Successful Applicant and Program Director Perspectives on the Virtual Residency Selection Process for Canadian Surgical Subspecialties.

Introduction: The COVID-19 pandemic imparted an important shift in strategies postgraduate surgical programs use to recruit, interact with, and select medical students applying through the Canadian Resident Matching Service (CaRMS). With this unprecedented shift toward virtual applicant selection, this study sought to explore and analyze perspectives of the first cohort of program directors (PDs) and applicants who participated in this process. Methods: A cross-sectional survey study was designed using Google Forms for both PDs and applicants participating in the 2021 CaRMS surgical subspecialty selection process. Questions pertained to format and content of virtual engagement methods, the interview itself, as well as advice for future applicants. Results: Thirty-five PDs and 40 successful applicants (n = 75) participated in the study. Cost reduction was the most commonly reported benefit of online interviewing by PDs (85%), followed by efficiency (71%), enhanced resource management (49%), and ability to conduct more interviews (23%). Strong letters of reference (80%) and interview performance (74%) remained the most significant factors in virtual applicant selection. Attendance to virtual recruitment events did not increase the likelihood of offering interviews (n = 24, 69% of PDs), although the ability to perform in-person electives held tremendous value. Most applicants (90%) reported on virtual information sessions as the best method for learning about programs; work culture and environment were topics most valued as discussion points (90%). Successful applicants provided an average confidence of 76% regarding their suitability with their matched programs. Seventy-three percent of applicants (n = 29) had either a preference for virtual interviews or were equivocal, while 51.4% of PDs (n = 18) preferred interviews to be conducted virtually for future cohorts. Conclusion: Trainees are entering residency with confidence following a virtual selection process, and PDs feel confident in their selections. Although no clear consensus exists regarding preference for virtual or in-person interviews, several advantages for virtual resident selection exist. The influence of an in-person elective was found difficult to replace, regardless of interview format. The importance of applicant engagement with programs prior to interviews is highlighted and discussed with recommendations provided for best practices.

Introduction: La pandémie de COVID-19 a induit un important changement de stratégies de l'utilisation des programmes chirurgicaux de 3e cycle pour recruter, interagir avec les étudiants en médecine et sélectionner les étudiants déposant une candidature par le biais du CaRMS, le service d'affectation des résidents canadiens. Avec ce mouvement sans précédent vers une sélection virtuelle des candidats, l'étude a cherché à explorer et analyser les points de vue de la première cohorte de directeurs de programmes (DP) et de candidats ayant participé à ce processus. Méthodes: Une enquête transversale a été conçue à l'aide de Google Forms pour, à la fois, les DP et les candidats participant au processus de sélection de sous-spécialité chirurgicale 2021 du CaRMS. Des questions portaient sur le format et le contenu des méthodes de contact virtuelles, l'entretien proprement dit ainsi que sur des conseils pour les candidats futurs. Résultats: Trente-cinq DP et quarante candidats acceptés (n = 75) ont participé à l'étude. La réduction des coûts a été l'avantage des entretiens en ligne le plus souvent cité par les DP (85 %) suivie de l'efficacité (71 %), d'une meilleure gestion des ressources (49 %) et de la capacité à réaliser plus d'entretiens (23 %). De solides lettres de recommandation (80 %) et la performance au cours de l'entretien (74 %) restaient les facteurs les plus significatifs pour la sélection virtuelle des candidats. La participation aux événements virtuels de recrutement n'augmentait pas la probabilité d'offre d'un entretien (n = 24, 69 % des DP), même si la possibilité de réaliser des entretiens facultatifs en personne avait une valeur considérable. La plupart des candidats (90 %) ont indiqué que les séances d'information virtuelles étaient la meilleure méthode pour en savoir plus sur les programmes; la culture et l'environnement de travail étaient les thèmes ayant le plus de valeur comme sujets de discussion (90 %). Les candidats ayant réussi ont indiqué à 76 % qu'ils s'estimaient confiants sur le fait de bien correspondre aux programmes auxquels ils étaient affectés. Soixante-treize pour cent des candidats (n = 29) avaient une préférence pour les entretiens virtuels ou étaient dans le doute, tandis que 51,4 % des DP (n = 18) préféraient que les entretiens des cohortes futures soient menés virtuellement. Conclusion: Les stagiaires commencent leur résidence avec confiance après un processus de sélection virtuel et les DP se sentent confiants quant à leurs choix. Même s'il n'existe pas un franc consensus concernant une préférence pour les entretiens virtuels ou en face à face, la sélection à distance des résidents présente plusieurs avantages. L'influence d'un entretien optionnel en personne s'est avérée difficile à remplacer, quelle que soit la forme donnée à l'entretien. L'importance de l'engagement du candidat dans des programmes antérieurs aux entretiens est soulignée et discutée avec des recommandations fournies pour de meilleures pratiques.

