Plastic surgery最新文献

{"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}

{"title":"Research Publications Among Canadian Plastic Surgery Residents Over 10 Years: A Cross-Sectional Analysis.","authors":"Anna-Lisa V Nguyen, Justin Haas, Carolyn Wang, Achilleas Thoma, Helene Retrouvey","doi":"10.1177/22925503261453069","DOIUrl":"10.1177/22925503261453069","url":null,"abstract":"<p><strong>Background: </strong>Scholarly activity is a key aspect of plastic surgery training, influencing resident selection and career progression. However, research productivity among Canadian plastic surgery residents has not been quantified.</p><p><strong>Methods: </strong>This cross-sectional study included Canadian plastic surgery residents enrolled between 2015 and 2024, identified through a systematic web search. Scholarly metrics were extracted from Scopus and PubMed. Descriptive statistics summarized demographics and research metrics of residents. Multivariable logistic and negative binomial regression analyses were used to identify associations and predictors of research productivity, defined as publications-per-postgraduate year (PGY).</p><p><strong>Results: </strong>Overall, 309 trainees were included (163 active, 146 graduates). Among 163 active residents, 53% identified as female, 41% held a graduate degree, and 11% of active residents were enrolled in a Clinician-Investigator Program (CIP). Mean publication-per-PGY was 0.62 ± 0.92. Higher research productivity was independently associated with preresidency publications (incidence rate ratio [IRR] = 1.09, <i>P</i> < .001), CIP enrolment (IRR=1.88, <i>P</i> = .041), and female identification (IRR=0.58 for males, <i>P</i> = .017). Among 146 graduates, 58% were female, 46% held a graduate degree, and 84% pursued at least one fellowship. Twenty-seven percent hold faculty positions. Faculty appointment was associated with higher research metrics (<i>P</i> < .001), and graduate degree status was the sole independent predictor (odds ratio = 3.41, <i>P</i> = .015). Program requirements and the productivity of PDs and RDs were not significant.</p><p><strong>Conclusions: </strong>Research productivity among Canadian plastic surgery residents is primarily influenced by individual factors, specifically preresidency research and CIP enrolment. Program-level factors such as research requirements and metrics of PDs and RDs are not associated with higher productivity in residents. Graduate degree status is a predictor of academic career pursuit, but not of fellowship. These findings aim to enhance scholarly involvement throughout the trainee lifespan and those aspiring for a faculty appointment.</p>","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261453069"},"PeriodicalIF":1.2,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199716","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: A Bibliometric Review of Capsular Contracture in Breast Implant: Global Trends and Research Hotspots.","authors":"Nina Hadzimustafic, Tyler Safran, Joshua Vorstenbosch","doi":"10.1177/22925503261453072","DOIUrl":"10.1177/22925503261453072","url":null,"abstract":"","PeriodicalId":20206,"journal":{"name":"Plastic surgery","volume":" ","pages":"22925503261453072"},"PeriodicalIF":1.2,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144355","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}