Doctors of Osteopathic Medicine as Plastic Surgery Residents: Demographics, Credentials, and Pathways to Residency.

OBJECTIVE: Doctors of Osteopathic Medicine (DOs) are sparsely represented within plastic and reconstructive surgery (PRS) and recent changes including the elimination of step 1 scoring have further disadvantaged DO applicants. The demographics, degrees, and scholarly output of DO PRS trainees were compared to that of Doctors of Medicine (MDs) to identify areas of focus which could be used to increase competitiveness of DO applications. DESIGN: A cross-sectional study was created, including ACGME-accredited PRS program trainees during the 2020 to 2021 academic year. DO and MD trainee demographics and scholarly accomplishments were compared using t-test and chi-squared analysis. SETTING: Web-based publicly available information was collected for subjects. PARTICIPANTS: A total of 1092 PRS MD and DO trainees were identified. DOs made up only 2.7% (n = 30) and MDs made up 97.3% (n = 1062). RESULTS: More DOs trained in independent programs (63.3%) than integrated (36.7%) compared to MDs (88.2% v. 11.8%, p < 0.001) and more DOs trained at lower ranked PRS programs (60.0% of DOs and 18.1% of MDs trained at Q4 programs, p < 0.001). DOs had fewer publications (median, IQR: 1, [0-2]) compared to MDs (3, [1-8]), fewer citations (0, [0-6]) vs. (10, [1-56]) and lower H-index (1, [0-1]) vs. (1, [1-3]). CONCLUSION: DO candidates should consider research years in the field of PRS and optimize clinical experience opportunities to increase the competitiveness of their PRS applications. Special attention should be paid to providing networking and research opportunities to DOs who lack home institutions.

Esthetic Surgery of the Chin in Cis- and Transgender Patients-Application of T-Genioplasty vs. Single-Piece Segment Lateralization.

Background and Objectives: Correction of lower face asymmetry still remains challenging in maxillofacial surgery. This report describes techniques for the lateral transposition of the symphyseal segment to restore lower face symmetry while maintaining gender-related features in cis- and transgender patients. Materials and Methods: A retrospective review of medical records of 31 patients who attended for esthetic corrective surgery after orthodontic camouflage or orthognathic treatment, or during facial feminization of the lower face between June 2021 and June 2023 was performed. Result: All patients underwent lateralization genioplasty (with or without advancement or setback), either with or without narrowing T-osteotomy supplemented with necessary procedures in order to obtain proper facial balance and desired esthetical effects, such as bichectomy, liposuction, and face and neck lift. The mean asymmetry of the chin was 5.15 mm and was surgically corrected either by single segment lateralization or T-shape narrowing genioplasty depending on the gender and esthetical requirements. No complications were reported. Conclusions: Lateral shift genioplasty serves as a powerful tool in primary and secondary corrective surgery for lower face asymmetry that maintains gender-specific facial features. It may serve either as an additive to orthodontic camouflage or a way to correct previous orthognathic surgery pitfalls. The surgeon performing esthetic genioplasty associated with gender-specific expectations must be trained in facelift and facial liposculpting techniques in order to provide the best results and properly choose the right procedures for the right patients.

ical Efficacy of Early Plastic Surgery Treatment for Patients with Deep Hand Burns.

Objective: This study aims to assess the effectiveness of early plastic surgery for deep hand burns by examining variables like VAS scores, wound healing time, and excellent hand function recovery rates. Methods: A total of 130 patients with deep hand burns admitted to our hospital between January 2020 and October 2021 were enrolled in this study. They were randomly assigned to either a control group (n = 65, deferred reconstructive surgery) or an observation group (n = 65, early reconstructive surgery) using a random number table. We compared the VAS scores, wound healing time, rates of excellent hand function recovery, complications, and overall treatment efficacy between the two groups. Results: The preoperative VAS scores were comparable between the observation and control groups (P > .05). Postoperative VAS scores in the observation group were significantly lower than those in the control group at 1, 3, and 7 days following surgery (P < .05). Additionally, the observation group exhibited shorter wound healing times and higher rates of excellent hand function recovery (P < .05). The incidence of complications such as numbness, infection, and necrosis of implants was lower in the observation group compared to the control group (P < .05). The overall treatment efficacy was also significantly better in the observation group than in the control group (P < .05). Conclusions: These findings underscore the high clinical value of early surgical intervention, supporting its broader application in the treatment of deep hand burns and potentially improving patient outcomes.