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.

Revisiting Level of Evidence Ratings in Plastic Surgery: A Call to Action.

BACKGROUND: Evidence-based medicine underpins medical and surgical practice, with level of evidence (LOE) being a key aspect that allows clinicians and researchers to better discriminate the methodological context by which studies are conducted and appropriately interpret their conclusions, and more specifically the strength of their recommendations. OBJECTIVES: The aim of this study was to reassess the LOE of articles published in plastic surgery journals. METHODS: To assess the overall LOE of publications from January 1 to December 31, 2021, a review of the following plastic surgery journals was performed: Aesthetic Surgery Journal (ASJ), Annals of Plastic Surgery (Annals), Journal of Plastic Reconstructive and Aesthetic Surgery (JRPAS), Plastic and Reconstructive Surgery (PRS), and Plastic and Reconstructive Surgery Global Open (PRS GO). RESULTS: Of 3698 PUBMED articles, 1649 original articles and systematic reviews were analyzed. The average LOE for each journal was: ASJ 3.02 ± 0.94, Annals 3.49 ± 0.62, JPRAS 3.33 ± 0.77, PRS 2.91 ± 0.77, and PRS GO 3.45 ± 0.70. The collective average LOE was 3.28 ± 0.78. Only 4.4% were LOE 1 and 7.3% were LOE 2. Compared to past studies, PRS showed a significant LOE improvement (P = .0254), while ASJ and JPRAS saw nonsignificant changes; Annals experienced a significant decrease (P = .0092). CONCLUSIONS: ASJ and PRS showed the highest LOE among the journals analyzed. Despite this, low LOE studies remain prevalent in plastic surgery. This paper serves as a call to action for both researchers and academic journals to elevate the standard, offering several strategies to help improve the LOE in plastic surgery.

The Fragility of Landmark Randomized Controlled Trials in the Plastic Surgery Literature.

Background: Randomized controlled trials (RCTs) are integral to the progress of evidenced-based medicine and help guide changes in the standards of care. Although results are traditionally evaluated according to their corresponding P value, the universal utility of this statistical metric has been called into question. The fragility index (FI) has been developed as an adjunct method to provide additional statistical perspective. In this study, we aimed to determine the fragility of 25 highly cited RCTs in the plastic surgery literature. Methods: A PubMed search was used to identify the 25 highest cited RCTs with statistically significant dichotomous outcomes across 24 plastic surgery journals. Article characteristics were extracted, and the FI of each article was calculated. Additionally, Altmetric scores were determined for each study to determine article attention across internet platforms. Results: The median FI score across included studies was 4 (2-7.5, interquartile range). The two highest FI scores were 208 and 58, respectively. Four studies (16%) had scores of 0 or 1. Three studies (12%) had scores of 2. All other studies (72%) had FI scores of 3 or higher. The median Altmetric score was 0 (0-3). Conclusion: The FI can provide additional perspective on the robustness of study results, but like the P value, it should be interpreted in the greater context of other study elements.

Canadian legal cases in ophthalmology: a closer look at 40 years' worth of data.

