Plastic surgery最新文献

{"title":"Development and Delivery of a Plastic and Reconstructive Surgery Case-Based Learning Curriculum for Pre-Clerkship Medical Students.","authors":"Dave Gwun, Victoria Tucci, Alexandra D'Souza, Thomas Milazzo, Sophocles Voineskos, David Wallace, Kyle R Wanzel, Shaishav Datta","doi":"10.1177/22925503261470691","DOIUrl":"10.1177/22925503261470691","url":null,"abstract":"<p><strong>Introduction: </strong>Canadian medical students receive limited exposure to Plastic and Reconstructive Surgery (PRS) during pre-clerkship. To address this gap, a longitudinal PRS case-based learning (PRS-CBL) curriculum was developed to parallel the pre-clerkship curriculum, with an aim to increase early exposure to PRS concepts.</p><p><strong>Methods: </strong>Guided by Medical Council of Canada objectives, PRS faculty and residents co-designed a 5-part case-based learning curriculum: Introduction to PRS, Skin and Soft Tissue Infections, Benign and Malignant Skin Lesions, Hand and Wrist Trauma, and Burns. Each session combined a didactic presentation, clinical case with facilitated discussion, and hands-on workshop. Eligible participants were first- and second-year medical students. Presession and postsession tests were compared using the Mann-Whitney <i>U</i> test. Written feedback was analyzed using thematic analysis.</p><p><strong>Results: </strong>From 2023 to 2025, 10 PRS-CBL sessions were delivered, with a mean of 45 (SD 28.8) registrants per session. Of 453 total registrants, 201 were unique participants, with 41% reporting no prior interest in PRS. Significant improvements in presession versus postsession test scores were observed at each session (<i>p</i> < .05), except for session 4. Over 83% of respondents strongly agreed that the learning objectives were met, content was appropriate, and sessions were highly effective. Qualitative themes highlighted the value of hands-on, multimodal teaching and opportunities to interact with PRS faculty and residents.</p><p><strong>Conclusion: </strong>The PRS-CBL curriculum filled a void in the current undergraduate medical curriculum, improved PRS knowledge, received favorable evaluations, and included students without prior interest in PRS. This adaptable model may support early career exploration in PRS and other underrepresented specialties.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261470691"},"PeriodicalIF":1.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes After Whole and Fascicular Sural Nerve Biopsies: A Retrospective Review.","authors":"Patrick J Kim, Carolyn Wang, Michael Bonert, Andrew T Chen, Jian-Qiang Lu, Mats Junek, Achilles Thoma, Helene Retrouvey","doi":"10.1177/22925503261461586","DOIUrl":"10.1177/22925503261461586","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic sural nerve biopsies can be taken as whole or fascicular nerve biopsies. It is unclear if this is associated with differences in diagnostic yield or procedural complications. We compared the clinical outcomes of fascicular versus whole sural nerve biopsies.</p><p><strong>Methods: </strong>This was a retrospective chart review of sural nerve biopsies performed between 2011 and 2024 at 4 tertiary academic hospitals in Canada. The primary outcome was the incidence of postoperative nerve-related complications. The secondary outcome was the concordance between the biopsy and the final diagnosis. Fisher's exact test was used to compare the incidence of postoperative complications. Two-sided Cochran-Armitage trend test was used to compare concordance between groups.</p><p><strong>Results: </strong>There were 75 patients who underwent whole sural nerve biopsies and 13 patients who underwent fascicular sural nerve biopsies; 54.6% of patients were male, with a mean age of 59.7 ± 15.9. The average nerve length sampled was 2.86 ± 1.3 cm in the whole nerve biopsy group and 2.35 ± 1.3 cm in the fascicular nerve biopsy group. Only a small proportion of patients had documented follow-up (whole: 26.7%; fascicular: 15.4%), among whom 40.0% in the whole nerve biopsy group and 0.0% in the fascicular group experienced complications (<i>P</i> = 1.00). The most common diagnosis was vasculitis in both groups (whole nerve biopsy: 17.0%, fascicular nerve biopsy: 36.4%). There was no statistically significant shift toward higher concordance in the whole nerve group (Z = 0.63, <i>P</i> = .53).</p><p><strong>Conclusion: </strong>Fascicular and whole sural nerve biopsies demonstrated similar diagnostic concordance. Prospective studies with larger sample sizes are needed to more accurately characterize postoperative complication rates.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261461586"},"PeriodicalIF":1.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13303256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Tradition to Wellness: A Systematic Review of Changing the Surgical Training Culture in Canada.","authors":"Sara B A Morel, Rawan Elabd, Joshua Vorstenbosch, Dino Zammit, Gaby Doumit, Stephanie Thibaudeau","doi":"10.1177/22925503261457119","DOIUrl":"10.1177/22925503261457119","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical training, historically characterized by long hours, hierarchical culture, and critical feedback, has been associated with burnout and mental health challenges. Reforms, including duty-hour limits, competency-based education, and initiatives promoting wellness, equity, and psychological safety, have begun reshaping training in Canada. This review provides a national overview of these cultural shifts, mapping recommendations for best practices and research.