A Procedure and Complication-Specific Assessment of Smoking in Aesthetic Surgery: A Systematic Review and Meta-Analysis.

Background: The popularity of aesthetic surgery is on the rise, as is patients' expectations towards excellent surgical results. In order to meet these expectations, risk factors that hinder desired outcomes, such as smoking, need to be identified and addressed. To that end, the present study summarizes an updated systematic review focused on the effects of smoking on cosmetic surgical procedures and outcomes. Methods: A systematic review of studies comparing aesthetic surgical outcomes by procedure, between tobacco smokers and non-smokers was carried out, querying PubMed, Embase and the Cochrane databases. Data regarding surgical outcomes were extracted and meta-analyzed by a random effects model in conjunction with the Mantel-Haenszel statistical method. Results: Eighty-two studies were included in the final synthesis. Abdominoplasty/panniculectomy (n = 19 cohorts) and breast reduction (n = 27 cohorts) were the most common types of procedures included in this review. Other than mastopexy and rhinoplasty, smoking conferred a statistically significant increased risk of overall complications for all studied aesthetic procedures. Conclusions: The data demonstrates that smoking is a clear risk factor for the vast majority of aesthetic plastic surgeries studied. Although our meta-analysis suggests that smoking is not a risk factor for complications in mastopexies and rhinoplasties, these two specific analyses may have been biased, and should therefore be re-evaluated with future additional evidence. The results of this systematic review confirm the importance of smoking cessation and education relative to the outcomes of common cosmetic surgical procedures.

Historique : La popularité de la chirurgie esthétique est en hausse, tout comme les attentes des patients envers l'excellence des résultats chirurgicaux. Pour répondre à ces attentes, il est nécessaire de nommer et de résoudre les facteurs de risque qui entravent les résultats souhaités, tels que le tabagisme. À cet effet, la présente étude résume une analyse systématique à jour des effets du tabagisme sur les interventions et les résultats en chirurgie esthétique. Méthodologie: Dans une analyse systématique des études, les chercheurs ont comparé les résultats de la chirurgie esthétique chez des fumeurs et des non-fumeurs en fonction de l'intervention, après une fouille dans les bases de données de PubMed, d'Embase et de Cochrane. Ils ont extrait les données relatives aux résultats des opérations et ont procédé à la méta-analyse à l'aide d'un modèle à effets aléatoires, conjointement avec la méthode statistique de Mantel-Haenszel. Résultats : Au total, les chercheurs ont inclus 82 études dans la synthèse définitive. Les interventions les plus fréquentes étaient les abdominoplasties et les panniculectomies (n = 19 cohortes), de même que les réductions mammaires (n = 27 cohortes). À part dans les cas de mastopexie et de rhinoplastie, le tabagisme provoquait une augmentation statistiquement significative du risque de complications globales dans tous les cas d'interventions esthétiques à l'étude. Conclusions : Les données ont démontré que le tabagisme est un facteur de risque évident dans la majorité des chirurgies esthétiques à l'étude. Même si la méta-analyse a indiqué que le tabagisme n'est pas un facteur de risque de complications dans les cas de mastopexie et de rhinoplastie, ces deux analyses peuvent avoir été biaisées et devraient donc être réévaluées d'après de futures données complémentaires. Les résultats de cette analyse systématique confirment l'importance de l'arrêt du tabagisme et de l'éducation sur les résultats des interventions chirurgicales esthétiques courantes.

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.

The effects of COVID-19 on Canadian surgical residents' education and wellness.

Background: The COVID-19 pandemic has challenged health care systems. We sought to comprehend the impact of the COVID-19 pandemic on surgical residents' education and mental well-being across Canada. Methods: An online 51-question survey was distributed to surgical residents across all 17 Canadian post- graduate surgical residency programs. The questionnaire contained questions concerning demographic factors, perceived effects of COVID-19 pandemic on surgical training and residents' mental health (categorically demonstrating whether it improved, stayed the same, or worsened). Health habits were measured as continuous variables and compared before and during the pandemic. Additionally, participants reported the performance of wellness offices' response to their needs during this crisis. Results: A total of 122 out of 650 (19%) residents from all surgical specialities anonymously completed the survey. The majority (68%) reported a worsening in their surgical training. 94% of participants favored online teaching as a complementary method to in-person teaching. As to health habits, 38% reported a rise in their alcohol consumption and time spent seated. Only a minority (25%) felt happier and 41% reported experiencing more anxiety in comparison to surgical training pre-COVID-19. Merely 14% reported benefitting from wellness programs. Conclusion: The COVID-19 pandemic had a negative effect on the perceived quality of surgical training, education, and resident mental health. There is an urgent need to reconsider the implemented measures in medical education and urge us to develop better agendas to face the current or future waves.

