The Ethics and Responsibilities of Social Media Usage by Plastic Surgeons: A Literature Review.

BACKGROUND AND OBJECTIVES: Social media has revolutionised how plastic surgeons advertise their work and promote their services, but concerns have been raised regarding the ethics of these practices. This review aims to identify said concerns and develop measures to address them. METHODS: PubMed, Cochrane and Medline were searched for studies assessing the ethics of social media use by plastic surgeons. Five search terms were used and 23 studies identified. Results were catalogued according to which principle of medical ethics was infringed. RESULTS: Autonomy: Patients must not be coerced into allowing their operative media to be shared and content anonymised by removing identifiable features and scrubbing metadata. Beneficence: It is difficult to balance the benefit to patients of posting photographs for educational purposes with the risk of identifiable features being present, particularly within craniofacial surgery. Non-maleficence: Taking operative media could be a distraction from the patient and lengthen the procedure which could lead to harm. Any content posted on social media should be adapted to avoid trivialisation or sexualisation. Justice: Surgeons should not entertain their audience to increase their following at the expense of patients. CONCLUSIONS: Greater oversight of social media use by plastic surgeons is required to avoid patient harm and tarnishing of the specialty's professional standing. Professional bodies should be tasked with devising a course dedicated to the responsible use of these platforms. This should ensure the public's trust in the specialty does not become eroded and patients are not harmed by unethical social media use. This review highlights the relevant shortfalls of SoMe use by plastic surgery Several proposals are made to reduce the incidence of these shortfalls and to ensure SoMe is used in a professional and responsible manner It also lists areas of the specialty where SoMe is underused and could be of help, such as academia LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

The use of artificial dermal substitutes for repair of the donor site following harvesting of a radial forearm free flap: A systematic review.

BACKGROUND: Artificial dermal substitutes (ADMs) have been trialled to improve outcomes at the donor site following the harvesting of a radial forearm free flap (RFFF). This systematic review compares donor site aesthetic and functional outcomes, with the use of an ADM versus conventional practice. METHODS: The databases Medline, Embase, Cochrane Library, Web of Science (Core Collection), and Scopus were searched for retrospective, prospective, and case-control studies and randomised control trials (RCTs) involving any ADM. Studies with adult patients having undergone RFFF harvesting and donor site repair with an ADM, commenting on appropriate clinical outcomes and without high risk of bias, were included. Direction-of-effect analysis was performed on relevant groupings of studies since heterogeneity in outcome measurement precluded meta-analyses. RESULTS: Across eight non-comparative studies included, 132 patients had donor site coverage with AlloDerm™, Integra™, Matriderm™, or Rapiderm. Across 11 comparative studies included, 240 patients had donor site coverage with fish-skin matrix, AlloDerm™, amniotic membrane, MegaDerm™, Hyalomatrix, Integra™, or Matriderm™. Five out of 11 comparative studies demonstrated superior aesthetic outcomes with ADMs according to at least one aesthetic metric compared to controls, whilst 6/11 demonstrated superior functional outcomes with ADMs. No study demonstrated poorer aesthetic or functional outcomes with an ADM compared to conventional practice. CONCLUSIONS: In summary, the lack of studies reporting poorer outcomes with them compared to conventional practices, and a cumulative effect direction in their favour, provide strong indications in support of the use of AlloDerm™, Integra™, or Matriderm™ grafts. Further comparative studies, including RCTs, are needed to reinforce these initial indications.

Comparing the safety profiles of implants and autologous fat grafting in gluteal augmentation: A systematic review.

Gluteal augmentation has become a popular esthetic procedure since its inception. The main methods are augmentation using implants or autologous fat grafting, which is the harvesting and grafting of patients' own fat tissue. The last review comparing the safety of these methods was written 7 years ago, which warrants the writing of a new one. PubMed, Cochrane, and Medline were searched for studies focusing on the methods of gluteal augmentation listed previously. Five search terms were used and 15 studies fulfilled the criteria. The data were cataloged according to the method described and outcomes compared. Seven articles focused on gluteal implants and another seven assessed autologous fat grafting, whereas one detailed both. The most common complications in 524 implant procedures were wound dehiscence (9.16%), excessive implant palpability (5.92%), and seroma (3.82%), with an overall complication rate of 25%. The most common complications in 1788 gluteal fat augmentation procedures were seroma (6.9%), infection (3.0%), and transient sciatic paresthesia (1.0%), with an overall complication rate of 13%. Several articles listed satisfaction figures, but these were not assessed because this article was not powered to assess this outcome. Overall, gluteal augmentation using autologous fat grafting leads to fewer postoperative complications than implants and allows greater contouring of the buttocks and the surrounding areas. However, it can also be a far more dangerous procedure if certain recommendations are not followed.

