Costs Versus Complications: Public Perspectives on International Cosmetic Surgery Tourism.

Introduction: The purpose of this study was to understand the perceptions of potential complications and motivations among patients willing to travel internationally for cosmetic surgery and to gain insight into public perceptions of cosmetic surgery tourism by surveying a large, cross-sectional sample of the general public. Methods: A cross-sectional survey was performed through Amazon Mechanical Turk regarding cosmetic surgery tourism in adults 18 years and older and currently residing in the United States (US). Results: A total of 484 responses were analyzed. Of those, 45.2% of participants would consider having plastic surgery. Among these participants, 67.1% would consider traveling outside of the US to receive cosmetic surgery. Participants who reported Hispanic or Latino ethnicity had increased odds of considering surgery abroad (OR 3.1, 95% CI 1.1-8.7, P = .030). Participants reported that the top advantages of traveling outside of the US for surgery were the price of surgery internationally, a shorter waiting list for surgery, and privacy during recovery. The top disadvantages were the risk of complications, lack of follow-up or continuity care after surgery, and distance from home. Although the risk of complications was acknowledged as the top disadvantage, the perceived safety of receiving plastic surgery abroad was not related to willingness to consider having surgery abroad (P = .268). Conclusion: These findings support the need for continued awareness of patients considering international travel for cosmetic surgery and increased education of the general public regarding the safety of cosmetic surgery tourism and the importance of selecting board-certified plastic surgeons and accredited facilities.

Introduction: La présente étude visait à comprendre les perceptions des complications potentielles et les motivations chez les patients désireux de se rendre à l'étranger pour subir des chirurgies esthétiques et à connaître les perceptions du public à l'égard du tourisme esthétique au moyen d'un sondage auprès d'un vaste échantillon représentatif du grand public. Méthodologie: Les chercheurs ont procédé à un sondage transversal par l'entremise de la plateforme Amazon Mechanical Turk au sujet du tourisme esthétique chez des adultes de 18 ans et plus qui habitent actuellement aux États-Unis. Résultats: Les chercheurs ont analysé 484 réponses. Au total, 45,2% des participants envisageraient la chirurgie plastique et, de cette proportion, 67,1% envisageraient de sortir des États-Unis pour ce faire. Les participants qui se disaient Hispaniques ou Latinos étaient plus susceptibles d'envisager de se rendre à l'étranger (rapport de cotes 3,1, IC à 95%, 1,1 à 8,7, P = 0030). Les participants indiquaient que le tourisme esthétique hors des États-Unis avait comme principaux avantages le prix des opérations, une liste d'attente plus courte et le respect de la vie privée pendant la convalescence. Le risque de complications, l'absence de suivi ou de continuité des soins après l'opération et la distance de la maison en étaient les principaux désavantages. Même si le risque de complications était reconnu comme le principal désavantage, la perception de sécurité liée à la chirurgie esthétique à l'étranger n'était pas associée à la volonté d'envisager une opération à l'étranger (P = 0268). Conclusion: Ces observations appuient la nécessité de sensibiliser constamment les patients qui envisagent le tourisme esthétique et de mieux informer le grand public de la sécurité du tourisme esthétique et de l'importance de privilégier des plasticiens agréés par l'Ordre et des établissements agréés.

Having Social Media among Integrated Plastic Surgery Applicants: Is It Needed to Match?

Background: Little information exists on the perceptions of integrated plastic and reconstructive surgery (PRS) residency applicants on the need for having social media (SoMe) during the application process. Methods: A cross-sectional survey study was conducted during the 2022 match cycle to assess integrated PRS residency applicants' perceptions on the role of SoMe during the match. Univariate and multivariate analyses were performed on variables of interest. Qualitative analysis was conducted on free-form responses. Results: Seventy-nine surveys were completed (response rate: 24%). The majority of respondents were educated in the United States (92%). Instagram was the most commonly used SoMe platform (92%). Of those surveyed, 18% thought that SoMe was beneficial to the application process. Twenty-nine percent of respondents agreed that a SoMe presence increases one's chances of matching into PRS residency (41% disagreed and 30% responded neutrally). Forty-four percent endorsed stress about maintaining a SoMe presence in PRS. Having mentors who recommended maintaining a SoMe presence was associated with the belief that SoMe increases one's chances of matching [odds ratio (OR) 8.1, 95% confidence interval (CI) 1.1-40.4, P = 0.011] and stress about maintaining a SoMe presence (OR 6.3, 95% CI 1.2-33.3, P = 0.030). Applicants who did research years had lower odds of experiencing stress (OR 0.16, 95% CI 0.04-0.70, P = 0.015). Conclusions: The growing role of SoMe in the residency selection process may be exacerbating applicants' stress and anxiety. PRS programs may consider establishing clear policies for how SoMe will be used in evaluating candidates.

