Qualitative needs assessment for the development of a smart thumb prosthesis.

PURPOSE: To critically explore experiences following thumb amputation and delineate elements of an ideal thumb prosthesis from the end user perspective. METHODS: A qualitative study was undertaken with end user stakeholder groups, which included persons with a thumb amputation, rehabilitation professionals, and prosthetists. Analysis proceeded in line with conventional content analysis. RESULTS: Six patients with traumatic thumb amputation and eight healthcare providers (HCPs) were interviewed. Six themes were identified. The first theme discussed the impact of losing a thumb upon function, occupational activities, and mental wellbeing. The second theme reflected the idiosyncratic nature of thumb amputees, including their goals and nature of injury. The third theme stressed the costs associated with obtaining a thumb prosthesis. The fourth theme explored patient frustration and causes of device abandonment. Theme five summarized opinions on currently available thumb prostheses, and theme seven was the ideal design for a thumb prosthetic, including sensory elements and materials. CONCLUSIONS: Representative data from stakeholders mapped the current status of thumb prostheses. Preferences for an ideal thumb prosthesis included a simple, durable design with the ability to oppose, grasp, and sense pressure. Affordable cost and ease of fit emerged as systemic objectives.

Provides insight into the experiences of individuals following thumb amputation.Identifies challenges that may lead to prosthetic abandonment so that these can be considered and addressed by rehabilitation professionals.Identifies positive elements and preferred materials in current prosthetics so that rehabilitation professionals may incorporate these more frequently.

Large-Volume Fat Grafting to the Breast With External Expansion Assist.

BACKGROUND: Large-volume autologous fat transfer (AFT) to the breast with external expansion has emerged as an alternative to alloplastic augmentation or reconstruction in appropriate patients. OBJECTIVES: Report the authors' technique for this procedure and experience with 49 consecutive patients of a single surgeon's practice from 2013 to 2021. METHODS: The authors performed a retrospective analysis of consecutive patients undergoing fat grafting to the breast with preexpansion. Patients were included if they had a clinical problem amenable to correction with large-volume fat injection and adequate donor sites, and were willing to undergo preexpansion. Data was collected through chart review and deidentified. Demographics, diagnosis, radiation status, volume grafted, complications, and adjunct procedures were recorded. RESULTS: Forty-nine patients underwent external expansion with AFT by a single surgeon. Twenty-three patients (47%) had hypoplastic indications, including tuberous breast deformity (n = 9) and Poland syndrome (n = 1). Seventeen patients (35%) had indications for secondary breast revision of previously placed implants. Nine patients (18%) utilized the procedure for primary oncologic breast reconstruction. A total of 71 procedures were performed, with an average of 1.45 procedures per patient. The average volume of fat grafted per breast was 372 mL for hypoplasia, 240 mL for secondary breast revision, and 429 mL for oncologic reconstruction. Concurrent procedures included implant exchange, implant removal, mastopexy, and breast reduction. Follow-up ranged from 1 to 84 (average = 20) months. CONCLUSIONS: The authors' experience shows promising results with external expansion and large-volume fat grafting to the breast.

Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action.

The global COVID-19 pandemic has brought to light the significant inequities in the delivery of healthcare, vaccine inequity, and differential access to life-saving treatments, which have disproportionately impacted marginalized and racialized populations. In this article, we acknowledge and recognize the centuries-old legacies perpetuating inequity, injustice, and oppression, we discuss the principles of Equity, Diversity, and Inclusion (EDI) and we call our Canadian plastic surgery colleagues and trainees to action. We propose a plan for (1) Education, (2) Mitigating Disparities in the Clinical Setting, and (3) Policy, Societies, and Leadership Education.

La pandémie mondiale de COVID-19 a mis en lumière des iniquités importantes dans la prestation des soins, l'iniquité vaccinale et l'accès différentiel à des traitements salvateurs, qui ont touché démesurément les populations marginalisées et racisées. Dans le présent article, les auteurs reconnaissent les héritages séculaires qui perpétuent l'iniquité, l'injustice et l'oppression, ils abordent les principes d'équité, de diversité et d'inclusion et ils appellent à l'action leurs collègues et leurs stagiaires canadiens en chirurgie plastique. Ils proposent un plan en matière (1) d'éducation, (2) d'atténuation des disparités en milieu clinique et (3) de politique, de société et d'éducation au leadership.

Impact of the COVID-19 Pandemic on the Wellness of Canadian Plastic Surgery Residents.

