Exploring the application of CHATGPT in plastic surgery: a comprehensive systematic review.

OBJECTIVE: To determine the impact of ChatGPT in plastic surgery research and assess the authenticity of such contributions. METHODS: The study conducted a literature search in Sep'23 from databases like Pubmed, Google Scholar, SCOPUS, and OVID Medline.The following keywords 'ChatGPT', 'chatbot', 'reconstruction', 'aesthetic' and 'plastic surgery' were used. 32 papers were included from the initial 131 results of articles. English language articles from November 2022 to July 2023 discussing ChatGPT's role in plastic and aesthetic surgery were included whereas non-English documents, irrelevant content, and non-academic sources were excluded from the study. RESULTS: The manuscripts included in the systematic review had a diverse range, including original research articles, case reports, letters to the editor, and editorials. Among the included studies, there were 9 original research articles, 1 case report, 23 letters to the editor, and 2 editorials. Most publications originated from the United States (18) and Australia (7). Analysis suggested concerns, such as inaccuracies, plagiarism, outdated knowledge, and lack of personalized advice. Various authors recommend using ChatGPT as a supplementary tool rather than a replacement for human decision-making in medicine. CONCLUSIONS: ChatGPT shows potential in plastic surgery research, concerns about inaccuracies and outdated knowledge may provide deceiving information and it always requires human input and verification.

Robotic-assisted free flap harvesting for diverse soft tissue reconstruction: a PRISMA scoping review of clinical outcomes over the last decade.

Introduction: The aim of our study was to assess the advantages and limitations of robotic technology in diverse reconstructive procedures. METHODS: A scoping review was conducted in Oct'23, on published studies from 2013 to 2023, focussing on robotic-assisted free flap harvesting. Three databases Ovid-MEDLINE, Scopus, and PubMed were searched. Original research studies reporting robotic-assisted free flap harvest were included. Studies on lesion excision, microvascular anastomosis, local flap harvest, roboticassisted flap inset, review articles, abstract-only studies, non-English documents, and animal studies were excluded from this review. RESULTS: Sixteen studies met the inclusion criteria out of a total of 318, searched initially. These studies included a total of 128 patients, who underwent robotic-assisted free flap harvest for the reconstruction of various defects, with 140 free flaps harvested. The most common flaps harvested by robotic technique were deep inferior epigastric artery perforator (DIEP) flap 120 (85.7%), radial forearm free (RFF) flap 11 (7.9%), latissimus dorsii flap 4 (2.9%), rectus abdominus flap 4 (2.9%), and omental flap 1 (0.7%). Breast reconstruction was the major procedure done i.e. 120 (85.7%) followed by head and neck 11 (7.9%) and limb defects 9 (6.4%) reconstruction procedures. The reported clinical outcomes were acceptable in all the studies with a 99% flap success rate and minimal complications. Variability in operating time was observed depending upon surgical steps undertaken with robotic systems. CONCLUSIONS: This scoping review highlights the role of robotic-assisted free flap harvesting in plastic surgery and its potential benefits on clinical outcomes, due to its high precision and minimal invasiveness. However, challenges like cost effectiveness, resource distribution and learning curve are there.

Use of Cephalic Vein for Venous Anastomosis in Head and Neck Reconstruction: A Case Series.

Purpose: To describe the use of the cephalic vein as a recipient vessel for venous outflow in head and neck reconstruction. The cephalic vein is used as a vessel in cases where there is a paucity of veins in the neck. This may be due to previous surgery, previous radiation therapy, or advanced cancer. The cephalic vein may also be used to salvage a failing free flap. Methods: It is a retrospective review of 230 free flaps that had been used in head and neck reconstruction performed from July 2014 to July 2018 by a single surgeon. Results: There were 6 patients in whom the cephalic vein was used as a recipient vessel. The cephalic vein was used in 2 cases where a tumor was involved with the internal jugular vein, in 1 case where a previous neck dissection had been done, in 1 case where internal jugular vein had iatrogenic damage, and in 2 cases a salvage procedure was done. In all cases, the cephalic vein was rotated above the clavicle. The cephalic vein easily reached the free flap vein and had a good caliber. There were no failures in any of the patients. Conclusion: The cephalic vein is a good option for venous anastomoses in patients in whom there is a paucity of recipient vessels in the neck.