The Evolution of Current Concept of the Reconstructive Ladder in Plastic Surgery: The Emerging Role of Translational Medicine.

Plastic surgeons have used the reconstructive ladder for many decades as a standard directory for complex trauma reconstruction with the goal of repairing body structures and restoring functionality. This consists of different surgical maneuvers, such as secondary intention and direct tissue closure, as well as more complex methods such as local tissue transfer and free flap. The reconstructive ladder represents widely known options achievable for tissue reconstruction and wound closure that puts at the bottom rung the simplest methods of reconstruction and strengthens the complexity by moving upward. Regenerative medicine and surgery constitute a quickly spreading area of translational research that can be employed by minimally invasive surgical strategies, with the aim of regenerating cells and tissues in vivo in order to reestablish normal function through the intrinsic potential of cells, in combination with biomaterials and appropriate biochemical stimuli. These translational procedures have the aim of creating an appropriate microenvironment capable of supporting the physiological cellular function to generate the desired cells or tissues and to generate parenchymal, stromal, and vascular components on demand, and above all to produce intelligent materials capable of determining the fate of cells. Smart technologies have been grown that give extra "rungs" on the classic reconstructive ladder to integrate a more holistic, patient-based approach with improved outcomes. This commentary presents the evolution of the traditional concept of the reconstructive ladder in the field of plastic surgery into a new course with the aim of achieving excellent results for soft tissue reconstruction by applying innovative technologies and biologically active molecules for a wide range of surgical diseases.

Electrical stimulation plus biofeedback improves urination function, pelvic floor function, and distress after reconstructive surgery: a randomized controlled trial.

PURPOSE: This study is aimed at assessing the effect of postoperative electrical stimulation (ES) plus biofeedback therapy on patient rehabilitation after pelvic floor reconstructive surgery. METHODS: Patients with pelvic organ prolapse (POP) who had received pelvic floor reconstructive surgery were randomly allocated to the intervention group and the control group at a 1:1 ratio. Patients in the control group received routine postoperative nursing care. Patients in the intervention group underwent ES plus biofeedback therapy. The outcomes included the recovery of urination function, the improvement of pelvic floor muscle (PFM) strength, and the change of Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20) scores. The study outcomes were evaluated at pre-intervention (T0, 2 months after surgery), 3 months after surgery (T1), and 6 months after surgery (T2). RESULTS: A total of 60 patients with POP were included in this study. For the urination function evaluation, the intervention group had a higher recovered rate than the control group at the time point of T2 (p = 0.038). For the EMG results, the changes of flick-max and tonic-mean values from T0 to T2 were much higher in the intervention group comparing to the control group. Corresponding to the EMG results, digital palpation showed that intervention group had a much higher proportion of patients who had elevated PFM strength. Furthermore, the intervention group also had more significant PFDI-20 score improvements compared with control group. CONCLUSIONS: Postoperative ES plus biofeedback therapy could significantly improve urination function, PFM strength, and patient's reported QoL. TRIAL REGISTRATION: Clinical registration number: hiCTR2000032432.

Distinguishing Authentic Voices in the Age of ChatGPT: Comparing AI-Generated and Applicant-Written Personal Statements for Plastic Surgery Residency Application.

BACKGROUND: ChatGPT, a generative artificial intelligence model, may be used by future applicants in the plastic surgery residency match. METHODS: Ten personal statements (5 generated by ChatGPT, 5 written by applicants) were rated by 10 reviewers, blinded to the source of the essay. RESULTS: A total of a 100 evaluations were collected. There was no significant difference in ratings for readability, originality, authenticity, and overall quality (all P > 0.05) when comparing computer-generated and applicant essays. CONCLUSION: Personal statements prepared by ChatGPT are indistinguishable from essays written by actual applicants. This finding suggests that the current plastic surgery application format be reevaluated to better aid in holistic evaluation of students.

Body Image among Girls in Indonesia: Associations with Disordered Eating Behaviors, Life Engagement, Desire for Cosmetic Surgery and Psychosocial Influences.

