Plastic and Reconstructive Surgery Global Open最新文献

{"title":"Is Reconstructive Plastic Surgery Appropriately Valued? Comparison of Reimbursement per Unit Time for Reconstructive versus Aesthetic Procedures.","authors":"Alexa De la Fuente Hagopian, Souha Farhat, Narainsai K Reddy, Sebastian Guadarrama-Sistos Vazquez, Pablo L Padilla, Anthony Echo","doi":"10.1097/GOX.0000000000006313","DOIUrl":"https://doi.org/10.1097/GOX.0000000000006313","url":null,"abstract":"<p><strong>Background: </strong>The work relative value units (wRVUs) system was established as a quantifier of physician labor, technical skill, medical decision-making, and training time required to complete a surgical procedure; hence, more challenging operations should theoretically result in higher reimbursement or compensation. Our purpose was to highlight the discrepancies between insurance-based reconstructive and fee-for-service aesthetic procedures based upon dollar/unit time.</p><p><strong>Methods: </strong>We analyzed national data from the American College of Surgeons National Surgical Quality Improvement Program, Aesthetic Surgery Databank, and Centers for Medicare and Medicaid Services to compare reimbursement for 8 reconstructive microsurgery and 3 aesthetic procedures and assessed operative times and reimbursement rates, then calculated \"relative value unit per unit time\" to measure compensation efficiency.</p><p><strong>Results: </strong>This difference in remuneration translates to a 4.7× difference, with an overwhelming gap of $25.26 per minute between microsurgical reconstructive and aesthetic cases. These findings suggest that aesthetic cases are more profitable considering the compensation per unit time. Based on national rates of reimbursement, there is a large discrepancy between reimbursement in microsurgical reconstructive procedures and aesthetic procedures.</p><p><strong>Conclusions: </strong>We demonstrated that complexity and time are not directly related to compensation.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6313"},"PeriodicalIF":1.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770801","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":"Real-world Use of AlloDerm Acellular Dermal Matrix in Head and Neck Procedures in the United States.","authors":"Annaliza Dominguez, Yi Liang, Turkia M Abbed, Vivek Mukhatyar, Sandhya Shimoga","doi":"10.1097/GOX.0000000000006339","DOIUrl":"10.1097/GOX.0000000000006339","url":null,"abstract":"<p><strong>Background: </strong>Real-world literature evaluating the use of AlloDerm SELECT Regenerative Tissue Matrix in head- and neck-related procedures is limited. To inform patient care decisions, this study evaluated healthcare resource utilization (HCRU) in US adults undergoing head- and neck-related procedures using AlloDerm.</p><p><strong>Methods: </strong>A retrospective claims analysis was conducted using MarketScan Commercial and Medicare Supplemental Databases (study period: October 1, 2015, to March 31, 2022; index period: November 1, 2015, to March 1, 2022). Adults aged 18 years or older with (1) medical claims for AlloDerm and a skin substitute on the same day during the index period, (2) a head/neck procedure diagnostic code, and (3) 30 or more days of continuous enrollment before and after first AlloDerm use index date. Descriptive statistics were used to describe surgery types and 30-day follow-up reoperations, graft complications, and all-cause HCRU.</p><p><strong>Results: </strong>Among 431 patients (51.7% women), mean (SD) age was 52.2 (15.8) years. AlloDerm was most used with oral cavity reconstruction (35.3%), septal perforation repair/rhinoplasty (16.5%), and parotidectomy (13.0%). Most procedures were performed in outpatient settings (hospital, 90.0%; ambulatory surgical center, 8.6%). Over 30 days, less than 1% of patients (4 of 431) required reoperation with AlloDerm; 0.5% (2 of 431) had graft-related complications. Most (75.6%) patients had an outpatient visit; few had an emergency room visit (7.9%) or inpatient claim (3.0%).</p><p><strong>Conclusions: </strong>Real-world evidence indicates that AlloDerm is used in head- and neck-related procedures in US adults, particularly oral reconstruction. Postprocedure complications and reoperations are uncommon during the follow-up period.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6339"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731758","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":"Critical Assessment of Fellowship Director Gender and Ethnic Diversity across the Five Major Plastic Surgery Fellowships.","authors":"Sam Boroumand, Sasha Stogniy, Beatrice Katsnelson, Omar Allam, Aliyar Zahedi Vafa, Janessa Sullivan, Bohdan Pomahac, Siba Haykal, Paris D Butler","doi":"10.1097/GOX.0000000000006286","DOIUrl":"10.1097/GOX.0000000000006286","url":null,"abstract":"<p><strong>Background: </strong>Subspecialty fellowship directors are essential to the selection and mentorship of trainees. The purpose of this study is to evaluate the gender and racial/ethnic diversity of fellowship directors across fellowship programs in plastic and reconstructive surgery (PRS).