Should 1 or 2 Venous Anastomoses Be Done in Microsurgical Flap Transfer?

BACKGROUND: Venous compromise is still the most common cause of free flap failure. The need of a second venous anastomosis to prevent free flap failure is controversial. It is proposed that the use of dual venous anastomoses reduces venous compromise. However, some surgeons suggest that dual venous drainage reduces venous blood flow causing a potential risk of thrombosis. OBJECTIVE: This study aimed to compare the frequency of reexploration secondary to venous thrombosis in free flap surgeries in reconstruction of soft tissue defects with 1-vein versus 2-vein anastomosis. MATERIALS AND METHODS: We performed a retrospective cohort study including 298 flaps. In 180 of these patients, 2-vein anastomosis was done, and in 118, 1-vein anastomosis was done. The study was conducted at Aga Khan University Hospital from January 2017 to December 2018. RESULTS: The number of venous anastomosis was not associated with flap survival. The group with dual anastomosis required more frequent reexploration as compared with 1 venous anastomosis group (8% vs 1.7%).Outcome and salvage rate were better in the 2-vein group as compared with the 1-vein group (64% vs 50%). CONCLUSION: There is no difference in flap survival in single or dual venous anastomosis, but we have noticed higher reexploration rates in the 2-vein group. However, outcome is better in the 2-vein group.

Free flap reconstruction after lower limb trauma - outcome analysis using National Surgical Quality Improvement Programme (NSQIP) parameters.

OBJECTIVE: To assess the outcomes of free flap reconstructions performed for the management of lower limb trauma. METHODS: This retrospective study was conducted at Aga Khan University Hospital (AKUH), Karachi and included data from June 2017 to May 2019 of patients who underwent free flap reconstruction as part of management of lower limb trauma. RESULTS: The mean age of the 8 adult patients was 34±11 years. Also included were two paediatric patients aged 7 and 8 years. Nine of the total 10 patients were male. Road traffic accidents were the most common mechanism of injury, occurring in 5(50%), followed by blast injuries in 3(33%). The anterolateral thigh flap was the most common type of flap used for reconstruction, done in 8(80%) patients. Flap survival rate was 90% and full flap loss was seen in only 1(10%) patient. Re-exploration surgery was done in 5(50%) patients during the same hospital stay. The length of hospital stay varied greatly from 4 to 105 days depending on associated diagnoses and whether the free flap surgery was performed during an elective admission. One patient did not survive to discharge, and the cause of death was attributed to septic complications. Functional outcomes on follow-up could not be determined. CONCLUSIONS: Free flap reconstruction surgery is an effective solution for management of lower limb trauma and has a high flap survival rate. Further studies are needed to ascertain the functional outcomes of limb salvage after free flap surgery.

Rare Presentation of an Ulnar Artery Aneurysm in a Six-Month-Old Baby: Case Discussion.

Ulnar artery aneurysm cases have been rarely reported in the literature previously. A number of these cases occur in the adult population and are mostly occupational associated. In children, however, this condition is much less. Only 10 cases in children have been reported in the literature to the best of our knowledge, and the minimum age was 1 year. The etiology is mainly post-traumatic. We present a case for discussion of an ulnar artery aneurysm in a 6-month-old baby with the habit of hitting his hand against a table and the floor.

Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap.

BACKGROUND: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site. METHODS: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor defects were closed primarily. The Stony Brook Scar Evaluation Scale and comparison with the contralateral hand were used to assess aesthetic and functional outcomes, respectively. RESULTS: A total of 24 patients underwent nRFFF procedures during the study period. The donor arm showed excellent motor function in 22 cases (91.7%), and very good function in the remaining two cases (8.3%). The aesthetic outcomes were excellent in four patients (16.6%), very good in eight patients (33.3%), good in 10 patients (41.6%), and fair in two patients (8.3%) who developed a hypertrophic scar. All flaps were successful and there were no cases of partial or complete loss. CONCLUSIONS: For small to medium-sized soft tissue defects, the nRFFF had acceptable outcomes due to its thinness, pliability, and major reduction in donor site aesthetic and functional morbidity.