Robotic and Plastic Surgery: actuality and prospects for the near future, a scoping review.

OBJECTIVE: This work aims to review the existing use of robotics in plastic surgery. METHODS: A meticulous selection process identified 22 articles relevant to this scoping review. RESULTS: The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery. CONCLUSION: This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.

An Analysis of the Characteristics and Trends in Practicing Plastic Surgeons in California.

BACKGROUND: Studies suggest an increasing trend of plastic surgeons choosing private practice after training, with up to 90% pursuing private practice without future fellowships.1 Previous data showed that 66.7% of graduates from plastic surgery residency programs chose to pursue private practice without future fellowship, while more recent studies estimate this statistic has risen close to 90%.1,2 The literature has yet to characterize the current plastic surgery workforce and changes in its composition over time. This study aims to analyze the characteristics and training of plastic surgeons in California through a comparative study with general surgeons. METHODS: Surgeon demographics were extracted from the Centers for Medicare and Medicaid Services open database. Urban/rural classification and academic affiliation were crosslinked from the Inpatient Prospective System database and sole proprietorship status was cross-linked from the NPI Registry. Summary statistics and logistic regressions with chi-squared analysis were analyzed using STATA/MP17. RESULTS: Our analysis consisted of 3871 plastic and general surgeons in California. Compared to general surgeons, plastic surgeons were less likely to be females (P < 0.000), and more likely to be sole proprietors (P < 0.000), and affiliated with a teaching hospital (P < 0.005). There was no statistically significant difference in the percentage of rural-practicing plastic and general surgeons (P = 0.590). More recent plastic surgery graduates were more likely to be affiliated with an academic hospital (P < 0.0000). The composition of females significantly increased from the older graduated cohort to the most recent one. There was no significant difference in sole proprietorship and rural practice status between the oldest and youngest graduating cohorts. CONCLUSIONS: Although the California plastic surgery workforce is gaining female plastic surgeons and shifting to academic institutions, significant progress in serving rural communities is yet to be made. Our study suggests that there may be a shift in the trend of plastic surgeons opting for private practice, possibly driven by a desire for more stable positions in academia. Continued improvement in diversity and training of future plastic surgeons is needed to alleviate the rural care gap.

Use of stem cell-enriched fat grafts in facial reconstruction: have they demonstrated superiority over autologous fat grafting? / Uso de injertos de grasa enriquecidos con células madre en la reconstrución facial: ¿han demostrado superioridad sobre los injertos de grasa autólogos?

Since the 1990s, big strides have been made in plastic and reconstructive surgery, thanks to the implementation of new techniques and resources for its execution. In cases where restoration is sought for small defects, biosurgery, involving the utilization of stem cells, biomaterials, chemical engineering, and tissue engineering, can be employed. The potential to stimulate the innate regenerative capacity of tissue and generate a persistent response over time, minimizing surgical trauma and re-interventions, lies in stem cell transplantation. However, the evidence published on this matter is very scarce, leading to divergence of opinions, suggestions, and recommendations. The aim of this review is to analyze the most recent evidence concerning the outcomes of using fat grafts enriched with stem cells in facial reconstruction, as compared to autologous fat grafts. The review of the literature demonstrates a marked trend suggesting that fat grafts enriched with stem cells may be superior to autologous grafts in facial reconstruction, with potential benefits in medium-term volume retention and faster attainment of results. (AU)

La cirugía plástica y reconstructiva, ha dado pasos agigantados desde la década de los años 90, con la implementación de nuevas técnicas y recursos para su realización. En los casos de defectos pequeños donde se busca la restauración, se puede hacer uso de la biocirugía, que involucra el uso de células madre, biomateriales, ingeniería química y de tejidos. El trasplante de células madre, tiene el potencial de estimular la capacidad innata regenerativa del tejido, así como de generar una respuesta persistente a lo largo del tiempo, minimizando el trauma quirúrgico y la reintervención. A pesar, de la ventaja plausible, la calidad y cantidad de la evidencia publicada al respecto es muy escasa, ocasionando divergencia de opiniones, sugerencias y recomendaciones. Con base en lo anterior, el objetivo de esta revisión consiste en realizar un análisis de la evidencia más reciente sobre los resultados en el uso de injertos de grasa enriquecidos con células madre en la reconstrucción facial, comparado a los injertos de grasa autólogos. A través de la revisión de la literatura, se pudo evidenciar que, aunque la evidencia es heterogénea a la fecha, existe una tendencia marcada en que el uso de injertos de grasa enriquecidos con células madre, podría ser superior a los injertos autólogos en la reconstrucción facial, con potenciales beneficios en la retención de volumen a mediano plazo y mayor celeridad en la obtención de resultados. (AU)