Body image is an important risk factor for mental and physical health during adolescence. Nonetheless, few studies have empirically investigated body image among girls in Southeast Asia. This cross-sectional study examined the prevalence of body esteem (a holistic measure of body image assessing the degree of satisfaction with one's appearance, weight, and shape), associated behavioral outcomes, and potential psychosocial influences on body image among Indonesian girls to inform future intervention efforts. Girls across Indonesia with internet access (N = 318, Mage = 13.59 years) completed a questionnaire that assessed body image, disordered eating behaviors, appearance-related life engagement, desire for cosmetic surgery, appearance ideal internalization, media literacy, appearance-related teasing, and self-esteem. The younger girls' (10-13 years) responses were analyzed separately from those of the older girls (14-17 years). Over half of the girls did not have high body esteem. Approximately a quarter of the girls across both age groups reported restricting their food intake, emotionally eating, and/or engaging in excessive exercise, and over half desired cosmetic surgery. Disordered eating behaviors and a desire for cosmetic surgery were negatively correlated with body esteem. Hierarchical regression analyses found BMI, internalization, appearance-related teasing, and self-esteem were uniquely associated with body esteem among younger girls. Appearance-related teasing and self-esteem were positively associated with body esteem among older girls. These findings suggest body image interventions may be important for this population, with appearance-related teasing and self-esteem potentially useful targets for intervention efforts. Further prospective research to investigate these findings would be beneficial for a deeper understanding of body image risk factors for girls across Indonesia.

[Analysis of surgical complications of reconstructive plastic surgery according to the ClavienDindo classification].

INTRODUCTION: The systematization of surgical complications has long been a serious problem since different types of surgical procedures have specific complications, in addition to general consequences. Created in 1992 and improved in 2004, the Clavien-Dindo classification was successfully validated in surgical centers in different countries and recognized as an important tool for the qualitative assessment of surgical complications. AIM: To improve reconstructive procedures by systematizing complications based on the ClavienDindo classification. MATERIALS AND METHODS: The results of substitution ileocystoplasty in 95 patients with contracted bladder due to tuberculosis and other diseases are presented. In 50 (52.6%) cases, the length of the bowel segment was 30-35 cm (group 1, main), while in 45 patients (47.4%) a segment of 45-60 cm was chosen (group 2, control). RESULTS: Early complications of grade II developed in 11 (22.0%) patients in the group 1 and in 13 (28.9%) in group 2, while grade III in 5 (10.0%) and 6 (13.3%) cases, respectively. Complications of IIIb grade were seen among patients of the main group in 9 (18.0%) cases compared to 12 (26.7%) in the control group. Severe complications of IVa and IVb grades were documented with the same frequency in both groups, in one case each. Complications of V grade (death) were recorded only in the group 2. Late complications were registered in 63 out of 94 patients. In group 1, there were 26 complications (16 somatic and 10 surgical), while in group 2, a total of 37 complications (24 somatic and 13 surgical) were seen, which indicates a significant higher rate in the control group (p<0.05). In group 1, transurethral resection of urethral-enteric anastomosis and ureteral reimplantation were performed less frequently than in group 2, while transurethral resection of the prostate was done with the same frequency. At the same time, percutaneous nephrostomy was required more often in the group 1 (6% vs. 4.5% in the group 2). After intestinal cystoplasty with a shortened fragment of the ileum, the voiding volume was significantly lower but corresponded to the physiological value (more than 150 ml). In this group, there was sufficient capacity of neobladder with a minimum amount of residual urine, effective emptying, satisfactory urinary continence, and low intraluminal pressure, which contributes to the protection of kidneys from reservoir-ureteral-pelvic reflux. The serum chloride level after surgery was 106.2+/-0.4 in the group 1 compared to 109.7+/-0.3 in the group 2, while base excess was -0.93+/-0.3 and -3.4+/-0.65, respectively (p<0.05). CONCLUSION: Early serious postoperative complications according to Clavien-Dindo were registered with approximately the same frequency in both groups, while late complications developed significantly more often in the group 2. The urodynamic parameters of a neobladder formed from ileum segment of 30-35 cm are satisfactory. In addition, a decrease in the length of the intestinal segment prevents the development of hyperchloremic metabolic acidosis.

