Trends in Academic "Ghost Publications" in Plastic Surgery Residency Applications: A 3-Year Study.

Plastic surgery is an attractive specialty to medical students. Residency training programs have the luxury of selecting their trainees from the "cream of the crop" from United States medical schools. Because of the steep competition for PGY-1 integrated program positions, the temptation exists for applicants to falsify parts of their applications, particularly those parts that are difficult to verify. METHODS: A retrospective analysis of the Integrated Plastic Surgery applications from the years (2010-2013) was done. Two reviewers manually and independently handsearched each of the articles in the databases (Medline, Scopus, Clinical trials, Google scholar) additionally, a specialized medical librarian corroborated. A ghost article was defined as the inability to find the listed applicant in the authorship list of the claimed article/abstract/chapter or the inability to find the submitted article. Misrepresentation was defined as a change in authorship order. Data were summarized and analyzed, generalized estimating equations model was used. SAS software, v9.4. RESULTS: All 392 applicants were included, 159 (2010-2011), 120 (2011-2012), and 119 (2012-2013). The number of manually reviewed records was 2,124. "Ghost" authorship was found in 234 articles out of 2,124 (11.02%). The overall rate of "Ghost" authorship in applicants to our program was found to be 34.4%, 135 applicants and misrepresentation in 5 cases (1.28%). CONCLUSIONS: Ghost publications are present in Plastic Surgery applications, its trend is similar through the years, "protective" factors are: first authorship and published peer reviewed abstract/article.

Pulmonary Function After Pedicled Transverse Rectus Abdominis Musculocutaneous Flap Breast Reconstruction.

Tight abdominal closures, as can be seen during transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction, have been shown to increase intra-abdominal pressure, thereby decreasing thoracopulmonary compliance and increasing the workload of breathing. The purpose of this article was to quantitate pulmonary function in patients who underwent pedicled TRAM flap breast reconstruction.A prospective clinical trial was conducted involving 22 women undergoing unilateral or bilateral pedicled TRAM flap breast reconstruction. Pulmonary function testing was conducted 1 week before the operation, 24 hours postoperatively, and 2 months postoperatively. The patients were stratified by age (<50 years vs ≥50 years), type of TRAM flap (unilateral vs bilateral), tobacco use (smoker vs nonsmoker), and body mass index. Changes were analyzed using 1-way repeated-measures analysis of variance and paired t tests. All comparisons used a 2-tailed test at the 0.05 level of significance.Other than residual volume, the 24-hour postoperative values were significantly lower than the preoperative values. The smokers had less change in functional residual capacity, total lung capacity, and forced vital capacity values than the nonsmokers at 24 hours postoperatively; however, they were noted to have decreased pulmonary function at baseline. The patients 50 years or older had significantly greater decline in functional residual capacity and residual volume compared with the younger cohort. No significant difference in pulmonary function testing values existed between those undergoing bilateral versus unilateral pedicled TRAM flap reconstruction. Pulmonary function tests returned to baseline at 2-month follow-up.Pulmonary function test values were significantly decreased at 24 hours after pedicled TRAM flap breast reconstruction.

Social problems in plastic surgery residents: a management perspective.

BACKGROUND: It is presumed that plastic surgery residents experience various social problems, just as do their peers in other specialty training programs and in the general public. These issues can occasionally disrupt the resident's personal training experience and sometimes the program as a whole. A survey was performed to assess the magnitude of the problem, and the issues revealed were assessed to assist the program director and the resident in reaching successful completion of the residency. METHODS: A survey was designed by the executive committee and staff of the American Council of Academic Plastic Surgeons and sent to all plastic surgery training programs in the United States. A response rate of 66 percent was achieved. The programs reported on the social issues occurring in their residents over the preceding 5 years. The results were presented at a business meeting of the Council. RESULTS: Thirty-seven percent of programs reported that at least one resident had left their program during the study period. Twenty percent reported that a resident had been asked to leave the program. The frequency of social problems resulting in disruption of the training program was tabulated in the following areas: divorce; pregnancy/parturition; financial, legal, or family issues; drug or alcohol abuse; illness/injury; and interpersonal conflicts. CONCLUSIONS: Plastic surgery residents experience social problems that can affect the timely completion of their training. Attention to these issues requires patience, creativity, sensitivity, and a commitment to the residents' ultimate success, and adherence to institutional, legal, and accreditation body mandates.

Academic plastic surgery: faculty recruitment and retention.