OBJECTIVE: To assess the characteristics of malpractice lawsuits against Canadian ophthalmologists and the predisposing factors leading to claims. DESIGN: Retrospective case series. METHODS: A systematic search of the 2 largest Canadian online legal databases, LexisNexis Canada and Westlaw Canada, was performed to collect cases against ophthalmologists in Canadian courts from 1977 to 2021. RESULTS: This study comprised 68 legal cases, including 52 lawsuits, 14 cases appealed once, and 2 cases appealed twice. Most cases concerned surgical procedures (46.2%), followed by misdiagnoses or lack thereof (32.7%) and nonsurgical procedures (21.2%). Half the cases (n = 26) were immediately dismissed by the judge in favour of the ophthalmologist, though among the remaining half that proceeded to trial the majority (88.5%) were won by the patients. All appeals by patients were dismissed by the judge. The median monetary value of damages awarded was $308,202. CONCLUSIONS: This study is the first to report on ophthalmology-involved medical litigation cases in Canada. Most cases were ruled in favour of the ophthalmologist, but most of those that were not immediately dismissed by the judge were ruled in favour of the plaintiff. Notably, a plurality of these cases argued for a lack of informed consent, and every case in which a lack was successfully pleaded was ruled in favour of the plaintiff, highlighting the importance of appropriate informed consent. The findings of this study give Canadian ophthalmologists insight into areas of practice that commonly lead to litigation and can aid in improving clinical practice and risk management.

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.

Practical Review on Delayed Primary Closure: Basic Science and Clinical Applications.

Wound healing complications present a significant burden on both patients and health-care systems, and understanding wound healing principles is crucial across medical and surgical specialties to help mitigate such complications. One of these longstanding principles, specifically delayed primary closure (DPC), described as mechanically closing a wound after several days of secondary intention healing, lacks clear consensus on its definition, indications, and outcomes. This practical review examines wound healing fundamentals, focusing on DPC, its execution, indications, and comparative outcomes. A PubMed literature search was conducted to retrieve studies on DPC. Inclusion criteria included comparative studies assessing outcomes and complications between DPC and other closure techniques, as well as articles investigating DPC's underlying physiology. Twenty-three comparative studies met inclusion criteria. DPC wounds have significantly higher partial pressure of oxygen, higher blood flow, and higher rates of collagen synthesis and remodeling activity, all of which help explain DPC wounds' superior mechanical strength. DPC seems most beneficial in contaminated wounds, such as complicated appendectomies, postcardiac surgery wounds, and complicated abdominal wall reconstructions, where it has been associated with lower rates of surgical site infections. This practical review provides an evidence-based approach to DPC, its physiology, technique, and indications. Based on the existing literature, the authors recommend that DPC wounds should be dressed in saline/betadine soaks, changed and irrigated daily, with delayed closure lasting between 3 and 5 days or until the infection has resolved. The clearest indications for DPC are in the context of contaminated abdominal surgery and sternal wound dehiscence post cardiac surgery.

The Positive and Negative Predictive Value of Targeted Diagnostic Botox Injection in Nerve Decompression Migraine Surgery.

INTRODUCTION: Nerve decompression surgery is an effective treatment modality for patients who suffer from migraines. Botulinum toxin type A (BOTOX) injections have been traditionally used as a method to identify trigger sites, however there is a paucity in data regarding its diagnostic efficacy. The goal of this study was to assess the diagnostic capacity of BOTOX in successfully identifying migraine trigger sites and predicting surgical success. METHODS: A sensitivity analysis was performed on all patients receiving BOTOX for migraine trigger site localization followed by a surgical decompression of affected peripheral nerves. Positive and negative predictive values were calculated. RESULTS: A total of 40 patients met our inclusion criteria and underwent targeted diagnostic BOTOX injection followed by a peripheral nerve deactivation surgery with at least three months follow-up. Patients with successful BOTOX injections (defined as at least 50% improvement in Migraine Headache Index (MHI) scores post injection) had significantly higher average reduction in migraine intensity (56.7% vs 25.8%; p=0.020, respectively), frequency (78.1% vs 46.8%; p=0.018, respectively), and MHI (89.7% vs 49.2%; p=0.016, respectively) post-surgical deactivation. Sensitivity analysis shows that the use of BOTOX injection as a diagnostic modality for migraine headaches has a sensitivity of 56.7% and a specificity of 80.0%. The positive predictive value is 89.5% and the negative predictive value is 38.1%. CONCLUSION: Diagnostic targeted BOTOX injections have a very high positive predictive value. It is therefore a useful diagnostic modality that can help identify migraine trigger sites and improve pre-operative patient selection.