A Comparison Between Piezosurgery and Conventional Osteotomies in Rhinoplasty on Post-Operative Oedema and Ecchymosis: A Systematic Review.

Piezosurgery use has become increasingly prevalent in osteotomies. Piezoelectric ultrasound waves can cut bone effectively, and some studies have shown reduced post-operative morbidities compared to conventional osteotomies. Oedema and ecchymosis are common complications of rhinoplasty and can impact patient satisfaction, wound healing, and recovery. We aim to provide an up-to-date comparison of post-operative oedema and ecchymosis in piezosurgery and conventional osteotomies. A literature search was conducted using the following online libraries; Pubmed, Cochrane, Science Direct, and ISRCTN (International Standard Randomised Controlled Trial Number). English publications between 2015 and 2020 were included. A systematic review was completed, and a comparison of oedema and ecchymosis in piezosurgery and conventional osteotomies was examined alongside other outcomes such as pain, mucosal injury, and surgery time. Eight randomised controlled trials (RCTs) met our criteria with a combined total of 440 patients: 191 male and 249 female. Piezosurgery had statistically significant (p < 0.05) reduction in short-term oedema compared to conventional osteotomies in 75% of the papers included, and in 50% this persisted across the whole follow-up period. Similarly, ecchymosis scoring was initially statistically lower (p < 0.05) in piezosurgery in 87.5% of the RCTs, and in 75% this persisted across the whole follow-up period. A reduction in pain (p < 0.05) and mucosal injury (p < 0.05) was also seen in piezoelectric osteotomies. The length of surgery time varied. Piezoelectric osteotomies reduce oedema and ecchymosis compared to conventional osteotomies, in addition to improving pain and mucosal injury. However, disadvantages such as length of surgery time and cost have been reported. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Resumption of Cosmetic Surgery During COVID - Experience of a Specialised Cosmetic Surgery Day-case Hospital.

The novel coronavirus outbreak (COVID-19) in 2019 resulted in the suspension of all elective hospital procedures during the height of the pandemic in the UK. The Clinic in London is one of the first day-case hospitals to resume cosmetic surgery in a post-COVID-19 clinical environment, whilst also employing the use of virtual consultations. Details of the protocol implemented by the Clinic to allow the safe resumption of cosmetic surgery are stated in this paper. The volume of procedures at the Clinic saw a significant increase post-lockdown; reasons as to why this occurred are also explored in this paper. The disruption of cosmetic practice during lockdown can be said to have resulted in a backlog of procedures once lockdown restrictions began to ease. Whilst this may be true, we believe that there are other confounding factors regarding what may have influenced the rise in cosmetic surgery during the pandemic, including the privacy of working from home and the increased exposure to video conferencing software.

Basic skin surgery interactive simulation: system description and randomised educational trial.

BACKGROUND: Learning the skills required for open surgery is essential for trainee progression towards more advanced technical procedures. Simulation supports skill enhancement at a time when exposure to actual surgical procedures and traditional apprentice-based teaching has declined. The proliferation of smartphone and tablet devices with rich, touch sensitive displays and increasing processing power makes a compelling argument for expanding accessibility further by development of mobile virtual simulations for training on demand in any setting, at any time.We present a tablet-based mobile simulation App for educating surgical trainees in the planning and surgical procedures involved in facial lesion resection and local skin flap surgery. METHODS: Novel algorithms were developed and modules included in a mobile simulation App to teach concepts required for three defect reconstruction techniques: elliptical closure, bilateral advancement (H flap) and the semi-circular rotation flap, with additional resources such as videos and formal guidelines made available at relevant points in the simulation. A randomised educational trial was conducted using the mobile simulation App with 18 medical students that were divided equally into two groups: the intervention group learning using the new mobile simulation App, and a control group, undergoing traditional text-based self-study. The students were then assessed on knowledge and skills' acquisition through an MCQ and a task analysis score. RESULTS: There was a statistically significant difference between the scores of students in the intervention group and the students in the non-intervention group in both forms of assessment, with an average multiple-choice assessment score of 62.95% points versus 56.73%, respectively (p = 0.0285), and an average task analysis score of 3.53 versus 2.58, respectively (p = 0.0139). CONCLUSIONS: Touch-based simulation provided an efficient and superior method of learning three different local flap techniques for facial soft tissue reconstruction, and helped recalling steps involved in the surgery in a fluid manner that also improved task performance.

Plastic Surgery Undergraduate Training: How a Single Local Event Can Inspire and Educate Medical Students.