Objective Residency Applicant Assessment Using a Linear Rank Model.

OBJECTIVES: Residency applicant assessment is imperfect, with little objectivity built into the process, which, unfortunately, impacts recruitment diversity. Linear rank modeling (LRM) is an algorithm that standardizes applicant assessment to model expert judgment. Over the last 5 years, we have used LRM to assist with screening and ranking integrated plastic surgery (PRS) residency applicants. This study's primary objective was to determine if LRM scores are predictive of match success and, secondarily, to compare LRM scores between gender and self-identified race categories. DESIGN: Data was collected on applicant demographics, traditional application metrics, global intuition rank, and match success. LRM scores were calculated for screened and interviewed applicants, and scores were compared by demographic groups. Univariate logistic regression was used to evaluate the association of LRM scores and traditional application metrics with match success. SETTING: University of Wisconsin, Division of Plastic and Reconstructive Surgery. Academic institution. PARTICIPANTS: Six hundred seventeen candidates who applied to a single institution over 4 application cycles (2019-2022). RESULTS: Using area under the curve modeling, LRM score was the most predictive indicator for match success. With every one-point increase in LRM score, there was an 11% and 8.3% increase in the likelihood of screened and interviewed applicant match success (p < 0.001). An algorithm was developed to estimate the probability of match success based on LRM score. No significant differences in LRM scores were appreciated for interviewed applicant gender or self-identified race groups. CONCLUSIONS: LRM score is the most predictive indicator of match success for PRS applicants and can be used to estimate an applicant's probability of successfully matching into an integrated PRS residency. Furthermore, it provides a holistic evaluation of the applicant that can streamline the application process and improve recruitment diversity. In the future, this model could be applied to assist in the match process for other specialties.

Plastic Surgery Roles in Wound Centers in the Northeastern United States.

INTRODUCTION: Wound care is a substantial industry costing nearly $19 billion USD, and dedicated wound care centers play a critical role via a multidisciplinary team-based approach. At the same time, plastic surgeons are often considered experts in evaluation and management of wounds, particularly chronic and complex wounds. However, the extent of direct involvement of plastic surgeons in wound care centers is unclear. In this study, we sought to evaluate the presence of plastic surgeons and other specialties in wound care centers across all Northeastern states Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Jersey, New York, New Hampshire, Pennsylvania, Rhode Island, Virginia, West Virginia, and Vermont. METHODS: A comprehensive list of wound care clinics in northeastern United States was obtained from the Healogics website. For each site, information was gathered via website listings, including number of providers and the professional certification/specialization for each provider. Providers were those with qualifications including Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Physical Therapy (DPT), Doctor of Podiatric Medicine (DPM), Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse Practitioner (CRNP), Physician Associate (PA), and Physical Therapist (PT). RESULTS: A total of 118 Healogics wound care clinics and 492 providers were located across 14 northeastern states including District of Columbia. After researching each location, updated in November 2022, plastic surgeons were only 3.7% (18 of 492) providers employed. Specialties such as internal medicine (90 of 492 [18%]), general surgery (76 of 492 [15%]), podiatry (68 of 292 [13.8% ]), and other midlevel providers such as nurse practitioners (35 of 492 [7.1%]) were more frequently employed over plastic surgery. All plastic surgeons were board certified the American Board of Plastic Surgery. CONCLUSIONS: Wound care requires collaboration between specialties, with significant repercussions on health care costs and patient outcomes. Plastic surgery provides unique surgical services for the healing of wounds, and the natural expectation would be that plastic surgery should be heavily involved at wound care centers. However, the data do not reflect significant involvement at an official level. Further studies will investigate causes and the societal, financial, and patient impacts of this lack of direct engagement. Although many plastic surgeons may not desire the majority of their practice to be wound care management, it stands to reason that some affiliation, at least for patient awareness and referral, may be warranted.

Use of Remimazolam Combined With Alfentanil for Plastic Surgery Anesthesia Cases: A Clinical Trial.

