Indian Perspective of Burnout Among Plastic Surgeons.

Introduction Over the last decade, the term "Burnout" has become familiar term in all walks of life, particularly medicine. Emotional exhaustion, depersonalization, and a low sense of personal accomplishment make up the triad. At least a third of plastic surgeons are having burnout according to the western literature. Data on burnout in Indian plastic surgeons is lacking. We have made an attempt to analyze the incidence and factors responsible for burnout among plastic surgeons in India. Materials and Methods An online survey was conducted in India to assess burnout among plastic surgeons from June to November 2019. Consent, demographic information, stress-related factors, the abbreviated Maslach Burnout Inventory (aMBI), and Satisfaction with Medicine were all included section wise in the survey. Both used scales were validated. Data were gathered using Google forms, then uploaded to an Excel file and analyzed. A multivariable and univariable analysis of factors associated with burnout was carried out. Results Twenty-two percent of 330 plastic surgeons who responded were assessed to have moderate to high emotional exhaustion, 5% had moderate to high depersonalization, and 3% had low personal accomplishment. The overall burnout rate was 8.2%. Seventy-three percent of plastic surgeons enjoyed a good to very good quality of life. Great over-volume of work, mid-career practicing plastic surgeons and professional satisfaction with work were found to have a significant association with burnout on multivariate analysis. Conclusions Plastic surgeons in India suffer an overall burnout rate of 8.2% with a multifactorial etiology. This occupational hazard is preventable and reversible. Plastic surgeons need to be vigilant about this and seek help whenever required.

Propeller Flaps.

A propeller flap is an islanded flap that reaches the recipient site through an axial rotation around its vascular axis. The degree of rotation varies from 90 degrees to 180 degrees. It is a highly reliable local reconstructive option. These flaps are simple, single-stage, easy to harvest, and not constrained by routine length-to-width ratios. Since their introduction, the technique has continued to evolve and more applications for the use of propeller flaps are being explored. In spite of their growing use in clinical practice in recent years, many reconstructive surgeons are unaware of their versatility, unsure of their safety, and apprehensive about using propeller flaps confidently. This article aims at understanding the nomenclature, key principles, biogeometry and planning, operative technical details, applications, and complications of propeller flaps.

Burnout among Plastic Surgery Residents in India: An Observational Study.

Introduction Burnout syndrome can be defined as emotional exhaustion, depersonalization, and perceived lack of personal accomplishment, all of which lead to decreased effectiveness at work. The Medscape burnout and depression report of 2018 suggests that the burnout range across various specialties ranges from 23 to 48%. There are no studies to assess the burnout among plastic surgery residents in India. This study is an attempt to assess the same. Materials and Methods An online survey was conducted in March and April 2019 for plastic surgery residents across India. Various parameters including those related to gender, year of the curriculum, hobbies, exercise, and marital status were assessed. There were multiple sections in the survey, which included the demographic details, stress-related variables, and the abbreviated Maslach Burnout Inventory. The abbreviated Maslach Burnout Inventory is a validated scale that has been used to assess the burnout among plastic surgery residents in India. The three subscales, emotional exhaustion, depersonalization, and personal accomplishment were measured on a Likert scale. Univariable and multivariable analysis of factors associated with burnout was performed. Results Of the 185 respondents, 48.4% experienced moderate-to-high burnout. Of these, 25% ( n = 46) were above the 75th centile of the overall burnout score, indicating severe burnout. Insufficient faculty involvement, insufficient time allotted for formalized teaching, conflict with colleagues, and lack of adequate support staff correlated with resident burnout on multivariate analysis. Residents who pursued their hobbies or performed physical activities for exercise had significantly lesser burnout. Conclusion The incidence of burnout in plastic surgery residents surveyed in our study was 48.4%. The faculty of the departments and the residents themselves, as well as the governing bodies, all have a role to play to address the issue of burnout among residents. Dedicated and persistent efforts toward improving physical and psychological well-being of plastic surgery residents will positively impact not only the well-being of the residents but also the quality of patient care.

The Reach of the Gastrocnemius Musculocutaneous Flap: How High Is High?

BACKGROUND: Gastrocnemius muscle and musculocutaneous flaps are very versatile and one of the commonly used flaps for lower extremity reconstruction. There is significant literature available on the use of these flaps. However, we feel that the potential of the gastrocnemius musculocutaneous (GMC) flaps has not yet been fully explored in terms of increasing their reach, viability and arc of rotation. An attempt is made to refine the technique of flap harvestation to optimize outcomes of this versatile flap. METHODS: Six patients of complex lower limb defects were managed using the GMC flaps. Harvesting of the flap was always initiated from the posterior midline to include the proximal sural pedicle, sural nerve, short saphenous vein and the muscle belly of either the medial or the lateral gastrocnemius muscle along with the cutaneous paddle. All the flaps were islanded and denervated. The origin of the gastrocnemius muscle was detached in all cases to increase the reach of this flap. RESULTS: The flap can reliably and comfortably cover defects from middle third-lower third junction of thigh and the entire posterior aspect of the thigh. Such a local option offers relatively simple but more cost-effective approach to complex clinical problem with tolerable impairment of the donor site. CONCLUSION: The GMC flap can be considered as a worthwhile alternative to free-tissue transfer for limb salvage.