INTRODUCTION: Plastic surgery teaching has a limited role in the undergraduate curriculum. We held a 1-day national course in plastic surgery for undergraduates. Our aim was to introduce delegates to plastic surgery and teach basic plastic surgical skills. We assessed change in perceptions of plastic surgery and change in confidence in basic plastic surgical skills. METHOD: The day consisted of consultant-led lectures followed by workshops in aesthetic suturing, local flap design, and tendon repair. A questionnaire divided into 3 sections, namely, (1) career plans, (2) perceptions of plastic surgery, and (3) surgical skills and knowledge, was completed by 39 delegates before and after the course. Results were presented as mean scores and the standard error of the mean used to calculate data spread. Data were analyzed using the Mann-Whitney U test for nonparametric data. RESULTS: Career plans: Interest in pursuing a plastic surgery career significantly increased over the course of the day by 12.5% (P < 0.0005).Perceptions: Statistically significant changes were observed in many categories of plastic surgery, including the perception of the role of plastic surgeons in improving patient quality of life, increased by 18.31% (P = 0.063). Before the course 10% of delegates perceived plastic surgery to be a superficial discipline and 20% perceived that plastic surgeons did not save lives. After completing the course, no delegates held those views.Surgical skills: Confidence to perform subcuticular and deep dermal sutures improved by 53% (P < 0.0001) and 57% (P < 0.0001), respectively. Delegates' subjective understanding of the basic geometry of local flaps improved by 94% (P < 0.0001). Interestingly, before the course, 2.5% of delegates drew an accurate modified Kessler suture compared with 87% of on completion of the course. CONCLUSIONS: A 1-day intensive undergraduate plastic surgery course can significantly increase delegates' desire to pursue a career in plastic surgery, dispel common misconceptions about this field, and increase their confidence in performing the taught skills. The results of this course demonstrate that a 1-day course is an effective means of teaching basic plastic surgery skills to undergraduates and highlights the potential role for local plastic surgery departments in advancing plastic surgery education.

A systematic review of the evolution of laser Doppler techniques in burn depth assessment.

Aims. The introduction of laser Doppler (LD) techniques to assess burn depth has revolutionized the treatment of burns of indeterminate depth. This paper will systematically review studies related to these two techniques and trace their evolution. At the same time we hope to highlight current controversies and areas where further research is necessary with regard to LD imaging (LDI) techniques. Methods. A systematic search for relevant literature was carried out on PubMed, Medline, EMBASE, and Google Scholar. Key search terms included the following: "Laser Doppler imaging," "laser Doppler flow," and "burn depth." Results. A total of 53 studies were identified. Twenty-six studies which met the inclusion/exclusion criteria were included in the review. Conclusions. The numerous advantages of LDI over those of LD flowmetry have resulted in the former technique superseding the latter one. Despite the presence of alternative burn depth assessment techniques, LDI remains the most favoured. Various newer LDI machines with increasingly sophisticated methods of assessing burn depth have been introduced throughout the years. However, factors such as cost effectiveness, scanning of topographically inconsistent areas of the body, and skewing of results due to tattoos, peripheral vascular disease, and anaemia continue to be sighted as obstacles to LDI which require further research.

Validation of open inguinal hernia repair simulation model: a randomized controlled educational trial.

BACKGROUND: A hernia repair open surgical simulation computer software was developed at Imperial College London. A randomized controlled educational trial was conducted to investigate the benefit of the simulation on the development of procedural knowledge. METHODS: Medical students in their clinical years were invited to participate in the trial. Students were block randomized to 4 groups: G1--Interactive Simulation; G2--Non-interactive Simulation; G3--Video Tutorial; G4--Control. On completion, they were objectively assessed on their ability to recall the tasks involved in an open inguinal hernia repair in the form of a multiple choice question (MCQ) and a simulated discussion with a consultant surgeon. RESULTS: Fifty-six students completed the study. Each arm carries similar baseline scores (pre-intervention MCQ) with means 43.33, 38.92, 38.33, and 39.57 in G1 to G4, respectively. MCQ score improvements and final assessment scores proved better in the intervention groups (1, 2, and 3) compared to controls. CONCLUSION: The interactive simulation has shown an objective benefit in teaching medical students the anatomical and procedural knowledge in performing an open inguinal hernia repair.

Perianal Paget's disease: a diagnostic dilemma.