Comparing Migraine Headache Index vs. Monthly Migraine Days Following Nerve Deactivation for Headache: A Systematic Review and Meta-Analysis.

BACKGROUND: Nerve deactivation surgery for the treatment of migraine has quickly evolved over the last two decades. Studies typically report changes in migraine frequency (attacks/month), attack duration, attack intensity, and their composite score, the migraine headache index (MHI), as primary outcomes. However, the neurology literature predominantly reports migraine prophylaxis outcomes as change in monthly migraine days (MMD). Therefore, the goal of this study is to foster common communication between plastic surgeons and neurologists by assessing the effect of nerve deactivation surgery on monthly migraine days (MMD) and motivating future studies to include MMD in their reported outcomes. METHODS: An updated literature search was performed according to the PRISMA guidelines. The National Library of Medicine (PubMed), Scopus, and EMBASE were systematically searched for relevant articles. Data was extracted and analyzed from studies which met the inclusion criteria. RESULTS: A total of 19 studies were included. There was a significant overall reduction in monthly migraine days (mean difference [MD] 14.11, 95% CI 10.95 to 17.27; I2 = 92%), total migraine attacks per month (MD 8.65, 95% CI 7.84 to 9.46, I2 = 90%), migraine headache index (MD 76.59, 95% CI 60.85 to 92.32; I2 = 98%), migraine attack intensity (MD 3.84, 95% CI 3.35 to 4.33; I2 = 98%), and migraine attack duration (MD 11.80, 95% CI 6.44 to 17.16; I2 = 99%) at follow-up (range 6-38 months). CONCLUSIONS: This study demonstrates the efficacy of nerve deactivation surgery on the outcomes used in both the PRS and neurology literature.

Dissecting Medical Litigation: An Analysis of Canadian Legal Cases in Plastic Surgery.

Introduction: Plastic surgeons are more likely to face medical litigation, compared to other specialists. Although this has been previously studied in other countries, there is a paucity of data regarding legal medical cases within Canada. The goal of this study was to compile and analyze all medical litigations in plastic surgery in Canada and identify themes associated them. Methods: A systematic search of the 2 largest Canadian online legal databases, LexisNexis Canada and WestLawNext Canada, was conducted to retrieve all legal medical cases against plastic surgeons in Canadian courts. Quantitative and qualitative analyses were performed to dissect the characteristics of plastic surgery litigation in Canada. Results: A total of 105 legal cases were included in this analysis, including 81 lawsuits and 24 appeals. The preponderance of cases was related to breast surgeries (47.0%), followed by head and neck surgeries (18.1%), with 76.5% being related to cosmetic surgery; 64.2% were ruled in favour of the surgeon. The lack of preoperative informed consent was highly associated with a final ruling in favour of the patient (P < .0001). The average monetary value of damages awarded was $61 076. There was no significant difference in monetary value between cosmetic and reconstructive cases. Conclusion: The majority of medical litigation in plastic surgery in Canada is associated with cosmetic surgeries, most commonly of the breast. Lack of informed consent is associated with judicial rulings in favour of patients. By understanding the themes underlying these legal cases, we hope to highlight the main issues that lead to litigation in plastic surgery.

Introduction: Les chirurgiens plastiques sont plus susceptibles de faire face à un contentieux médical que d'autres spécialistes. Si cela a déjà été étudié dans d'autres pays, il y a peu de données sur les affaires judiciaires de nature médicale au Canada. L'objectif de cette étude était de compiler et analyser les contentieux médicaux en chirurgie plastique au Canada et d'identifier les thèmes qui leur sont associés. Méthodes: Une recherche systématique a été menée dans les deux grandes bases de données juridiques canadiennes sur internet, LexisNexis® Canada et WestLawNext® Canada, pour en tirer toutes les affaires judiciaires contre des chirurgiens plastiques passées devant les tribunaux canadiens. Des analyses quantitatives et qualitatives ont été réalisées pour disséquer les caractéristiques des contentieux en chirurgie plastique au Canada. Résultats: Un total de 105 cas judiciaires ont été inclus dans cette analyse, dont 81 poursuites en justice et 24 appels. Une prépondérance de cas avait trait à la chirurgie mammaire (47,0 %), suivie par la chirurgie de la tête et du cou (18,1 %), et 76,5 % étant liés à chirurgie cosmétique. Dans 64,2 % des cas, la décision a été en faveur du chirurgien. L'absence de consentement éclairé préopératoire a été fortement associée à des jugements définitifs en faveur des patients (P < 0,0001). La valeur monétaire moyenne des dommages et intérêts accordés était de 61 076 $. Il n'y a pas eu de différence significative de valeur monétaire entre les cas cosmétiques et la chirurgie reconstructrice. Conclusion: La majorité des cas de contentieux médicaux en chirurgie plastique au Canada est associée à la chirurgie cosmétique, le plus souvent la chirurgie mammaire. L'absence de consentement éclairé est associée aux décisions judiciaires favorables aux patients. En comprenant les thèmes sous-tendant ces affaires judiciaires, nous espérons souligner les principaux problèmes qui débouchent sur un contentieux en chirurgie plastique.