</p><p><strong>Design: </strong>A systematic review identified studies on Canadian surgical residency culture. Two reviewers independently screened and extracted data, with risk of bias (ROB) assessed.</p><p><strong>Results: </strong>Twenty-one studies were included. Key themes were wellness and mental health (19 studies), feedback and learning environments (20), evolving surgical culture (17), equity, diversity, and inclusion (12), duty-hour reforms (14), and international transferability (8). ROB was low in 44.00%, medium in 36.00%, and high in 20.00% of studies.</p><p><strong>Discussion: </strong>This review of 25 studies highlights evolving themes in Canadian surgical training culture. Traditional endurance-based models are shifting toward inclusivity, wellness, and equity, with increasing attention to mental health, mentorship, and structured feedback. Duty-hour reforms, parental leave policies, and competency-based initiatives indicate generational and structural changes, though implementation varies across programs. Studies emphasize culturally responsive mentorship, psychological safety, and systemic supports to improve learning environments. While Canadian experiences provide valuable insights, differences in legal, institutional, and cultural contexts limit direct transferability internationally. Recommendations include implementing fatigue management plans, mentorship, simulation-based learning, and national coordination to foster a sustainable, learner-centered surgical culture.</p><p><strong>Conclusion: </strong>Canadian surgical training is evolving through duty-hour reforms, wellness initiatives, and equity-focused policies. While progress has been made, challenges remain in mentorship and cross-provincial consistency.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261457119"},"PeriodicalIF":1.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13303271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Propensity Score Analysis of Wound Complications Following Revision Total Knee Arthroplasty With Concurrent Flap Coverage.","authors":"Morvarid Mehdizadeh, Allan A Weidman, Jian H Li, Valeria P Bustos, Samuel J Lin, Arriyan Samandar Dowlatshahi","doi":"10.1177/22925503261461601","DOIUrl":"https://doi.org/10.1177/22925503261461601","url":null,"abstract":"<p><p><b>Background:</b> Despite advancements in total knee arthroplasty (TKA), complications requiring revisions still occur. In these cases, flap coverage is often required to achieve a stable soft tissue envelope. This study analyzes wound complications following flap coverage for revision TKAs (rTKA) on a national level. <b>Methods:</b> Patients who underwent rTKA from 2012 to 2020 were identified in the National Surgery Quality Improvement Program database using Current Procedural Terminology codes. The cohort was divided into 2 subgroups: patients who underwent rTKA with a pedicled or free flap and those without a flap. A propensity score was generated from patients' baseline characteristics. A multivariable logistic regression model adjusting for propensity scoring and wound classification was constructed to assess differences in outcomes. <b>Results:</b> rTKA was performed in 33,922 encounters, 104 (0.3%) of which utilized a flap (99 pedicled and 5 free flaps). Patients who received flaps had poorer preoperative functional status, higher frailty scores, longer operative times, longer hospital stays, and were more likely to have contaminated or dirty/infected wounds. Patients who underwent flaps had higher reoperation rates compared to patients who did not (12.1% vs 3.0%, <i>P</i> < .001). Following propensity score matching, flap coverage was not associated with systemic complications, dehiscence, or superficial or deep surgical site infection. <b>Conclusion:</b> Soft tissue flap coverage was more common in large and infected wounds following TKA. Higher wound infection rates among flap patients are likely due to the complexity of the original wound and possibly lack of adequate source control. Patients undergoing rTKA for infection may benefit from wound optimization before flap reconstruction.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261461601"},"PeriodicalIF":1.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Hyaluronan in Keloid and Hypertrophic Scar Pathogenesis and Treatment.","authors":"Jay Shah, Ayushi Bhatt, Sammie Yu, Kathleen A Hill, Eva Turley, Caitlin J Symonette","doi":"10.1177/22925503261457127","DOIUrl":"10.1177/22925503261457127","url":null,"abstract":"<p><strong>Introduction: </strong>Keloid and hypertrophic scars are products of abnormal wound healing and can cause disfigurement, discomfort, and decreased quality of life. The precise mechanisms of how these scars form remain unclear, and despite several management strategies, there is currently no definitive management approach that prevents recurrence of keloid scars. Hyaluronan (HA) is a polysaccharide with critical functions in inflammation, fibrosis, and skin health. This narrative review explores what is currently known about the role of HA and associated proteins in keloid and hypertrophic scar pathogenesis and management.