Gender Equality in Plastic Surgery Training: A Canadian Nationwide Cross-sectional Analysis.

Introduction: One of the important factors in achieving gender equity is ensuring equitable surgical training for all. Previous studies have shown that females get significantly lower surgical exposure than males in certain surgical specialties. Gender gap in surgical exposure has never been assessed in plastic surgery. To that end, the goal of this study was to assess if there are any differences in plastic surgery training between male and female residents. Methods: A survey was sent to all plastic surgery residency programs in Canada to assess the No. of surgeries residents operated on as a co-surgeon or primary assistant during their training. The survey also assessed career goals, level of interest in the specialty, and subjective perception of gender bias. Results: A total of 89 plastic surgery residents (59.3% participation rate) completed the survey and were included in the study. The average No. of reconstructive cases residents operated on as a co-surgeon or primary assistant was 245 ± 312 cases. There was no difference in either reconstructive or aesthetic surgery case logs between male and female residents (p > .05). However, a significantly larger proportion of females (39%) compared to males (4%) felt that their gender limited their exposure to surgical cases and led to a worsening of their overall surgical training (p < .001). Finally, a larger proportion of male residents were interested in academic careers while a larger proportion of female residents were interested in a community practice (p = .024). Conclusion: While there is no evidence of differences in the volume of logged cases between genders, female surgical residents still feel that their respective gender limits their overall surgical training. Gender inequalities in training should be addressed by residency programs.

Introduction: L'un des facteurs importants pour atteindre l'égalité des genres est d'assurer une formation chirurgicale équitable pour tous. Des études antérieures ont montré que les femmes ont une exposition significativement moindre à la chirurgie que les hommes dans certaines spécialités chirurgicales. L'écart entre genres pour l'exposition à la chirurgie n'a jamais été évalué en chirurgie plastique. À cette fin, la présente étude a eu pour objectif d'évaluer s'il y avait des différences dans la formation à la chirurgie plastique entre les résidents masculins et féminins. Méthodes: Une enquête a été envoyée à tous les programmes canadiens de résidence en chirurgie plastique pour évaluer le nombre d'interventions auxquelles les résidents ont participé en tant que co-chirurgien ou assistant principal au cours de leur formation. L'enquête a également évalué les objectifs de carrière, le niveau d'intérêt dans la spécialité et la perception subjective d'un biais lié au genre. Résultats: En tout, 89 résidents en chirurgie plastique (taux de participation de 59,3 %) ont répondu à l'enquête et ont été inclus dans l'étude. Le nombre moyen de cas de chirurgie reconstructrice au cours desquelles les résidents sont intervenus en tant que co-chirurgien ou principal assistant était de 245 ± 312 cas. Il n'y a pas eu de différence entre les journaux de cas, qu'il s'agisse de chirurgie reconstructrice ou de chirurgie esthétique entre résidents masculins et féminins (P > 0,05). Cependant, un nettement plus grand pourcentage de femmes (39 %) que d'hommes (4 %) estimait que leur genre limitait leur exposition à des cas chirurgicaux et résultait dans une aggravation de leur formation globale à la chirurgie (P < 0,001). Enfin, un plus grand pourcentage de résidents masculins était intéressé par une carrière universitaire alors qu'un plus grand pourcentage de résidentes était intéressé par une pratique dans la communauté (P = 0,024). Conclusion: Bien qu'il n'y ait pas de données probantes étayant des différences de volume des cas consignés entre les genres, les résidentes féminines en chirurgie pensent encore que leur genre limite leur formation chirurgicale. Les inégalités entre genres devraient être abordées par les programmes de résidence.

Complex Nasal Reconstruction in a Wide-awake Ambulatory Setting: A Study of Efficacy and Perioperative Patient Experience.

The use of local anesthesia in nasal surgery has gained popularity as a cost-effective and safe alternative. With the potential benefit of reconstruction without using general anesthesia, the goal of the study was to evaluate the patient-reported experience in addition to surgical outcomes and perioperative complications. Methods: A mixed-methods study was completed with retrospective chart review and patient-reported outcome questionnaire. The primary outcome measures were demographics, oncologic and surgical details, and postoperative complications. Secondary outcome measures were aesthetic outcomes and procedure tolerance, which were gathered from the FACE-Q questionnaire. Results: Of the 22 patients who met inclusion criteria, nine patients (41%) had forehead flaps performed and 13 patients (59%) had multilayer reconstruction with local flaps and cartilage grafts. The average number of surgeries performed, including revisions, was 2.3 ± 0.2. The overall complication rate for reconstructions and revisions was 20%, most of these were minor complications. The overall subjective rating of patient's appearance was excellent with an average score of 83.9 (± 17.3) out of 100. There was minimal appearance distress as a product of the surgery with an average score of 84.9 (±18.8). On a scale of one to five, patients reported an average of 4.3 for convenience, 3.8 for efficiency of setup and procedure, and 3.4 out of 5 for comfortability with having an operation performed on their face wide awake. Conclusion: Our study demonstrated that complex nasal reconstruction performed under local anesthetic in a minor procedure setting is a feasible and safe option with good patient-reported outcomes.

Oncological Safety, Surgical Outcome, and Patient Satisfaction of Oncoplastic Breast-Conserving Surgery With Contralateral Balancing Reduction Mammoplasty.

