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Background: Free flap reconstruction in acute burns is high risk but often required for limb salvage and coverage of vital structures. Prior studies have shown a flap loss rate up to 44%. This study aimed to compare the complications associated with muscle and fasciocutaneous free flaps in acute burn reconstruction. Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered on the PROSPERO database (CDR42023471088). The databases accessed were Embase, PubMed, Web of Science, and Cochrane Library. The primary outcome was free flap failure rate based on flap type. Secondary outcomes included venous congestion, arterial thrombosis, amputation, and need for reintervention. Results: Twelve studies with 181 free flaps were included: 87 muscle flaps and 94 fasciocutaneous flaps. Muscle flaps had a higher risk ratio (RR) for total flap loss [RR: 2.32, 95% confidence interval (CI): 1.01-5.32, P = 0.04], arterial thrombosis (RR: 3.13, 95% CI: 1.17-8.42, P = 0.02), and amputations (RR: 8.89, 95% CI: 1.27-70.13, P = 0.03) compared with fasciocutaneous flaps. No significant differences were found in venous thrombosis (RR: 1.33, 95% CI: 0.37-4.78, P = 0.65) or need for reinterventions (RR: 1.34, 95% CI: 0.77-2.32, P = 0.29). Conclusions: Muscle flaps in burn injuries are associated with higher risks of flap failure, arterial thrombosis, and amputations. Fasciocutaneous free flaps in acute burns seem to be safer with better outcomes, though further research is needed to confirm these findings.
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Background: Free tissue transfer is usually considered as a last resort in severe burn cases, when skin substitutes and local flaps are not viable options. Prior studies have demonstrated a free flap loss rate ranging from 0% to 44%. The aim of this study is to identify the ideal timing to perform free flap reconstruction in acute burn-related injuries to minimize free flap loss. Methods: A systematic review and meta-analysis was performed and reported according to PRISMA guidelines. PubMed, Embase, Web of Science, and Cochrane Library databases were queried. The review protocol was registered on PROSPERO database (CRD42023404478). Three time intervals from day of injury were identified: (1) 0-4 days, (2) 5-21 days, and (3) 22 days-6 weeks. The primary outcome was total free flap loss. Results: A total of 17 articles met inclusion criteria. The analysis included 275 free flaps performed in 260 patients (88% men, 12% women) affected by acute burn injuries. The pooled prevalence of free flap failure in the three time intervals (0-4 days, 5-21 days, and 22 days-6 weeks) were 7.32% [95% confidence interval (CI): 2.38%-20.37%], 16.55% (95% CI: 11.35%-23.51%), and 6.74% (95% CI: 3.06%-14.20%), respectively. Conclusions: Free flap reconstruction carries a high risk of failure in patients with acute burn. However, timing of the reconstruction appears to influence surgical outcomes. Free flap reconstruction performed between 5 and 21 days from burn injury had a trend toward higher flap loss rates and should be discouraged.
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Background: Free tissue transfer is often considered a last resort in burn reconstruction due to its complexity and associated risks. A comprehensive review on free flap outcomes in delayed burn reconstruction is currently lacking. The study aimed to evaluate the available evidence on the failure and contracture recurrence rates in free flap delayed burn reconstruction. Methods: A systematic review and meta-analysis was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The protocol was registered on PROSPERO (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The measured outcomes were free flap loss and contracture recurrence rate. Results: Of the 1262 retrieved articles, 40 qualified for inclusion, reporting on 1026 free flaps performed in 928 patients. The mean age was 29.25 years [95% confidence interval (CI), 24.63-33.88]. Delayed burn reconstruction was performed at an average of 94.68 months [95% CI, - 9.34 to 198.70] after initial injury, with a follow-up period of 23.02 months [95% CI, 4.46-41.58]. Total flap loss rate was 3.80% [95% CI, 2.79-5.16] and partial flap loss rate was 5.95% [95% CI, 4.65-7.57]. Interestingly, burn contracture recurrence rate was 0.62% [95% CI, 0.20-1.90]. Conclusions: This systematic review provides a comprehensive evaluation of the free flap outcomes in delayed burn reconstruction. The flap loss rate was relatively low, given the complexity of the procedure and potential risks. Furthermore, burn contracture rate was found to be extremely low. This study demonstrates that free flaps are a safe and effective option for delayed burn reconstruction.
