given its association with the power and ubiquity of Google. This study aims to evaluate the utility of the i10-index for plastic surgery research by examining its relationship with author bibliometrics and article metrics, including the H-index and Altmetric Attention Score (AAS). Methods Article metrics were extracted from articles published in the highest impact plastic surgery journal, Plastic and Reconstructive Surgery, over a 2-year period (2017-2019). Senior author bibliometrics, including i10-index and H5-index, were obtained from Web of Science. Correlation analysis was performed using Spearman's rank correlation coefficient (r s ). Results A total of 1,668 articles were published and 971 included. Senior author i10-index measurements demonstrated moderate correlation with times emailed (r s = 0.47), and weak correlations with H5-index, total publications, and sum of times cited with and without self-citations. The H5-index correlated very strongly with total publications (r s = 0.91) and sum of times cited (both r s = 0.97), moderately with average citations per item (r s = 0.66) and times emailed (r s = 0.41), and weakly with number of citations by posts, AAS, and times tweeted. Conclusions Although the i10 strongly correlates with the H5-index, it fails to prove superior to the H5-index in predicting the impact of specific research studies in the field of plastic surgery.

TikTok: Is It Time to Start Trending with #PlasticSurgery?

BACKGROUND: TikTok is a short-form video social media platform created in 2016 that has rapidly grown in popularity. The aim of this study was to examine trending plastic surgery videos on TikTok and to understand the dynamics of the #PlasticSurgery conversation on this relatively new social media platform. METHODS: A prospective analysis of TikTok videos identified by directly querying the platform using #PlasticSurgery was performed during November of 2020. Top trending videos at time of data collection, defined as having more than 100,000 likes, were included. Videos were analyzed for user credentials, video engagement (number of views, likes, shares, and comments), associated hashtags, and video purpose and content. RESULTS: The top 376 trending videos were viewed a total of 1,680,910,700 times at time of analysis. Videos made by board-certified plastic surgeons were, on average, more popular than videos made by non-plastic surgeons [490.4 versus 378.6 million likes ( P = 0.006); 5.1 versus 3.8 billion views ( P = 0.046)]. The most popular procedures featured were augmentation mammaplasty (531,143,800 views; 42,825,400 likes), followed by body contouring procedures such as liposuction and abdominoplasty (276,810,500 views; 22,362,000 likes) and rhinoplasty (243,724,100 views; 27,588,200 likes). Educational videos on average had significantly higher levels of engagement than entertainment-focused videos [549,336 versus 340,163 likes ( P = 0.002); 6.3 versus 2.9 million views ( P < 0.001)]. CONCLUSIONS: Videos about plastic surgery, particularly educational videos by board-certified plastic surgeons, perform exceptionally well on the TikTok platform. TikTok presents an opportunity for plastic surgeons to educate patients about plastic surgery procedures and to present themselves as board-certified plastic surgeons.

Perspectives on the Plastic Surgery Common Application (PSCA): A Survey of 2021-2022 Integrated Plastic Surgery Applicants.

The Plastic Surgery Common Application (PSCA) was introduced as a free and specialty-specific application for plastic surgery applicants in the 2020-2021 cycle. Now in its second year, the PSCA is being piloted by all integrated residency programs with future plans to replace Electronic Residency Application Service (ERAS) in the 2022-2023 cycle. This study aimed to explore applicant perspectives related to the PSCA and ERAS applications. Methods: An anonymous survey was distributed to integrated plastic surgery residency applicants from the 2021-2022 application cycle. Participants were asked to provide basic demographic information, their perspectives of the PSCA, and overall application preference. Results: One hundred forty (43.1%) applicants completed the survey. Nearly, 63% of applicants responded "slightly well" or "not well at all" regarding their ability to highlight at least one aspect of their application. Forty-one percent of applicants believed ERAS best highlighted the strengths of their application compared with 27% who believed their strengths were better highlighted by the PSCA. Seventy-nine percent reported the cost savings associated with the PSCA were "very" or "extremely important." Overall, 63% of respondents reported a preference to apply with the PSCA alone. Conclusions: This is the first study to provide insight on applicants' perspectives of the PSCA. Although the majority preferred applying with the PSCA, there may be challenges with transitioning to this application solely. Future iterations of the PSCA may aim to ameliorate functionality concerns, optimize application content, and incorporate plastic surgery-specific information that may be important to selection committees.