</p><p><strong>Methods: </strong>In December 2023, listings of fellowship programs/directors were surveyed from respective professional society websites across the 5 primary PRS fellowships: hand (American Society for Surgery of the Hand), craniofacial (American Society of Craniofacial Surgeons), microsurgery (American Society for Reconstructive Microsurgery), aesthetic (The Aesthetic Society), and burn (American Burn Association). Fellowship director demographics from each program were researched and identified.</p><p><strong>Results: </strong>In total, 248 fellowship directors were identified: 94 hand, 34 craniofacial, 62 microsurgery, 38 aesthetic, and 20 burn. There was a significantly greater percentage of male versus female directors across all fellowships (87.5% versus 12.5%; <i>P</i> < 0.01). Men were noted to have a significantly higher average h-index score (20.4 versus 15.0; <i>P</i> = 0.045) but constituted a lower proportion of assistant professorships (32.3% versus 12.9%; <i>P</i> < 0.01). Relative to directors from racial/ethnic minority backgrounds, White directors constituted a significantly greater percentage of fellowship directors (72.9% versus 27.1%; <i>P</i> < 0.01) and had a greater number of years passed since completing their most recent training (21.7 versus 17.1; <i>P</i> = 0.030).</p><p><strong>Conclusions: </strong>Across PRS fellowship programs, women and racial/ethnic minorities are disproportionately underrepresented in leadership. Targeted initiatives to promote diversity in PRS fellowship directors should be considered as medicine works toward a surgical workforce more reflective of the patient population.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6286"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731743","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":"Remaining Steadfast on Diversity and Inclusion in Plastic Surgery.","authors":"Nicole Z Sommer, Paris D Butler","doi":"10.1097/GOX.0000000000006284","DOIUrl":"10.1097/GOX.0000000000006284","url":null,"abstract":"<p><p>Organized plastic and reconstructive surgery has recognized the importance of diversity for optimal patient care and advancement of the specialty. Initial goals focused on increasing opportunities for underrepresented members of the society: women and Blacks and Hispanic/Latino members. The diversity lens has expanded to not only include race and sex but also diversity of religion, sexual orientation, gender identity, disability, geography, economic status, membership status, and employment type. In response to diversity antagonists who argue that diversity abandons a system based on \"excellence,\" we counter that diversity efforts demand excellence but realize that success often requires a more level playing field with the elimination of discriminatory barriers.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6284"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731760","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 Regional Analysis of Diversity, Equity, and Inclusion Initiatives in Plastic Surgery Residency Programs.","authors":"Dylan G Choi, Kevin Luu, Gabrielle Brite, Alexander T Plonkowski, Mariam Al-Hamad Daubs, Aleksandra Krajewski","doi":"10.1097/GOX.0000000000006283","DOIUrl":"10.1097/GOX.0000000000006283","url":null,"abstract":"<p><strong>Background: </strong>Residents seek inclusive training environments that prioritize diversity. To evaluate programs that focus on these elements, websites have become essential for applicants but often lack in diversity, equity, and inclusion (DEI) content. Thus, this study aimed to assess current efforts and attention to DEI within plastic surgery residency programs and compare them by region.</p><p><strong>Methods: </strong>A retrospective review of Accreditation Council for Graduate Medical Education plastic surgery residency program websites was conducted. Various elements of DEI were identified on each program's page and were compared based on geographic region.</p><p><strong>Results: </strong>Upon review, 82 residency programs were identified. Of these programs, 40 (48.7%) mentioned at least 1 element of DEI on their website, 38 (46.3%) promoted gender affirmation surgery as a part of their program, 29 (35.4%) mentioned advocacy, and 39 (47.6%) showcased at least 1 publication/presentation about DEI. Between the regions, there was no statistically significant difference in mention of DEI or perceptible representation in leadership. However, there was a significant difference in the mention of gender affirmation surgery, with the Northeast having the most mention (74.1%, P = 0.006). In addition, there was a significant difference in DEI research featured on websites, with the West having the highest rate of features (69.2%, P = 0.019).