Plastic and Reconstructive Surgery Global Open最新文献

{"title":"The Future of Resident Unionization.","authors":"Aidan M Fitzgerald, Lawrence Scott Levin","doi":"10.1097/GOX.0000000000007536","DOIUrl":"https://doi.org/10.1097/GOX.0000000000007536","url":null,"abstract":"<p><p>Burnout is a recognized phenomenon among residents and attending surgeons in the United States, resulting in physical and mental exhaustion. Residents see a reduction in working hours as being essential to deal with this issue. Consequently, residents have unionized to improve collective bargaining power and advocacy with employers to achieve their aims. Unionization has proved controversial and spawned generational conflict within the profession. Older attending surgeons suggest that such unionization demeans the profession, as it is at odds with their sense of vocation and \"nostalgic\" professionalism. Residents and younger attending surgeons are not prepared to make the same commitments as their predecessors given the increased work-life balance they crave, reflecting the new societal norm. The United States must heed the lessons from those who have traveled this road previously. In the United Kingdom, working hours have significantly reduced in recent decades, requiring moves away from apprentice-style resident training towards a more remote shift pattern style of working. This has resulted in unintended consequences: (1) disruption of the \"hidden\" curriculum through which professionalism was previously taught and (2) an isolated and demoralized resident workforce. This tension reflects a breakdown in the social contract among medicine, society, and government that, if not addressed in the United States, may result in continued discord, as recently manifested by resident strikes in the United Kingdom. Looking forward, United States training programs should ensure that any changes in working hours must maintain teamwork between residents and attending surgeons, not only for their own well-being but also for that of their patients.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 4","pages":"e7536"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Model for Malpractice Preparedness for Plastic Surgery Residents.","authors":"Silvia Gandolfi, Abdulaziz Asiry, Benoît Chaput, Elise Lupon","doi":"10.1097/GOX.0000000000007622","DOIUrl":"https://doi.org/10.1097/GOX.0000000000007622","url":null,"abstract":"","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 4","pages":"e7622"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Simple Primer on Relative Value Units for Surgeons.","authors":"Sydney Ladas, Rajiv Chandawarkar, Gregory Pearson, Douglas Chonko, Kathleen Roy, Taylor Kinnaird, Allison Capek","doi":"10.1097/GOX.0000000000007591","DOIUrl":"https://doi.org/10.1097/GOX.0000000000007591","url":null,"abstract":"<p><strong>Background: </strong>Relative value units (RVUs) have become the universal yardstick for clinical practice. They measure physician performance, productivity, patient volumes, pay, and bonuses, and affect personal well-being. Despite its vast influence, the RVU model is not taught in formal residency training curricula, leaving graduates to learn on the job; through online sources, blogs, or recruiters: or from informal conversations with junior attendings. This study aims to create a primer that explains the role RVUs play in practice and delivers a framework for graduates to navigate this complex environment.</p><p><strong>Methods: </strong>Available medical school and plastic surgery curricula, published literature, and internet sources were searched to identify formal RVU teaching modules.</p><p><strong>Results: </strong>There is little formal training on RVUs within the curricula of most medical schools, putting young graduates at risk of unintentional wrongdoing and fraud. Published literature on the topic is scant, whereas internet sources and blogs provide more information on the RVU model. They focus less on RVU education and more on its financial implications, including the effects of RVUs on physician behavior and cost-cutting decisions made by hospitals and payors based on RVU productivity. This primer aims to bridge the RVU literacy gap by explaining why the RVU system was developed; its structure; its widespread applications; and the dangers it poses, especially to underprepared learners starting practice.</p><p><strong>Conclusions: </strong>Plastic surgeons must master the RVU model to build an ethical and fulfilling practice that signals credibility, maintains professional autonomy, and delivers quality patient care.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 4","pages":"e7591"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Dedicated Research Time and Output Among Plastic Surgery Applicants: Implications of the Research Year.","authors":"Luke Schwetschenau, Blake Sparkman, Ali Aral, Kevin Chen, Sumesh Kaswan, Christina Plikaitis, Michael Bernstein, Brian Mailey","doi":"10.1097/GOX.0000000000007623","DOIUrl":"https://doi.org/10.1097/GOX.0000000000007623","url":null,"abstract":"","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 4","pages":"e7623"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: 4D Lips Technique Based on Anatomy for Naturalization: Erratum.","authors":"Melina Kichler, Marta Barros, Carolina de Freitas, Renata Viana, Marcelle Nogueira, Maria Bussade","doi":"10.1097/GOX.0000000000007652","DOIUrl":"10.1097/GOX.0000000000007652","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/GOX.0000000000007270.].