Plastic Surgery最新文献

{"title":"Accessibility and Insurance Coverage for Gender-affirming Surgery in Canada: A Cross-Sectional Analysis","authors":"Alan P C Gou, M. Bonapace-Potvin, Blair R. Peters","doi":"10.1177/22925503241258153","DOIUrl":"https://doi.org/10.1177/22925503241258153","url":null,"abstract":"Purpose: While visibility and acceptance of the transgender community have increased across Canada, barriers persist in accessing gender-affirming surgeries (GAS). This study aims to determine the current state of GAS care in Canada, focusing on insurance coverage by province and identifying regions needing the development of specialized GAS programs. Methods: This cross-sectional study was conducted by examining provincial health ministry webpages and contacting health authorities and gender clinics to collect data on GAS coverage. Information on various procedures, including chest surgery, facial GAS, and genital surgeries was collected to determine which procedures are covered in each respective province. Geographic distribution of clinics that perform GAS procedures in Canada was also collected and sorted by referrals in-province and out-of-province. Results: There are 32 unique gender-affirming procedures covered by Canadian provincial health plans. Prince Edward Island provides the highest coverage of GAS procedures, while Nunavut covers the least. Quebec offers the most comprehensive in-province GAS program, with some in-province care available in the other provinces. The three territories generally lack access to any in-province procedures. Conclusions: Coverage for gender-affirming surgical procedures in Canada varies widely. Genital procedures have the most comprehensive coverage, chest surgeries are covered by most provinces, and facial GAS were only covered in two provinces. There is also a disparity between coverage and availability of GAS in most provinces. Physicians should advocate for broader coverage and targeted training and recruitment of GAS specialized surgeons in key geographic regions.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141339737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor Site Outcomes Following Autologous Breast Reconstruction with DIEP Flap: A Retrospective and Prospective Study in a Single Institution","authors":"Stacy Fan, Stephanie Kim, Kaveh Farrokhi, Dianna Deng, Laryssa Laurignano, Devin Box, Aaron Grant, Sarah Appleton, Tanya DeLyzer","doi":"10.1177/22925503241255118","DOIUrl":"https://doi.org/10.1177/22925503241255118","url":null,"abstract":"Background: The deep inferior epigastric perforator artery (DIEP) free flap is the most commonly performed autologous breast reconstruction. Despite the relative reduction in donor site complications compared to nonmuscle-sparing options, there is still high morbidity associated with this surgery. The purpose of this study is to compare outcomes and complications at our institution and to discuss potential quality improvement initiatives. Methods: A retrospective cohort study was performed looking at patients who underwent delayed or immediate autologous breast reconstruction with a DIEP flap over a 6-year period (2015-2021) at our institution. Complication rates for abdominal infection, seroma, hematoma, wound dehiscence, delayed wound healing, umbilical necrosis, subjective abdominal weakness, abdominal bulge, and hernia were calculated. Additionally, a prospective cohort study was conducted using a portable ultrasound device to detect postoperative changes in the abdominal donor site, including fluid collections and postoperative edema. Results: One hundred seventeen patients underwent autologous breast reconstruction with a DIEP-free flap. Forty-one percent of patients experienced 1 or more donor site complications. Complication rates were 16.2%, 12.8%, 1.7%, 15.4%, 8.5%, 4.3%, 0%, 10.3%, and 2.6%, respectively, for the list above. There was a higher proportion of complications in patients who smoked within the past 3 months and those who had a body mass index (BMI) between 35 and 39.9, although this was not statistically significant. Bilateral reconstructions had higher rates of umbilical necrosis (24.5% vs 7.8%) and wound dehiscence (9.4% vs 0%) compared to unilateral. Twenty-one patients were included in the prospective analysis. No significant changes in abdominal wall edema were found. Twenty-four percent of the patients had detectible collections on ultrasound, and these were associated with wound dehiscence and the need for debridement. Discussion: Our institutional abdominal donor site complication rates in DIEP reconstruction patients are higher than those published in the literature. Similar complication rates were identified regardless of smoking status, BMI, and unilateral/bilateral surgery. Quality improvement initiatives could be considered and implemented to reduce future complications.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Current Practices and Trends of Plastic and Oncoplastic Breast Surgeons in Canada","authors":"Andrew Gorgy, Tyler Safran, J. Vorstenbosch","doi":"10.1177/22925503231224195","DOIUrl":"https://doi.org/10.1177/22925503231224195","url":null,"abstract":"","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139453160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Instagram Practices of Successful Plastic Surgeon Accounts: Is There a Magic Formula?","authors":"Michael J. Stein","doi":"10.1177/22925503231219208","DOIUrl":"https://doi.org/10.1177/22925503231219208","url":null,"abstract":"","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138974638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Out-of-Pocket Costs and Physician Payment Variations in Abdominal Contouring: Evidence From United States Claims Data","authors":"Olachi O. Oleru, N. Seyidova, Peter J Taub","doi":"10.1177/22925503231217513","DOIUrl":"https://doi.org/10.1177/22925503231217513","url":null,"abstract":"Background: Abdominal contouring after massive weight loss has positive impacts on quality of life. There are often cost and access barriers for patients who desire these procedures. Objectives: To examine levels of access to body contouring in the era of price transparency, this study aims to characterize the out-of-pocket expenses and physician/facility payments in abdominal contouring procedures. Setting: The IBM MarketScan Commercial Databases were queried to identify patients who underwent outpatient abdominal contouring surgeries in the United States in 2021. Methods: Financial variables of interest included gross payments to the provider (facility and/or physician) and out-of-pocket costs (total