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Artificial intelligence and large language models (LLMs) have recently gained attention as promising tools in various healthcare domains, offering potential benefits in clinical decision-making, medical education, and research. The Advanced Burn Life Support (ABLS) program is a didactic initiative endorsed by the American Burn Association, aiming to provide knowledge on the immediate care of severely burn patients. The aim of the study was to compare the performance of three LLMs (ChatGPT-3.5, ChatGPT-4, and Google Bard) on the ABLS exam. The ABLS exam consists of 50 questions with 5 multiple-choice answers. The passing threshold is 80% of correct answers. The 3 LLMs were queried with the 50 questions included in the latest version of the ABLS exam, on July 18th, 2023. ChatGPT-3.5 scored 86% (43 out of 50), ChatGPT-4 scored 90% (45 out of 50), and Bard scored 70% (35 out of 50). No difference was measured between ChatGPT-3.5 and ChatGPT-4 (P = .538) and between ChatGPT-3.5 and Bard (P = .054), despite the borderline P-value. ChatGPT-4 performed significantly better than Bard (P = .012). Out of the 50 questions, 78% (n = 39) were direct questions, while 12% (n = 11) were presented as clinical scenarios. No difference in the rate of wrong answers was found based on the type of question for the 3 LLMs. ChatGPT-3.5 and ChatGPT-4 demonstrated high accuracy at the ABLS exam and outperformed Google Bard. However, the potential multiple applications of LLMs in emergency burn and trauma care necessitate appropriate surveillance and most likely should represent a tool to complement human cognition.
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Queimaduras , Humanos , Queimaduras/terapia , Queimaduras/psicologia , Avaliação Educacional/métodos , Inteligência ArtificialAssuntos
Compreensão , Letramento em Saúde , Humanos , Educação de Pacientes como Assunto , EndoscopiaRESUMO
ABSTRACT: A 10 year cohort of patients admitted to a verified burn unit were analyzed to assess the role of plastic surgeons in the operative management of those patients. All 3843patients were admitted during this study period. Of these, 1509 of those patients underwent surgical procedures. Plastic surgeons performed 658 operations on these patients, including acute and delayed reconstruction of hand and facial burn injuries. In this population, plastic surgeons played a critical role in acute and reconstructive burn injuries in anatomically complex areas. This series illustrates the need for plastic surgery training in burn care.
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Traumatismos Faciais , Internato e Residência , Lesões do Pescoço , Procedimentos de Cirurgia Plástica , Cirurgiões , Cirurgia Plástica , Humanos , Cirurgia Plástica/educaçãoRESUMO
BACKGROUND: Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation. METHODS: A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool. RESULTS: A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers' ratings, with a SMD of - 1.09 [95% CI: - 1.32; - 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was - 0.99 [96% CI: - 1.31; - 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations. CONCLUSIONS: Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Tecido Adiposo , Cicatriz , Hiperpigmentação , Humanos , Cicatriz/etiologia , Hiperpigmentação/etiologia , Tecido Adiposo/transplante , Feminino , Masculino , Resultado do Tratamento , Estética , Medição de Risco , Transplante Autólogo , AdultoAssuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Linfoma Anaplásico de Células Grandes , Humanos , Feminino , Implantes de Mama/efeitos adversos , Linfoma Anaplásico de Células Grandes/epidemiologia , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/patologia , Ferramenta de Busca , Implante Mamário/efeitos adversos , Fonte de Informação , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Neoplasias da Mama/cirurgiaRESUMO
BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare complication associated with the use of breast implants. Breast implant illness (BII) is another potentially concerning issue related to breast implants. This study aims to assess the quality of ChatGPT as a potential source of patient education by comparing the answers to frequently asked questions on BIA-ALCL and BII provided by ChatGPT and Google. METHODS: The Google and ChatGPT answers to the 10 most frequently asked questions on the search terms "breast implant associated anaplastic large cell lymphoma" and "breast implant illness" were recorded. Five blinded breast plastic surgeons were then asked to grade the quality of the answers according to the Global Quality Score (GQS). A Wilcoxon paired t-test was performed to evaluate the difference in GQS ratings for Google and ChatGPT answers. The sources provided by Google and ChatGPT were also categorized and assessed. RESULTS: In a comparison of answers provided by Google and ChatGPT on BIA-ALCL and BII, ChatGPT significantly outperformed Google. For BIA-ALCL, Google's average score was 2.72 ± 1.44, whereas ChatGPT scored an average of 4.18 ± 1.04 (p < 0.01). For BII, Google's average score was 2.66 ± 1.24, while ChatGPT scored an average of 4.28 ± 0.97 (p < 0.01). The superiority of ChatGPT's responses was attributed to their comprehensive nature and recognition of existing knowledge gaps. However, some of ChatGPT's answers had inaccessible sources. CONCLUSION: ChatGPT outperforms Google in providing high-quality answers to commonly asked questions on BIA-ALCL and BII, highlighting the potential of AI technologies in patient education. LEVEL OF EVIDENCE: Level III, comparative study LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Implante Mamário , Implantes de Mama , Neoplasias da Mama , Linfoma Anaplásico de Células Grandes , Cirurgiões , Humanos , Feminino , Implantes de Mama/efeitos adversos , Linfoma Anaplásico de Células Grandes/epidemiologia , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/patologia , Ferramenta de Busca , Implante Mamário/efeitos adversos , Fonte de Informação , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Neoplasias da Mama/cirurgiaRESUMO