</p><p><strong>Conclusions: </strong>This study demonstrates the variance of different aspects of DEI on plastic surgery websites. To foster diverse prospective applicants, plastic surgery residency programs must be aware of these paucities and address them accordingly.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6283"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731721","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":"Diversity in the US Academic Microsurgery Pathway.","authors":"Leila Musavi, Sri Harshini Malapati, Kshipra Hemal, Wendy Chen, Robyn Broach, Mark T Yost, Paris D Butler","doi":"10.1097/GOX.0000000000006282","DOIUrl":"10.1097/GOX.0000000000006282","url":null,"abstract":"<p><p>Although the representation of women and ethnic minority students in the US medical schools has recently increased, discrepancies in representation among plastic surgery residents and faculty continue. The state of sex and ethnic diversity in academic microsurgery remains minimally investigated. We aimed to evaluate the sex, race, and ethnicity demographics among academic microsurgeons and identify underrepresentation along the leadership pathway. The US-based microsurgery fellowship programs provided contact information of fellowship graduates from 2006 to 2020. An anonymous electronic survey was distributed, and demographic, training background, mentorship, and career path data were collected. Program websites were reviewed to collect data on academic microsurgery faculty nationwide. We found that women and non-White surgeons reported similar rates of effective mentorship in training. Compared with White surgeons, non-White surgeons had lower probability of holding an academic position directly after fellowship (odds ratio = 0.28, <i>P</i> = 0.023) and reported fewer perceived opportunities for professional advancement (61% versus 91%, <i>P</i> = 0.007). The majority of academic leadership positions were held by White surgeons (72%). Overall, women faculty were earlier in their careers than men (mean time out of fellowship 7.2 years for women versus 14.8 years for men, <i>P</i> < 0.001), signifying a lack of senior female faculty. Male faculty had higher rates of leadership than female faculty (24.7% versus 8.0%, <i>P</i> = 0.01). Our results demonstrate that women and non-White surgeons are not adequately represented in academic microsurgery faculty and leadership positions. Future interventions seeking to increase diversity can help improve the delivery of equitable reconstructive care.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6282"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731746","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":"Dr. Sylvester J. Carter: First Black American Hand Surgeon and Early Pioneer in Hand Surgery.","authors":"Daniella M Dennis, Rachel C Hooper, Paris D Butler","doi":"10.1097/GOX.0000000000006285","DOIUrl":"10.1097/GOX.0000000000006285","url":null,"abstract":"","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6285"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731748","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":"Spinoplastic Reconstruction Using Iliac Crest Vascularized Bone Graft following Sacral Ependymoma Resection.","authors":"Edward M Reece, Nicole Van Spronsen, Calogero Velluto, Jonathan L Jeger, Christopher Fullmer, Isra Abdulwadood, Jenna Meyer, Alexander E Ropper, Sebastian Winocour, Michael A Bohl, Maziyar A Kalani","doi":"10.1097/GOX.0000000000006341","DOIUrl":"10.1097/GOX.0000000000006341","url":null,"abstract":"<p><p>Sacral reconstruction post tumor resection has historically been executed with the placement of hardware or free tissue transfer. Reconstruction using a vascularized bone graft is an alternative that avoids the complications associated with hardware placement or free tissue transfer. This article describes the first documented case of spinoplastic reconstruction using an iliac crest vascularized bone graft (IC-VBG) after the resection of a sacral ependymoma. This is a case of a 17-year-old boy with a history of a sacral myxopapillary ependymoma. He presented to a local emergency department complaining of 6 months of urinary incontinence and progressive paresthesias affecting the left lower extremity. Magnetic resonance imaging was significant for a lesion located in the extradural spinal canal. Biopsy confirmed a myxopapillary ependymoma, World Health Organization grade II. The initial intervention involved tumor resection with titanium hardware placement. He subsequently required replacement of the titanium hardware with carbon fiber, secondary to the need for surveillance imaging. He underwent harvesting and inset of the IC-VBG at the time of hardware replacement. IC-VBG is a safe and effective modality for spinoplastic reconstruction. It enhances the potential for solid bony union and offers a practical alternative to free bone transfer. This approach provides an asset to add to a reconstructive surgeon's armamentarium, making it an essential tool for reconstructive surgeons working in conjunction with spinal surgery colleagues.