The Implications of Virtual Learning on Plastic Surgery Education: A National Survey of Plastic Surgery Residents and Fellows.

Background: Graduate medical education during the COVID-19 pandemic has seen the shift to a "virtual learning" format in many aspects of training. The purpose of this study was to describe the perceived strengths and weaknesses of virtual learning compared with a conventional, in-person format. Methods: A 45-question survey was sent to independent and integrated plastic surgery residents and postresidency fellows nationally. The survey collected basic demographic information and evaluated three general categories of virtual learning in comparison to an in-person format: (1) time, (2) learning proficiency, and (3) collaboration. Results: In total, 108 surveys were submitted from 48 different training programs. Participants reported that virtual learning was more efficient (mean: 3.9), conducive to more free time (mean: 3.9), and a more comfortable medium for expressing opinions (mean: 3.5) and asking questions (mean: 3.6) compared with an in-person format. When stratified between training levels, the PGY 1-3 group reported more difficulties in exam preparedness (P = 0.05), motivation to study (P = 0.01) and less time-saving benefits (P = 0.05) with a virtual format than the PGY 4+ group. Lastly, respondents who had higher self-reported levels of multitasking were found to have lower mean Likert scale scores on all questions related to "time," "learning proficiency," and "collaboration" (P < 0.01). Conclusions: A virtual and in-person hybrid approach toward plastic surgery education may be beneficial for encouraging flexibility. Our results demonstrate impairment with collaboration and learning proficiency with a virtual format, especially with increased multitasking, but increased comfort with expressing opinions and asking questions.

A Comparison of Perioperative Complications of Hand and Wrist Arthroplasty for Osteoarthrosis by Orthopedic Versus Plastic Surgeons.

BACKGROUND: Arthroplasty is commonly performed in the management of osteoarthrosis of the hand and wrist by orthopedic or plastic surgeons with a fellowship in hand. The differences between operative outcomes between the 2 groups have not been described. Therefore, we analyzed a national database to determine acute outcomes between orthopedic and plastic surgery when performing arthroplasty for osteoarthrosis of the hand and wrist. METHODS: A retrospective cross-sectional analysis was performed by including patients with osteoarthrosis of the hand and wrist by International Classification of Diseases codes. Demographic, operative, and outcome variables were collected. Pearson χ2 and Fischer exact tests were used for categorical variables, while a Mann-Whitney U test was performed for continuous variables. Multivariate regression analysis was performed to determine strength of predictors. RESULTS: There were 3721 patients who received arthroplasty for osteoarthrosis of the hand and wrist from 2007 to 2020. Most cases were performed by orthopedic surgeons (82.7%); however, there were an increasing number of surgeries performed by plastic surgeons. Most cases were performed on the intercarpal or carpometacarpal joints (81.7%). The incidence of acute complications was low (1.9%) with superficial surgical site infections (SSIs) being the most common complication. Univariate analysis found that plastic surgery may result in higher chances of superficial SSIs, but multivariate analysis indicated that there were no significant differences between the 2 groups. CONCLUSION: There were no significant differences on multivariate regression analysis between plastic and orthopedic surgeons, suggesting that both can perform arthroplasty of the hand and wrist without safety concerns.

Effect of the COVID-19 Pandemic on Global Interest in Plastic Surgery.

Introduction: Due to the SARS-CoV-2 (COVID-19) pandemic, many elective surgeries were canceled, including most aesthetic plastic surgery procedures. Although studies have shown COVID-19's effect on plastic surgery in the United States, no study to date has examined the international interest in plastic surgery procedures after the start of the COVID-19 pandemic. Thus, we sought to find this effect using the Google Trends tool. Material and Methods: The most common cosmetic procedures and top countries with the highest plastic surgery volume were selected from the International Society of Plastic Surgeons report and used as the search terms for Google Trends. Weekly search data from each procedure and country were collected from March 18, 2018 to March 13, 2022, split into 2 periods according to the start of the US COVID-19 lockdown, and compared. Results: Among the countries, the United States had the most plastic surgery interest after the COVID-19 pandemic, with India and Mexico closely following. On the other hand, Russia and Japan had the fewest changes in procedure interest. Regarding specific procedures, interest in breast augmentation, forehead lift, injectable filler, laser hair removal, liposuction, microdermabrasion, and rhytidectomy increased in all countries after the COVID-19 pandemic. Conclusions: After COVID-19, there has been increasing interest in almost all plastic surgery procedures globally, especially nonsurgical procedures and facial plastic surgery, with the greatest increases in the United States, India, and Mexico. These results can help inform plastic surgeons which procedures to focus on and which devices or technologies to invest in that are specific to their country.

