Algorithm for Temple Reconstruction With Consideration of Anatomic and Defect Characteristics.

The temple is an intriguing region of the face with unique anatomic features, such as the temporal hairline, concave contour, and close proximity to vital structures like the frontal branch of the facial nerve. However, cancerous skin lesions can plague this sun-exposed region and, when excised, it can result in large and significant defects. Reconstruction in this area is a formidable challenge for surgeons, as it requires comprehensive knowledge of temple morphology and the use of creative techniques in order to minimize disruption of surrounding functional and aesthetic structures. In this study, we describe our experience with temple reconstruction in patients of varying defect size and depth. Based on these defect characteristics, anatomic and aesthetic principles of the temple, we propose a surgical algorithm for temple reconstruction to aid surgeons in achieving optimal results.

One-Step Triple-Layer Reconstruction of an Exposed Calvarium in a Patient With Radiated Tinea Capitis.

Full-thickness large scalp defects with underlying exposed calvarium pose a significant reconstructive challenge. Traditional reconstructive techniques are usually not an option in patients with irradiated scalp with thin skin and reduced laxity.Dermal substitutes-based reconstruction techniques have been described in recent years. A common approach is the staged methodology, with the initial application of skin substitute followed by a split-thickness skin graft few weeks later; however, this method involves a prolonged period of local wound management prior to skin grafting and is often associated with complications that interfere with wound healing.This report describes a single-stage triple-layer technique for the reconstruction of a large scalp defect with exposed bone in a patient with a history of radiation treatment, using 3 turnover pericranial flaps in conjunction with a Matriderm dermal substitute and split-thickness skin graft. This immediate multilayered reconstruction provides a long-lasting structural and aesthetic outcome, with minimal donor site morbidity and reduced complications.

Research Productivity among Plastic Surgeons in the State of Israel: h-index and M-quotient Assessment.

The h-index has been proven in the US and Canada to be a solid tool to assess the quality and impact of individual scientific work in the field of plastic surgery. M-quotient is an additional metric that mitigates the h-index's inherent bias toward more seasoned researchers. The objective of this study was evaluating the relationship between h-index and M-quotient and research productivity among plastic surgeons in the state of Israel. METHODS: A list of all Israeli board-certified plastic surgeons registered in the Israeli Society of Plastic and Aesthetic Surgery was obtained from the organization's website. Relevant demographic and academic factors of each surgeon were retrieved. The Scopus database was queried to determine each surgeon's h-index and M-quotient, among other bibliometric parameters. RESULTS: Our study included 173 plastic surgeons, 90% of whom were men. In total, 49.7% were working in academically affiliated hospitals; 14.4% of the surgeons had an academic rank. The mean h-index was 6.13; mean M-quotient was 0.27. Statistical analysis demonstrated a positive correlation between total number of publications (P < 0.0001), total number of citations (P < 0.0001), the surgeon's seniority (P < 0.0001), academic rank (P = 0.007), appointed as past/present plastic surgery department director (P < 0.0001), and working in an academic affiliated hospital (P < 0.025). The same parameters were found to have a positive correlation with M-quotient. CONCLUSIONS: The h-index is an effective measure to compare plastic surgeons' research productivity in Israel. M-quotient is an ancillary tool for the assessment of research productivity among plastic surgeons, with the advent of neutralizing the surgeon's seniority.

Is Being Left Handed an Advantage toward a Plastic Surgery Residency?

Left hand dominance is a minority trait historically regarded as disadvantageous for surgeons. Contemporary scientific literature and folklore have shed new light on left handedness as a "boutique trait" and possible marker of gifted and exceptional individuals. Our subjective impression that left handedness is prevalent in the unique field of plastic surgery raised questions regarding the scope and possible causality of this phenomenon. METHODS: One hundred eleven medical doctors in our medical center filled out a 13-item questionnaire regarding hand dominance, medical speciality, and various creative outlets or hobbies. RESULTS: Sixty-four percent of the participating plastic surgeons were left handed (significantly higher than the approximate 12% of the general population; P = 0.007). Many of the left-handed doctors admitted to practicing musical instruments and various arts, crafts, and other hobbies. CONCLUSIONS: Plastic surgery is a unique profession requiring astute minds capable of creative and "outside-the-box" thinking; traits we have learned in recent decades may be particularly keen in left-handed individuals, perhaps suggest a causal relationship to the conglomeration of a majority of left-handed plastic surgeons.

Improving Outcome in Immediate Alloplastic Breast Reconstruction, an Algorithm for Operative Decision Making.

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