of coinsurance, deductible, and copayments). Univariate analysis and mixed-effects linear regression were utilized to study the variations in costs across regions, insurance plan types, and places of service. Results: A total of 1319 abdominal contouring episodes were identified. The average age was 44.7, and the majority of patients were female (91%) and in the South region (44%). Median out-of-pocket costs were low overall ($30, IQR $768) and median total physician/facility payments for abdominal contouring was $4982.47 (IQR $7392.46). Out-of-pocket costs were highest in the South ($105) and $0 in all other regions ( P < .05). The highest physician/facility payments were in the Northeast ($6392) and the lowest was in the South ($3936). Conclusions: Patients undergoing abdominal contouring incur relatively low out-of-pocket costs overall, but there is a need for further reimbursement negotiation in regions where physician payments are lower and out-of-pocket costs are higher. Further study should explore reimbursement and payment gaps in procedural coverage.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We Need a Bio-Psycho-Social-Spiritual Approach to Life","authors":"D. Courtemanche","doi":"10.1177/22925503231219221","DOIUrl":"https://doi.org/10.1177/22925503231219221","url":null,"abstract":"","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139007245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Two-Eyed Seeing (Aistotsastip) and the Medicine Wheel for the Plastic Surgeon","authors":"Celina Mekhele Nahanni, Laura Snell","doi":"10.1177/22925503231220368","DOIUrl":"https://doi.org/10.1177/22925503231220368","url":null,"abstract":"","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139009362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Assessment of Quality-of-Life Following Tissue Expansion in Pediatric Patients","authors":"Dara Rykiss, R. Courtemanche, Sally Hynes","doi":"10.1177/22925503231217516","DOIUrl":"https://doi.org/10.1177/22925503231217516","url":null,"abstract":"Introduction: There is limited data on the effects of tissue expansion (TE) surgery on quality-of-life (QOL) in pediatric patients. Evidence-based information may help clinicians, patients, and their families with treatment decision-making and post-operative expectations. This study explores QOL following TE in pediatric patients. Methods: A post-intervention QOL survey and retrospective chart review was performed. Patients who underwent TE at a pediatric tertiary hospital between October 2004 and March 2020 completed the Glasgow Children's Benefit Inventory or the Glasgow Benefit Inventory. Total scores range from −100(worsened QOL) to +100(improved QOL). Participants were also asked if they would recommend TE to other patients with the same indication. Results: The response rate was 38% (n = 20; 14 females, 6 males). The median QOL score was +17[−2,+49]. Higher QOL scores were found for TE indications of scar (+49) and alopecia (+40), compared to giant congenital melanocytic nevus (−2). Higher scores were also associated with shorter time in active treatment ( r = −0.65) and fewer complications ( r = −0.56). 18/20 participants would recommend TE. Participants whose QOL improved (n = 11, 55%) reported increased self-confidence, fitting in with peers, and improved function. Participants with unchanged or decreased QOL (n = 9, 45%) described a negative experience with residual scarring. However, 7/9 with unchanged or decreased QOL would still recommend TE. Conclusions: This preliminary descriptive study demonstrated variable QOL following TE. Patient and treatment-related factors impact QOL outcomes. Despite the range in QOL outcomes, the majority of participants would recommend TE. Further research evaluating QOL following TE is necessary to better understand this relationship.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139010112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Considerations in Pediatric External Ear Surgery","authors":"Becher Al-Halabi, Abdulaziz Alabdulkarim, Sabrina Cugno","doi":"10.1177/22925503231213868","DOIUrl":"https://doi.org/10.1177/22925503231213868","url":null,"abstract":"The distinction between reconstructive and aesthetic surgery becomes less apparent when body image and self-esteem secondary to congenital deformities affect psychosocial well-being. Parents and plastic surgeons debate the appropriate age to correct non-life-threatening congenital defects to avoid a psychologically distressing event to the child. Furthermore, an ethical debate emerges when parents make decisions on behalf of children below the age of consent and lack the necessary cognitive development. This challenging responsibility then rests upon the operating practitioner to prioritize the child's best interests. This paper examines three hypothetical cases to explore the psychosocial and ethical aspects of conducting external ear surgery in the pediatric population and determining the ideal timing.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136351294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Previous Transradial Catheterization on Radial Forearm Free Flaps","authors":"Jamie A. Mawhinney, Craig A. Mounsey, Nick A. Johnson, Peter G. Russell","doi":"10.1177/22925503231213872","DOIUrl":"https://doi.org/10.1177/22925503231213872","url":null,"abstract":"Radial forearm free flaps (RFFF) are a versatile option for the reconstruction of a wide variety of soft tissue defects and are particularly common in head and neck surgery. Benefits of RFFF include a relatively short operating time, a long pedicle, and a thinner, more pliable flap. However, in addition to its role in reconstructive surgery, the radial artery may be utilized for a number of other procedures including coronary angiography and percutaneous coronary interventions. Concern has previously been raised that prior catheterization may deleteriously affect the function of the radial artery and in the field of cardiothoracic surgery, individuals are increasingly advising against its use as a graft for coronary artery bypass graft surgery in such circumstances. Despite this, little is known about the effect on RFFF. In this review article, we concisely consider the available evidence of the effect of previous transradial catheterization on the radial artery and discuss the implications for reconstructive surgery. We then summarize the key considerations regarding their use in current practice.","PeriodicalId":50714,"journal":{"name":"Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136282352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}