OBJECTIVE: This study aims to observe the safety and effectiveness of remimazolam benzenesulfonate combined with alfentanil for painless and comfort anesthesia in plastic surgery. METHODS: Two hundred patients with American Society of Anesthesiologists (ASA) I-II for elective facial autologous lipofilling + autologous liposuction (thigh or abdomen) plastic surgery in our hospital were selected. One hundred patients received comfort anesthesia (observation group) on odd-numbered day of surgery, and other 100 patients received painless anesthesia (control group) on even-numbered day. Patients in both groups were given slow injection of remimazolam benzenesulfonate 0.1 mg/kg and alfentanil 5 µg/kg to induce sleep before local anesthesia. Depending on body action reaction to surgical stimulation, patients in the observation group were received with remimazolam 0.05 mg/kg and alfentanil 2.5 µg/kg for maintenance until the end of surgery after local anesthesia, and patients in the control group received with remimazolam 0.25 to 0.5 mg/kg/h and alfentanil 25 to 50 µg/kg/h in continuous pumps. Time to fall asleep, sedation score, time to end of medication, time to open eyes, recovery score, and the presence of body movement, glossoptosis, arousal or jaw support during hypoxia, hypotension, bradycardia, operation time, total amount of remimazolam and alfentanil used, and the presence of postoperative complications such as pruritus, dizziness, nausea, and vomiting were recorded in both 2 groups. RESULTS: There were no significant differences in the preoperative vital sign parameters as mean arterial pressure, heart rate, and oxygen saturation between 2 groups ( P > 0.05). Intraoperative mean arterial pressure and heart rate were significantly lower in both groups compared with preoperative ( P < 0.05), but there was no statistically significant between the 2 groups ( P > 0.05). There was no significant decrease in oxygen saturation in both groups under the condition of intraoperative oxygen inhalation ( P > 0.05). There was no significant difference between the 2 groups in the incidence of adverse reactions, such as intraoperative body movement induced by skin cutting, glossoptosis requiring jaw thrust, postoperative pruritus, dizziness, nausea, and vomiting ( P > 0.05). There was no statistically significant difference in time to fall asleep, sedation score during local anesthesia, time to open eyes after stopping anesthetics, and recovery score between the 2 groups ( P > 0.05). Meanwhile, the total amount of remimazolam and alfentanil use was significantly reduced in patients in the observation group compared with the control group ( P < 0.05). CONCLUSIONS: Remimazolam benzenesulfonate combined with alfentanil can be used as a comfort anesthesia and painless anesthesia protocol in plastic surgery, which has the advantages of rapid onset of action, safety and comfort for patients, rapid recovery, and good cooperation. Furthermore, the protocol of remimazolam benzenesulfonate combined with alfentanil used in the observation group can significantly reduce the total amount of remimazolam and alfentanil used.

Zur medizinischen Indikation bei ästhetisch-plastischen Operationen.

The concept of indication is used in many ways in medicine and in the healthcare industry. In connection with "medical" and/or "physician-based", it is often used to describe the path that a doctor and a patient take - after weighing up all available information - to describe a common treatment goal and to define measures derived from that goal. From today's perspective, however, there is a third factor that plays a role: the healthcare industry, here in particular in the form of health insurance (both statutory health insurance and private health insurance), but more recently also in the form of financial administration. Plastic surgery is faced with the dilemma that, although there is a medically proven indication in many cases, neither the payers nor the financial courts or offices are willing to follow the medical assessment and reject the indication (usually without justification). This article offers support in defining an indication for aesthetic plastic surgery.

Distinct Approaches to Perioperative Management of Anticoagulation and Antiplatelet Therapy among Providers Performing Cutaneous Surgery.

BACKGROUND: Despite increasing cross-collaboration between providers who perform cutaneous surgery, a disparity still exists in the current practices regarding perioperative management. This could lead to treatment delays, patient confusion, and increased morbidity, such as clotting, infection, and discomfort of patients. OBJECTIVE: To characterize the management practices of different providers in regards to perioperative anticoagulation and antiplatelet therapy for cutaneous surgery. METHODS AND MATERIALS: This study used an electronic survey to assess current perioperative management practices of dermatologic surgeons and plastic and reconstructive surgeons. RESULTS: 177 physicians (115 dermatologic surgeons and 62 plastic and reconstructive surgeons) responded to the survey. For all therapeutic agents, dermatologic surgeons were significantly more likely than their plastic and reconstructive surgery colleagues to continue all anticoagulant and antiplatelet agents perioperatively for cutaneous surgery (vitamin K antagonists, antiplatelets, LMWH, direct Xa inhibitors, direct thrombin inhibitors, NSAIDS: P<0.001; fish oil, vitamin E: P<0.01). CONCLUSION: Our data highlight the significant practice gaps that exist between dermatologic surgeons and plastic and reconstructive surgeons. Reducing this disparity will facilitate improved continuity of care, especially when patients are referred from dermatologic surgeons to plastic and reconstructive surgeons for more complex repairs, and potentially reduce morbidity and mortality associated with medication discontinuation. J Drugs Dermatol. 2022;21(7):766-772. doi:10.36849/JDD.6726.