</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 3","pages":"e7652"},"PeriodicalIF":1.8,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of a Vertical Reconstruction of the Abdomen Following Massive Weight Loss.","authors":"Gudjon L Gunnarsson, Jørn Bo Thomsen","doi":"10.1097/GOX.0000000000007588","DOIUrl":"10.1097/GOX.0000000000007588","url":null,"abstract":"<p><strong>Background: </strong>The size and shape of a patient's abdomen after massive weight loss (MWL) vary according to the extent and pattern of abdominal fat distribution. The panniculus adiposus results from a combined pull of heavy fat on the skin and the weakening of the connective tissue, creating an irreversible sagging and ptotic abdomen with several folds. Reconstruction aims to reverse the topographic anatomical changes caused by underlying pathology of central abdominal fat. This study aimed to illustrate the burden of central abdominal fat pathology after MWL and evaluate a reconstructive surgical solution termed central angiosome vertical abdominoplasty (CAVA).</p><p><strong>Methods: </strong>This retrospective cohort study included patients who underwent surgery using the CAVA method from August 2019 to August 2024. Inclusion criteria were physical burden and medical morbidity caused by abdominal skin and residual fat after MWL. Patient charts were reviewed for preoperative health status, including weight loss, comorbidities, and operative and postoperative information.</p><p><strong>Results: </strong>The study included 25 patients, aged 31-66 years, with varying degrees of weight loss. Most patients achieved weight loss through bariatric surgery. The average operative time was 150 minutes, and the resection weight ranged from 553 to 17,680 g. Complications were mostly minor, with 2 patients requiring readmission.</p><p><strong>Conclusions: </strong>The CAVA technique is designed to remove central abdominal pathology and reconstruct the abdominal wall using displaced, adjacent tissue. A focus on central abdominal resection with midline reconstruction offers a viable solution for patients burdened by central abdominal pathology after MWL.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 3","pages":"e7588"},"PeriodicalIF":1.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saying \"Yes\" to Saying \"No\": A Conceptual Framework for Setting Boundaries in Plastic Surgical Practice.","authors":"Rajiv Chandawarkar, Gregory Pearson, Aleksandra Krajewski, Sydney Ladas, Kathleen Roy","doi":"10.1097/GOX.0000000000007592","DOIUrl":"10.1097/GOX.0000000000007592","url":null,"abstract":"<p><strong>Background: </strong>In most clinical specialties, including plastic surgery, saying \"no\" to unnecessary, ill-timed, or simply frivolous referrals is discouraged and never taught. Carried forward into practice, this inability leads to overwhelming workloads, chaotic schedules, loss of professional autonomy, and exhaustion-well-known triggers for burnout. Providing communication tools to politely frame a refusal without jeopardizing professional relationships is essential.</p><p><strong>Methods: </strong>This narrative review provided a broad overview of existing literature on the topic across medical and nonmedical customer-service sectors, combined with the authors' own experience. It established a context for a comprehensive summary and used the available material to create vignette-based training modules for residents and junior attendings.</p><p><strong>Results: </strong>Specifically, the traditional teaching is to always say yes to all clinical consults, no matter what they are or how overworked one already is. In contrast, publications on physician-burnout strongly recommend setting boundaries, none of which teach physicians how to do so. Although communication skills are taught during training, specific skills for politely refusing referrals, especially if inappropriate or ill-timed, are lacking.</p><p><strong>Conclusions: </strong>Using the reviewed material and our experience, a rich source of teaching materials, including clinical vignettes, was created that can be used by program leaders and younger faculty to say \"no,\" while maintaining honesty, professionalism, and positive referral relationships. Removing the stigma of self-guilt associated with saying \"no\" when appropriate, and doing so via clear and respectful communication, builds credibility, maintains professional autonomy, demonstrates integrity, and also ensures that patients receive the best possible care.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 3","pages":"e7592"},"PeriodicalIF":1.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prefabricated Expanded Skin Flap With the Serratus Branch of the Thoracodorsal Artery for Extensive Facial Resurfacing.","authors":"Ke Li, Hao Ma, Jingyi Chen, Yanji Zhang, Geoffrey G Hallock, Hua Li, Yixin Zhang, Peiru Min","doi":"10.1097/GOX.0000000000007528","DOIUrl":"10.1097/GOX.0000000000007528","url":null,"abstract":"<p><strong>Background: </strong>Extensive postburn facial scarring cannot achieve aesthetic resurfacing with skin graft or mismatched flaps. Although adjacent flap donor sites, such as the neck or deltopectoral area, provide ideal skin characteristics, flap transfer may be highly limited due to the absence of proper axial vessels. Here, we demonstrate an innovative reconstructive alternative in terms of prefabrication and tissue expansion for extensive facial resurfacing.