Outpatient Prosthetic-Based Reconstruction during COVID-19 Pandemic Possible in Selected Patients without Increased Complications.

BACKGROUND: Following the reopening of elective surgery, the authors' division transitioned from inpatient admission to same-day discharge for immediate prosthetic breast reconstruction in an effort to decrease the hospital's clinical burden and minimize potential coronavirus disease of 2019 exposure. This study aims to compare complication rates following this acute transition for patients who had inpatient and outpatient mastectomy with immediate alloplastic reconstruction. METHODS: A retrospective chart review was performed on patients who underwent mastectomy with immediate prosthetic reconstruction. The outcome of interest was 30-day morbidity. Descriptive statistics were compared for patients with outpatient and inpatient operations. Odds ratios were calculated to determine whether any preoperative factors increased odds of 30-day complications. RESULTS: A total of 115 patients were included in this study. Twenty-six patients had outpatient surgery and 89 stayed inpatient postoperatively. Same-day discharge did not significantly impact the odds of having one or more 30-day complications (OR, 0.275; 95% CI, 0.047 to 1.618; P = 0.153). Patients with complications had significantly longer median operating times [5.0 hours (interquartile range, 4.0 to 6.0 hours) versus 4.0 hours (interquartile range, 3.0 to 5.0 hours; P = 0.05), and there was a statistically significant association between length of surgery and odds of complication (OR, 1.596; 95% CI, 1.039 to 2.451; P = 0.033). Age was independently associated with increased risk of 30-day complication (OR, 1.062; 95% CI, 1.010 to 1.117; P = 0.020). CONCLUSION: The authors' findings support a continuation of same-day discharge strategy, which could decrease costs for patients and hospitals without increasing complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Public Confidence for Undergoing Elective Plastic Surgery Procedures during the COVID-19 Pandemic.

Background: The COVID-19 vaccine rollout has since been followed by a gradual resumption of elective surgery. Many individuals remain cautious about visiting a hospital or clinic to undergo surgery. As plastic surgeons are starting to resume elective surgery at this time, it is important to understand the perspectives of potential patients and the concerns they may have. Methods: A survey was distributed to participants in the United States through Amazon's Mechanical Turk (mTurk) during March of 2021. Participants were surveyed regarding their views on the severity of COVID-19, vaccination status, and how much COVID-19 has affected their interest in undergoing surgery. Results: Thirty-nine percent of respondents were either no longer willing or less willing to undergo elective plastic surgery. Seventy-three percent of respondents felt comfortable going to an office for a consultation. With regards to feeling comfortable visiting a hospital, 43.4% reported they would feel safe, 36% felt they would feel safe only if they could be discharged on the same day, and 30.6% reported not feeling safe. Fifty-two percent of respondents reported feeling comfortable undergoing surgery now or within the next year. Respondents who do not think COVID-19 is still a major health issue were more likely to still want plastic surgery. Conclusion: The results of this study highlight that the majority of patients, regardless of vaccination status, currently feel comfortable undergoing elective plastic surgery, particularly in an office setting. Plastic surgeons may expect to see a return in demand for elective procedures in the coming months.

Plastic Surgery Residency Applicants' Perceptions of a Virtual Interview Cycle.