Changing Aesthetic Surgery Interest in Men: An 18-Year Analysis.

BACKGROUND: Historically, men have been shamed if they cared seemingly too much about their appearance and especially, if they pursued aesthetic surgery. However, due to the changing landscape of the culture, this stigma has seemed to decrease. Men have diverse and quickly changing interests in particular procedures that have not been readily explored in the currently available reports. To examine this, we analyzed interest in specific plastic surgery procedures in men over the last two decades using the Google Trends tool. METHODS: The most common cosmetic procedures were chosen from the American Society of Plastic Surgeons website and served as the search terms for the Google Trends tool from 2004 to 2021. All 19 procedures were examined for overall trends and for changes in the last decade through comparing the data in bisected time periods. RESULTS: Interest in all plastic surgery procedures in men increased since 2004 except for breast reduction. Most notably, jawline filler, Botox, microneedling, lip filler, chemical peel, CoolSculpting, and butt lift had the largest trend increases. In the last decade, all procedures showed a significant increase in interest. CONCLUSIONS: While surgical volume data are valuable, our study shows that Google Trends is a beneficial tool to predict quickly changing and specific trends, especially as the patient population of plastic surgery grows with increased diversity and generational changes. Our study shows that there is an increase in male-centered plastic surgery procedures, especially nonsurgical facial procedures. Male interest in plastic surgery will continue to increase with time. 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   www.springer.com/00266 .

Online Patient Reviews of Breast Reconstruction: RealSelf Analysis.

RealSelf is an online community that hosts an expansive number of online reviews for cosmetic and reconstructive plastic surgery procedures. The purpose of this study is to analyze patient satisfaction with breast reconstruction procedures from RealSelf to determine factors contributing to a positive or negative patient experience. Methods: The breast reconstruction category from RealSelf.com was analyzed using a web crawler-based application built from Python and Selenium. Reviews were collected from May 2009 to November 2021. Information including RealSelf's inherent "worth it" ranking system, review text, the number of submitted photographs, and the number of readers who found the review helpful was captured. The content of the review was then independently reviewed by the authors and was categorized with key factors that determined positive or negative reviews. Results: A total of 3451 breast reconstruction reviews were collected. After the authors analyzed each review, 3225 (94.33%) were identified as positive reviews. The most common factors associated with positive reviews were physician demeanor (n = 2600, 31.7%), aesthetic outcome (n = 1955, 23.8%), or staff (n = 1543, 18.8%), while negative reviews were associated with unfavorable aesthetic outcome (n = 94, 28.9%), physician demeanor (n = 82, 25.2%), or postoperative complications (n = 75, 23.1%). Conclusions: Although there are surveys that analyze patient satisfaction for breast reconstruction, there has not been a study that analyzed a large online review database. Predominating factors in both positive and negative reviews were physician demeanor and aesthetic outcome.

The Positive Patient Experience: A Comprehensive Analysis of Plastic Surgery Online Reviews.