On top of preexisting burnout, depression, and anxiety among trainees, the COVID-19 pandemic has introduced novel stressors. The objectives of this study were to determine the effects of the COVID-19 pandemic on Canadian plastic surgery residents' practice, wellness, and overall training. Methods: Surveys for program directors and residents were created and disseminated to all English-speaking Canadian plastic surgery residency training programs. Survey results were pooled and presented as a percentage of responses for each question. Results: Response rates were 50% (n = 5/10) and 25% (n = 19/77) for program directors and residents, respectively. All program directors believed that the pandemic has a negative effect on resident wellness, 80% (n = 4/5) of which believed that their residents were coping effectively. They rated program support for resident wellness as neutral or supportive. Most programs (80%; n = 4/5) introduced strategies to support resident well-being. Most trainees (84%; n = 16/19) reported the pandemic as having a negative effect on their well-being, with approximately 50% endorsing worse emotional, social, psychological, and physical wellness, as well as feelings of burnout. Some reported difficulties coping (21%; n = 4/19). Residents felt that their wellness was supported externally by their own resilience (89%; n = 17/19), family members (74%; n = 14/19), friends (74%; n = 14/19), their partner (68%; n = 13/19), or co-residents (53%; n = 10/19). Internal support by their program was rated as neutral or negative (63%; n = 12/19). Conclusions: Our findings of negative effects of the COVID-19 pandemic on the wellness of Canadian plastic surgery trainees are concerning. Programs must implement appropriate identification and support strategies to improve resident well-being.

Systematic Review Comparing Cost Analyses of Fasciectomy, Needle Aponeurotomy, and Collagenase Injection for Treatment of Dupuytren's Contracture: Une analyse de coûts systématique comparant la fasciectomie, l'aponévrotomie percutanée à l'aiguille et l'injection de collagénase pou traiter la maladie de Dupuytren.

PURPOSE: Surgeons now have a variety of treatment options for Dupuytren's contracture including traditional partial fasciectomy (PF), percutaneous needle aponeurotomy (PNA), and collagenase Clostridium histolyticum (CCH) injection. An important factor in clinical decision making is the cost-effectiveness of the various modalities, as will be discussed in this article. METHODS: A literature search was performed by 2 independent reviewers. A total of 14 articles and 3 abstracts met inclusion criteria. Papers were excluded for non-English language, insufficient breakdown of costs by treatment type, promotional materials, or works-in-progress. Cost data were extracted and subsequently converted to US dollars. Weighted means were used to objectively pool data that were sufficiently similar in methodology and population. RESULTS: Seven observational cohort studies were pooled and found to have a weighted mean cost in favour of PNA at US$3335 per patient as compared to CCH at US$3673.14 and PF at US$4734.14. Two expected-value decision analysis models were in agreement that PF is not cost-effective, but they differed on whether PNA or CCH was the most cost-effective strategy. Two cost minimization studies agreed that CCH was less costly than PF by US$486. One cost-benefit analysis found no significant cost benefit to CCH or PF, but found significant indirect benefit to CCH. Overall 10 of 17 studies found CCH to be superior with respect to direct cost, indirect cost, or both. Only 2 of the 17 studies found PF to be the most cost-effective method. Of the 7 studies that considered PNA, 4 found it to be lowest cost. CONCLUSION: The vast majority of studies found PF to be the most costly treatment modality; however, it is still the treatment of choice in certain clinical scenarios. It is difficult to compare CCH to PNA, as many studies did not consider PNA. More studies, especially considering indirect costs, are required to be able to accurately determine which method is most cost-effective.

OBJECTIF: Les chirurgiens possèdent désormais diverses options pour traiter la maladie de Dupuytren, y compris la fasciectomie partielle (FP) classique, l'aponévrotomie percutanée à l'aiguille (APA) et l'injection de collagénase issue du Clostridium histolyticum (CCH). Le rapport coût-efficacité des diverses modalités est un facteur important de la prise de décision clinique, comme on le verra dans le présent article. MÉTHODOLOGIE: Deux analystes indépendants ont procédé à une analyse bibliographique. Au total, 14 articles et trois résumés respectaient les critères d'inclusion. Les articles qui n'étaient pas rédigés en anglais, dont la ventilation des coûts par type de traitement était insuffisante, qui contenaient du matériel promotionnel ou qui rendaient compte de travaux en cours étaient exclus. Les chercheurs ont extrait les données sur les coûts et les ont converties en dollars américains. Ils ont utilisé les moyennes pondérées pour regrouper objectivement les données dont la méthodologie et la population étaient suffisamment semblables. RÉSULTATS: Les chercheurs ont regroupé quatre études de cohorte observationnelles et ont constaté que le coût moyen pondéré de l'APA, à 3 335 $ par patient, était plus favorable que celui de la CCH, à 3 673,14 $ et de la FP, à 4 734,14 $. Trois modèles d'analyse décisionnelle de la valeur attendue concluaient que la FP n'était pas rentable, mais divergeaient sur le coût de l'APA et de la CCH. Deux études de minimisation des coûts ont convenu que la CCH coûtait 486 $ de moins que la FP. Une analyse coût-bénéfice n'a pas établi de coûts-avantages significatifs pour la CCH ou la FP, mais a constaté des avantages indirects significatifs pour la CCH. Bref, selon 11 des 17 études, la CCH était supérieure sur le plan des coûts directs, des coûts indirects ou de ces deux coûts. Seulement deux des 17 études ont indiqué que la FP était la plus rentable. Sur les sept études qui évaluaient l'APA, quatre ont indiqué qu'il s'agissait de la moins coûteuse. CONCLUSION: La grande majorité des études ont établi que la FP était le traitement le plus coûteux, mais elle demeure à privilégier dans certains scénarios cliniques. Il est difficile de comparer la CCH à l'APA, car de nombreuses études n'évaluaient pas l'APA. Il faudra mener plus d'études, notamment sur les coûts indirects, pour déterminer la méthode qui est vraiment la plus rentable.