BACKGROUND: The 2020 to 2021 residency application cycle marked the first year of fully virtual integrated plastic surgery interviews. The virtual format was a double-edged sword for applicants with several advantages, such as reduced costs and time lost from travel, and disadvantages as the novel format introduced new stressors on top of an already demanding process. Concerns included unfair interview invitation distribution, interview "hoarding," and assessing "fit" virtually. In this study, the authors aimed to understand applicants' experiences of the 2020 to 2021 virtual plastic surgery interview cycle. METHODS: A survey was sent to 330 applicants in the 2020 to 2021 integrated plastic surgery application cycle. The survey included questions about participant demographics, preinterview preparation, virtual interview experiences, and postinterview process. Statistical comparisons were performed on responses using IBM SPSS Statistics version 25.0 (IBM, Armonk, N.Y.). RESULTS: Eighty-nine participants responded to the survey, representing a 27 percent response rate. Applicants received an average of 13.3 interview invitations (range, 0 to 45) and attended an average of 11.4 interviews (range, 0 to 30). Almost half (48.2 percent) did not feel interview invitations were distributed equitably, and more than half (68.2 percent) reported that there should be a limit on the number of interview invitations an applicant can accept. The majority of respondents (88.1 percent) reported spending $500 or less on virtual interviews. Half (50.6 percent) participated in virtual subinternships, of which 30.4 percent became significantly less interested in a program afterward. CONCLUSIONS: The inaugural virtual interview cycle had several advantages and disadvantages. Lessons learned from this year could be utilized toward building a more equitable, fair, and effective potential virtual cycle in years to come.

Neurotization in Innervated Breast Reconstruction: A Systematic Review of Techniques and Outcomes.

BACKGROUND: Significant improvements in sensory recovery after innervated breast reconstruction have been reported. However, surgical approaches and sensory testing methods have been widely variable. This systematic review aimed to synthesize neurotization techniques and outcomes in breast reconstruction surgery. METHODS: A comprehensive literature search of the MEDLINE, Embase, Web of Science, and Cochrane databases was conducted to identify all studies reporting outcomes of neurotization in innervated breast reconstruction. Data extracted from each study included neurotization techniques, operative times, sensory methods and outcomes, and patient-reported outcomes. RESULTS: A total of 1,350 articles were identified, and 23 articles were included for analysis. Nerve coaptation was performed in 536 breasts and 419 patients, with techniques consisting of direct coaptation (65.1% of flaps), coaptation with nerve conduit (26.3%), and coaptation with nerve allograft (8.6%). The neural component of operating time ranged from 8 to 38 min, and the pooled neurotization success rate among nine studies that reported this outcome was 90.6% (95% CI: 83.6%-96.0%). Overall, innervated breasts achieved earlier and superior sensory recovery that was more uniformly distributed throughout the flap compared to non-innervated breasts. Despite high heterogeneity between studies, all included studies supported neurotized breast reconstruction to improve the rate, quality, and magnitude of sensory recovery. CONCLUSIONS: Neurotization during breast reconstruction may be worth the investment of additional operating time to increase the prospect of high-quality sensory recovery. Further investigation with standardized sensory testing methods and patient-reported outcome tools is needed to definitively support neurotization as a standard of care in breast reconstruction surgery.

Reflections on a Career in Plastic Surgery: A National Survey of Retired Surgeons.

Introduction: Retired plastic surgeons can provide valuable insights for the greater plastic surgery community. The purpose of this study was to gather demographics, personal reflections, and advice for a career in plastic surgery from retired American plastic surgeons. Methods: An email survey was distributed to 825 members of the American Society of Plastic Surgeons during September 2021. The survey distribution was designed to engage members of the plastic surgery community, who were retired from surgical practice in the United States. The form consisted of 29 questions, five of which were free response. Descriptive statistical analyses were performed. Results: A total of 214 completed surveys were received, with a response rate of 25.9%. The average age at retirement was 67.6 years. The majority of respondents were men (87.6%) and White (93.3%); 46.9% of surgeons practiced at individual private practice. Ninety percent of surgeons indicated that they would choose to practice as a plastic surgeon again. Free responses provided positive career reflections and advice for young plastic surgeons regarding navigating the changing landscape of healthcare. Conclusions: Retired plastic surgeons are interested in engaging with the plastic surgery community and demonstrate continued interest in the future of the field. Efforts can be made to avail the field of their expertise and experience.