</p><p><strong>Methods: </strong>The online MEDLINE and EMBASE databases were searched for articles on keloid and hypertrophic scarring and HA from 1946 to 2026. English-language, peer-reviewed articles with empirical evidence examining human keloid scar tissue, animal models, cell-culture models, hyaluronic acid, or hyaluronome-associated genes were included. Twenty-one studies met all inclusion criteria.</p><p><strong>Results: </strong>HA concentration was diminished in cell-based models of keloid and hypertrophic scars relative to normal skin. Observed aberrant localization of HA was likely related to the altered expression of genes encoding proteins responsible for the synthesis, degradation, binding, and signaling properties of HA. Intralesional and topical applications of HA both improve appearance and reduce recurrence rates of keloid scars in the short term.</p><p><strong>Conclusion: </strong>Our review suggests that altered HA production, metabolism, and localization play a key role in keloid and hypertrophic scar pathogenesis. While early evidence supports the potential utility of HA in keloid scar treatment, further robust clinical validation is necessary.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261457127"},"PeriodicalIF":1.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional Instagram Use by Ontario Plastic Surgeons: Content Patterns and Engagement by Practice Setting.","authors":"Alice Wang, Patrick J Kim, Tracy Xiong, Helene Retrouvey","doi":"10.1177/22925503261457118","DOIUrl":"10.1177/22925503261457118","url":null,"abstract":"<p><strong>Introduction: </strong>Although social media is widely used in plastic surgery, differences in content and posting patterns across practice settings are poorly understood. This study characterized Ontario plastic surgeons Instagram posting patterns and audience engagement by practice setting.</p><p><strong>Methods: </strong>This observational cross-sectional study analysed publicly accessible professional Instagram profiles of registered academic, community, or mixed practice plastic surgeons in Ontario. Up to 30 posts (posted on or after January 1, 2020) per account were coded by content type and clinical domain. Chi-square, Kruskal-Wallis, and analysis of variance tests were used to evaluate the association between surgeon characteristics, posting patterns, and engagement rates.</p><p><strong>Results: </strong>Eighty-six of 261 (33%) plastic surgeons had professional Instagram profiles, yielding 2032 posts. Pre-/post-procedure results (32%) and facial aesthetics (20%) were the most represented content type and domain, respectively. Academic surgeons posted significantly more announcements, research, and reconstructive content (<i>P</i> < .001), while community surgeons posted significantly more advertising/promotional (<i>P</i> = .02) and facial aesthetics (<i>P</i> < .001) content. Engagement rates were highest for academic surgeons, personal posts, and craniofacial content, with significant differences among practice types, content categories, and domains (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Instagram use among plastic surgeons varies substantially by practice setting. Cosmetic content dominates posting volume, whereas reconstructive and academic content, despite higher observed engagement, remains under-represented. These findings identify content-practice mismatches that warrant further qualitative, longitudinal, and interventional study before practice recommendations can be made.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261457118"},"PeriodicalIF":1.2,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Accuracy of Clinical Examination in Suspected Pediatric Scaphoid Fractures-A Systematic Review.","authors":"Aneesh Karir, Sydnee Tuckett","doi":"10.1177/22925503261460023","DOIUrl":"10.1177/22925503261460023","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261460023"},"PeriodicalIF":1.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13279246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Approach Matter? Pain, Plane, and Efficacy in Dorsal Versus Volar Trigger Finger Injections-A Discussion.","authors":"Tanis Quaife","doi":"10.1177/22925503261453825","DOIUrl":"https://doi.org/10.1177/22925503261453825","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261453825"},"PeriodicalIF":1.2,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: The Impact of Breast Reduction Practice Variation in Hamilton, Ontario: A Cost Analysis.","authors":"Mitchell Brown","doi":"10.1177/22925503261460025","DOIUrl":"https://doi.org/10.1177/22925503261460025","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261460025"},"PeriodicalIF":1.2,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"The Classification of Nerve Injury Revisited: Sundland 0-VI\": Toward a Roadmap for Surgical Decision Making in Nerve Injury.","authors":"Emily M Krauss","doi":"10.1177/22925503261453810","DOIUrl":"10.1177/22925503261453810","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261453810"},"PeriodicalIF":1.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13253552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}