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6341"},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731762","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":"Postrhinoplasty Depression: A Systematic Review.","authors":"Rafeef Alhajress, Dana Obeid, Alhanouf Alhedaithy, Hassan Assiri, Ahmed Alarfaj","doi":"10.1097/GOX.0000000000006321","DOIUrl":"10.1097/GOX.0000000000006321","url":null,"abstract":"<p><strong>Background: </strong>Even though an increased number of patients indicate satisfaction with rhinoplasty outcomes, unexpected postoperative psychological reactions might occur. Postrhinoplasty depression is a type of adverse psychological response in relation to cosmetic surgery.</p><p><strong>Methods: </strong>The present systematic review seeks to evaluate postoperative depression following successful rhinoplasty in patients who are psychologically stable.</p><p><strong>Results: </strong>The findings on postrhinoplasty depression are a reminder to cosmetic surgeons that better surgery outcomes might not consistently generate happy and satisfied patients. Even though preoperative mental evaluations are considered important in the screening of patients to undergo rhinoplasty, the assessments might not often be predictive. Cosmetic surgeons should therefore be ready and willing to aid their patients in coping with the adverse psychological responses, including depression. Moreover, this systematic review seeks to enhance the comprehension of both the preoperative and postoperative psychology and mood changes in patients undergoing rhinoplasty.</p><p><strong>Conclusions: </strong>Plastic surgeons are required to offer effective counseling services to their patients, ensuring effective and clear communication of their expectations, to aid in the decision on whether patients are apt candidates for rhinoplasty and to reduce the possibility of postrhinoplasty depression and anxiety.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6321"},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731757","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":"Planned Y-shaped Muscle Wrapping for Salvaging Aortic Graft Infection: Latissimus Dorsi and Reverse Serratus Anterior Muscles.","authors":"Itaru Tsuge, Susumu Saito, Kazuhiro Takatoku, Takehiko Matsuo, Kenji Minatoya, Naoki Morimoto","doi":"10.1097/GOX.0000000000006350","DOIUrl":"10.1097/GOX.0000000000006350","url":null,"abstract":"<p><p>Aorta-related infections are life threatening. Aggressive replacement surgery using artificial aortic grafts should be performed using well-vascularized tissue wrapping to avoid reinfection. An omental flap is the first choice; however, a history of abdominal surgery necessitates other methods. In a cadaveric study in 2021, we verified the distal tight attachment area between the latissimus dorsi (LD) muscle and serratus anterior (SA) muscle to apply a Y-shaped combined flap consisting of the LD and reverse SA. We used this procedure to treat a 79-year-old man who underwent stent-graft insertion in the descending thoracic aorta. Descending aortic graft replacement was performed with a left anterior lateral thoracotomy. Then, we elevated the LD and SA combined flap by \"posterior-to-anterior elevation\" based on the previous cadaveric study. After blocking blood flow from the SA branch with a microvascular clip, blood flow from the LD branch of the thoracodorsal artery to the distal part of the SA muscle across the distal attachment area was evaluated using indocyanine green fluorescence. Fluorescence had spread throughout the distal part of the SA muscle. Postoperative computed tomography and the clinical course indicated successful regulation of infection. We established a novel surgical technique for the complete muscle wrapping of the descending thoracic aorta, including the aortic arch. The accumulation of further cases is needed to determine whether the blood flow of the distal connection area from the LD to the SA has individual variations; however, we hope this technique improves the mortality and morbidity associated with aorta-related infections.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"12 11","pages":"e6350"},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11595633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731754","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}