</p><p><strong>Methods: </strong>A serratus anterior fascia flap within the serratus branch of the thoracodorsal artery was harvested and microsurgically transferred as the pedicle of a prefabricated cervicothoracic flap. The flap, with the fascia located in a subcutaneous pocket over a tissue expander, was raised, islanded, and rotated to reconstruct the facial defect after reliable expansion and maturation. Flap size, donor/recipient site, surgical outcomes, and donor-site morbidity were all evaluated.</p><p><strong>Results: </strong>The flap sizes ranged from 13 × 10 to 27 × 21 cm. All 15 patients with extensive postburn facial scars, aged 15-40 years (mean 30.73 y), achieved successful reconstruction without major complications after 6-12 months of follow-up.</p><p><strong>Conclusions: </strong>The prefabricated, expanded cervicothoracic flap with the serratus branch of the thoracodorsal artery demonstrated a favorable color and texture match with the recipient site. The donor site can be primarily closed with minimized aesthetic and functional compromise.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 3","pages":"e7528"},"PeriodicalIF":1.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Dedicated Facial Trauma Operating Room at a Level 1 Trauma Center.","authors":"John Y Ha, Julia Ting, Julie E Park, Howard D Wang","doi":"10.1097/GOX.0000000000007603","DOIUrl":"10.1097/GOX.0000000000007603","url":null,"abstract":"<p><p>Facial fracture repairs are often performed as add-on cases to work around elective schedules and emergent cases. This practice pattern can lead to delays in care and after-hours operations, longer hospital stays, operating room (OR) inefficiencies, and increased provider and staff burnout. To address this, we implemented a dedicated facial trauma OR model at our level 1 trauma center. A dedicated OR is available twice weekly and managed by the attending facial trauma surgeon on call. Any facial trauma case can be scheduled until 6 am on the same day, after which any unused OR time is then released to accommodate add-on cases. Pearson χ² tests, Fisher exact tests, and <i>t</i> tests were performed for statistical analysis. Analysis of mandibular fracture repairs after 1 year of implementation identified several important benefits compared with the previous add-on surgery model. After-hours operations, defined as operations after 5 pm, were reduced by 26.5% (<i>P</i> = 0.02). Several other variables showed improvement but did not reach statistical significance, including inpatient hospital length of stay (34.3% reduction), time from injury to surgery for inpatients (38.5% decrease), and the proportion of patients managed as outpatients (13.6% increase). Analysis of nasal fracture reductions during the period found a 24.8% reduction in OR time (<i>P</i> = 0.03). These results suggest that the dedicated facial trauma OR model has the potential to improve efficiency and should be further examined as a model for delivery of facial trauma care at major trauma centers.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 3","pages":"e7603"},"PeriodicalIF":1.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Glucagon-like Peptide-1 Receptor Agonist Era and Its Influence on Body-Contouring Referrals After Weight Loss in Appalachia.","authors":"Armein Rahimpour, Isabell Stuart, Jentre H Hyde, Kelsie Roberts-Moore, Kassidy R Price, Joshua D Keefer, Alexandra Persily, Paul Bown, Rahman Barry","doi":"10.1097/GOX.0000000000007620","DOIUrl":"10.1097/GOX.0000000000007620","url":null,"abstract":"<p><strong>Background: </strong>Obesity remains a major public health concern in the United States, with increasing demand for body-contouring procedures following significant weight loss. Appalachia-a region characterized by limited healthcare access and a high prevalence of obesity-provides a unique setting to evaluate evolving referral patterns for post-weight-loss body contouring in the era of modern obesity pharmacotherapy.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients referred for body-contouring procedures between October 2022 and November 2024 at a tertiary referral center serving Appalachia. Patients were categorized by primary method of weight loss: lifestyle modification, glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy, or bariatric surgery. Temporal trends were evaluated across 4 consecutive 6-month intervals using χ² testing and linear regression. Differences in age and body mass index were assessed using 1-way analysis of variance and Kruskal-Wallis testing.</p><p><strong>Results: </strong>A total of 134 patients met inclusion criteria. Lifestyle modification accounted for the largest proportion of referrals (n = 67, 50.0%), followed by bariatric surgery (n = 49, 36.6%) and pharmacological therapy (n = 23, 17.2%). Among pharmacological patients, semaglutide was the most commonly used GLP-1 RA (78.3%), whereas sleeve gastrectomy represented the most frequent bariatric procedure (73.5%). Although age and body mass index differences between groups were not statistically significant, patients using pharmacotherapy tended to be older. Referral volumes increased across all pathways, with a positive but nonsignificant trend toward GLP-1-associated referrals (slope = +2.7 patients per interval; <i>R</i> ^² = 0.75; <i>P</i> = 0.14).</p><p><strong>Conclusions: </strong>Lifestyle modification remains the predominant referral pathway for post-weight-loss body contouring in Appalachia. However, referrals associated with GLP-1 RA therapy are increasing and may soon rival traditional sources, reflecting evolving strategies in obesity management.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 3","pages":"e7620"},"PeriodicalIF":1.8,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}