Preventing and Managing Operating Room Fires in Plastic Surgery: A Review of Incidence, Risk Factors, and Recommendations with Case Experiences.

Fires in operating rooms are rare yet devastating incidents. There are guidelines for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case reports. Almost all surgical procedures have an oxidizer (oxygen, nitrous oxide), an ignition source (such as a laser or "Bovie"), and a fuel, which together make up the three elements of an operating room fire. Our review analyzes each fire component to decide on the most effective clinical approach for reducing the risk of fire. We investigate the incidence, risk factors, legal repercussions, preventive strategies, and the precise management of fires in the operating room, with a particular focus on plastic surgery procedures. In addition, we share insights from our own experiences and propose guidelines based on our findings to enhance safety and response measures in surgical settings. Fires most commonly occur around the head, neck, and upper chest. High-risk procedures include tonsillectomies, tracheostomies, laryngoscopies, and facial/neck surgeries. Checklists help ensure proper precautions are taken, like using moist towels and lowering oxygen concentration. If a fire erupts, prompt removal of the oxygen source and irrigation are critical. From our experience, fires spread rapidly and can cause severe burns and inhalation injuries. We share illustrative cases of surgical fires at our institution over the past decade. Our review underscores the importance of fire prevention and preparedness through safety protocols, equipment maintenance, staff training, and maintaining situational awareness. More research is needed to quantify risk factors and determine optimal management strategies when fires do occur.

Awareness and Knowledge of the Adverse Effects of Dermal Fillers Among the Saudi Population: A Cross-Sectional Study.

Introduction Dermal filling for aesthetics and facial rejuvenation is one of the most common aesthetic procedures, with hyaluronic acid (HA) being the most commonly used filler due to its high safety profile. Nevertheless, adverse effects have been reported that people should be aware of before the procedure. This study aims to assess Saudi Arabians' awareness of dermal fillers, their side effects, and information sources. Methods This cross-sectional study used an online questionnaire to determine participants' level of knowledge, from January 2, 2022, to February 19, 2023. Statistical analysis and ordinal logistic regression were used to assess the respondents' knowledge of dermal fillers and other parameters. Results Of the 1,208 respondents, 290 reported using fillers, and 44% reported that complications were mentioned to them before the procedure. The results also showed that the primary source of information was social media (44.8%), followed by the Internet, physicians, and books. Respondents to whom physicians explained complications reported bruising, bluish discoloration at the injection site, redness, swelling, and accumulation of body cells under the skin, as discussed with them. Bruising and bluish discoloration were the significantly reported complications in people who received fillers, whereas lumps, epistaxis, ulceration/loss of skin, and swelling/accumulation were reported in those who did not receive fillers. Conclusion Although some adverse effects may occur with HA, its enormous advantages led to its use in facial rejuvenation. With social media as a major source of information, many respondents reported unlikely adverse effects as common ones, suggesting that information sources need to be corrected by physicians to raise awareness of the adverse effects of cosmetic procedures and enhance informed decision-making by patients.

Dermatology residents as educators: a qualitative study of identity formation.

BACKGROUND: One of the many identities a physician comes to form during their career is their identity as an educator. Exploring formation of this identity may enrich our understanding of how physicians make decisions related to their roles as educators, their behaviors, and how this ultimately influences the educational environment. It is the aim of this study to investigate educator identity formation of dermatology residents while early in their careers. METHODS: Drawing on a social constructionist paradigm, we conducted a qualitative study, utilizing an interpretative approach. We examined longitudinal data over a 12-month period using dermatology residents' written reflections from their professional portfolios and semi-structured interviews. We collected this data as we progressed through and beyond a 4-month professional development program designed to encourage residents' growth as educators. Sixty residents in their second, third, or final year of residency programs located in Riyadh, Saudi Arabia were invited to take part in this study. Twenty residents participated with sixty written reflections and 20 semi-structured interviews. Qualitative data were analyzed using a thematic analysis approach. RESULTS: Sixty written reflections and 20 semi-structured interviews were analyzed. Data was categorized according to themes corresponding to the original research questions. For the first research question regarding identity formation, themes included definitions of education, the process of education, and identity development. For the second research question, 1 theme entitled professional development program included, the following sub-themes: individual act, interpersonal activity, and an organizational undertaking, with many believing that residency programs should prepare residents for their educator roles. Participants also described newfound leadership ambitions of creating new dermatology fellowship programs as a result of taking part in the Resident-as-Educator program. CONCLUSIONS: Our study provides insights on the dynamic formation of educator identities amongst dermatology residents. Investment in developing residents as educators through professional development programs may instigate transformational change on the individual physician level and profession's level.

Current Practices and Guidelines for Perioperative Blood Management in Post-Bariatric Body Contouring Surgery: A Comprehensive Review of Literature.