Contexte: La pandémie de la COVID-19 a mis au défi les systèmes de soins de santé. Nous avons tenté de mesurer les impacts de la pandémie sur la formation et le bien-être mental des résidents en chirurgie au Canada. Méthodes: Un sondage en ligne comportant 51 questions a été effectué auprès des résidents des 17 programmes de résidence en chirurgie au Canada. Les questions concernaient les facteurs démographiques et les effets perçus de la pandémie de la COVID-19 sur la formation en chirurgie et sur la santé mentale des résidents (indiquant si leur santé mentale s'était améliorée, si elle était restée inchangée ou si elle s'était détériorée). Les habitudes de santé ont été mesurées en tant que variables continues, et comparées avant et pendant la pandémie. De plus, les participants se sont prononcés sur la capacité des services d'aide au bien-être de répondre à leurs besoins pendant la crise. Résultats: Au total, 122 des 650 résidents (19 %), toutes spécialités chirurgicales confondues, ont répondu au sondage de manière anonyme. La plupart des participants (68 %) ont signalé une détérioration de leur formation en chirurgie et 94 % d'entre eux se sont dits favorables à l'enseignement en ligne comme méthode complémentaire à l'enseignement en personne. En ce qui concerne les habitudes de santé, 38 % des participants ont signalé une augmentation de leur consommation d'alcool et du temps passé assis. Une minorité de résidents (25 %) se sont sentis plus heureux et 41 % ont déclaré éprouver plus d'anxiété dans leur formation chirurgicale qu'avant la pandémie. Seulement 14 % des participants affirment avoir profité des programmes d'aide au bien-être. Conclusion: La pandémie de la COVID-19 a eu un effet négatif sur la perception des résidents quant à la qualité de la formation chirurgicale, de l'éducation et de leur santé mentale. Il est urgent de revoir les mesures mises en œuvre dans l'enseignement médical et d'élaborer de meilleurs plans d'action pour faire face à la vague actuelle ou toute autre vague future.

Open Versus Laparoscopic Surgical Management of Rectus Diastasis: Systematic Review and Pooled Analysis of Complications and Recurrence Rates.

BACKGROUND: Rectus diastasis (RD) is defined as widening of the linea alba and laxity of the abdominal muscles. It can be treated via a wide array of both conservative and surgical modalities. Due to the quickly evolving nature of this field coupled with the multiple novel surgical modalities described recently, there is a need for an updated review of surgical techniques and a quantitative analysis of complications and recurrence rates. METHODS: A systematic review of PUBMED and EMBASE databases was preformed to retrieve all clinical studies describing surgical management of RD. Pooled analyses were preformed to assess recurrence and complication rates after both open and laparoscopic RD repairs (after controlling for herniorrhaphy). RESULTS: A total of 56 papers were included in this review. In patients who underwent both an RD and a herniorrhaphy, there was no significant difference in recurrence rates between open (0.86%) and laparoscopic repairs (1.6%) (p > 0.05). Similarly, in patients who underwent RD repair without a herniorrhaphy, there was no significant difference in recurrence rates between open (0.89%) and laparoscopic repairs (0%) (p > 0.05). The most common complications reported were seroma, skin dehiscence, hematoma/post-operative bleeding, and infection. After controlling for a herniorrhaphy, there were no significant difference in total complication rates between open and laparoscopic RD repair. The total complication rates in patients who underwent an open RD repair with a herniorrhaphy were 13.3% compared to 14.5% in patients who underwent laparoscopic repairs (p > 0.05). Similarly, the total complication rates in patients who underwent RD repair without a herniorrhaphy were 11.8% in patients who underwent open repairs compared to 16.2% in their counterparts who underwent laparoscopic repairs (p > 0.05). CONCLUSION: Both open and laparoscopic approaches are safe and effective in repairing RD in patients with and without concurrent herniorrhaphy. Future research should report patient reported outcomes to better differentiate between different surgical approaches.