Outcomes Associated with Moberg and Modified Moberg Flaps in Thumb Reconstruction: A Systematic Review.

Background: Appropriate thumb function is critical as it is makes up approximately 40% of the hand's function leading to the greatest influence in activities of daily living (ADLs). Local flaps are the primary option for thumb reconstruction, of which the Moberg flap has been reported to have the added advantage of its advancement capacity relative to other flaps. This systematic review aims to describe the outcomes of the Moberg advancement flap and its associated modifications for coverage of palmar thumb defects. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the conduct of this systematic review. Medline, Embase, CINAHL and Cochrane Library were systematically searched to retrieve relevant citations. Title and abstract as well as full-text assessment were performed in duplicate. Full texts were extracted by one reviewer and data extracted was confirmed by a second. Complication rates and overall means were calculated for the appropriate outcomes. Results: A total of 1,794 citations were retrieved; 15 papers were retained, including 169 patients. The overall mean follow-up was 28.6 months (n = 5 studies). In 136 patients, there was 100% flap viability (n = 12 studies). With regard to thumb aesthetics, 92% (59/64 patients) had favourable outcomes (n = 6 studies). No evidence of postoperative flexion contractures (n = 0/56 patients, 5 studies) was found. Cold intolerance occurred at a rate of 29.8% (n = 17/57, 4 studies) and the infection rate was 10.3% (6/58 patients, 3 studies). Conclusions: Moberg/modified Moberg flaps are a safe option for thumb reconstruction given their associated postoperative outcome and complication profile. Level of Evidence: Level III (Therapeutic).

Revisiting the Role of Occipital Artery Resection in Greater Occipital Nerve Decompression.

BACKGROUND: Greater occipital nerve surgery has been shown to improve headaches caused by nerve compression. There is a paucity of data, however, specifically regarding the efficacy of concomitant occipital artery resection. To that end, the goal of this study was to compare the efficacy of greater occipital nerve decompression with and without occipital artery resection. METHODS: This multicenter retrospective cohort study consisted of two groups: an occipital artery resection group (artery identified and resected) and a control group (no occipital artery resection). Preoperative, 3-month, and 12-month migraine frequency, duration, intensity, Migraine Headache Index score, and complications were extracted and analyzed. RESULTS: A total of 94 patients underwent greater occipital nerve decompression and met all inclusion criteria, with 78 in the occipital artery resection group and 16 in the control group. The groups did not differ in any of the demographic factors or preoperative migraine frequency, duration, intensity, or Migraine Headache Index score. Postoperatively, both groups demonstrated a significant decrease in migraine frequency, duration, intensity, and Migraine Headache Index score. The decrease in Migraine Headache Index score was significantly greater among the occipital artery resection group than the control group ( p = 0.019). Patients in both groups had no major complications and a very low rate of minor complications. CONCLUSION: Occipital artery resection during greater occipital nerve decompression is safe and improves outcomes; therefore, it should be performed routinely. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Increasing Collaboration between Headache Medicine and Plastic Surgery in the Surgical Management of Chronic Headache.