With the increase in obesity prevalence, a noticeable increase in bariatric surgeries has been reported in national and international statistics. Therefore, body contouring surgeries have increased to help individuals achieve their desired body shape. Plastic surgeons need to consider potential hematologic complications that may occur in this specific group of patients before performing body contouring surgery. This review illustrates the perioperative medical, laboratory, and management strategies needed to minimize blood loss and blood transfusion requirements during body contouring. Using Google Scholar and PubMed, a comprehensive literature review was conducted to identify articles discussing post-bariatric body contouring perioperative blood management strategies, including the effects of bariatric surgery on hemostasis as well as basic hematology and coagulation. In preoperative blood management, blood investigations aid in the early detection of electrolytes, protein, and vitamin deficiencies and anemia, resulting in the early correction of nutritional deficiencies. In order to reduce postoperative complications, surgical and anesthesia techniques, as well as intraoperative pharmacological therapy, play an essential role. Postoperative blood transfusion and restrictive transfusion thresholds are tailored to the patient's needs and depend on various physiological indicators, such as heart rate, blood pressure, urine output, and laboratory findings, such as acidosis and hematocrit level. Generally, post-bariatric body contouring blood management measures are still lacking, and more research is required to develop standardized guidelines for optimizing patient safety and satisfaction.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Little Finger Duplication.

Polydactyly is defined as an extra finger or toe that is present at birth. It is a congenital anomaly that can manifest as a single disorder or as a component of a syndrome. Treatment can be conservative or operative depending on the anticipated function of the extra digit. In this report, we describe a case of a bifid 5th digit on the right hand. The aim of this report was to report a new variant of type IIIB described by Duran (2015). This will possibly lead to the modification of the current classifications, which will improve the diagnosis and treatment of patients.

Morbidity of the Donor Site and Complication Rates of Breast Reconstruction with Autologous Abdominal Flaps: A Systematic Review and Meta-Analysis.

Background: Numerous studies have evaluated the use of autologous abdominal tissue for breast reconstruction; nevertheless, complications and donor site morbidity rates vary significantly. The study aims to compare the literature regarding morbidity of the donor site and complication rates of breast reconstruction with autologous abdominal flaps. Methods: The databases of MEDLINE, EBSCO, Scopus, Wiley Library, and Web of Sciences were searched for studies that compared different flaps in terms of complications and donor site morbidity. The procedures studied included pedicled transverse rectus abdominis myocutaneous flap (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery perforator (SIEA) flaps. A total of 34 studies were included. Of these, 28 were retrospective studies and 9 were prospective cohort studies. Results: When compared to DIEP, fTRAM flaps were found to have a decreased incidence of flap fat necrosis, hematoma, and total thrombotic events, yet a higher risk of donor site hernia/bulging. pTRAM flaps were also associated with an increased risk of hernia/bulging at the donor site, as well as wound infection, yet flap hematoma was less common. On the other hand, SIEA flaps showed the lowest risk of donor site hernia/bulging while still having a high risk of wound infection. Conclusion: fTRAM procedures comparatively had the least complications. However, regarding flap choice, patients would benefit most from a case-by-case analysis, taking into consideration individual risk factors and preferences.

Association of Academic Performance With Obesity and Unhealthy Lifestyle Among Female University Students.

Aim This study aims to examine the relationship between obesity and academic performance and to investigate the relevance between an unhealthy lifestyle and academic performance, which may exist among obese and non-obese female students in the College of Science and College of Medicine of Imam Mohammad Ibn Saud Islamic University. Method The study is observational, descriptive, and cross-sectional in nature and covers a sample of 328 female students aged 19 to 23 years. They were randomly selected from the College of Science and College of Medicine. Sample collection was conducted from December 12, 2020 to June 15, 2021. Results The result indicates that obesity did not influence academic performance. The association between obesity and academic performance was non-significant (p = 0.335). In the College of Science, grades in physics and math were analyzed, which reflected a weak association with obesity (p = 0.893 and p = 0.872, respectively). Various factors exerted a positive impact on academic performance, such as eating yogurt at least 1-5 times per week (p < 0.05) and spending less than 4 hours on social media or watching TV (p < 0.05). Conclusion Academic performance is influenced by many factors. Eating yogurt more frequently and watching TV and less time for social media are the factors with the largest influence on academic performance. However, obesity does not influence academic performance. In summary, physical activity and a healthy diet exerted no direct effect on academic performance.

Knowledge and attitudes of physicians toward forensic psychiatry in Saudi Arabia.

OBJECTIVES: To assess the knowledge and attitudes of physicians of different specialties, including psychiatrists, regarding forensic psychiatry to determine whether further modification or training is needed in the psychiatry residency program. METHODS: This cross-sectional study was carried out using a 3-page, 3-section questionnaire containing 21 questions disseminated randomly online via Google forms using social media platforms. The 482 participants were residents, specialists, and consultants of various specialties. The study was conducted between September 2020 and August 2021 in various tertiary hospitals across Saudi Arabia. RESULTS: A total of 482 physicians were recruited. The most common age group was 25-35 years, comprising mostly Saudis (62.4%). Based on the results, "poor" and "good" knowledge of forensic psychiatry was identified in 89% and 11% of the physicians, while "negative" and "positive" attitudes were identified in 16.4% and 83.6% of the physicians. CONCLUSION: Although the perspective of physicians regarding forensic psychiatry was found to be positive, their knowledge of the topic seems to be lacking.