BACKGROUND: Subjective online physician evaluation is an important component of patient decision-making. Understanding reviews may improve satisfaction and build positive online reputation. OBJECTIVES: The aim of this study was to analyze and compare the top predictive factors driving patient satisfaction across the most popular plastic surgery procedures. METHODS: Online reviews were analyzed from RealSelf, Yelp, and Google for the 5 highest-rated plastic surgeons in 6 US metropolitan areas. Blank, non-English, consultation, duplicate, and unrelated reviews were excluded. Data from free-text reviews included physician rating, patient-reported reasons for rating, procedure, and complications. Univariate analysis was performed to compare predictive factors of online ratings. RESULTS: In total, 11,078 reviews were included. RealSelf had the highest average rating (4.77), and Yelp had the lowest (4.66). Reviews in Miami, Philadelphia, New York City, and Chicago were mostly published on RealSelf, whereas Houston and Los Angeles mostly used Google and Yelp, respectively. Reconstructive procedures were rated significantly higher than cosmetic procedures (P = 0.035). Aesthetic appearance was the strongest predictor of rating across all procedures. Buccal fat removal (98.8%) and abdominoplasty (98.1%) had the highest satisfaction, and Brazilian butt lift had the lowest (88.2%) (P < 0.001). Additional significant contributors included staff interaction, bedside manner, health outcomes, complications, and postoperative care (P < 0.001). CONCLUSIONS: Although aesthetic outcome is an important predictor of satisfaction, other aspects of care, such as bedside manner and staff interaction, provide an important foundation of support. Excellent patient-surgeon communication and postoperative care may mitigate patient dissatisfaction and elicit high-satisfaction online patient reviews.

The Greater Palatine "Notch": Clinical Sequelae of an Incomplete Greater Palatine Foramen.

The anatomy of the greater palatine foramen has variation with regard to location, but there have been no reports on the absence of a complete foramen. We present 2 cases of pediatric patients with cleft palates possessing a greater palatine "notch" as opposed to a bony foramen. Awareness of this anomaly is advantageous in preventing injury to the greater palatine vessels during palatoplasty.

Volumetric analysis of simulated alveolar cleft defects and bone grafts using cone beam computed tomography.

BACKGROUND: Cone beam computed tomography allows for a significantly lower radiation dose than conventional computed tomographic scans, with generation of accurate images of the maxillofacial skeleton. The authors investigated its accuracy in the volumetric analysis of alveolar cleft defects and simulated bone grafts. METHODS: Five simulated alveolar clefts were created using a burr drill in three dry pediatric skulls and filled with simulated bone grafts. Pregrafting and postgrafting cone beam computed tomographic scanning of skulls was performed using specialized imaging software. The authors compared actual volumes of the simulated bone grafts obtained using a water displacement technique with scan-derived volumes of both the grafts and the defects. RESULTS: The average of the five simulated bone grafts calculated by cone beam computed tomography scanning was 0.380 ml, which was lower than their mean volume of 0.392 ml calculated by water displacement. The percentage difference between measurements ranged from 2.9 to 8.6 percent (mean, 4.86 percent). The mean of the simulated defects of 0.399 ml derived from scanning was higher than the actual mean volume of 0.392 ml derived by water displacement. The mean difference in defect comparison was 2.52 percent. There was no statistically significant difference between real volume and scan-derived graft and defect volume. CONCLUSIONS: Cone beam computed tomography calculation of simulated alveolar cleft and bone graft volume is precise and accurate. The volume of bone graft needed to fill alveolar defects can be accurately predicted using volume measurements of the bony defect. These findings further validate its use in the perioperative assessment of alveolar grafting.

Late complications of chest wall reconstruction: management of painful sternal nonunion.

Although rare, sternal nonunion after median sternotomy or traumatic injury is associated with a high rate of morbidity. Pain and sternal clicking are two of the most common complaints and reasons these patients seek evaluation and treatment. Diagnosis of sternal nonunion is based on a thorough history and physical examination and can be confirmed with subsequent radiographic imaging. The treatment for symptomatic sternal nonunion requires stable fixation of the bony fragments and chest wall after the debridement of all nonviable bony and soft tissue by the cardiothoracic or reconstructive surgery team. Multiple fixation techniques have been described and incorporate a wide variety of materials including combinations of wires, cables, pins, bands, staples, and plates. Most recently, several new commercially available plating systems have demonstrated low recurrence and complication rates and resolution of the patient's symptoms on follow-up evaluation. Included in this review are three cases demonstrating the management of symptomatic sternal nonunion using these new techniques and review the history, diagnosis, risk factor, and classification, as well as several of the previously described fixation methods.