We aimed to evaluate current trends and future directions in the field of AI research since ChatGPT was launched. We performed a bibliometric analysis of the literature published during the first 7 months of the life of ChatGPT since its introduction, updated to July 1st, 2023. Seven hundred and twenty-four (724) articles were retrieved. This analysis highlights a significant increase in publications exploring ChatGPT use across various medical disciplines, indicating its expanding relevance in healthcare. A decline proportion of studies focusing on ethical considerations was observed. Simultaneously, there was a steady increase in studies focused on the exploration of possible applications of ChatGPT. As ChatGPT applications continue to expand, ongoing vigilance and collaborative efforts to optimize ChatGPT performance are essential in harnessing the benefits while mitigating the risks of AI use in healthcare.
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Bibliometria , Atenção à SaúdeRESUMO
Appropriate patient education and preparation prior to surgery represent a fundamental step in managing expectations, avoiding unnecessary encounters and eventually achieving optimal outcomes. Thus, the objective of this study is to evaluate ChatGPT's potential as a viable source for patient education by comparing its responses and provided references to frequently asked questions on body contouring, with Google's. A Google search was conducted on July 15th, 2023, using the search term "body contouring surgery". The first 15 questions under the "People also ask" section and answers provided by Google were recorded. The 15 questions were then asked to ChatGPT-3.5. Four plastic surgeons evaluated the answers from 1 to 5 according to the Global Quality Scale. The mean score for responses given by Google was 2.55 ± 1.29, indicating poor quality but some information present, of very limited use to patients. The mean score for responses produced by ChatGPT was 4.38 ± 0.67, suggesting that the content was of good quality, useful to patients, and encompassed the most important topics. The difference was statistically significant (p = 0.001). Deficiencies in providing references represent one of the most evident weaknesses of ChatGPT. However, ChatGPT did not appear to spread misinformation, and the content of the generated responses was deemed of good quality and useful to patients. The integration of AI technology as a source for patient education has the potential to optimize patient queries on body contouring questions.
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Contorno Corporal , Educação a Distância , Humanos , Ferramenta de Busca , Educação de Pacientes como Assunto , PacientesRESUMO
BACKGROUND: ChatGPT, an artificial intelligence (AI) chatbot that uses natural language processing (NLP) to interact in a humanlike manner, has made significant contributions to various healthcare fields, including plastic surgery. However, its widespread use has raised ethical and security concerns. This study examines the presence of ChatGPT, an artificial intelligence (AI) chatbot, in the literature of plastic surgery. METHODS: A bibliometric analysis and scoping review of the ChatGPT plastic surgery literature were performed. PubMed was queried using the search term "ChatGPT" to identify all biomedical literature on ChatGPT, with only studies related to plastic, reconstructive, or aesthetic surgery topics being considered eligible for inclusion. RESULTS: The analysis included 30 out of 724 articles retrieved from PubMed, focusing on publications from December 2022 to July 2023. Four key areas of research emerged: applications in research/creation of original work, clinical application, surgical education, and ethics/commentary on previous studies. The versatility of ChatGPT in research, its potential in surgical education, and its role in enhancing patient education were explored. Ethical concerns regarding patient privacy, plagiarism, and the accuracy of information obtained from ChatGPT-generated sources were also highlighted. CONCLUSION: While ethical concerns persist, the study underscores the potential of ChatGPT in plastic surgery research and practice, emphasizing the need for careful utilization and collaboration to optimize its benefits while minimizing risks. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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The aim of the study was to evaluate whether ChatGPT-3.5 and Bard provide safe and reliable medical answers to common topics related to soft tissue infections and their management according to the guidelines provided by the Infectious Disease Society of America (IDSA). IDSA's abridged recommendations for soft tissue infections were identified on the IDSA official website. Twenty-five queries were entered into the LLMs as they appear on the IDSA website. To assess the concordance and precision of the LLMs' responses with the IDSA guidelines, two infectious disease physicians independently compared and evaluated each response. This was done using a 5-point Likert scale, with 1 representing poor concordance and 5 excellent concordance, as adapted from the validated Global Quality Scale. The mean ± SD score for ChatGPT-generated responses was 4.34 ± 0.74, n = 25. This indicates that raters found the answers were good to excellent quality with the most important topics covered. Although some topics were not covered, the answers were in good concordance with the IDSA guidelines. The mean ± SD score for Bard-generate responses was 3.5 ± 1.2, n = 25, indicating moderate quality. Despite LLMs did not appear to provide wrong recommendations and covered most of the topics, the responses were often found to be generic, rambling, missing some details, and lacking actionability. As AI continues to evolve and researchers feed it with more extensive and diverse medical knowledge, it may be inching closer to becoming a reliable aid for clinicians, ultimately enhancing the accuracy of infectious disease diagnosis and management in the future.