Republication of "Open Repair of Acute Achilles Tendon Ruptures: Is the Incidence of Clinically Significant Wound Complications Overestimated?"

Background: Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures. Operative repair is thought to afford patients a lower risk of rerupture, albeit at a higher overall risk of wound complications. Methods: A retrospective chart review of 369 consecutive patients undergoing open repair of acute Achilles tendon ruptures performed by a single foot and ankle fellowship-trained orthopedic surgeon was undertaken. Healing was classified as no complications, complications without prolonging treatment, complications requiring prolonged local treatment, and complications requiring operative intervention. A statistical analysis comparing the rates of complications in this cohort to that reported in the literature was conducted. Results: There were a total of 33 (8.94%) wound complications. Compared to the rates reported in the literature, no significant difference was detected (P = .3943; CI 6.24-12.33). However, when the complications not requiring additional treatment or prolonged care were excluded, only 9 wound complications (2.44%) were identified-a significantly lower complication rate than that reported in the literature (P < .0001; CI 1.12-4.58). There were only 2 (0.54%) major complications requiring operative intervention, also a significantly lower rate than in the literature (P < .0001; CI 0.067-1.94). Conclusion: In the past, wound-healing complications have been cited as a concern when treating patients operatively. We found that when solely looking at healing complications prolonging the patients' overall recovery, a significantly lower rate of complications existed compared to that reported in the literature. Level of Evidence: Level IV.

Acute Diplopia Following Rhinoplasty: Clearing the Air.

Diplopia after rhinoplasty is a rare complication that requires immediate medical attention. Workup should include a complete history and physical examination, appropriate imaging, and consultation with ophthalmology. Diagnosis may be challenging due to the wide differential ranging from dry eyes to orbital emphysema to an acute stroke. Patient evaluation should be expedient, though thorough to facilitate time-sensitive therapeutic interventions. Here, we present a case of transient binocular diplopia presenting 2 days after closed septorhinoplasty. The visual symptoms were attributed to either intra-orbital emphysema or a decompensated exophoria. This is the second documented case of orbital emphysema after rhinoplasty presenting with diplopia. It is the only case with a delayed presentation as well as the only case that resolved after positional maneuvers.

La diplopie après la rhinoplastie est une complication rare qui exige des soins médicaux. Le bilan inclut une histoire complète et un examen physique, une imagerie appropriée et une consultation en ophtalmologie. Le diagnostic peut être difficile à poser en raison du vaste diagnostic différentiel, qui va de la sécheresse oculaire à l'emphysème orbitaire, en passant par l'accident vasculaire cérébral aigu. L'évaluation des patients doit être rapide, mais approfondie, pour favoriser des interventions opportunes. Les auteurs présentent un cas de diplopie binoculaire transitoire s'étant manifestée deux jours après une septorhinoplastie fermée. Les symptômes visuels étaient attribués à un emphysème intraorbitaire ou une exophorie décompensée. Il s'agit du deuxième cas répertorié d'emphysème orbitaire après une rhinoplastie démontrée par une diplopie. C'est le seul cas aux manifestations tardives, de même que le seul à s'être résorbé après des manœuvres positionnelles.

The Upcoming Pass/Fail USMLE Step 1 Score Reporting: An Impact Assessment From Medical School Deans.

Background: The US Medical Licensing Examination (USMLE) Step 1 change to pass/fail has been met with mixed reviews, and the impact on medical student education and residency match is unknown. We surveyed medical school student affairs deans regarding their thoughts on the upcoming transition of Step 1 to pass/fail. Methods: A questionnaire was emailed to medical school deans. Deans were asked to rank the importance of the following after the Step 1 reporting change: Step 2 Clinical Knowledge (Step 2 CK), clerkship grades, letters of recommendation, personal statement, medical school reputation, class rank, Medical Student Performance Evaluation, and research. They were asked how the score change will affect curriculum, learning, diversity, and student mental health. Deans were asked to select 5 specialties they thought would be most affected. Results: Regarding perceived importance of residency applications following the scoring change, the most frequent number 1 choice was Step 2 CK. The majority of deans (93.5%, n = 43) felt that the change to pass/fail would benefit medical student education/learning environment; however, most (68.2%, n = 30) did not believe their school curriculum would change. Students applying to dermatology, neurosurgery, orthopedic surgery, ENT, and plastic surgery were felt to be most affected by the scoring change; 58.7% (n = 27) felt it would not adequately address future diversity. Conclusion: The majority of deans feel the USMLE Step 1 change to pass/fail would benefit medical student education. Deans feel that students applying to traditionally more competitive specialties (ie, programs with fewer overall residency positions available) will be most affected.

