Dermatome-Induced Lacerations: An Unspoken Problem in Burn Surgery.

BACKGROUND: Dermatome-induced lacerations are a known complication; however, there is a paucity of literature discussing the incidence and predisposing factors. The aim of this study was to determine the incidence and risk factors to develop a preventive algorithm. METHODS: An 18-question survey was sent to all US and Canadian burn unit directors. Surgeons were queried about type and location of their practices, average annual caseload of skin graft harvesting, and number of dermatome-induced lacerations. The survey also asked about donor site location, harvesting technique and equipment, laceration severity, and causative factors. An algorithm was developed based on the results. RESULTS: Fifty-six responses (42% response rate) were received from the burn unit directors. They reported an estimated 133 lacerations over the past 5 y. The overall incidence of dermatome-induced lacerations was approximately 0.1% per year (1.3 per 1000 cases). The most commonly attributed causes were excessive pressure (25.0%) and patient factors (18.4%). Most lacerations occurred when using air dermatomes (73.0%) with a 4-inch guard (63.5%), 0.010- to 0.015-inch thickness (78.4%), and 30°-45° angulation (47.3%); the most common brand was Zimmer (71.6%). The dermatome was typically set up by a scrub tech or nurse (48.6%), whereas the skin harvesting was performed by residents (39.2%) or attendings (35.1%). Lacerations typically extended to subcutaneous tissue (70.3%), with no neurovascular injury (86.5%). CONCLUSIONS: Our study showed that dermatome-induced lacerations are rare events and that certain factors predispose patients to injury. An algorithm was developed to provide guidance on risk factor identification and the set up and use of dermatomes.

Aesthetic Surgery Fellowship Selection Criteria: A National Fellowship Director Survey.

BACKGROUND: Desirable candidate characteristics for aesthetic surgery fellowship applicants remain unknown because of a lack of data in the literature. OBJECTIVES: This study aims to identify the criteria used to select applicants for aesthetic surgery fellowship in the United States. METHODS: A 38-question survey was sent in April 2015 to all directors of fellowships endorsed by the American Society for Aesthetic Plastic Surgery (n = 20) in the United States. The survey investigated various factors including residency training and fellowship interview. A 5-point Likert scale was used to grade 33 influential factors from 1 ("not at all important") to 5 ("essential"); a separate 5-point Likert scale was used for 5 controversial factors from 1 ("very negative impact") to 5 ("very positive impact"). RESULTS: Sixty-five percent (13 out of 20) of directors responsed. The most important factors were letters of recommendation by well-established plastic surgeons (4.6 ± 0.7), interpersonal skills (4.5 ± 0.8), overall interview performance (4.5 ± 0.7), professionalism and ethics (4.4 ± 1.0), and letters of recommendation by aesthetic surgeons (4.4 ± 1.2). The least important factors were Alpha Omega Alpha Honor Medical Society membership (1.8 ± 0.6), postgraduate degrees (1.9 ± 0.9), US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK)/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 Cognitive Evaluation and USMLE/COMLEX Step 3 score (1.9 ± 0.9), and research fellowships (2.0 ± 0.6). CONCLUSIONS: This study provides data on the aesthetic surgery fellowship directors' perceptions about the criteria important for applicant selection. We trust that fellowship directors, residency programs, and applicants find this data useful as they prepare for the aesthetic surgery fellowship match.