BACKGROUND: A critical element of a thriving academic plastic surgery program is the quality of faculty. A decline in recruitment and retention of faculty has been attributed to the many challenges of academic medicine. Given the substantial resources required to develop faculty, academic plastic surgery has a vested interest in improving the process of faculty recruitment and retention. METHODS: The American Council of Academic Plastic Surgeons Issues Committee and the American Society of Plastic Surgeons/Plastic Surgery Foundation Academic Affairs Council surveyed the 83 existing programs in academic plastic surgery in February of 2012. The survey addressed the faculty-related issues in academic plastic surgery programs over the past decade. Recruitment and retention strategies were evaluated. This study was designed to elucidate trends, and define best strategies, on a national level. RESULTS: Academic plastic surgery programs have added substantially more full-time faculty over the past decade. Recruitment efforts are multifaceted and can include guaranteed salary support, moving expenses, nurse practitioner/physician's assistant hires, protected time for research, seed funds to start research programs, and more. Retention efforts can include increased compensation, designation of a leadership appointment, protected academic time, and call dilution. CONCLUSIONS: Significant change and growth of academic plastic surgery has occurred in the past decade. Effective faculty recruitment and retention are critical to a successful academic center. Funding sources in addition to physician professional fees (institutional program support, grants, contracts, endowment, and so on) are crucial to sustain the academic missions.

Core measures: implications for plastic surgery.

BACKGROUND: Perioperative complications are a major source of morbidity, mortality, and expenditures in health care. Many of these complications are preventable with simple, cost-effective measures when implemented in a standardized manner. Surgical specialties are increasing efforts to implement standardized and easily monitored measures to reduce perioperative complications. METHODS: The recommendations provided by the U.S. Department of Health and Human Services and published by the Joint Commission on Accreditation of Healthcare Organizations were summarized as they pertain to plastic surgery. A review of recent plastic surgery literature was pursued to evaluate these recommendations as they pertain to the specialty. RESULTS: Measures exist to reduce the incidence of perioperative infection, venous thromboembolism, and mortality associated with cardiac events. These measures include type and timing of prophylactic antibiotics, maintenance of perioperative normothermia, appropriate hair removal, early discontinuation of urinary catheters, appropriate venous thromboembolism prophylaxis, and use of preoperative beta-blockers. CONCLUSIONS: As national quality measures are implemented across an increasing number of specialties, the expansions will likely affect plastic surgery. These measures are evidence based and validated across a diverse group of surgical specialties, resulting in improved measured outcomes. Plastic surgeons would benefit by actively providing leadership as these and similar measures are implemented.

Traumatic palatal perforation after orotracheal intubation: a case report and a review of the literature.

In this report, we describe an unusual case of a traumatic palatal perforation caused by orotracheal intubation. The paucity of reports of palatal perforation resulting from intubation in the literature suggests that it is a rare occurrence. However, recognizing this potential complication and managing the airway appropriately may reduce patient morbidity.

Incidence of breast hematoma after placement of breast prostheses.

BACKGROUND: Prosthetic breast implants are frequently used by plastic surgeons for reconstructive and aesthetic procedures. One known complication of the procedure is postoperative breast hematoma. However, the incidence and risk factors of this problem are not fully characterized. METHODS: A retrospective analysis was performed of a prospectively collected patient medical record database based on procedure codes to identify breast hematomas and possible risk factors over a 12-year period from November of 1996 to October of 2008. RESULTS: One thousand nine hundred thirty-six operations were performed on 3474 breasts with prosthetic implants used. Average patient follow-up was 48.9 months, with 32 hematomas identified following 32 operations. The latest hematoma identified was 21 months after the procedure. Hematomas were identified on average 37 days after the operation. CONCLUSIONS: In the authors' experience, postoperative breast hematomas after prosthetic implant placement occur in 0.92 percent of breast prostheses placed. No individual surgical approach is associated with the occurrence of breast hematomas. Hematomas are not statistically associated with any measured patient or surgically defined characteristic. Specifically, no statistical significance was shown for larger implant size, reoperation, operative indication, type of surgery, or implant type as an independent risk factor. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

A 5-year review of ethics complaints to the American Society of Plastic Surgeons.

BACKGROUND: The Code of Ethics of the American Society of Plastic Surgeons (ASPS) exists to encourage and enforce ethical behavior among its members. Complaints against individual members may be filed by patients or their representatives, members of the Society, or other members of the public. METHODS: Data from a total of 677 complaints from 2004 to 2008 were reviewed by the author. These complaints were categorized with regard to geographic area, type of complaint, and the outcome of the investigation of the complaint, including disciplinary actions. The system of managing these complaints within the Society is discussed. RESULTS: States with the most complaints filed included California, Florida, Texas, Illinois, and New York, with all others having a minimal number. The most common complaint was filed regarding unethical advertising, followed by unprofessional conduct and participation in a contest. Differences in frequency of complaints were statistically significant (Fisher's exact test, p < 0.001). Fifty-four cases were heard by the Judicial Council, with 31 receiving discipline, primarily the less severe types of censure. The total number of complaints per year seems to be trending downward. CONCLUSIONS: Ethical complaints (filed mostly by ASPS members) vary in frequency according to geographic area and the type of complaint. A downward trend was noted in the total number of complaints over the years 2004 to 2008, although this was not statistically significant. Given the basic purposes of the development of a code of ethics and its subsequent enforcement, the ethical construct within the ASPS seems to serve the specialty well.