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Mesial temporal lobe epilepsy (mTLE) is an important cause of drug-resistant epilepsy (DRE) in adults and children. Traditionally, the surgical option of choice for mTLE includes a frontotemporal craniotomy and open resection of the anterior temporal cortex and mesial temporal structures. Although this technique is effective and durable, the neuropsychological morbidity resulting from temporal neocortical resections has resulted in the investigation of alternative approaches to resect the mesial temporal structures to achieve seizure freedom while minimizing postoperative cognitive deficits. Outcomes supporting the use of selective temporal resections have resulted in alternative approaches to directly access the mesial temporal structures via endoscopic approaches whose direct trajectory to the epileptogenic zone minimizes retraction, resection, and manipulation of surrounding cortex. The authors reviewed the utility of the endoscopic transmaxillary, endoscopic endonasal, endoscopic transorbital, and endoscopic supracerebellar transtentorial approaches for the treatment of drug-resistant mesial temporal lobe epilepsy. First, a review of the literature demonstrated the anatomical feasibility of each approach, including the limits of exposure provided by each trajectory. Next, clinical data assessing the safety and effectiveness of these techniques in the treatment of DRE were analyzed. An outline of the surgical techniques is provided to highlight the technical nuances of each approach. The direct access to mesial temporal structures and avoidance of lateral temporal manipulation makes endoscopic approaches promising alternatives to traditional methods for the treatment of DRE arising from the temporal pole and mesial temporal lobe. A dearth of literature outlining clinical outcomes, a need for qualified cosurgeons, and a lack of experience with endoscopic approaches remain major barriers to widespread application of the aforementioned techniques. Future studies are warranted to define the utility of these approaches moving forward.
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Epilepsia Resistente a Medicamentos , Epilepsia do Lobo Temporal , Adulto , Criança , Humanos , Epilepsia do Lobo Temporal/cirurgia , Lobo Temporal/cirurgia , Endoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Epilepsia Resistente a Medicamentos/cirurgia , Base do Crânio/cirurgia , Resultado do Tratamento , Hipocampo/cirurgiaRESUMO
Zinc is a highly abundant cation in the brain, essential for cellular functions, including transcription, enzymatic activity, and cell signaling. However, zinc can also trigger injurious cascades in neurons, contributing to the pathology of neurodegenerative diseases. Mitochondria, critical for meeting the high energy demands of the central nervous system (CNS), are a principal target of the deleterious actions of zinc. An increasing body of work suggests that intracellular zinc can, under certain circumstances, contribute to neuronal damage by inhibiting mitochondrial energy processes, including dissipation of the mitochondrial membrane potential (MMP), leading to ATP depletion. Additional consequences of zinc-mediated mitochondrial damage include reactive oxygen species (ROS) generation, mitochondrial permeability transition, and excitotoxic calcium deregulation. Zinc can also induce mitochondrial fission, resulting in mitochondrial fragmentation, as well as inhibition of mitochondrial motility. Here, we review the known mechanisms responsible for the deleterious actions of zinc on the organelle, within the context of neuronal injury associated with neurodegenerative processes. Elucidating the critical contributions of zinc-induced mitochondrial defects to neurotoxicity and neurodegeneration may provide insight into novel therapeutic targets in the clinical setting.