Nerve transfer surgery in spinal cord injury: online information sharing.

BACKGROUND: Nerve transfer to improve upper extremity function in persons with cervical spinal cord injury (SCI) is a new reconstructive option, and has led to more people seeking and sharing surgical information and experiences. This study evaluated the role of social media in information-sharing on nerve transfer surgery within the SCI community. METHODS: Data were collected from Facebook, which is the favored information-sharing platform among individuals seeking medical information. Searched terms included 'spinal cord injury' and 'SCI' and excluded groups with: less than two members (n = 7); closed groups (n = 2); not pertaining to SCI (n = 13); restricted access (n = 36); and non-English (n = 2). Within public and private accessed groups, searches were conducted for 'nerve', 'transfer', 'nerve transfer', and 'nerve surgery'. Each post about nerve transfer, responses to posts, and comments about nerve transfer in response to unrelated posts were tabulated. Thematic content analyses were performed and data were categorized as seeking information, sharing information, sharing support, and sharing appreciation. RESULTS: The search yielded 99 groups; 35 met the inclusion criteria (average size = 2007, largest = 12,277). Nerve transfer was discussed in nine groups, with 577 total mentions. In the seeking information axis, posts were related to personal experience (54%), objective information (31%), surgeon/center performing the procedure (9%), and second opinion (4%). At least 13% of posts were from individuals learning about nerve transfers for the first time. In the sharing information axis, the posts: shared personal experience (52%); shared objective information (13%); described alternative treatment (3%); tagged someone to share information (11%); linked to outside resources (12%); and recommended a specific surgeon/center (9%). CONCLUSION: Social media is an important source of information and support for people with SCI. There is a paucity of information on nerve transfers. These study findings will inform implementation of future education strategies.

Reporting Outcomes and Outcome Measures in Thumb Carpometacarpal Joint Osteoarthritis: A Systematic Review.

PURPOSE: In the thumb carpometacarpal (CMC) joint osteoarthritis (OA) literature, there is substantial heterogeneity in outcome and outcome measure reporting. This could be rectified by a standardized core outcome set (COS). This study aimed to identify a comprehensive list of outcomes and outcome measures for thumb CMC joint OA, which represents the first step in developing a COS. METHODS: A computerized search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed to identify randomized controlled trials, as well as observational studies involving at least 50 participants aged greater than 18 years undergoing surgery for thumb CMC joint OA. Reported outcomes and outcome measures were extracted from these trials and summarized. RESULTS: This search yielded 3,498 unique articles, 97 of which were used for analysis. A total of 33 unique outcomes and 25 unique outcome measures were identified. The most frequently used outcomes were complications (78), postoperative pain (73), radiologic outcomes (64), and grip strength (63). Within each reported outcome, there was substantial variation in how the outcome was measured. Of the 25 unique outcome measures, 10 were validated. Of the remaining 15, 12 were created ad hoc by the author. The Disabilities of the Arm, Shoulder, and Hand questionnaire was the most commonly reported outcome measure (34%). CONCLUSIONS: There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. A standardized COS created by stakeholder consensus would improve the consistency and therefore the quality of future research. CLINICAL RELEVANCE: This systematic review of outcomes represents the first step in developing a core outcome set for thumb CMC joint OA.

Reporting Outcomes and Outcome Measures in Digital Replantation: A Systematic Review.