Neurorrhaphy of anterior and posterior interosseous nerves in the prevention of neuroma following a radical neurectomy: A case report.

Selective wrist denervation is a surgical technique frequently performed for the treatment of chronic wrist pain. While this technique is often effective in pain reduction, it is still associated with certain complications such as pain recurrence secondary to neuroma formation. We present a case report that details the clinical case of a young yoga teacher suffering from debilitating chronic wrist pain, refractory to conservative treatments. We describe a new surgical technique for the treatment of chronic wrist pain: posterior interosseous nerve and anterior interosseous nerve neurectomy followed by neurorrhaphy in preventing neuroma formation. Post-operatively, the patient's wrist pain continuously improved and completely resolved without any signs of recurrence. Posterior interosseous nerve and anterior interosseous nerve neurectomy followed by an end-to-end neurorrhaphy can be used as an effective novel surgical technique in the management of chronic wrist pain with prevention of neuroma formation.

The effect of COVID-19 on medical students' education and wellbeing: a cross-sectional survey.

BACKGROUND: Canadian medical school curriculums have undergone major restructuring during the COVID-19 pandemic. This study's goal was to assess the perceived impact of COVID-19 on medical students' education and wellbeing. METHODS: An online survey was distributed to Canadian medical students. Descriptive analyses and ANOVAs were used to assess changes in mental health, health habits and quality of education during the pandemic. RESULTS: 248 medical students from 13 schools across Canada participated in this study. 74% reported a reduction in the quality of their education since COVID-19. 58% of students found online to be inferior to in-person teaching. 65% of students had more time for wellness and leisure activities, about half of the cohort felt more depressed (48%) and lonelier (52%). Student's overall health habits worsened after the start of the pandemic (F=37.4, p < 0.001). Alcohol drinking, time spent seated, and screen time also increased since the pandemic (p < 0.001). During the pandemic, students with a prior history of depression or anxiety expressed increased depressive symptoms (66% vs. 42%, p =0.003), increased anxiety (69% vs. 41%, p < 0001), worse sleep quality (34% vs. 18%, p = 0.031), and poorer quality of life (55% vs. 65%, p = 0.024) versus those with no prior history. CONCLUSION: Canadian medical student's education and wellbeing has been negatively impacted during the pandemic.

CONTEXTE: Les cursus des facultés de médecine canadiennes ont subi une restructuration majeure pendant la pandémie du COVID-19. L'objectif de cette étude était d'évaluer l'impact perçu de la pandémie sur l'éducation et le bien-être des étudiants en médecine. MÉTHODES: Un sondage en ligne a été distribué aux étudiants en médecine au Canada. Des analyses descriptives ont été effectuées et une analyse de variance a été réalisée pour évaluer le changement de quatre habitudes de santé pendant la pandémie. RÉSULTATS: 248 étudiants en médecine de 13 établissements au Canada ont participé à cette étude. 74% d'entre eux ont signalé une baisse de la qualité de leur enseignement depuis le début de la pandémie. 58% des étudiants ont trouvé que l'enseignement en ligne était inférieur à l'enseignement en présentiel. 65% des étudiants ont déclaré avoir plus de temps à consacrer à leurs loisirs et à des activités en lien avec le bien-être, environ la moitié de la cohorte s'est sentie plus déprimée (48 %) et plus seule (52 %). Les habitudes de santé des étudiants se sont considérablement détériorées à l'arrivée de la pandémie (F=37,4, p < 0,001). La consommation d'alcool, le temps passé assis et le temps passé devant un écran ont également augmenté de manière significative depuis le début de la pandémie (p < 0,001). Pendant la pandémie, les étudiants ayant des antécédents de dépression ou d'anxiété ont présenté des niveaux plus élevés de symptômes liés à ces états (66 % contre 42 %, p = 0,003 pour la dépression et 69 % contre 41 %, p<0001 pour l'anxiété), ils avaient une moins bonne qualité de sommeil (34 % contre 18 %, p = 0,031) et une moins bonne qualité de vie en général (55 % contre 65 %, p = 0,024) que ceux qui n'avaient pas de tels antécédents. CONCLUSION: L'éducation et le bien-être des étudiants en médecine canadiens ont été touchés négativement pendant la pandémie.

