Protective Effects of Authenticity Against Depression, Suicide, and Burnout among Surgeons.

BACKGROUND: Physician burnout and poor mental health are highly prevalent issues within the surgical community. Authenticity, defined as the degree to which individuals align their actions with their true selves, has been identified as a potential factor facilitating positive mental health. This study explores the impact of authenticity on burnout, depression, and suicide among surgeons. STUDY DESIGN: Members of the department of surgery at a large academic medical center were sent an anonymous survey between April to May 2023. The survey evaluated authenticity using Authenticity Scale, depression using Patient Health Questionnaire (PHQ9), burnout using Copenhagen Burnout Inventory, and suicidality using Ask-Suicide Screening Questions (ASQ) tool. RESULTS: Of the 170 surgeons, 94 (55.3%) completed the survey. Higher Authentic Living scores (ALS) correlated with reduced burnout (r=-0.21, p=0.047) and depression (r=-0.37, p=0.0002). Conversely, higher Accepting External Influence (AEI) were associated with increased depression (r=0.23, p=0.023) and higher Self-Alienation (ASA) were associated with increased burnout (r=0.43, p<0.0001) and depression (r=0.48, p<0.0001). While authenticity domain scores were not significantly associated with ASQ, specific AEI and ASA questions indicated an elevated odds ratio (p=0.029 and p=0.010 respectively) of a positive ASQ. ALS increased with advancement in professional rank (p=0.007), while AEI (p=0.0001), ASA (p=0.003), depression (p=0.014), and ASQ (p=0.02) decreased. CONCLUSIONS: In this study, higher authenticity was associated with a lower likelihood of burnout and depression among surgeons. This study contributes valuable insights into the development of targeted intervention and support mechanisms aimed at promoting authenticity and mental health within the surgical profession.

Thin Profunda Artery Perforator Flap for Hand and Upper Extremity Coverage.

The profunda artery perforator (PAP) flap provides a good option for hand and upper extremity reconstruction. The reliable quality, caliber, and number of perforators in the posteromedial thigh support large flaps with long pedicles. The PAP flap has been widely used for breast reconstruction, although its use in the extremities has been slower to catch on due to the bulk and thickness of the subcutaneous tissue. The authors discuss evolution of thin flaps and our application of the thin and superthin PAP flap for upper extremity reconstruction.

Comparison of Aesthetic Outcomes of Epidermal Staples vs Sutures in Deep Epigastric Perforator Flap Breast Reconstruction.

Background: A secondary benefit of abdominally based autologous breast reconstruction may be improving the abdominal contour; however, poor scaring can lead to aesthetic dissatisfaction and complications. Although studies have demonstrated favorable aesthetic results and decreased operative time using dermal or subcuticular stapling (Insorb), no reports exist regarding epidermal stapling. Objectives: The aim of this study is to compare the aesthetic abdominal scar outcomes, closure time, and postoperative complications of abdominally based breast reconstruction patients who have undergone suture closure vs epidermal staple closure. Methods: A total of 217 patients who underwent abdominally based autologous breast reconstruction from 2011 to 2022 were included and retrospectively analyzed (staples = 41, suture = 176). Twenty-four patients' postoperative abdominal scar photographs were randomly chosen (staples = 12, sutures = 12) and assessed by 3 board-certified plastic surgeons using a modified patient observer scar assessment scale (POSAS) and visual analog scale (VAS). Closure time (minutes per centimeter) using staples or sutures was also analyzed. Results: The assessment of abdominal scars closed by epidermal staples revealed significant improvements in thickness (P = .033), relief (P = .033), surface area (P = .017), overall opinion (P = .033), POSAS score (P = .034), and VAS scar score (P = .023) in comparison with scars closed by sutures. Closing the abdominal wound with staples was significantly faster than closing with sutures (P < .0001). Staple and suture closure had similar postoperative complication rates. Conclusions: Abdominal donor-site scar quality may be superior and faster using the epidermal staple compared to traditional suture closure.

Hardware Salvage in the Lower Extremity after Flap Coverage: 10-Year Single Center Outcomes Analysis.

An unanswered question with open tibial fractures is whether the type of flap used affects hardware retention. Flap survival may not equate hardware retention or limb salvage. In this study, we performed a 10-year single institution review and analysis of all patients who had placement of hardware for open tibial fractures followed by flap coverage. Methods: Inclusion criteria consisted of patients who underwent pedicled or free flap coverage of Gustilo IIIB or IIIC tibial fractures requiring open reduction and internal fixation. Outcomes and complications were statistically analyzed based on flap type. Flap type was stratified into free versus pedicled flaps and muscle versus fasciocutaneous flaps. Primary outcome measures included hardware failure and infection requiring hardware removal. Secondary outcome measures included limb salvage, flap success, and fracture union. Results: Overall primary outcome measures were better for pedicled flaps (n = 31), with lower rates of hardware failure and infection (25.8%; 9.7%) compared with free flaps (n = 27) (51.9%; 37.0%). Limb salvage and flap success was not different comparing pedicled and free flaps. There was no significant difference in outcomes between muscle and fasciocutaneous flaps. Multivariable analysis showed that patients who had free versus pedicled flaps or muscle versus fasciocutaneous flaps had a higher chance of hardware failure. A formal orthoplastic team was established in the period from 2017 to 2022, after which flap numbers were higher and hardware failure less for pedicled and fasciocutaneous flaps. Conclusions: Pedicled flaps were associated with lower rates of hardware failure and infection requiring hardware removal. A formal orthoplastic team improves hardware-related outcomes.