The Role of Complementary and Alternative Medicine in Facial Plastic Surgery.

Complementary and alternative medicine (CAM) has become increasingly popular among facial plastic surgery patients. Over the last few decades, there has been a surge in the use of CAM. Despite the increasing prevalence of CAM, patients may feel uncomfortable discussing these therapies with their physicians, and physicians feel under-equipped to engage in meaningful discussions regarding these nontraditional therapies. This article reviews recent literature on the use of CAM for skin treatment in an attempt to provide additional resource. To date, the evidence to support statistically significant symptom improvement with use of non-traditional therapies remains limited. While preliminary data supports essential oil therapy in some cases, the results of the studies investigating other CAM therapies (traditional Chinese medicine, Ayurveda, and homeopathy) have been mixed and inconclusive.

Difusão e propaganda sobre antienvelhecimento na mídia brasileira: um estudo de representações sociais / Diffusion and propaganda about anti-aging in brazilian media: a study of social representations / Difusión y propaganda sobre el antienvejecimiento en los medios de comunicación brasileños: un estudio de las representaciones sociales

Esta pesquisa buscou mapear conteúdos relativos ao antienvelhecimento em revistas de grande circulação e no noticiário brasileiro, entre 1º de janeiro de 2016 e 31 de dezembro de 2019. Foram investigadas as revistas Claudia, Boa Forma, VIP e Carbono Uomo. Houve ainda coleta no portal de notícias G1, da Rede Globo de Televisão, voltado ao público geral. Foram criados dois corpora distintos formados pelos conteúdos do G1 e das revistas que, então, foram submetidos à Classificação Hierárquica Descendente pelo software IRaMuTeQ, dando origem a dois subcorpora e quatro classes para cada um. Os resultados apontam uma forte tendência mercadológica nas revistas, que buscam conduzir os leitores ao consumo de produtos e à realização de procedimentos estéticos. Por outro lado, as notícias jornalísticas apregoam um modelo de vida mais saudável como principal prática antienvelhecimento, ao mesmo tempo que alertam sobre os riscos envolvidos nos procedimentos e produtos estéticos irregulares. Em geral, o conteúdo das revistas dissipa representações sociais que idealizam um padrão de beleza do corpo jovial, associando a velhice à fealdade, enquanto o do portal de notícias G1 voltam-se à saúde e longevidade.(AU)

This survey aimed to map anti-aging content, in magazines with wide circulation and also in Brazilian news, between January 1, 2016 and December 31, 2019. Claudia, Boa Forma, VIP and Carbono Uomo magazines were studied. News were also collected from the G1 news portal, from Globo television network, aimed at the general audience. Two distinct corpora formed by the contents of the G1 and the magazines were created, which were then submitted to the Descending Hierarchical Classification, by the IRaMuTeQ software, leading to two subcorpora and four classes for each. The results show a strong market orientation in the magazines, which aim to lead readers to purchase products and undertake aesthetic procedures. The news reports, on the other way, promote a healthier life model as the main anti-aging practice, while warning about the risks involved in irregular aesthetic procedures and products. In general, the content of the magazines spreads social representations which idealize a pattern of beauty of a young body, connecting old age with ugliness, whereas that of the G1 news portal are focused on health and longevity.(AU)