Perianal Paget's disease (PPD) is part of the spectrum of pagetoid skin lesions occurring outside the region of the nipple/areolar complex that are collectively referred to as extramammary Paget's disease (EMPD). However, unlike Paget's disease of the breast, which in the vast majority of cases is invariably associated with an underlying ductal carcinoma, most cases of EMPD occur as either insitu or invasive adenocarcinomas with visceral malignancy being a rare entity. We present a case of a 50-year-old man who was referred to us with PPD. This case highlights the difficulties associated with making a clinical diagnosis of this condition. Furthermore, investigative workup to exclude possible malignancy with associated metastatic spread as well as the treatment options available are also discussed. In addition, this case highlights the need for a multidisciplinary team approach when dealing with this difficult problem.

Open surgical simulation--a review.

BACKGROUND: Surgical simulation has benefited from a surge in interest over the last decade as a result of the increasing need for a change in the traditional apprentice model of teaching surgery. However, despite the recent interest in surgical simulation as an adjunct to surgical training, most of the literature focuses on laparoscopic, endovascular, and endoscopic surgical simulation with very few studies scrutinizing open surgical simulation and its benefit to surgical trainees. The aim of this review is to summarize the current standard of available open surgical simulators and to review the literature on the benefits of open surgical simulation. CURRENT STATE OF OPEN SURGICAL SIMULATION: Open surgical simulators currently used include live animals, cadavers, bench models, virtual reality, and software-based computer simulators. In the current literature, there are 18 different studies (including 6 randomized controlled trials and 12 cohort studies) investigating the efficacy of open surgical simulation using live animal, bench, and cadaveric models in many surgical specialties including general, cardiac, trauma, vascular, urologic, and gynecologic surgery. The current open surgical simulation studies show, in general, a significant benefit of open surgical simulation in developing the surgical skills of surgical trainees. However, these studies have their limitations including a low number of participants, variable assessment standards, and a focus on short-term results often with no follow-up assessment. FUTURE OF OPEN SURGICAL SIMULATION: The skills needed for open surgical procedures are the essential basis that a surgical trainee needs to grasp before attempting more technical procedures such as laparoscopic procedures. In this current climate of medical practice with reduced hours of surgical exposure for trainees and where the patient's safety and outcome is key, open surgical simulation is a promising adjunct to modern surgical training, filling the void between surgeons being trained in a technique and a surgeon achieving fluency in that open surgical procedure. Better quality research is needed into the benefits of open surgical simulation, and this would hopefully stimulate further development of simulators with more accurate and objective assessment tools.

Khat: social habit or cultural burden? A survey and review.

The aim of this article was to investigate the psychological and socioeconomic ramifications of Khat on its users and their communities. A thorough literature review was undertaken and a questionnaire was distributed among a Somali community in South London. From the 62 individuals surveyed, 79% were born in Somalia and 15% in the United Kingdom. Participants were asked to answer specific questions about their Khat use, their attitudes toward Khat use, and its perceived effect on their communities. The harms of Khat use are numerous, although they are not well recognized by its users. Khat's legal status means that it is widely available. Measures to reconsider its legality should be considered given the harm on its users.

Development and validation of a computerized model of smiling: Modeling the percentage movement required for perception of smiling in unilateral facial nerve palsy.

BACKGROUND: The inability to smile stands out as a notable difficulty for individuals with facial nerve palsies; a problem that facial reanimation surgery aims to rectify. However, smile reconstruction currently lacks quantitative data by which to objectively measure outcomes. This study aims to identify the relative importance of different oral muscles in terms of smiling, and explore the percentage function that needs to be restored for a smile to be perceived by an observer. METHODS: A computer animation tool was developed to model the oral facial muscles and demonstrate the facial expressions produced by contraction of different muscle groups. By programming a variable unilateral paralysis of the zygomaticus major, the effects of 0-100% function of this muscle can also be seen in a further set of animations using the basic muscular structure of a smile to produce a computerized proxy smile. These animations were shown to 75 adults from the general population who reported those expressions they perceived as a smile. RESULTS: The only facial expression consistently associated with a perceived smile was caused by the combined contraction of the zygomaticus major and the levator anguli oris (P < 0.001). This concurs with previously reported observations of the human smile. Over 70% of the subjects were able to perceive a smile with just 40% function of the unilateral paralyzed zygomaticus major. CONCLUSIONS: These results present an objective target for facial reanimation surgery by which outcomes may be measured. This computerized model also provides a valuable tool for patient education during pre-operative consent.

Giant intrathoracic lipoma presenting as a lump in the supraclavicular fossa.

A 25-year-old man presented with a lump in the supraclavicular fossa. Subsequent investigations showed that the patient had a giant intrathoracic lipoma that has caused the deviation of his trachea to the left and had encased his great vessels. Multidisciplinary discussions concluded that tracheal stenting was most suitable for the patient. We describe details of his presentation, clinical findings and discuss the management options of a giant intrathoracic lipoma.