El uso correcto del teléfono inteligente en la fotografía estética del área facial: consejos y trucos / The correct use of the smartphone in aesthetic photography for the facial area: tips & tricks

Introducción y objetivo: Una galería fotográfica estandarizada con alto valor clínico depende de una correcta técnica, adecuada selección de tecnología y el entendimiento de ambas por el médico. Los teléfonos celulares inteligentes y sus cámaras digitales tienen ventajas de versatilidad, omni-presencia y accesibilidad con el mismo nivel de calidad requerida para fotografía clínica; también ofrecen una alternativa a un costo razonable y son más prácticos, sin embargo, presentan algunas limitantes. El objetivo de este artículo es proponer estrategias para sobreponerse ante estas limitantes y así ajustarse a las normas de estandarización en la fotografía clínica. Material y método: Revisamos la literatura actual sobre uso de teléfonos celulares con cámara digital en Medicina, tomando artículos con múltiples guías sobre estandarización y recomendaciones para fotografía clínica. Buscamos los manuales y las características de un teléfono inteligente iPhone 8s Plus® y una cámara Digital SLR (Single Lens Reflex) Sony® SLT A55V, estudiamos sus características y diferencias, Resultados: Comparando ambas tecnologías, identificamos las diferencias y sus limitantes individuales, con las cuales proponemos una serie de recomendaciones para obtener toma fotográfica mediante teléfono inteligente con cámara digital de tipo y calidad científica dentro de los parámetros de estandarización actuales. Conclusiones: El teléfono inteligente con cámara digital es un dispositivo electrónico versátil, portátil, útil y sencillo de usar para tomas fotográficas de alta calidad científica, siempre y cuando se cuente con un adecuado nivel de entendimiento de la tecnología en uso para superar sus limitaciones sin riesgo de sesgo. (AU)

Background and objective: A standardized photographic gallery with high clinical value depends on a correct technique, adequate selection of technology and the understanding of these by the physician. Smartphones and their digital cameras have advantages of versatility, omnipresence and accessibility with the same level of quality required for clinical photography, they also offer an alternative at a reasonable cost and being more practical, however, they have some limitations. The objective of the paper is to propose strategies to overcome these limitations and thus remain within the guidelines of standardization in clinical photography. Methods: The current literature on the use of smartphones with digital cameras in Medicine is described; articles with multiple guidelines on standardization and recommendations regarding clinical photography were taken. The manuals and characteristics of an iPhone 8s Plus® smartphone and a Sony® SLT A55V Digital SLR (Single Lens Reflex) camera were searched, their characteristics, differences were studied, Results: Comparing both technologies, the differences and their individual limitations were identified with which a series of recommendations were proposed which allow to obtain photographic shots by means of a smartphone with a digital camera of scientific type and quality within the current standardization parameters. Conclusions: Smartphone with a digital camera is a versatile, portable, useful and easy-to-use electronic device for high-quality scientific photographic taking, as long as you have an adequate level of understanding of the technology in use to overcome its limitations without risk of bias. (AU)

Uneven Progress in Gender Equality at Plastic Surgery Conferences: Lessons from a Decade of Meetings.

BACKGROUND: The demographics of plastic surgeons and plastic surgery trainees are changing, reflecting an increase in the diversity of medical school graduates. The authors investigated the gender diversity of speakers at several plastic surgery conferences and evaluated temporal trends over a 10-year period. METHODS: The following societies' conferences and years were included based on the conference agendas available for review: American Society for Aesthetic Plastic Surgery, Plastic Surgery Research Council, American Association of Plastic Surgeons, Northeastern Society of Plastic Surgeons, and American Society for Reconstructive Microsurgery. Differences in the average amount of time spoken were analyzed using an independent one-tailed t test. RESULTS: The number of female speakers and the time allotted to speak increased for all conferences. There was not a consistent difference in the amount of time individual men and women were allotted to speak. Across the five conferences, there was no consistent relationship found between years since board certification and female participation in conference. Gender diversity among speakers at plastic surgery conferences has not kept pace with the increase in female plastic surgery trainees because those who are selected to speak are overwhelmingly men. The hypothesis that a paucity of female speakers reflects the relatively shorter duration of career experience of female plastic surgeons was not supported by these findings. CONCLUSION: It is imperative that conferences increase the participation of women and strive toward more accurately reflecting the burgeoning role that female surgeons have in the field at present and will have in the future.