A national analysis of outpatient mastectomy and breast reconstruction trends from 2013 through 2019.

BACKGROUND: Traditionally, patients with breast reconstruction (BR) were hospitalized at least one day postoperatively. However, new trends suggest that outpatient surgery is a viable and safe alternative. This study aims to assess trends among patients with breast cancer who underwent outpatient mastectomy alone, with immediate BR (IBR) or delayed BR (DBR). METHODS: A retrospective analysis of the 2013-2019 ACS NSQIP® database was conducted. All women who underwent outpatient mastectomy were included in this study. The cohort was divided as follows: (1) mastectomy without BR, (2) IBR, and (3) DBR. A Cochran-Armitage test and adjusted multivariable logistic regression models were performed to evaluate linear trends over time within groups, and overall and pairwise comparisons between groups across the years, respectively. RESULTS: A total of 84,954 women were included in this study. Overall, 54.9%, 16.2%, and 28.9% underwent mastectomy without BR, IBR, and DBR, respectively. From the BR groups, the majority had implant placement. A significant difference in incidence trends between the three groups was evidenced over time (p<0.001). The greatest increase was evidenced in the IBR group and the lowest in the mastectomy without BR group. CONCLUSION: In this cohort of patients, a significant difference in linear trends was evidenced over time within and between the three groups. Our results suggest that outpatient IBR procedures are increasing in a greater proportion compared to other surgical approaches. Further studies are required to better characterize this population and comprehend the decision-making process toward a surgical procedure within each of the three groups.

Comparison of Various Modalities Utilized for Preoperative Planning in Microsurgical Reconstructive Surgery.

BACKGROUND: The benefits of preoperative perforator imaging for microsurgical reconstruction have been well established in the literature. METHODS: An extensive literature review was performed to determine the most commonly used modalities, and their applicability, advantages and disadvantages. RESULTS: The review demonstrated varioius findings including decreases in operative time and cost with the use of CT angiography to identification of perforators for inclusion in flap design with hand-held Doppler ultrasound. Modalities like MR angiography offer alternatives for patients with contrast allergies or renal dysfunction while maintaining a high level of clarity and fidelity. Although the use of conventional angiography has decreased due to the availability of less invasive alternatives, it continues to serve a role in the preoperative evaluation of patients for lower extremity reconstruction. Duplex ultrasonography has been of great interest recently as an inexpensive, risk free, and extraordinarily accurate diagnostic tool. Emerging technologies such as indocyanine green fluorescence angiography and dynamic infrared thermography provide real-time information about tissue vascularity and perfusion without requiring radiation exposure. CONCLUSION: This article presents an in-depth review of the various imaging modalities available to reconstructive surgeons and includes hand held Doppler ultrasound, CT angiography, MR angiography, conventional angiography, duplex ultrasonography, Indocyanine Green Fluorescence Angiography and Dynamic Infrared Thermography.

A Systematic Review and Meta-Analysis Evaluating the Impact of Tranexamic Acid Administration in Aesthetic Plastic Surgery.