INTRODUCTION: Oncoplastic breast-conserving surgery (OBCS) is considered a cornerstone in the management of locally invasive breast cancer. We evaluated patient-reported outcomes of OBCS with contralateral balancing breast reduction mammoplasty and reviewed its oncologic outcomes and complications. METHODS: This is mixed method study design using retrospective chart review and prospective cohort study. Patient demographics were reviewed. Outcome measures included clinicopathologic characteristics, complications, margin status, local recurrence, tumor histopathologies, duration of follow-up, patient satisfaction, self-esteem, event-related stress, and quality of life. RESULTS: A total of 48 patients were included in this study. Complete excision with negative margins was obtained in 42 (87.5%) patients, positive margins in 6 (12.5%) patients, all who had re-excision with repeat lumpectomy. Thirteen patients developed minor complications, defined as being managed as an outpatient. No patients developed major complications requiring inpatient admission. These complications did not delay commencement of chemotherapy or radiotherapy. Postsurgery BREAST-QTM26 scores demonstrated no statistical difference in satisfaction with breasts, nipples, and sexual well-being. There was high satisfaction with overall outcome with average score of 80.8%. For the Rosenberg self-esteem scale, the results were similar for 3- and 12-month post-operative indicating maintenance of normal self-esteem post-operatively. The Impact of Events Scale showed statistically significant difference at 12-month post-operative (25.1) when compared with preoperative scores indicating that patients had lower event-related stress. There was no significant change in Hospital Anxiety and Depression Scale. CONCLUSION: Our study has shown that the patient who undergo OBCS have high patient-reported outcomes with acceptable oncologic outcomes and complication rates.

INTRODUCTION: La chirurgie oncoplastique de conservation mammaire (COCM) est considérée comme un pilier de la prise en charge du cancer du sein localement invasif. Les chercheurs ont évalué le pronostic de COCM déclaré par les patientes après une mammoplastie de réduction avec symétrie controlatérale et ont analysé les résultats oncologiques et les complications. MÉTHODOLOGIE: Dans la présente étude à méthodologie mixte, les chercheurs ont privilégié une analyse rétrospective de dossiers et une étude de cohorte prospective. Les chercheurs ont examiné la démographie des patients. Les mesures de résultat incluaient les caractéristiques clinicopathologiques, les complications, l'état des marges, les récurrences locales, l'histopathologie des tumeurs, la durée du suivi, la satisfaction des patientes, l'estime de soi, le stress lié à l'événement et la qualité de vie. RÉSULTATS: Au total, 48 patientes ont participé à l'étude. De ce nombre, 42 (87,5 %) ont subi une excision complète aux marges négatives, et six (12,5 %), une excision complète aux marges positives et toutes ont subi réexcision avec une reprise de la lumpectomie. Treize patientes ont développé des complications mineures, définies comme prises en charge dans un contexte ambulatoire. Aucune patiente n'a développé de complications majeures exigeant une hospitalisation. Les complications n'ont pas retardé le début de la chimiothérapie ou de la radiothérapie. Les scores BREAST-QTM26 après l'opération n'ont démontré aucune différence statistique pour ce qui est de la satisfaction envers les seins, les mamelons et le bien-être sexuel. Les patientes avaient un taux de satisfaction élevé à l'égard des résultats globaux, pour un score moyen de 80,8 %. Sur l'échelle d'estime de soi de Rosenberg, le maintien de l'estime de soi normal était semblable trois et 12 mois après l'opération. L'échelle d'effet des événements a révélé une différence statistiquement significative 12 mois après l'opération (25,1) par rapport aux scores avant l'opération, indiquant que les patientes ressentaient moins de stress envers l'événement. Il n'y avait pas de changement significatif dans l'échelle d'anxiété et de dépression à l'hôpital. CONCLUSION: La présente étude a révélé que la patiente qui subit une COCM déclare des résultats très positifs, dont les pronostics oncologiques et le taux de complications sont acceptables.

Treatment of Frostbite With Hyperbaric Oxygen Therapy: A Single Center's Experience of 22 Cases.

INTRODUCTION: Frostbite is well documented in the military and countries with extreme temperatures, and it is most likely due to increased exposure to cold temperatures and/or risk-taking behavior. Severity of injury depends on absolute temperature, wind chill, duration of exposure, wet or dry cold, immersion, clothing quality, and substance use. Hyperbaric oxygen therapy (HBOT) has been described as a treatment option but only in small case series. OBJECTIVE: The aim of this retrospective study is to describe the usage patterns, side effects, and outcomes of HBOT used as an adjunct to wound care at a single major Canadian university hospital. MATERIALS AND METHODS: A retrospective review of patients with frostbite injury admitted and treated with HBOT between January 2000 and March 2015 was performed. A total of 22 patients were studied. Available data included patient demographics, duration of exposure to cold temperature, severity of injury, time to HBOT, duration of therapy, side effects of therapy, concurrent therapies (dressing, anticoagulation, antibiotics), bone scan results, and consequent level of amputation. RESULTS: The cohort consisted mostly of men (18, 81.8%) and patient mean age of 40 years (range, 13-70 years). Ten patients (45.5%) were intoxicated at the time of injury, and psychiatric illness was implicated in 9 (40.9%) patients. Of the presented injuries, 17 (77.3%) had frostbite to the upper extremity. Bone scans were performed on 16 (72.7%) patients. In 4 patients, the absence of radiotracer activity correlated with a protective effect on subsequent amputation levels. All patients received anticoagulant therapy. Of the 22 patients, 16 (72.7%) experienced at least 1 side effect of HBOT, including otologic barotrauma, nausea, vomiting, anxiety, oxygen toxicity seizure, and myopic changes. All study patients recovered without permanent sequelae; it is unclear whether HBOT reduced soft-tissue damage or amputation rates. CONCLUSIONS: This is the largest cohort reported in the literature of patients with frostbite injuries treated with HBOT. Hyperbaric oxygen therapy may show positive impact on the demarcation level of frostbite and, despite the common side effects, it generally causes no long-term sequelae.