Decreasing Surgical Site Infections in Plastic Surgery: A Systematic Review and Meta-analysis of Level 1 Evidence.

BACKGROUND: Although many interventions are implemented to prevent surgical site infections (SSIs) in plastic surgery, their supporting evidence is inconsistent. OBJECTIVES: The goal of this study was to assess the efficacy of methods for decreasing SSIs in plastic surgery. METHODS: A systematic review and meta-analysis were performed to compare the effects of SSI prevention methods. All the studies were assessed for quality of evidence according to the GRADE assessment. RESULTS: Fifty Level 1 randomized controlled trials were included. The most common interventions for preventing SSIs were antibiotic prophylaxis, showering, prepping, draping, and the use of dressings. Current evidence suggests that antibiotic prophylaxis is largely unnecessary and overused in many plastic surgical procedures, with the exception of head and neck oncologic, oral craniofacial, and traumatic hand surgeries. CONCLUSIONS: Efficacy of antibiotic prophylaxis in plastic surgery is dependent on surgery type. There is a lack evidence that showering and prepping with chlorohexidine and povidone reduces SSIs.

Educational Alternatives for the Maintenance of Educational Competencies in Surgical Training Programs Affected by the COVID-19 Pandemic.

Along with the socio-economic burden the COVID-19 pandemic carried, the strain it brought upon our health care system is unparalleled. In an attempt to conserve much needed personal protective equipment (PPE) as well as to free up available hospital beds to accommodate the significant influx of COVID-19 patients, many elective surgical cases were essentially put on hold. Furthermore, to taper the spread of this highly contagious virus and to protect the medical staff, surgical clinics were limited to urgent care that could not be managed through virtual platforms. Surgical trainees, such as residents and fellows, who solemnly rely on clinical and surgical exposure to hone their operative and clinical skills, were evidently left deprived. As the pandemic rapidly progressed, medical staff in the emergency departments and what is now known as the COVID wards and COVID ICUs quickly became overwhelmed and overworked. This new reality required surgical trainees to rapidly redeploy to help meet the rising hospital needs. With no clear end to this pandemic, surgical trainees worry they will not reach the appropriate milestones and acquire the amount of surgical experience required to become competent surgeons. As a result, a rapid solution should be found and applied to remedy this newly created gap in surgical education. The measures we recommend include access to regular webinars from world-renowned experts, increased implementation of surgical simulation, selective redeployment of residents to favor level-appropriate learning opportunities and lastly, the active participation of trainees in telemedicine with an increase in surgical exposure as soon as the restrictions are lifted.

Restoration of shoulder motion using single- versus dual-nerve repair in obstetrical brachial plexus injury.

OBJECTIVE The purpose of this study was to compare shoulder abduction and external rotation (ER) after single-nerve repair of the upper trunk alone versus dual-nerve repair of both the upper trunk and the suprascapular nerve. METHODS A retrospective chart review of a single surgeon's experience repairing obstetrical brachial plexus injuries between June 1995 and June 2015 was performed. Eight patients underwent repair of the upper trunk alone, and 10 patients underwent repair of the upper trunk and the suprascapular nerve. Shoulder abduction and ER ranges of motion (ROMs) (in degrees) were recorded preoperatively and postoperatively. Postoperative ROM and the difference in ROM gained after surgery were compared by independent t-test analysis. RESULTS The mean follow-up time was 161.4 weeks (range 62-514 weeks, SD 124.0 weeks). The mean patient age at the time of surgery was 31.3 weeks (range 19.9-47.0 weeks, SD 6.9 weeks). The mean postoperative shoulder abduction ROMs were 145.0° (range 85°-180°, SD 39.4°) after single-nerve repair and 134.0° (range 90°-180°, SD 30.3°) after dual-nerve repair (p = 0.51). The mean postoperative shoulder ER ROMs were 67.5° (range 10°-95°, SD 28.8°) after single-nerve repair and 72.0° (range 10°-95°, SD 31.3°) after dual-nerve repair (p = 0.76). CONCLUSIONS The authors found no difference in shoulder abduction and ER between patients who underwent single-nerve repair of the upper trunk alone and those who underwent dual-nerve repair of both the upper trunk and the suprascapular nerve.