Esta iniciativa buscó mapear material de antienvejecimiento, en revistas de gran tirada y en las noticias de Brasil, entre el 1 de enero de 2016 y el 31 de diciembre de 2019. Se analizaron las revistas Claudia, Boa Forma, VIP y Carbono Uomo. También se recogieron noticias del sitio de noticias G1 y de la red de televisión Globo, ambas dirigidas al público en general. Se crearon dos corpora distintos formados por el contenido del G1 y de las revistas, que luego fueron sometidos a la Clasificación Jerárquica Descendente, por el software IRaMuTeQ, dando lugar a dos subcorpora y cuatro clases para cada uno de los corpora. Los resultados señalan una fuerte orientación del mercado de promoción en las revistas, que buscan llevar a los lectores a consumir productos y realizar procedimientos estéticos. En cambio, las noticias periodísticas difunden un modelo de vida más saludable como la principal práctica antienvejecimiento, mientras que al mismo tiempo advierten sobre los riesgos que implican los procedimientos irregulares y los productos estéticos. De forma general, el contenido de las revistas difunde representaciones sociales que idealizan un estándar de belleza del cuerpo joven, asociando la vejez con la fealdad, mientras que el del portal de noticias G1 se orienta a la salud y la longevidad.(AU)

Corrección de arrugas perioculares con plasma rico en plaquetas / Correction of periocular wrinkles with platelet-rich plasma

Las arrugas son surcos o pliegues en la piel, que aparecen principalmente por efecto del envejecimiento. Este artículo describe el caso de un paciente masculino de 47 años de edad, piel blanca, que acudió a consulta de cirugía plástica ocular por inconformidad con el aspecto envejecido de su rostro a causa de las arrugas perioculares. Se le aplicó plasma rico en plaquetas intradérmico en el trayecto de las arrugas a razón de 3 dosis con intervalo promedio de 30 días entre cada una. Se logró la corrección total de las arrugas, con buenos resultados estéticos. No se encontró reacción adversa. Se reafirma el criterio planteado por estudios de que el plasma rico en plaquetas es una opción terapéutica de primera línea para rejuvenecer la región periocular(AU)

Wrinkles are a creases or folds which appear in the skin mainly as a result of aging. A case is described of a male 47-year-old patient of white skin color who attended ocular plastic surgery consultation for dissatisfaction with the periocular wrinkles on his face, which gave it an aged appearance. Intradermal platelet-rich plasma was applied along the course of the wrinkles at three doses with an average separation of 30 days between them. Total wrinkle correction was achieved, with good esthetic results. There was not any adverse reaction. The case confirms the criterion contained in previous studies that platelet-rich plasma is a first-line therapeutic option to rejuvenate the periocular region(AU)

Reconstrucción mamaria diferida con expansor-implante y matriz dérmica autóloga. Una alternativa terapéutica aplicable en tejidos no irradiados. / Delayed breast reconstruction with expander-implant and autologous dermal matrix. An alternative applicable therapeutic in non irradiated tissues.

INTRODUCCIÓN Y OBJETIVO: la reconstrucción mamaria diferida o post mastectomía tiene una importancia trascendental en la vida de la mujer así también como parte del tratamiento integral y multidisciplinario del cáncer mamario, ya que tamaña agresión impacta en la autoestima y funcionalidad social en aquellas mujeres que por algún motivo no fueron sometidas a reconstrucción inmediata. El objetivo es describir a través de la técnica expansor-implante, matriz dérmica autóloga, injerto de grasa y reconstrucción del complejo areola pezón con tejidos autólogos, los resultados alcanzados en pacientes mastectomizadas y reconstruidas de manera diferida. MATERIAL Y MÉTODO: es un estudio retrospectivo, longitudinal, observacional y descriptivo de una serie pequeña de 5 pacientes privadas mastectomizadas no irradiadas que no fueron sometidas por algún motivo a reconstrucción inmediata en otros centros médicos y que acudieron al consultorio privado derivadas por médicos cirujanos mastólogos-oncólogos para ser sometidas en forma diferida a reconstrucción con expansor implante en una secuencia técnica de 3 tiempos quirúrgicos en un periodo comprendido entre abril del 2015 y octubre del 2020. RESULTADOS: la reconstrucción diferida habitualmente la realizamos con expansor-implante y optamos por la utilización de colgajos autólogos siempre cuando se hubiera irradiado la mama enferma. En 4 de 5 pacientes realizamos la reconstrucción del complejo areola pezón (CAP), 3 pacientes fueron de reconstrucción unilateral y 2 de bilateral, en 2 mujeres ocupamos prótesis de doble lumen tipo anatómicos y en 3 mujeres expansor con puerto a distancia, utilizando en 2 pacientes, prótesis de forma redonda y en un implante expansor anatómico. Presentamos un caso de deflación del implante a los 3 años post reconstrucción no reportamos casos de necrosis grasa, ni cuadros infecciosos, no presentamos casos de contractura capsular y reportamos un solo caso de seroma tardío de origen traumático en una paciente de reconstrucción unilateral a los 7 meses post implante. CONCLUSIÓN: la técnica reconstructiva diferida de expansor-implante, matriz dérmica autóloga, y tejidos propios para la reconstrucción del CAP, representan una buena opción terapéutica de baja morbilidad en pacientes que no han sido sometidas a irradiación post mastectomía. Creemos que a nivel nacional aún faltan políticas en salud y conductas que beneficien a las mujeres con cáncer mamario en el camino largo del tratamiento integral de la enfermedad hasta la reconstrucción mamaria y su re inserción con funcionalidad social, laboral y emocional, para unificar criterios y protocolos entre servicios públicos, privados, ministerio de salud, secretarias regionales de salud y sociedades científicas de Mastologia y Cirugía Plástica apoyando a los pocos equipos en reconstrucción mamaria , optimizando protocolos médicos que beneficien a las pacientes enfermos.