Introduction There is a lack of consensus on what the critical outcomes in replantation are and how best to measure them. This review aims to identify all reported outcomes and respective outcome measures used in digital replantation. Materials and Methods Randomized controlled trials, cohort studies, and single-arm observational studies of adults undergoing replantation with at least one well-described outcome or outcome measure were identified. Primary outcomes were classified into six domains, and outcome measures were classified into eight domains. The clinimetric properties were identified and reported. A total of 56 observational studies met the inclusion criteria. Results In total, 29 continuous and 29 categorical outcomes were identified, and 87 scales and instruments were identified. The most frequently used outcomes were survival of replanted digit, sensation, and time in hospital. Outcomes and measures were most variable in domains of viability, quality of life, and motor function. Only eight measures used across these domains were validated and proven reliable. Conclusion Lack of consensus creates an obstacle to reporting, understanding, and comparing the effectiveness of various replantation strategies.

A systematic review identifying outcomes and outcome measures in Dupuytren's disease research.

This systematic review summarizes the outcome reporting standards in Dupuytren's disease treatment research. A search of Ovid Medline, Ovid Embase, and CINAHL was conducted. Randomized controlled trials, cohort studies, and case series published between 1997 and 2017, investigating treatment of Dupuytren's disease with fasciectomy, fasciotomy, or collagenase, were eligible for inclusion. Range of motion was the most commonly reported outcome, appearing in 77% of included studies. Outcomes, such as range of motion, recurrence, and clinical success, were frequently defined, however many different definitions were used. We identified 37 unique measurement methods for range of motion, 28 for recurrence, and 25 for clinical success. Most outcomes were assessed at multiple time points, and only a few studies reported results according to established clinical significance thresholds. Development of a core outcome set will help standardize outcome reporting, and ensure future research in this field is relevant, interpretable, and amenable to systematic review and/or meta-analysis.

Outcomes and Outcome Measures in Breast Reduction Mammaplasty: A Systematic Review.

BACKGROUND: Reduction mammaplasty remains critical to the treatment of breast hypertrophy. No technique has been shown to be superior; however, comparison between studies is difficult due to variation in outcome reporting. OBJECTIVES: The authors sought to identify a comprehensive list of outcomes and outcome measures in reduction mammaplasty. METHODS: A comprehensive computerized search was performed. Included studies were randomized or nonrandomized controlled trials involving at least 100 cases of female breast hypertrophy and patients of all ages who underwent 1 or more defined reduction mammaplasty technique. Outcomes and outcome measures were extracted and tabulated. RESULTS: A total 106 articles were eligible for inclusion; 57 unique outcomes and 16 outcome measures were identified. Frequency of patient-reported and author-reported outcomes were 44% and 88%, respectively. Postoperative complications were the most frequently reported outcome (82.2%). Quality-of-life outcomes were accounted for in 37.7% of studies. Outcome measures were either condition-specific or generic; frequencies were as low as 1% and as high as 5.6%. Five scales were formally assessed in the breast reduction populations. Clinical measures were defined in 15.1% of studies. CONCLUSIONS: There is marked heterogeneity in reporting of outcomes and outcome measures in the literature. A standardized outcome set is needed to compare outcomes of various reduction mammaplasty techniques.

Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery: A Systematic Review.

BACKGROUND: Current guidelines for randomized controlled trial reporting do not require authors to justify their choice of time horizon. This is concerning, as the time horizon when an outcome is assessed has important implications for the interpretation of study results, and resources allocated to an investigation. Therefore, this study seeks to examine the standards of time horizon reporting in the plastic surgery literature. METHODS: This is a systematic review of plastic surgery randomized controlled trials published within the past 4 years. The MEDLINE database was searched to yield relevant studies. All studies included were English language, prospective, nonpharmaceutical randomized controlled trials, comparing two plastic surgical interventions. Studies were classified into plastic surgery domains, and information regarding study population, time horizon reporting, and justification of chosen time horizon, was extracted. RESULTS: The search retrieved 720 articles, of which 103 were eligible for inclusion. Time horizons were reported as either a standardized time point at which all patients were assessed, or a follow-up duration range, or were not reported at all. Although most studies (85.4 percent) reported a standardized time horizon, the majority (85.4 percent) failed to provide a valid justification to support their selection of time horizon. CONCLUSIONS: Clinical investigators failed to justify their choice of time horizon in the majority of published randomized controlled trials. To limit heterogeneity, time horizons for given interventions should be standardized to improve validity of outcome assessments, enable future pooling of results, and increase research efficiency.

Introducing Knowledge Translation to Plastic Surgery: Turning Evidence into Practice.

Best evidence has no bearing on quality of life if it is not implemented in clinical practice. The authors introduce knowledge translation as a theoretical framework for closing the gap between evidence and practice in plastic surgery. The current state of published evidence in plastic surgery is reviewed and evaluated, with the recommendation to use the EQUATOR Network's guidelines for reporting clinical research findings. Tools and strategies are offered for the reader to understand and integrate evidence at the bedside. Systemic solutions are also proposed for the dissemination of best evidence to facilitate its translation into practice.