Optimizing revenue at a cosmetic surgery centre.

BACKGROUND: The demand for cosmetic surgery and services has diminished with recent fluctuations in the economy. To stay ahead, surgeons must appreciate and attend to the fiscal challenges of private practice. A key component of practice economics is knowledge of the common methods of payment. OBJECTIVE: To review methods of payment in a five-surgeon group practice in central Texas, USA. METHODS: A retrospective chart review of the financial records of a cosmetic surgery centre in Texas was conducted. Data were collected for the five-year period from 2003 to 2008, and included the method of payment, the item purchased (product, service or surgery) and the dollar amount. RESULTS: More than 11,000 transactions were reviewed. The most common method of payment used for products and services was credit card, followed by check and cash. For procedures, the most common form of payment was personal check, followed by credit card and financing. Of the credit card purchases for both products and procedures, an overwhelming majority of patients (more than 75%) used either Visa (Visa Inc, USA) or MasterCard (MasterCard Worldwide, USA). If the amount of the individual transaction surpassed US$1,000, the most common method of payment transitioned from credit card to personal check. CONCLUSIONS: In an effort to maximize revenue, surgeons should consider limiting the credit cards accepted by the practice and encourage payment through personal check.

Plastic surgery leadership in an institution: a primer.

Leadership can be defined as not only the position of a leader, but the ability to function as one. This brief review of leadership is focused on what is involved in leading a plastic surgery unit in an institution. Characteristics of a good leader, identified by those who are being led, are discussed. In addition to that, the character of the individual leading is also reviewed, because it is such a critical ingredient in a person's capacity to lead others. Leadership characteristics can be learned and opportunities for growth in this area are discussed. The result of good leadership of a plastic surgery unit will indubitably result in the enhancement of the plastic surgery unit in an institution and plastic surgery as a specialty.

Through-and-through gunshot wounds to the foot: the "Fearless Fosdick" injury.

Through-and-through gunshot wounds of the foot present the unique problem of needing to fill a defect while at the same time providing coverage of the dorsum and plantar surface of the foot. A series of 5 patients from 2 institutions is presented. These patients all sustained gunshot wounds that penetrated the forefoot, leaving a rim of uninjured soft tissue and bone around the periphery. All patients were reconstructed with free-tissue transfers, but no bone grafting was required to replace missing bone. One patient did have an arthrodesis and wedge osteotomy to help with walking mechanics. Soft-tissue reconstruction only is adequate to restore the foot sufficiently to allow the patient to walk satisfactorily.

TRAM flaps: a reconstructive option after bilateral nipple-sparing total mastectomy.

BACKGROUND: Transverse rectus abdominis musculocutaneous (TRAM) flaps have commonly been used as a reconstructive option after total mastectomy or modified radical mastectomy, but they can also serve as an appropriate alternative after bilateral nipple-sparing total mastectomy. In this study, performed from 1992 to 2002, 16 patients underwent TRAM flap breast reconstruction after bilateral nipple-sparing total mastectomy. METHODS: The indications for bilateral nipple-sparing total mastectomy all involved benign breast disease; these patients were evaluated using a health outcomes study and the aesthetic evaluations of four judges using postoperative photographs. One patient had free flaps and 15 patients received pedicled flaps. Eleven patients had secondary reconstruction with bilateral TRAM flaps after implant removal, and five patients underwent immediate reconstruction with bilateral TRAM flaps. RESULTS: Patients reported satisfactory physical and emotional functioning after the surgery without any significant detrimental effects on quality of life. Follow-up ranged from 3 to 90 months (median follow-up, 21 months). The cosmetic outcome of the reconstructed breast after bilateral nipple-sparing total mastectomy yielded fair to excellent results in the majority (80 percent) of patients. CONCLUSIONS: Bilateral nipple-sparing total mastectomy remains an option for women with symptomatic breast conditions or with a high risk of familial breast cancer. Autologous tissue remains a reasonable alternative for reconstruction after bilateral nipple-sparing total mastectomy in the appropriately selected patient. To date, all patients in the study have remained free of breast cancer (range, 2 to 21 years).