BACKGROUND: Recent evidence suggests tranexamic acid (TXA) may improve outcomes in aesthetic surgery patients. OBJECTIVES: This systematic review aimed to investigate the impact of TXA use in aesthetic plastic surgery on bleeding and aesthetic outcomes. METHODS: A systematic literature search was conducted to identify studies evaluating TXA use in aesthetic plastic surgery. The primary outcome of interest was perioperative bleeding, reported as total blood loss (TBL), ecchymosis, and hematoma formation. Meta-analyses analyzing TBL and postoperative hematoma were performed. RESULTS: Of 287 identified articles, 14 studies evaluating TXA use in rhinoplasty (6), rhytidectomy (3), liposuction (3), reduction mammaplasty (1), and blepharoplasty (1) were included for analysis. Of 820 total patients, 446 (54.4%) received TXA. Meta-analysis demonstrated TXA is associated with 26.3 mL average blood loss reduction (95% CI, -40.0 to -12.7 mL; P < 0.001) and suggested a trend toward decreased odds of postoperative hematoma with TXA use (odds ratio, 0.280; 95% CI, 0.076-1.029; P = 0.055). Heterogeneity among reporting of other outcomes precluded meta-analysis; however, 5 of 7 studies found significantly decreased postoperative ecchymosis levels within 7 days of surgery, 3 studies found statistically significant reductions in postoperative drain output, and 1 study reported significantly improved surgical site quality for patients who received TXA (P = 0.001). CONCLUSIONS: TXA is associated with decreased blood loss and a trend toward decreased hematoma formation in aesthetic plastic surgery. Its use has the potential to increase patient satisfaction with postoperative recovery and decrease costs associated with complications, including hematoma evacuation.

Trends and characteristics of neurotization during breast reconstruction: perioperative outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).

This study aimed to investigate the impact of performing neurotization during breast reconstruction on total operating time and post-operative morbidity. The 2015 through 2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases were utilized to identify patients who underwent breast reconstruction with and without neurotization. Baseline demographics, comorbidities, operative characteristics and outcomes were examined for each group. Thirty-day complication and readmission rates were compared using univariable and multivariable logistic regressions. Of 73,507 patients identified who underwent breast reconstruction, 240 had reconstruction with neurotization. Autologous reconstruction was more prevalent for patients with neurotization (90.8% vs. 18.5%, p<.001). Average operating time was longer when neurotization was performed during both autologous (527.1 ± 152.4 vs. 414.8 ± 186.3, p<.001) and alloplastic-only reconstruction (310.9 ± 115.9 vs. 173.0 ± 94.3, p<.001). The likelihood total operating time exceeded 521 min (two standard deviations above average) increased when neurotization was performed (OR 2.464, CI 1.864-3.255, p<.001). Thirty-day complications occurred in 13.8% of patients with neurotization and 6.8% without (p<.001). Similarly, 30-day readmission rates were higher for patients with neurotization (7.5% vs. 4.2%, p<.001). However, when adjusted for comorbidities and operative characteristics, neurotization did not significantly impact 30-day complication rates (OR 0.802, CI 0.548-1.174, p=.256) or 30-day readmission rates (OR 1.352, CI 0.822-2.223, p=.077). Although neurotization during breast reconstruction increases operating time, comorbidities and procedural characteristics play a greater role in post-operative outcomes than neurotization alone.

Evaluation of Social Media Utilization by Academic Plastic Surgery Programs during the COVID-19 Pandemic.

BACKGROUND: In response to the cancellation of away rotations and the shift to virtual interviews due to the coronavirus disease of 2019 (COVID-19) pandemic, residency programs have pursued other methods of sharing program details, most notably with the use of social media. This study aimed to evaluate the extent of social media utilization in the setting of the COVID-19 pandemic by plastic surgery residency programs. METHODS: Instagram, Twitter, and Facebook accounts of plastic surgery programs, program directors, and chiefs were identified. Number of followers, total posts, and posts since March 1, 2020, were extracted. Account content was categorized as informational, social, operative, research, self-promotional, guest lecture, education, or other. Spearman's coefficient was used to determine correlations among account data. Differences among regions and program pathways were evaluated using the Kruskal-Wallis test. RESULTS: Since March 1, 2020, 17 Instagram, five Twitter, and three Facebook accounts have been created. Instagram was most widely used and followed (1720 posts, 1235.7 ± 735.9 followers) compared with Twitter (722 tweets, 325.6 ± 451.0 followers) and Facebook (430 posts, 338.3 ± 363.3 followers). Although the majority of content was informational (45.1 percent), Instagram contained more social content (21 percent), Twitter contained more research (21 percent), and Facebook contained more self-promotional content (25 percent). Integrated-only programs on average posted more on Instagram (21.5 ± 15.1 posts) than did independent-only programs (9.4 ± 8.5 posts), and post volume moderately correlated with number of followers. There were no statistically significant differences among regional means. CONCLUSION: Plastic surgery residency programs have incorporated social media into their recruitment strategies and will likely continue to increase and diversify their posts to effectively engage with future applicants.