Contexte : Le changement de l'épreuve 1 de l'USMLE pour un résultat de type réussite/échec a été accueilli par des opinions variées et son impact sur la formation des étudiants en médecine et l'adéquation des résidences est inconnu. Nous avons mené une enquête auprès des doyens des affaires étudiantes des facultés de médecine pour connaître leur opinion sur la transition prochaine de l'épreuve 1 à un score réussite/échec. Méthodes : Un questionnaire a été envoyé par courriel aux doyens des facultés de médecine. Il leur a été demandé de classer l'importance des éléments suivants après la modification de déclaration des résultats de l'Épreuve 1: Épreuve 2 CK, notes d'externat, lettres de recommandation, déclaration personnelle, réputation de l'école de médecine, classement, évaluation des performances des étudiants en médecins (MSPE) et recherche. Il leur a été demandé comment le changement de notation allait affecter les programmes, l'apprentissage, la diversité et la santé mentale des étudiants. Les doyens devaient sélectionner les 5 spécialités qui, à leur avis, allaient être les plus touchées. Résultats : Pour ce qui concerne l'importance perçue des demandes de résidence après le changement de notation, le choix numéro 1 le plus fréquent a été l'épreuve 2 CK. La majorité des doyens (93,5%, n = 43) a eu le sentiment que le changement en Réussite/Échec serait bénéfique pour la formation des étudiants en médecine et leur environnement pédagogique; toutefois, la plupart d'entre eux (68,2%, n = 30) ne croyaient pas que les programmes d'études changeraient. Les étudiants faisant des demandes en dermatologie, neurochirurgie, chirurgie orthopédique, ORL, et chirurgie plastique étaient perçus comme les plus touchés par le changement de notation. Par ailleurs 58,7% des répondants (n = 27) ont estimé que cela n'aborderait pas de manière adéquate la diversité future. Conclusion : La majorité des doyens a le sentiment que le passage à une notation Réussite/Échec de l'Épreuve 1 de l'USMLE serait bénéfique à la formation des étudiants en médecine. Les doyens estiment que les étudiants faisant des demandes pour des spécialités où règne traditionnellement une plus grande concurrence (c.-à-d. les programmes avec un moins grand nombre global de postes de résidents) seront les plus touchés.

Trends of Autologous Free-Flap Breast Reconstruction and Safety during the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Autologous free-flap breast reconstruction (ABR) is a valuable surgical option for patients following mastectomy. The coronavirus disease 2019 (COVID-19) pandemic has led to a myriad of factors that have affected access to care, hospital logistics, and postoperative outcomes. This study aims to identify differences in patient selection, hospital course and severity, and postoperative outcomes for patients who underwent ABR during and prior to the COVID-19 pandemic. METHODS: Patients undergoing ABR from the American College of Surgeons National Surgical Quality Improvement Program 2019 to 2020 database were analyzed to compare sociodemographics, hospital course, and outcomes over the first postoperative month. Multivariable logistic regression was used to identify factors predictive of complications based on the operative year. RESULTS: In total, 3,770 breast free flaps were stratified into two groups based on the timing of reconstruction (prepandemic and pandemic groups). Patients with a diagnosis of disseminated cancer were significantly less likely to undergo ABR during the COVID-19 pandemic. On univariate analysis, there were no significant differences in postoperative complications between the two groups. When controlling for potentially confounding sociodemographic and clinical risk factors, the COVID-19 group was significantly more likely to undergo reoperation compared with the prepandemic group (p < 0.05). CONCLUSION: When comparing outcomes for patients who underwent ABR prior to and during the COVID-19 pandemic, we found a significant increase in the odds of reoperation for those who had ABR during the pandemic. Debridement procedures and exploration for postoperative hemorrhage, thrombosis, or infection increased in the prepandemic group compared to the COVID-19 group. Notably, operative times decreased.

Perspectives on the Plastic Surgery Common Application (PSCA): A Survey of 2021-2022 Integrated Plastic Surgery Applicants.