Introduction: Chronic headache is one of the most disabling conditions afflicting humankind. The management of chronic headaches has, to date, been only partially successful. The goal of this paper is to highlight the importance of collaboration between surgeons and headache physicians in treating this condition. Methods: We present a narrative review of migraine pathophysiology, its medical and surgical treatment options, and the important role of collaboration between headache physicians and surgeons. Results: Migraine headaches can be treated with both medication-based regimens and surgery. Novel medications such monoclonal antibodies directed at the CGRP molecule or its receptor have recently been FDA approved as an effective treatment modality in chronic migraines. However, these medications are associated with a high cost, and there is a paucity in data regarding effectiveness compared to other treatment modalities. The pathophysiology of headache likely exists along a spectrum with peripheral - extracranial and meningeal - factors at one end and central - brain - factors at the other, with anatomic and physiologic connections between both ends. Recent evidence has clearly shown that surgical decompression of extracranial nerves improves headache outcomes. However, appropriate patient selection and preoperative diagnosis are of paramount importance to achieve excellent outcomes. Conclusions: Surgeons and headache physicians who are interested in providing treatment for patients with chronic headache should strive to form a close collaboration with each other in order to provide the optimal plan for migraine/headache patients.

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.

The Presence of Ghost Publications Among Canadian Plastic Surgery Residency Applicants: How Honest Are Canadians?

Background: Physicians with history of unprofessional behaviour during their medical training are shown to be 3 times more likely to have board disciplinary action later in their career. One realm in which unprofessional behaviour takes place is the phenomenon of unverifiable publications or "ghost publications." To that end, this study aims to assess the rate of ghost publications among a recent cohort of Canadian Plastic Surgery residency applicants to determine if this phenomenon is geographic in nature. Methods: The current study was a retrospective, cross-sectional observational study; a review of all residency applications submitted to a single Canadian Plastic Surgery residency program from 2015 to 2018 was performed and all their listed publications were verified for accuracy. The review was conducted by a third party librarian and a research coordinator blinded to the authors identifying information. "Ghost publication" was defined as any publication listed as "published," "accepted," or "in-press" that did not exist in the literature. Results: A total of 196 applications of 186 applicants were submitted over the span of 4 years. A total of 362 publications listed as peer-reviewed articles, belonging to 114 applications were extracted and reviewed. Among the 362 publications listed as peer-reviewed articles, 2 could not be found in the literature (0.55%). Additionally, 42 citations were found with 48 minor differences than what was cited. Conclusions: The rate of ghost publications among recent applicants to a Plastic Surgery residency program is low (less than 1%). Future studies should investigate methods to further improve and instill the value of professionalism in our future plastic surgery trainees.

Historique: Il est démontré que les médecins qui adoptent un comportement non professionnel pendant leur formation risquent trois fois plus de recevoir des sanctions disciplinaires de leur ordre pendant leur carrière. Le phénomène des publications non vérifiables, ou publications fictives, représente l'un des volets du comportement non professionnel. La présente étude vise à évaluer la fréquence de publications fictives dans une récente cohorte de candidats canadiens à la résidence en plasturgie pour déterminer si ce phénomène est de nature géographique. Méthodologie: Dans la présente étude d'observation transversale et rétrospective, toutes les candidatures en résidence déposées à un seul programme de résidence canadien en plasturgie entre 2015 et 2018 ont été examinées, et l'exactitude de toutes les publications présentées a été vérifiée. Un tiers bibliothécaire et un coordonnateur de recherche ne connaissant pas les données nominatives des auteurs ont effectué l'analyse. Une publication fictive désignait toute publication présentée comme « publiée ¼, « acceptée ¼ ou « sous presse ¼, mais qui n'existait pas dans les revues scientifiques. Résultats: Au total, 196 demandes de 186 candidats ont été déposées sur une période de quatre ans. Les chercheurs ont extrait et examiné 362 publications présentées comme des articles dotés d'un comité de lecture, cités par 114 candidats. De ces 362 publications, les chercheurs n'en ont pas trouvé deux dans les revues scientifiques (0,55 %) et ont relevé 42 citations comportant 48 différences mineures par rapport à la version originale. Conclusions: Les récents candidats à un programme de résidence en plasturgie s'approprient peu de publications fictives (moins de 1 %). De prochaines études devraient porter sur des méthodes pour améliorer et inculquer la valeur du professionnalisme chez les futurs résidents en plasturgie.

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.