Virtual Interviews for the Integrated Plastic Surgery Residency Match: The Program Director Perspective.

Interviews for the integrated plastic surgery residency match took place in a virtual format for the 2020-2021 application cycle. Current literature lacks the perspectives of program directors (PDs) on virtual interviews compared with traditional in-person interviews. METHODS: Following institutional review board approval, an anonymous 17-question survey was distributed by email to 82 program directors of integrated plastic surgery residency programs in the United States. Participants were asked baseline program information, the number of positions and interview invites offered, and their perspectives on various aspects of the virtual interview process. RESULTS: Sixty-two (75.6%) PDs completed the survey. Thirty-seven percent reported increasing the number of interview offers per available residency spot. On a five-point Likert scale (1, not well at all; 5, extremely well), PDs showed no significant differences in their ability judge an applicant's professionalism (3.1 ± 1.1), interpersonal and communication skills (3.2 ± 1.1), and "fit" with their program (2.9 ± 0.9) during virtual interviews (P = 0.360). Sixty-eight percent reported being satisfied (15.3% extremely satisfied, 52.5% somewhat satisfied) with the virtual interview process, though 76.3% preferred in-person interviews. CONCLUSIONS: This study is the first to provide insight into PDs' impressions of virtual residency interviews. Although most reported being satisfied with the virtual interview process, the majority still preferred in-person interviews. Further long-term studies evaluating the pros and cons of each interview modality may provide more information on whether virtual interviews could become a sustainable alternative to the traditional in-person residency interview.

Analysis of Alternative Metrics of Research Impact: A Correlation Comparison between Altmetric Attention Scores and Traditional Bibliometrics among Plastic Surgery Research.

BACKGROUND: Scholarly output has typically been measured by citation-based metrics such as the Hirsch index (h-index). The Altmetric Attention Score has emerged as a substitute to measure digital attention given to a project. This study aims to determine whether there is any correlation between h-index and the Altmetric score in the plastic surgery literature. METHODS: Article metrics (full-text views, abstract views, PDF downloads, times e-mailed, Altmetric Attention Score, times tweeted, and number of citations by posts) were extracted from articles published in Plastic and Reconstructive Surgery over a 2-year period. Author metrics, including h5-index, were also collected. Pairwise correlations were performed using Spearman's rank correlation coefficient (r). RESULTS: A total of 1668 articles were published, with 971 included. Altmetric Attention Scores showed strong correlation with other article metrics (r = 0.48 to 0.97; p < 0.001) but weak correlation with h5-index (r = 0.14; p < 0.001) and sum of times cited without self-citation (r = 0.14; p < 0.001). It did not correlate with total publications, average citations per item, or sum of times cited. The h5-indexes showed strong positive correlation with other author bibliometrics (r = 0.66 to 0.97; p < 0.001); moderate correlation with times e-mailed (r = 0.41; p < 0.001); weak correlation with number of citations by posts (r = 0.10; p = 0.002); and no correlation with full-text views, abstract views, PDF downloads, and times tweeted. CONCLUSION: The Altmetric Attention Score and conventional senior author bibliometrics have weak positive correlation at best and appear to have distinct but complementary roles in measuring scholarly output.