The Plastic Surgery Common Application (PSCA) was introduced as a free and specialty-specific application for plastic surgery applicants in the 2020-2021 cycle. Now in its second year, the PSCA is being piloted by all integrated residency programs with future plans to replace Electronic Residency Application Service (ERAS) in the 2022-2023 cycle. This study aimed to explore applicant perspectives related to the PSCA and ERAS applications. Methods: An anonymous survey was distributed to integrated plastic surgery residency applicants from the 2021-2022 application cycle. Participants were asked to provide basic demographic information, their perspectives of the PSCA, and overall application preference. Results: One hundred forty (43.1%) applicants completed the survey. Nearly, 63% of applicants responded "slightly well" or "not well at all" regarding their ability to highlight at least one aspect of their application. Forty-one percent of applicants believed ERAS best highlighted the strengths of their application compared with 27% who believed their strengths were better highlighted by the PSCA. Seventy-nine percent reported the cost savings associated with the PSCA were "very" or "extremely important." Overall, 63% of respondents reported a preference to apply with the PSCA alone. Conclusions: This is the first study to provide insight on applicants' perspectives of the PSCA. Although the majority preferred applying with the PSCA, there may be challenges with transitioning to this application solely. Future iterations of the PSCA may aim to ameliorate functionality concerns, optimize application content, and incorporate plastic surgery-specific information that may be important to selection committees.

Rodent Model for Orthotopic Implantation of Engineered Liver Devices.

This study presents a novel surgical model developed to provide hematological support for implanted cellularized devices augmenting or replacing liver tissue function. Advances in bioengineering provide tools and materials to create living tissue replacements designed to restore that lost to disease, trauma, or congenital deformity. Such substitutes are often assembled and matured in vitro and need an immediate blood supply upon implantation, necessitating the development of supporting protocols. Animal translational models are required for continued development of engineered structures before clinical implementation, with rodent models often playing an essential early role. Our long-term goal has been generation of living tissue to provide liver function, utilizing advances in additive manufacturing technology to create 3D structures with intrinsic micron to millimeter scale channels modeled on natural vasculature. The surgical protocol developed enables testing various design iterations in vivo by anastomosis to the host rat vasculature. Lobation of rodent liver facilitates partial hepatectomy and repurposing the remaining vasculature to support implanted engineered tissue. Removal of the left lateral lobe exposes the underlying hepatic vasculature and can create space for a device. A shunt is created from the left portal vein to the left hepatic vein by cannulating each with separate silicone tubing. The device is then integrated into the shunt by connecting its inflow and outflow ports to the tubing and reestablishing blood flow. Sustained anticoagulation is maintained with an implanted osmotic pump. In our studies, animals were freely mobile after implantation; devices remained patent while maintaining blood flow through their millifluidic channels. This vascular anastomosis model has been greatly refined during the process of performing over 200 implantation procedures. We anticipate that the model described herein will find utility in developing preclinical translational protocols for evaluation of engineered liver tissue. Impact statement Tissue and organ transplantation are often the best clinically effective treatments for a variety of human ailments. However, the availability of suitable donor organs remains a critical problem. Advances in biotechnology hold potential in alleviating shortages, yet further work is required to surgically integrate large engineered tissues to host vasculature. Improved animal models such as the one described are valuable tools to support continued development and evaluation of novel therapies.

Outpatient Prosthetic-Based Reconstruction during COVID-19 Pandemic Possible in Selected Patients without Increased Complications.

BACKGROUND: Following the reopening of elective surgery, the authors' division transitioned from inpatient admission to same-day discharge for immediate prosthetic breast reconstruction in an effort to decrease the hospital's clinical burden and minimize potential coronavirus disease of 2019 exposure. This study aims to compare complication rates following this acute transition for patients who had inpatient and outpatient mastectomy with immediate alloplastic reconstruction. METHODS: A retrospective chart review was performed on patients who underwent mastectomy with immediate prosthetic reconstruction. The outcome of interest was 30-day morbidity. Descriptive statistics were compared for patients with outpatient and inpatient operations. Odds ratios were calculated to determine whether any preoperative factors increased odds of 30-day complications. RESULTS: A total of 115 patients were included in this study. Twenty-six patients had outpatient surgery and 89 stayed inpatient postoperatively. Same-day discharge did not significantly impact the odds of having one or more 30-day complications (OR, 0.275; 95% CI, 0.047 to 1.618; P = 0.153). Patients with complications had significantly longer median operating times [5.0 hours (interquartile range, 4.0 to 6.0 hours) versus 4.0 hours (interquartile range, 3.0 to 5.0 hours; P = 0.05), and there was a statistically significant association between length of surgery and odds of complication (OR, 1.596; 95% CI, 1.039 to 2.451; P = 0.033). Age was independently associated with increased risk of 30-day complication (OR, 1.062; 95% CI, 1.010 to 1.117; P = 0.020). CONCLUSION: The authors' findings support a continuation of same-day discharge strategy, which could decrease costs for patients and hospitals without increasing complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.