INTRODUCTION AND OBJECTIVE: delayed breast reconstruction or post mastectomy has a transcendental importance in women ́s life as well as part of the comprehensive and multidisciplinary treatment of breast cancer. Such aggression impacts on self-esteem and social functionality in women who for some reason were not undergoing immediate reconstruction. The objective is to describe the results achieved in mastectomized patients, through the expander-implant technique, autologous dermal matrix, fat graft and reconstruction of the nipple areola complex (NAC) with autologous tissues MATERIAL AND METHOD: it is a retrospective, longitudinal, observational and descriptive study of a small group of 5 non-irradiated mastectomized private patients who were not subjected to an immediate reconstruction at other medical centers. They came to the private practice referred by other mastologists-oncologists medical surgeons to be submitted to a delayed breast reconstruction with expander prosthesis in a 3 surgical times technique between April 2015 and October 2018. RESULTS: the delayed breast reconstruction is usually performed with expander prosthesis and for those injured breasts that had been irradiated, we use autologous flaps. In 4 out of 5 patients we performed the reconstruction of the NAC, 3 were submitted to unilateral reconstruction and 2 were bilateral, 2 women had anatomical double lumen prosthesis, 3 had expander implant with remote port at which 2 were round and one anatomical. We presented only one case of deflation 3 years later after reconstruction. We didn ́t report cases of fat necrosis nor infectious symptoms. We didn ́t have any case of capsular contracture but only a single case of late seroma after 7 months' post implant in a patient with unilateral reconstruction due to a traumatic incident. CONCLUSION: the delayed breast reconstructive technique with expander-implant, uses of autologous dermal matrix or own tissues for reconstructing the NAC, represents a good therapeutic option of low morbidity to patients who have not undergone post-mastectomy irradiation. We briefly believe that at a National level there is a lack of health policies and therapeutic behaviors that could benefit women with breast cancer on this long path from a complete treatment of this disease to breast reconstruction and its social, labor and emotional reintegration, to unify criteria and protocols between public services, private services, ministry of health, regional secretaries of health and scientific societies such as Mastology and Plastic Surgery to support the few teams in breast reconstruction and optimize medical protocols to benefits the sick patient.

Assessment of Plastic Surgery Residency Applications without United States Medical Licensing Examination Step 1 Scores.

SUMMARY: The United States Medical Licensing Examination announced the changing of Step 1 score reporting from a three-digit number to pass/fail beginning on January 1, 2022. Plastic surgery residency programs have traditionally used United States Medical Licensing Examination Step 1 scores to compare plastic surgery residency applicants. Without a numerical score, the plastic surgery residency application review process will likely change. This article discusses advantages, disadvantages, and steps forward for residency programs related to the upcoming change. The authors encourage programs to continue to seek innovative methods of objectively and holistically evaluating applications.